动态脉压对老年高血压患者靶器官损害的影响

目的探讨动态脉压对老年高血压患者靶器官损害的影响。方法选择原发性高血压患者146例,按24 h平均脉压(MPP)分为2组:24 h MPP≥60 mm Hg(1 mm Hg=0.133 kPa)为A组(60例),24 h MPP<60 mm Hg为B组(86例);另选健康体检者为对照组(C组,30例)。所有患者均行血清肌酐、动态血压、超声心动图、颈动脉超声检查;计算肌酐清除率(Ccr)、24 h平均收缩压(MSBP)、24 h平均舒张压、24 h MPP、左心室重量指数(LVMI)、LVEF、颈动脉内膜中层厚度(IMT)。结果与C组比较,A组和B组患者24 h MSBP、24 h MPP、LVMI、IMT、左心室肥厚、左心室功能受损、脑损害、肾功能受损、颈动脉斑块发生率明显升高,Ccr、LVEF水平明显降低(P<0.05,P<0.01);与B组比较,A组患者Ccr、LVEF水平明显降低,24 h MSBP、24 h MPP、LVMI、IMT、靶器官损害发生率均明显升高(P<0.05,P<0.01)。24 h MPP与心脑肾和颈动脉损害相关(P<0.05)。结论动态脉压增大与老年高血压患者靶器官结构和功能的损害相关;动态脉压越大,靶器官损害越严重。

Effects of dynamic pulse pressure on target-organ damage in aged patients with essential hypertension

Objective To investigate the effects of dynamic pulse pressure on target-organ damage in aged patients with essential hypertension.Methods 146 patients with essential hypertension were divided into two groups according to the 24-hour mean pulse pressure(24-h MPP):group A, 24-h MPP≥60 mm Hg(n=60),group B,24-h MPP<60 mm Hg(n=86),and 30 healthy subjects were enrolled as the control group(group C).All subjects received measurement of serum creatinine,ambulatory blood pressure monitoring,echocardiography,carotid ultrasonography.The calculated variables were creatinine clearance rate(Ccr),24-hour mean systolic blood pressure (24 h MSBP),24 hour mean diastolic blood pressure,24-h MPP,left ventricular mass index (LVMI),LVEF,and carotid intima-media thickness(IMT).Results Compared with group C,patients in groups A and B showed higher levels of 24-h MSBP and 24-h MPP,increase in LVMI and IMT,left ventricular hypertrophy,left ventricular function damage,brain damage,kidney function damage and increase in carotid plaque,while Ccr and LVEF were significantly lower(P<0.05, P<0.01).Compared with group B,patients in group A showed lower levels of Ccr and LVEF, while 24 h MSBP,24-h MPP,LVMI,IMT and target organ damage were significantly higher (P<0.05,P<0.01).Correlation analysis indicated that the level of 24-h MPP was significantly correlated with the damage of heart,brain,kidney and carotid artery(P<0.05).Conclusions The elevated dynamic pulse pressure level is correlated with the structural and functional damage of target-organ;the greater the dynamic pulse pressure is,the more serious the target-organ damage will be.