原发性高血压患者血压昼夜节律及夜间血压与阵发性心房颤动的相关性

<正>中华老年心脑血管病杂志,2015,17(2):121-124.该文探讨原发性高血压患者血压昼夜节律及夜间血压与阵发性心房颤动(房颤)的相关性,并探讨其他危险因素对阵发性房颤的影响。方法:选择原发性高血压患者411例,其中阵发性房颤组159例,窦性心律组252例,所有患者采集病史、体格检查、行动态血压、常规生化等检查。结果:阵发性房颤组非杓型血压比例(96.2%比83.7%)、夜间收缩压[(132.2±16.5)比(122.4±17.7)mm Hg,1mm Hg=0.133kPa]、夜间     

中国男性老老年高血压患者24h动态血压与脑小血管疾病的关系

目的探讨中国老老年原发性高血压患者24h动态血压与脑小血管疾病(SVD)的关系。方法选择原发性高血压患者106例,进行24h动态血压监测。SVD包括腔隙性脑梗死(LI)和脑白质病变(WML)。根据WML级别分为低级别WML组52例和高级别WML组54例。根据LI数目分为非LI组22例,单发LI组22例,多发LI组62例。根据血压类型分为杓型血压组10例,非杓型血压组96例。结果与低级别WML组比较,高级别WML组夜间收缩压、昼间舒张压、夜间舒张压、24h舒张压明显升高(P0.05,P0.01)。多发LI组夜间收缩压、夜间舒张压较非LI组和单发LI组明显升高[(135.5±13.5)mm Hg vs(125.6±9.0)mm Hg,(129.1±19.6)mm Hg,(67.0±8.7)mm Hg vs(61.8±5.8)mm Hg,(59.9±7.9)mm Hg,1mm Hg=0.133kPa,P0.05],夜间血压下降幅度较非LI组和单发LI组明显减小[(-3.8±6.9)%vs(3.1±6.5)%,(1.7±8.2)%,P0.01]。非杓型血压组多发LI发生率显著高于杓型血压组(62.5%vs 20.0%,P=0.024)。结论中国男性老老年原发性高血压患者异常的血压昼夜节律可能是SVD的一种危险因素。     

高龄老年高血压患者动态血压特点

目的探讨高龄老年高血压患者动态血压特点。方法选择我院心血管内科及老年医学科住院的高血压患者265例,按年龄分为高龄老年组(年龄≥80岁)94例、老年组(60～79岁)90例和60岁组81例,行动态血压监测,分析其血压节律、3个时段(24h、昼间及夜间)血压均值及血压变异性的特点。结果高龄老年组和老年组杓型血压发生率、24h舒张压、昼间舒张压、昼间平均压、夜间舒张压明显低于60岁组,反杓型血压发生率、24h脉压、昼间脉压、夜间收缩压、夜间脉压明显高于60岁组(P0.05,P0.01);高龄老年组杓型血压发生率及24h、昼间、夜间舒张压明显低于老年组[13.83%vs 26.66%,(66.17±7.39)mm Hg(1mm Hg=0.133kPa)vs (70.39±10.96)mm Hg,(66.90±7.55)mm Hg vs (70.88±11.68)mm Hg,(64.10±8.14)mm Hg vs (68.27±11.86)mm Hg,P0.05,P0.01],24h、夜间脉压明显高于老年组(P0.05,P0.01),昼间收缩压变异明显高于老年组和60岁组,24h收缩压变异高于60岁组,差异有统计学意义(P0.01);老年组24h平均压明显低于60岁组(P0.05)。结论高龄老年高血压患者动态血压表现出血压节律异常、脉压增大、血压变异性升高等特点。     

老年原发性高血压患者血压变异性对新发心房颤动的影响

目的探讨老年原发性高血压患者血压变异性对新发心房颤动(房颤)的影响。方法回顾性研究2010年1月~2011年12月在我院住院治疗不伴房颤的老年原发性高血压患者683例,根据随访期间是否新发房颤分为房颤组69例及非房颤组614例。记录基线特征、超声心动图参数。进行动态血压监测,按收缩压变异性中位数9.89mm Hg(1mm Hg=0.133kPa)将入选患者分为高变异性342例和低变异性341例。应用Cox回归方程分析血压变异性对新发房颤的影响。结果房颤组24h收缩压变异性明显高于非房颤组[(11.13±3.50)mm Hg vs(10.21±3.41)mm Hg,P=0.034],24h舒张压明显低于非房颤组[(67.19±8.16)mm Hg vs(69.33±8.39)mm Hg,P=0.045]。多因素Cox回归分析显示,24h收缩压变异性、脑出血及心脏永久性起搏器置入是老年原发性高血压患者新发房颤的独立危险因素(HR=1.949,95%CI:1.175~3.233,P=0.010;HR=2.983,95%CI:1.075~8.277,P=0.036;HR=2.567,95%CI:1.370~4.810,P=0.003)。结论收缩压变异性升高是老年原发性高血压患者新发房颤的独立危险因素。     

动脉粥样硬化性肾动脉狭窄患者24小时动态血压特征及靶器官损害相关研究

目的探讨动脉粥样硬化性肾动脉狭窄(ARAS)患者24 h动态血压、昼夜节律变化特征及靶器官损害。方法选择2014年1月~2018年12月在上海交通大学医学院附属瑞金医院高血压科连续住院的ARAS患者121例(ARAS组),另选择同期年龄、性别、体质量指数和高血压病程等匹配的原发性高血压(EH)患者418例(EH组),观察并比较2组诊室及24 h动态血压及靶器官损害的差异。结果与EH组比较,ARAS组诊室收缩压[(155±23)mm Hg(1mm Hg=0.133k Pa)vs(145±22)mm Hg,P<0.01]、诊室脉压[(75±20)mm Hg vs(65±18)mm Hg,P<0.01]、24h收缩压[(143±19)mm Hg vs(130±16)mm Hg,P<0.01]、昼间收缩压[(145±18)mm Hg vs(133±16)mm Hg,P<0.01]、夜间收缩压[(138±21)mm Hg vs(123±18)mm Hg,P<0.01]、夜间舒张压[(75±12)mm Hg vs(73±10)mm Hg,P<0.05]明显升高,差异有统计学意义。与EH组比较,ARAS组杓型血压比例明显降低,反杓型血压比例明显升高(P<0.05)。校正相关因素后,与EH组比较,ARAS组颈动脉内膜中层厚度、左心室质量指数及血浆N末端B型钠尿肽前体水平明显升高,差异有统计学意义(P<0.01)。结论ARAS患者收缩压及夜间血压较高,更多表现为反杓型血压。有独立于血压及肾功能水平更严重的靶器官损害。     

血压控制良好的原发性高血压患者夜间收缩压下降率与心率及心率变异性的关系

目的探讨血压控制良好的原发性高血压患者夜间收缩压下降率与心率及心率变异性的关系。方法选取2013年8月至2015年5月就诊于郑州大学第二附属医院的原发性高血压患者159(男79、女80)例,年龄40~80岁,行动态血压心电监测,根据动态血压监测结果,按夜间收缩压下降率分成杓型组(n=61)、非杓型组(n=59)和反杓型组(n=39),比较3组间白天、夜间平均心率及心率变异性时域分析指标正常窦性R-R间期标准差(SDNN)、每5min正常窦性R-R间期平均值的标准差(SDANN)和相邻R-R间期差的均方根(RMSSD)的差异。采用Pearson相关和多元线性回归分析夜间收缩压下降率与白天平均心率、夜间平均心率、SDNN、SDANN、RMSSD的关系。结果非杓型组、反杓型组夜间平均心率高于杓型组[(63.9±6.2)、(68.6±7.5)比(60.2±5.1)次/min,均P0.05],SDNN、SDANN、RMSSD低于杓型组[分别为(116.1±14.9)、(103.9±12.9)比(138.5±13.7)ms,(100.0±16.9)、(90.6±14.9)比(116.0±23.7)ms,(32.3±8.7)、(23.9±7.2)比(38.2±10.7)ms,均P0.05];夜间收缩压下降率与白天、夜间平均心率呈负相关(r=-0.302、-0.441,均P0.01),与SDNN、SDANN、RMSSD呈正相关(r=0.635、0.409、0.505,均P0.01);多元线性回归分析显示,SDNN和RMSSD为夜间收缩压下降率的影响因素(B=0.176,0.213;均P0.05)。结论血压控制良好的原发性高血压患者夜间收缩压下降率降低与夜间心率加快及心率变异性降低有关。     

持续性心房颤动对原发性高血压患者血压昼夜节律的影响

目的:探讨持续性心房颤动(房颤)对原发性高血压患者血压昼夜节律变化的影响。方法:选取2013-01至2014-01我院就诊患者173例,将其分为原发性高血压组(高血压组,n=88),持续性房颤合并原发性高血压组(房颤合并高血压组,n=85例)。分析所有患者基线资料,并用Logistic回归分析影响持续性房颤合并原发性高血压患者的危险因素。结果:与高血压组比较,房颤合并高血压组白天平均舒张压、白天最小收缩压、白天最小舒张压、24 h平均舒张压均显著降低,夜间最大收缩压显著升高及舒张压反杓型比例显著升高(P均0.05);两组白天平均收缩压、白天最大收缩压、白天最大舒张压、24 h平均收缩压、夜间平均收缩压、夜间平均舒张压、夜间最大舒张压、夜间最小收缩压、夜间最小舒张压及收缩压反杓型比例差异无统计学意义(P均0.05)。多因素Logistic回归分析显示,夜间最大收缩压与持续性房颤合并高血压显著相关(比值比=1.038,95%可信区间:1.014~1.062,P0.01)。结论:持续性房颤可导致原发性高血压患者白天血压显著下降,而夜间血压下降不明显。     

老年高血压患者血压昼夜节律与颈动脉粥样硬化相关性研究

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关系。方法选择2016年9月～2018年6月青岛大学附属医院保健科住院的老年高血压患者117例,根据24h动态血压监测结果分为杓型组24例和异常昼夜节律组93例,异常昼夜节律组又分为非杓型组67例,反杓型组26例。所有患者行颈动脉超声检查,检测左右颈总动脉内膜中层厚度(IMT)、颈动脉斑块及管腔狭窄情况,对颈动脉粥样硬化进行分级。测定患者空腹血糖,血脂,同型半胱氨酸,记录24h收缩压、24h舒张压、昼间收缩压、昼间舒张压、夜间收缩压和夜间舒张压。结果异常昼夜节律组左侧IMT、右侧IMT、斑块发生率和颈动脉粥样硬化程度明显高于杓型组,差异有统计学意义(P0.05,P0.01)。反杓型组夜间收缩压、夜间舒张压明显高于非杓型组[(132.92±15.75)mm Hg vs (122.85±14.91)mm Hg(1mm Hg=0.133kPa),(72.38±8.75)mm Hg vs (64.34±9.98)mm Hg,P0.01]。非杓型组和反杓型组左侧IMT和左侧斑块发生率明显高于右侧,差异有统计学意义(P0.05)。结论老年高血压患者血压昼夜节律与颈动脉粥样硬化关系密切,异常血压昼夜节律损伤靶器官概率更大,并且对左侧颈动脉内膜损害较右侧明显。     

2型糖尿病患者非杓型血压节律与血同型半胱氨酸、颈动脉粥样硬化的关系研究

目的:探讨2型糖尿病(T2DM)患者非杓型血压节律与血同型半胱氨酸(Hcy)、颈动脉粥样硬化(CAS)之间的关系。方法:纳入T2DM患者240例,其中男性139例,女性101例。(1)根据夜间血压下降率分为杓型血压组(80例)和非杓型血压组(160例);(2)根据有无CAS,分为硬化者(119例)和非硬化者(121例),比较组间Hcy、颈动脉内膜-中层厚度(CIMT)、24 h平均收缩压(24 h SBP)、昼间平均收缩压(d SBP)、夜间平均收缩压(n SBP)、24 h平均舒张压(24 h DBP)、昼间平均舒张压(d DBP)、夜间平均舒张压(n DBP)的差异,并分析CAS的危险因素。结果:与杓型血压组比较,非杓型血压组Hcy(μmol/L,16.41.0±8.08 vs 12.55±4.07)、CIMT(mm,1.00±0.59vs 0.80±0.30)、24 h SBP[mm Hg(1 mm Hg=0.133 k Pa),138.7±19.2 vs 127.5±15.6]、d SBP(mm Hg,139.4±19.2vs 132.0±16.2)、n SBP(mm Hg,136.4±20.0 vs 113.8±15.0)、n DBP(mm Hg,74.0±12.0 vs 64.9±9.8)均明显升高(P0.01);多元线性回归分析提示Hcy(β=0.011;P0.01)、n SBP(β=0.021;P0.01)、n DBP(β=0.018;P0.01)是血压节律改变的影响因素;与非硬化者比较,硬化者CIMT(mm,1.18±0.65 vs 0.69±0.72)、年龄(岁,62.33±12.02vs 59.17±10.80)、24 h SBP(mm Hg,138.2±18.2 vs 131.9±18.9)、d SBP(mm Hg,139.5±18.4 vs 134.4±18.5)、nS BP(mmH g,133.9±20.7 vs 123.9±20.9)、nD BP(mmH g,73.3±12.8 vs 68.6±11.0)明显升高(P0.05或P0.01),而硬化者夜间收缩压下降率[SBPF(%),4.00±7.89 vs 7.66±7.36)]、夜间舒张压下降率[DBPF(%),5.95±8.44 vs 10.19±8.67)]明显低于非硬化者(P0.01);Logistic回归分析提示年龄[比值比(OR)=2.204];P0.05)、nD BP(OR=2.357;P0.05)、SBPF(OR=2.562;P0.01)是CAS的危险因素;Spearman相关分析CIMT与年龄呈正相关(r=0.195,P0.05),CIMT与SBPF呈负相关(r=-0.191,P0.01)。结论:非杓型血压节律的T2DM患者存在高同型半胱氨酸血症,非杓型血压是CAS的独立危险因素,恢复血压节律对预防动脉粥样硬化有重要意义。     

血压变异性对老年女性高血压患者颈动脉硬化的影响

目的探讨血压变异性对老年女性高血压患者颈动脉硬化的影响。方法选择198例诊室血压正常的女性高血压患者作为高血压组,同时选择女性正常血压者200例作为对照组。2组均行颈动脉超声检查,测颈动脉内膜中层厚度(IMT),测定24h动态血压和生化指标。结果高血压组冠心病(48.5%vs 39.5%)、脑血管病(51.0%vs 40.5%)和肾病(15.2%vs 8.5%)及颈动脉硬化(65.7%vs 26.0%)比例明显高于对照组(P<0.05,P<0.01),高血压组IMT明显高于对照组[(1.18±0.31)mmvs(0.81±0.24)mm,P=0.003]。高血压组夜间平均收缩压[(159.1±13.2)mm Hg)vs(141.3±11.3)mm Hg,1mm Hg=0.133kPa],夜间收缩压标准差[(15.9±3.1)mm Hg vs(9.5±1.2)mm Hg]及夜间收缩压血压负荷[(41.4±2.2)%vs(21.3±2.6)%]明显增高,夜间舒张压标准差[(9.1±4.1)mm Hg vs(6.2±2.3)mm Hg]及夜间舒张压血压负荷[(34.7±11.2)%vs(22.6±11.5)%]明显增高,差异有统计学意义(P<0.05,P<0.01)。结论血压变异性增大,夜间血压增高及血压负荷的增加是女性颈动脉硬化的危险因素。     

Significance of mean blood pressure for blood pressure control

The significance of pulse pressure (PP) and mean blood pressure (MBP) for blood pressure (BP) control is unclear. The aim of this study was to examine the relationship between PP and MBP and BP control. We obtained home BP measurements for 117 patients aged 40-75 years with either office systolic BP (SBP) >or= 140 mmHg or office diastolic BP (DBP) >or= 90 mmHg. Patients were treated with 1 to 2 antihypertensive drugs for 6 months to achieve home SBP < 135 mmHg and home DBP < 85 mmHg. At follow-up, 72 patients were taking a single drug with good BP control, 23 were taking two drugs with good BP control, and 22 were taking two drugs without good BP control. Although office SBP and DBP at baseline were similar in the three groups, home SBP and DBP at baseline in the single drug group were lowest among the three groups (P < 0.01). Home MBP at baseline in the single drug group was lowest among the three groups (P < 0.01). Home PP at baseline was highest in the two-drug without good control group (P < 0.001). In multivariate logistic regression analysis, only home MBP at baseline was significantly correlated with a lack of BP control. Home MBP rather than home PP is associated with achieving adequate BP control.     

Low blood pressure

When facing a chronic hypotension, underlying chronic diseases must be ruled out. In most cases, it concerns a "constitutional" benign, low blood pressure, however ill-tolerated and associated with neurovegetative dystonia. In so far as it is not a disease, there is no specific treatment. The long-term prognosis is excellent since symptoms usually improve with years and a low blood pressure is a sign of longevity.     

Wrist blood pressure overestimates blood pressure measured at the upper arm

OBJECTIVE: Whether blood pressure (BP) measured at the wrist differs from blood pressure measured at the arm is not well known. The aim of this study was to compare the BP readings obtained at the arm with those obtained at the forearm and to assess whether the wrist-arm discrepancies were related to subjects' clinical characteristics. METHODS: We measured blood pressure at the forearm and at the upper arm in 85 subjects using conventional sphygmomanometry. Wrist-arm blood pressure discrepancies were assessed in relation to gender, age, body mass index, skin-fold thickness, arm size, blood pressure level, and arterial compliance measured with the HDI/Pulsewave CR-2000. RESULTS: Blood pressure measured at the wrist consistently overestimated blood pressure taken at the arm with a mean (+/-SD) discrepancy of 8.2 +/- 9.7/9.2 +/- 6.4 mmHg. The systolic blood pressure differences were greater in men than in women (p=0.006) and, among the men, varied according to arm adiposity (positive association, p=0.01). In men, diastolic blood pressure differences correlated with diastolic blood pressure level (negative association, p=0.01). Among the women, only age (p=0.04) was a significant positive independent predictor of the wrist-arm diastolic BP differences. CONCLUSIONS: These results indicate that forearm blood pressure measurement markedly overestimates upper arm blood pressure and that the between-site difference may vary from subject to subject. Wrist blood pressure measurement is not a valid alternative to traditional measurement at the arm and its use should be discouraged.