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目的探讨老老年原发性高血压(EH)患者动态脉压(APP)与颈动脉内膜中膜厚度(IMT)的相关性。方法收集82例年龄≥80岁(老老年)EH患者的临床资料,应用24h动态血压监测仪监测患者的APP水平,根据APP的平均值将患者分为两组:APP<60mmHg组(n=40)和APP≥60mmHg组(n=42),分别以彩色多普勒超声测定其颈动脉IMT,采集其静脉血测定血脂及其他代谢指标含量。结果APP≥60mmHg组IMT明显大于APP<60mmHg组[(0.19±0.06)比(0.15±0.03)cm,P<0.01];IMT与APP呈正相关(r=0.38,P<0.01)。APP≥60mmHg组的24h收缩压(SBP)、24h脉压(PP)及24h动态脉压指数(PPI)均大于APP<60mmHg组[24hSBP(138.1±11.8)比(119.0±10.2)mmHg,P<0.01;24hPP(72.8±8.9)比(54.9±6.2)mmHg,P<0.01;24hPPI(0.52±0.09)比(0.45±0.08),P<0.05]。两组患者的血脂及其他代谢指标水平、24hDBP(舒张压)水平均无显著差异(P>0.05)。多元逐步回归分析经校正血糖、血尿酸、胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、血压参数(24hSBP、24hDBP、24hPP)未能证明24hPPI与颈动脉IMT有关。结论APP大的老老年EH患者颈动脉IMT增加更明显,老老年EH患者颈动脉IMT增加的主要危险因素可能更主要的是“老龄化”所致。
Objective To investigate the relationship between dynamic pulse pressure (APP) and carotid intima-media thickness (IMT) in elderly patients with essential hypertension (EH). Methods The clinical data of 82 EH patients aged> 80 years (old age) were collected. The level of APP was monitored by 24h ambulatory blood pressure monitor. According to the average value of APP, patients were divided into two groups: APP <60mmHg group ) And APP≥60mmHg group (n = 42). The carotid IMT was measured by color Doppler sonography, and the contents of blood lipid and other metabolic parameters were measured. Results IMT in APP≥60mmHg group was significantly higher than that in APP <60mmHg group [(0.19 ± 0.06) vs (0.15 ± 0.03) cm, P <0.01]. IMT was positively correlated with APP (r = 0.38, P <0.01). The systolic blood pressure (SBP), 24h pulse pressure (PP) and 24h dynamic pulse pressure index (PPI) in APP≥60mmHg group were significantly higher than those in APP <60mmHg group [24hSBP (138.1 ± 11.8) vs (119.0 ± 10.2) mmHg, 0.01; 24hPP (72.8 ± 8.9) vs (54.9 ± 6.2) mmHg, P <0.01; 24hPPI (0.52 ± 0.09) vs (0.45 ± 0.08), P <0.05; There were no significant differences in serum lipids and other metabolic indexes between two groups and 24hDBP (P> 0.05). Multivariate stepwise regression analysis showed that 24hPPI was not related to carotid IMT after corrected blood glucose, serum uric acid, cholesterol, triglyceride, HDL, LDL, blood pressure parameters (24hSBP, 24hDBP, 24hPP) Conclusion The increase of IMT in carotid artery of APP elderly patients with EH is more obvious. The main risk factors of carotid IMT increase may be more importantly due to “aging” in elderly patients with EH.