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解放军总医院医学创新研究部、国家老年疾病临床医学研究中心(解放军总医院)、解放军总医院第六医学中心心血管病医学部
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中华老年多器官疾病杂志编辑委员会
100853, 北京市复兴路28号
电话:010-66936756
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E-mail: zhlndqg@mode301.cn
创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
薛玉婷,任洁.老年高血压患者长时血压变异性及降压治疗对动脉僵硬度的影响[J].中华老年多器官疾病杂志,2022,21(9):670~674
老年高血压患者长时血压变异性及降压治疗对动脉僵硬度的影响
Effect of long-term blood pressure variability and anti-hypertensive treatment on arterial stiffness in elderly hypertensive patients
投稿时间:2022-06-12  
DOI:10.11915/j.issn.1671-5403.2022.09.145
中文关键词:  高血压  动脉僵硬度  降压治疗  长时血压变异性
英文关键词:hypertension  arterial stiffness  anti-hypertensive treatment  long-term blood pressure variability This work was supported by the General Project of Soft Science Research of Shanxi Province
基金项目:山西省软科学研究一般项目(2017041035-5)
作者单位E-mail
薛玉婷 山西医科大学第三医院·山西白求恩医院·山西医学科学院·同济山西医院心血管内科,太原030032 renjie1011@163.comeffect 
任洁 山西医科大学第三医院·山西白求恩医院·山西医学科学院·同济山西医院心血管内科,太原030032 renjie1011@163.comeffect 
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中文摘要:
      目的 探讨长时血压变异性(BPV)和降压治疗对动脉僵硬度的影响。方法 选取2017年1月至6月于山西白求恩医院进行降压治疗及管理的原发性老年高血压患者411例,用臂踝脉搏波传导速度(baPWV)和踝臂指数(ABI)作为评估动脉僵硬度的指标。采用线性回归分析血压指数及BPV与baPWV、ABI的相关性,BPV用收缩压标准差(SBP_SD)表示。采用SPSS 26.0统计软件进行数据分析。采用t检验分析降压治疗的效果以及降压治疗对动脉僵硬度的影响。结果 通过3年降压治疗,老年高血压患者平均SBP、DBP、PP、MAP均较治疗前出现明显下降,FPG、TC、TG也较前明显下降,HDL-C较前明显升高,差异均有统计学意义[(131.78±7.36)和(142.92±17.14)mmHg(1mmHg=0.133kPa),(80.22±6.31)和(81.49±10.01)mmHg,(51.57±7.81)和(61.43±14.06)mmHg,(97.41±5.57)和(101.97±10.98)mmHg,(5.30±1.67)和(5.81±1.69)mmol/L,(3.85±0.95)和(4.42±0.90)mmol/L,(1.27±0.68)和(1.79±1.13)mmol/L,(1.35±0.31)和(1.21±0.31)mmol/L;均P<0.05];而治疗前后LDL-C的差异无统计学意义。调整混杂因素后线性回归结果显示,在老年高血压患者中SBP、PP、MAP、SBP_SD均与baPWV呈正相关(β=10.390,5.500,14.940,11.110;均P<0.05),与ABI呈负相关(β=-0.002,-0.001,-0.002,-0.003;均P<0.05);而DBP仅与baPWV呈正相关(β=8.690,P<0.05),而与ABI无相关性。降压治疗后,baPWV由(1782.70±308.87)cm/s降至(1732.43±261.73)cm/s、ABI由(1.12±0.10)升至(1.14±0.08),差异均有统计学意义(均P<0.05);其中baPWV在性别和年龄分层分析中均表现出下降趋势,与降压治疗前相比,差异均有统计学意义(均P<0.05);而ABI在女性患者及60~70岁患者中,与降压治疗前相比,差异均有统计学意义(均P<0.05)。降压前后SBP差值、DBP差值与baPWV差值均呈正相关(β=3.000,3.290;P<0.05),而与ABI差值无相关性。结论 SBP_SD是动脉僵硬度的影响因素,对老年高血压患者进行降压治疗及综合管理,可以显著改善患者的baPWV值,而降压治疗对ABI的影响尚需进一步的研究去明确。
英文摘要:
      Objective To explore the effect of long-term blood pressure variability and anti-hypertensive treatment on arterial stiffness. Methods A total of 411 elderly patients with essential hypertension who were treated and managed in our hospital from January to June 2017 were enrolled in this study. Brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI) were used as indicators to evaluate arterial stiffness. Linear regression analysis was employed to analyze the correlations of blood pressure index and long-term blood pressure variability (BPV) with baPWV and ABI. BPV was expressed as systolic blood pressure standard deviation (SBP_SD). SPSS statistics 26.0 was applied for data analysis. The efficacy of anti-hypertensive therapy and the effect of antihypertensive therapy on arterial stiffness were analyzed by student′s t test. Results In those elderly patients with hypertension, 3 years′ anti-hypertensive treatment resulted in significantly decreased average systolic blood pressure [SBP, (131.78±7.36) vs (142.92±17.14) mmHg(1 mmHg=0.133 kPa)], diastolic blood pressure [DBP, (80.22±6.31) vs (81.49±10.01) mmHg], pulse pressure [PP, (51.57±7.81) vs (61.43±14.06) mmHg] and mean artery pressure [MAP, (97.41±5.57) vs (101.97±10.98) mmHg], obviously reduced fasting plasma glucose [FPG, (5.30±1.67) vs (5.81±1.69) mmol/L], total cholesterol [ (3.85±0.95) vs (4.42±0.90) mmol/L] and triglyceride [(1.27±0.68) vs (1.79±1.13) mmol/L], but remarkably elevated high-density lipoprotein cholesterol [(1.35±0.31) vs (1.21±0.31) mmol/L] when compared the corresponding values before treatment (all P<0.05). No such statistical change was seen in low-density lipoprotein cholesterol level before and after treatment. After adjustment for confounding factors, SBP, PP, MAP and SBP_SD were positively correlated with baPWV (β=10.390,5.500,14.940,11.110, all P<0.05) and negatively with ABI (β=-0.002, -0.001, -0.002, -0.003, all P<0.05 ) in the patients. DBP was only positively correlated with baPWV (β=8.690, P<0.05), but had no correlation with ABI. After antihypertensive treatment, baPWV was decreased from (1 782.70±308.87) cm/s to (1 732.43±261.73) cm/s, and ABI was increased from (1.12±0.10) to (1.14±0.08), with statistically differences (both P<0.05). Among them, baPWV showed a downward trend in gender and age stratifications, and significant difference was seen compared with that before antihypertensive treatment (P<0.05). ABI in the female patients and those aged 60-70 years was significantly different from that before anti-hypertensive treatment (P<0.05). The SBP difference and DBP difference before and after treatment were positively correlated with the difference of baPWV (β=3.000,3.290, P<0.05), but not with the difference of ABI. Conclusion SBP_SD is an influencing factor of arterial stiffness. The antihypertensive treatment and comprehensive management of elderly hypertensive patients can significantly improve their baPWV value, but the effect on ABI needs further research to clarify.
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