动态血压监测药物治疗老年高血压病168例临床分析

目的探讨药物治疗对老年高血压病患者的疗效及24h血压昼夜变化、血压变异性的影响。方法将168例高血压病患者分为单纯收缩压增高（SH）和收缩压及舒张压均增高（DH）两组,治疗药物分为长效和短效,在治疗开始和治疗2个月后做24h动态血压监测;同时对两组患者的24h动态血压波动曲线的变化进行总结,结合临床资料进行统计学分析。结果DH组患者与SH组比较,24h血压波动曲线的昼夜节律变化、靶器官损害发生率差异有统计学意义（P〈0.01）,血压负荷、血压变异性差异有统计学意义（P〈0.05）;DH组应用长、短效药物治疗,血压控制均不理想;SH组患者经过长效药物治疗,夜间的平均收缩压、舒张压和平均动脉压均比短效药物治疗组低（P〈0.05）,24h血压变化曲线大部分可以恢复昼夜节律,血压负荷明显减少,心脑血管并发症少见。结论应用动态血压监测有助于了解老年高血压患者24h血压波动曲线的变化规律,对指导患者临床治疗和判断预后有着十分重要的意义。

Analysis of ambulatory blood pressure monitoring in 168 elderly hypertension patients

Objective To investigate the drug therapy on the 24h diurnal,nocturnal blood pressure(BP)and the BP variability in elderly hypertension patients by ambulatory blood pressure monitoring(ABPM).Methods 168 cases of elderly hypentension patients were divided into two groups,isolated systolic blood pressure(SBP)high group(SH group),both SBP and DBP high group(DH group),long-term or short-term effective therapeutic drugs were prescribed respectively,ABPM at the beginning of the treatment and 2 months later were monitored,data of the 24h ambulatory BP profiles of the two groups were analysed,combining clinical data.Results There are significant differences(P<0.01)in 24h diurnal,nocturnal blood pressure variation,damage occurrence of target organ between the DH group and SH group,and there are significant differences(P<0.05)in load value of blood and BP variability between the two group.The BP control in DH group with long-term and short-term effective therapeutic drugs treatment is discontent;All the nocturnal average BP,diastolic pressure and average BP of the patients in SH group with long-term effective drugs therapy are lower(P<0.05)than that with short-term effective drugs therapy.Most of the 24h ambulatory BP profiles can renew to the diurnal,nocturnal rhythm.The load value of blood pressure remarkably decreased.Cardial or cerebral vascular disease is rare.Conclusions Applying ABPM to examine the elderly hypertension patients is helpful to find out the variation rule of the 24h ambulatory BP profiles,and is important for directing the clinical treatment and judging the prognosis.