中老年人群血压变化与新发颈动脉斑块的关系探讨

目的探讨开滦研究队列基线（2010年）血压水平及2年后（2012年）血压变化对新发颈动脉斑块的影响。方法选择来自开滦研究中的脑卒中队列作为研究对象，2010年和2012年分别对观察队列进行健康体检，并进行颈动脉超声检查。选取队列中基线非高血压且无斑块人群1 445例进行分析。根据基线血压及2年间血压变化进一步分为:稳定为正常血压组（Ⅰ组）284例，正常血压进展为正常高值血压组（Ⅱ组）184例、正常高值血压降为正常血压组（Ⅲ组）238例，稳定为正常高值血压组（Ⅳ组）498例，正常血压或正常高值血压进展为高血压组（Ⅴ组）241例。观察血压变化与2012年新发颈动脉斑块的关系。结果2年后正常高值血压人群颈动脉新发斑块检出率高于正常血压人群（P < 0.01）。Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ组新发斑块的检出率分别为18.9%、14.3%、17.1%、24.2%、26.4%，随着血压水平的增加，新发斑块的检出率呈增加趋势（P < 0.05）。调整混杂因素后，与Ⅱ组比较，Ⅳ组、Ⅴ组发生颈动脉斑块的RR值（95%CI）分别为2.007（1.162~3.464）和1.823（1.009~3.291）。结论非高血压人群中，颈动脉斑块的检出率随着血压水平的升高而增加。与正常血压进展为正常高值血压比较，血压稳定在正常高值水平颈动脉粥样硬化风险已经增加。

Study on the relationship between blood pressure changes and new carotid artery plaque in middle-aged and elderly people

ObjectiveTo investigate the effects of baseline blood pressure level of the Kailuan cohort study(2010) and blood pressure changes 2 years later(2012) on newly developed carotid artery plaque.MethodsThe physical examination and carotid ultrasound in stroke cohort in Kailuan study were performed in 2010 and 2012, respectively.According to the changes of blood pressure during the two years, the 1445 participants were divided into the normal blood pressure group(group Ⅰ, n=284), normal blood pressure progressing to high-normal blood pressure group(group Ⅱ, n=184), high-normal blood pressure dropping to normal blood pressure group(group Ⅲ, n=138), stabilizing at the normal high blood pressure group(group Ⅳ, n=498) and normal blood pressure or high-normal blood pressure progressing to hypertension group(group Ⅴ, n=241).The relationship between the changes in blood pressure and new carotid artery plaque was analyzed.ResultsThe detection rate of new carotid artery plaque in normal blood pressure population was higher than that in high normal blood pressure population(P < 0.01).The detection rates of new carotid artery plaque in the group Ⅰ, Ⅱ, Ⅲ, Ⅳ and Ⅴ were 18.9%, 14.3%, 17.1%, 24.2 and 26.4%, respectively.With the increasing of blood pressure level, the detection rate of new carotid artery plaque showed an increasing trend(P < 0.05).After adjusting the other risk factors, compared to the groupⅡ, the RR value(95%CI) of new carotid artery plaque in group Ⅳ and Ⅴ were 2.007(1.162 to 3.464) and 1.823(1.009 to 3.291), respectively.ConclusionsAmong non-hypertension people, the detection rate of carotid artery plaque increases with the increasing of blood pressure.Compared with the normal blood pressure progressing to high-normal blood pressure people, the risk of atherosclerosis increases in blood pressure stabilizing at high-normal level people.