高血压患者血压变异性与脑梗死发病关系的探讨

目的探讨血压变异性（BPV）与高血压患者脑梗死发病的关系。方法收集2008年1月一2010年5月因头颅DWI诊断为新发脑梗死而住院的高血压患者797例，其中半年内规范降压且检查过24h动态血压的共31例，将其与同期半年内接受过相同降压治疗和检查的无新发脑梗死的高血压患者共42例进行比较。将资料分为钙拮抗剂组（CCB，43例）及非钙拮抗剂组（nCCB，30例），其中CCB组又分为拜心同（Procardin，26例）和络活喜（Norvasc，17例）2亚组。以单因素分析比较各分组或亚组间血压的变异性，以二项分类Logistic回归分析影响高血压患者发生脑梗死的因素。结果CCB组高血压患者脑梗死的发生率低于nCCB组（X^2=12．378，P=-0．002）；高血压伴有脑梗死组BPVsBP及BPVDBP高于不伴脑梗死组（t=-6．324，P=0．000；t=-2．822，P=0．006），但2组间24h平均收缩压（SBP）及平均舒张压（DBP）差异无显著性（P〉0．05）；BPVSBP在Procardin、Norvasc及nCCB3组中呈渐增高趋势且差异有显著性（P〈0．01）；BPVsBF是脑梗死发病的危险因素（0R=9．94E＋40，P=0．000），CCB类药物是脑梗死发病的保护性因素（OR=0．049，P=0．015）。结论血压的变异性是高血压患者发生脑梗死的独立危险因素；CCB类降压药，特别是拜心同，可以通过降低血压的变异性来降低高血压患者脑梗死的发生率，使患者获得更大的收益。

Relationship between blood pressure variability and occurrence of cerebral infarction in hypertensive patients

Objective To investigate the relationship between blood pressure variability （ BPV ） and occurrence of cerebral infarction in hypertensive patients. Methods From January 2008 to May 2010, 797 hospitalized patients with hypertension were diagnosed as new occurrence of cerebral infarction by head DWI scanning, 31 of whom received standard antihypertensive therapy and 24-hour ambulatory blood pressure monitoring within 6 months. 42 hypertensive patients without new occurrence of cerebral infarction who received the same therapy and blood pressure monitoring were used as control. The 73 patients were divided into group with calcium channel blocker （ CCB, 43 patients ） and group with none- CCB （ nCCB, 30 patients ）. Group with CCB was subdivided into procardin group （ 26 patients ） and Norvasc group （ 17 patients ）. Univariate analysis was used to analyze the difference of BPV between the group with CCB and the group with nCCB or between procardin group and Norvasc group, so was binary logistic regression to analyze the factors affecting the oceurrenee of cerebral infarction in hypertensive patients. Results The incidence of cerebral infarction was significantly lower in the group with CCB than in the group with nCCB （ X2= 12.378, P= 0.002 ）. Higher BPVsBpand BPVoBpwere found in hypertensive patients with cerebral infarction than in those without cerebral infarction （ t = 6.324, P= 0.00（~ and t = 2.822, P=-O.O06 ）. 24-hour mean systolic blood pressure （ SBP ） and mean diastolic blood pressure （ DBP ） did not differ significantly. BPVsBP had a trend of gradual increase in the three groups with procardin, Norvase, and nCCB, with statistical differences among them （ P〈 0.O1 for all comparisons ）. BPVsBP was the risk factor of occurrence of cerebral infarction （ OR = 9.94E ＋ 40, P= 0.000 ）, while CCB was the protective factor （ OR = 0.049, P= 0.015 ）. Conclusions Blood pressure variability is the independent risk factor of occurrence of cerebral infarction in hypertensive patients. CCB antihypertensives, especially procardin, is more beneficial for the patients by reducing the incidence of cerebral infarction resuhing from a decrease in BPV.