目的 探讨原发性高血压24 h动态血压患者的特点及其影响因素。方法 选取312例原发性高血压患者进行24 h动态血压监测(ABPM),根据年龄分为<40岁组、40～49岁组、50～59岁组和≥60岁组,分析不同年龄及性别对高血压患者血压型及清晨血压的影响。结果 312例中杓形、非杓形、反杓形和超杓形血压者分别为45.19%、41.35%、7.37%和6.09%。杓形血压在<40岁的青年组比例最高(65.00%),反杓形血压在≥60岁的老年组比例最高(18.92%)。性别对血压类型无明显影响,仅反杓形血压比例男性低于女性(P<0.01),其他血压类型男女两组差异无统计学意义。312例患者清晨高血压比例高达96.5%。年龄对清晨高血压比例无明显影响,而性别对清晨高血压比例有影响:男性组检出率明显高于女性(P<0.05)。结论 老年患者血压节律异常比例较高,男性患者更易发生清晨高血压,应根据患者血压昼夜节律制定个体化降压治疗方案。
Abstract
Objective To investigate the effect of age and gender on blood pressure (BP) rhythm of patients with essential hypertension based on 24-hour ambulatory blood pressure.Methods 312 patients with essential hypertension were analyzed by 24-hour ambulatory blood pressure monitoring (ABPM).They were divided into four groups according to age: the <40-year-old group, 40-49-year-old group, 50-59-year-old group and the ≥60--year-old group. The influence of age and gender on the characteristics of blood pressure rhythm and morning hypertension was studied.Results The incidence of dippers, non-dippers, reverse dippers and ultra-dippers was 45.19%, 41.35%,7.37% and 6.09%, respectively. The proportion of dippers in the youngest group (65%) was the highest while reverse dippers were prevalent(18.92%) in the elderly group.Gender had no significant effect on blood pressure type. Only reverse dippers were more common in the female group than in the male group(P<0.01).Cases of morning hypertension accounted for 96.5%.Age had no effect on the incidence of morning hypertension, but there was significant difference between the male group(98.6%) and the female group (92.4%)in this regard.Conclusions Elderly patients with abnormal circadian rhythm outnumber younger patients. Male patients are more prone to morning hypertension. More attention should be paid to abnormal circadian rhythm, especially to morning hypertension, in order to individualize antihypertensive treatments.
关键词
高血压 /
昼夜血压 /
清晨高血压 /
年龄 /
性别
Key words
hypertension /
circadian rhythm /
morning hypertension /
age /
gender
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] O’Brien E, Sheridan J, O’Malley K. Dippers and non-dippers[J]. Lancet,1988,2:397.
[2] Verdecchia P, Reboldi G, Porcellati C, et al. Risk of cardiovascular disease in relation to achieved office and ambulatory blood pressure control in treated hypertensive subjects[J].J Am Coll Cardiol,2002,39:878-885.
[3] Staessen J A, Thijs L, Fagard R, et al. Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. Systolic Hypertension in Europe Trial Investigators [J]. Jama, 1999, 282:539-546.
[4] Fagard R H, Celis H, Thijs L, et al. Daytime and nighttime blood pressure as predictors of death and cause-specific cardiovascular events in hypertension[J].Hypertension,2008,51:55-61.
[5] Hansen T W, Jeppesen J, Rasmussen F, et al. Ambulatory blood pressure monitoring and mortality: a population-basedstudy [J].Hypertension,2005,45:499-504.
[6] Wiinberg N, Hoegholm A, Christensen H R, et al. 24-h Ambulatory blood pressure in 352 normal Danish subjects, related to age and gender [J].Am J Hypertens,1995, 8:978-986.
[7] 中华医学会心血管病学分会高血压学组.清晨血压临床管理中国专家指导建议[J].中华心血管病杂志,2014, 42(9):721-725.
[8] Julian F.Thayer, John J.Sollers III, Bruce H. Friedman & Julian Koenig, et al. Gender differences in the relationship between resting heart rate variability and 24-hour blood pressure variability[J]. Blood Pressure, 2016, 25 (1 ):58-62.
[9] Wang Y X, Song L, Xing A J,et al. Predictive Value of Cumulative Blood Pressure for All-Cause Mortality and Cardiovascular Events[J].Sci Rep, 2017,2:25-27.
[10] Riyahi-Alam S1, Derakhshan A1, Mansournia M A2,et al. Blood pressure and cardiovascular morbidity risk in type 2 diabetes with hypertension over a decade of follow-up: evidence for J-shaped phenomenon[J].Hum Hypertens,2017, 26 (1): 1004-1010.
[11] R.C. Hermida, C. Calvo, D.E. Ayala, et al. Evaluation of the extent and duration of the "ABPM effect" in hypertensive patients[J]. J Am Coll Cardiol, 2002, 40:710-717.
[12] Karaagac K , Vatansever F , Tenekecioglu E, et al. The Relationship between Non-Dipper Blood Pressure and Thoracic Aortic Diameter in Metabolic Syndrome[J]. Eurasian J Med, 2014,46(2):120-125.
[13] Muller J E. Circadian variation in the frequency of onset of acute myocardial infarction.[J]. N Engl J Med, 1985,313:1315-1322.
[14] Marler J R. Morning increase in onset of ischemic stroke[J].Stroke, 1989,20:473-476.
[15] Sante D. Pierdomenico,Francesca Coccina,Domenico Lapenna,et al. Prognostic value of nondipping and morning surge in elderly treated hypertensive patients with controlled ambulatory blood pressure[J]. Am J Hypertens,2017,30 (2): 159-165.
[16] RedónJ, Roca-CusachsA,Mora-Maciá J. Uncontrolled early morning blood pressure in medicated patients: the ACAMPA study. Analysis of the Control of Blood Pressure using Ambulatory Blood Pressure Monitoring[J]. Blood Press Monit, 2002,7(2):111-116.
[17] Ishikawa J,Kario K,Hoshide S,et al.Determinants of exaggerated difference in morning and evening blood pressure measured byself-measured blood pressure monitoring in medicated hypertensive patients[J].Am J Hypertens,2005,18(7):958-965.
[18] 汪宇鹏,李昭屏,白 琼,等.高血压患者清晨血压控制现状和用药分析[J].中华心血管病杂志,2013,14(7):587-589.
[19] Hermida R C, Ayala D E, Smolensky M H, et al. Sleep-time blood pressure: Unique sensitive prognostic marker of vascular risk and therapeutic target for prevention[J]. Sleep Med Rev,2016,14(4): 17-27.
PDF(538 KB)
