老年人杓型高血压晨峰现象与轻度认知功能障碍、踝肱指数、尿蛋白/肌酐的相关性分析

目的研究老年人杓型高血压晨峰(morning blood pressure surge,MBPS)现象与轻度认知功能障碍(mild cognitive impairment,MCI)、踝肱指数(ankle brachial index,ABI)、尿微量白蛋白/肌酐(UmAlb/Cr)的关系,探讨老年人杓型高血压MBPS对动脉粥样硬化的影响。方法 458例老年杓型高血压患者,根据动态血压监测结果分为MBPS组及NMBPS组,所有患者均进行简短精神状态量表(mini-mental state examination,MMSE)、ABI、UmAlb/Cr检测,并常规检测血尿素氮(BUN)、肌酐(Cr)、血糖(Glu)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、总胆固醇(TC),分析2组MMSE评分、ABI、UmAlb/Cr的差异。结果 2组患者在性别、年龄、高血压病程、BUN、Cr、Glu、HDL-C、LDL-C、TG、TC比较差异均无统计学意义(P0.05)。MBPS组24hSBP、dSBP、nSBP、24hMAP、dMAP、收缩压晨峰变异幅度均高于NMBPS组,差异具有统计学意义(P0.05或P0.01)。MBPS组与NMBPS组比较,MMSE评分、ABI显著降低,UmAlb/Cr显著升高,MBPS组MCI发生率、外周动脉血管闭塞性疾病(PAD)发生率、UmAlb/Cr阳性率均高于NMBPS组,差异具有统计学意义(P0.01)。Pearson相关分析显示,MBPS与MCI、ABI、UmAlb/Cr呈中度相关,与年龄呈低相关,差异具有统计学意义(P0.05或P0.01)。结论老年人杓型高血压MBPS是导致MCI、PAD以及早期肾损害的重要危险因素,对动脉粥样硬化产生重要影响。

Relationship between morning blood pressure surge phenomena and mild cognitive impairment,ankle brachial index,UmAlb/Cr in elderly patients with dipper essential hypertension

Objective To study the relationship between mild cognitive impairment（ MCI）,ankle brachial index（ ABI）,UmAlb/Cr and morning blood pressure surge（ MBPS） in elderly patients with dipper essential hypertension,and to investigate the impact of MBPS on atherosclerosis in elderly patients with dipper essential hypertension. Methods Totally 458 elderly patients with dipper essential hypertension were divided into MBPS group（ observation group,n = 273） and NMBPS group（ control group,n = 185） according to the ambulatory blood pressure monitoring（ ABPM）. The mini-mental state examination（ MMSE）,ABI,UmAlb /Cr ratio,as well as blood urea nitrogen（ BUN）,creatinine（ Cr）,glucose（ Glu）,high density lipoprotein cholesterol（ HDL-C）,low density lipoprotein the cholesterol（ LDL-C）,triglyceride（ TG）and cholesterol（ TC） were routinely detected. The differences of MMSE,ABI and UmAlb /Cr in the two groups were analyzed. Results There were no significant differences in sex,age,course of hypertension,BUN,Cr,Glu,HDL-C,LDL-C,TG and TC between the two groups（ P〉0. 05）. The 24 hSBP,dSBP,nSBP,24 hMAP,dMAP,the amplitude of variation in morning systolic pressure peak were higher significantly in MBPS group than those in NMBPS group（ P〈0. 05 or P〈0. 01）. Compared with NMBPS group,the MBPS group had significantly reduced MMSE score and ABI,and had significantly increased UmAlb /Cr,as well as the MCI incidence,and PAD incidence and UmAlb /Cr positive rate were significantly higher. The differences were statistically significant（ P〈0. 05 or P〈 0. 01）. Pearson correlation analysis showed that MBPS was moderately correlated with MCI,ABI,UmAlb /Cr,and it was lowly correlated with age（ P〈 0. 05 or P〈 0. 01）.Conclusions MBPS in elderly patients with dipper essential hypertension is an important risk factor for MCI,PAD and early kidney damage,and it has a critical impact on atherosclerosis.