老年高血压患者血压昼夜节律与颈动脉粥样硬化的相关性研究

目的探讨老年高血压患者血压昼夜节律与颈动脉粥样硬化的相关性。方法2003￣2004年来我院老年高血压患者共72例(男68例女4例),根据动态血压监测(ABPM)结果分为正常昼夜节律组,即杓型组(n=37,男35例女2例)和异常昼夜节律组,即非杓型组(n=35,男33例女2例)。对所有患者均行颈动脉超声检查,测定右侧颈总动脉(RCCA)、颈内动脉(RICA)内膜中层厚度(IMT)、管腔内径(D),并计算各自的IMT/D值,测定右侧颈动脉分叉处(RBIF)的IMT,观察并记录双侧颈动脉系统斑块的大小、数量。结果(1)两组年龄(Age)、体重指数(BMI)、总胆固醇(TC)、甘油三酯(TG)、全天平均收缩压(24hMSP)、全天平均舒张压(24hMDP)比较均无显著性差异(P>0.05)。(2)两组的RCCA及RICA的IMT、D、IMT/D比较均无显著性差异(P>0.05)。而右颈动脉分叉处IMT,非杓型组明显高于杓型组(P<0.001)。(3)两组总斑块检出率无显著差异,但多发性斑块检出率非杓型组显著高于杓型组(P<0.05)。结论老年高血压患者血压昼夜节律与颈动脉粥样硬化明显相关,异常的血压昼夜节律提示可能存在更严重的靶器官损害。

RELATIONSHIP BETWEEN DAY-NIGHT RHYTHM OF BLOOD PRESSURE AND CAROTID ATHEROSCLEROSIS IN THE ELDERLY WITH HYPERTENSION

Objective To investigate the relationship between day-night rhythm of blood pressure and carotid artherosclerosis in elderly with hypertension. Methods We evaluated 72 elderly hypertensive patients who visited to our hospital from 2003 to 2004. After ambulatory blood pressure monitoring(ABPM) , they were divided to two groups of dipper(n=37) or non-dipper (n=35). All patients underwent ultrasound examinations of carotid arteries. We recorded the intima- media thickness(IMT) and the internal diameter(D) of the common carotid artery(CCA) , internal carotid artery(ICA) and the IMT of the bifurcation in the right side. Meanwhile , atherosclerosis plaques were detected in both side. Results (1)There were no significant differences in age, body mass index(BMI),serum total cholesterol (TC), triglyceride (TG) ,24 hours mean systolic blood pressure(24hMSP) and 24 hours mean diastolic blood pressure between the dipper and non-dipper groups(P >0.05). (2) There were no significantly differences in IMT, D, IMT/D of the right CCA and ICA between the two groups (P >0.05). The IMT of the bifurcation in the non-dipper group was significantly higher than that in the dipper group (P <0.001). (3) There was no significant difference of the total detection rate of atherosclerosis plaques between the dipper and non-dipper groups (P >0.05), but the detection rate of multiple atherosclerosis plaques in the non-dipper group was significantly higher than that in the dipper group(P < 0.05). Conclusions Day-night rhythm of blood pressure has significantly correlation with carotid atherosclerosis in elderly with hypertension. Abnormal day-night rhythm of blood pressure indicates the possibility of more severe target organ damage.