Relationship between circadian rhythm of blood pressure and carotid atherosclerosis in the elderly with hypertension
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摘要:
目的 探讨老年高血压患者不同类型的血压昼夜节律与颈动脉粥样硬化之间的关系。 方法 选取2019年2月—2020年2月在西安交通大学第一附属医院治疗的老年高血压患者128例为研究对象，根据24 h动态血压监测结果将患者分为杓型组(32例)和异常昼夜节律组(96例)，再将异常昼夜节律组分为非杓型组(68例)和反杓型组(28例)。检测各组患者左、右侧颈总动脉内膜中层厚度(IMT)和斑块发生情况，并测定各组患者的24 h收缩压、24 h舒张压、昼间收缩压、昼间舒张压、夜间收缩压和夜间舒张压，统计一般临床资料和相关生化指标。比较各组患者的临床指标。 结果 异常昼夜节律组患者夜间收缩压、夜间舒张压明显高于杓型组患者(均P < 0.01);异常昼夜节律组患者斑块检出率明显高于杓型组患者(P < 0.01);异常昼夜节律组患者左、右两侧IMT值均明显高于杓型组患者(均P < 0.01)。反杓型组患者夜间收缩压、夜间舒张压明显高于非杓型组患者(均P < 0.01);非杓型组与反杓型组患者左侧颈总动脉斑块检出率和左侧IMT均明显高于同组右侧(均P < 0.05)。 结论 老年高血压患者异常血压昼夜节律变化主要为夜间收缩压和舒张压之间存在明显差异; 其血压昼夜节律与颈动脉粥样硬化具有密切关系，异常血压昼夜节律对靶器官的损伤更大; 非杓型和反杓型患者的异常血压昼夜节律对左侧颈动脉内膜的损害程度较右侧更加明显。 Abstract:Objective This study aimed to investigate the relationship between circadian rhythm of blood pressure and carotid atherosclerosis in elderly patients with hypertension. Methods A total of 128 patients with senile hypertension, who were undergoing treatment in the First Affiliated Hospital of Xi'an Jiaotong University from February 2019 to February 2020, were selected as the research object. On the basis of the 24 h ambulatory blood pressure monitoring results, the patients were divided into the dipper hypertension group (32 cases) and abnormal circadian rhythm (96 cases), and abnormal circadian rhythm was then divided into the non-dipper hypertension group (68 cases) and the reverse dipper hypertension group (28 cases). The intima-media thickness (IMT) and plaque occurrence in the left and right common carotid artery in each group were measured, and the 24-h systolic blood pressure, 24-h diastolic blood pressure, daytime systolic blood pressure, daytime diastolic blood pressure, nocturnal diastolic blood pressure systolic blood pressure of each group were measured, and the general clinical data and relevant biochemical indicators were collected. The clinical indicators of patients in each group were compared. Results Nocturnal systolic blood pressure and nocturnal diastolic blood pressure in patients with abnormal circadian rhythm were significantly higher than those in the dipper hypertension group (all P < 0.01). The incidence of plaque in patients with abnormal circadian rhythm was significantly higher than that of the dipper hypertension group (P < 0.01). The IMT values of the left and right sides of patients with abnormal circadian rhythm were significantly higher than those of the dipper hypertension group (all P < 0.01). The nocturnal systolic blood pressure and nocturnal diastolic blood pressure were significantly higher in the anti-arytenoid group than in the non-arytenoid group (all P < 0.01). The detection rate of left common carotid artery plaque and left IMT in the non-dipper hypertension and reverse dipper hypertension groups was significantly higher than those in the right side of the same group (all P < 0.05). Conclusion The circadian rhythm of blood pressure in elderly patients with hypertension is significantly different between nocturnal systolic blood pressure and diastolic blood pressure. The circadian rhythm of blood pressure is related to carotid atherosclerosis, and abnormal circadian rhythm of blood pressure causes more damage to target organs. Moreover, abnormal circadian rhythm of blood pressure of non -dipper hypertension and reverse dipper hypertension patients causes more damage to left carotid intima than right. -
表 1 2组老年高血压患者一般资料及动态血压比较(x ±s)
组别 例数 性别[例(%)] 吸烟史[例(%)] 高血压家族史[例(%)] 男性 女性 有 无 有 无 杓型组 32 15(46.88) 17(53.12) 9(28.13) 23(71.87) 7(21.87) 25(78.13) 异常昼夜节律组 96 37(38.54) 59(61.46) 29(30.21) 67(69.79) 25(26.04) 71(73.96) 统计量 0.691a 0.050a 0.222a P值 0.406 0.823 0.637 组别 例数 年龄(岁) 高血压病程(年) BMI TC(mmol/L) 空腹血糖(mmol/L) TG(mmol/L) 杓型组 32 71.65±2.87 13.68±1.81 23.15±2.76 4.48±0.21 5.16±0.17 1.23±0.23 异常昼夜节律组 96 71.87±2.79 13.81±1.72 23.19±2.84 4.45±0.27 5.18±0.14 1.18±0.26 统计量 0.691b 0.365b 0.069b 0.573b 0.662b 0.968b P值 0.406 0.716 0.945 0.568 0.509 0.335 组别 例数 24 h收缩压(mm Hg) 24 h舒张压(mm Hg) 昼间收缩压(mm Hg) 昼间舒张压(mm Hg) 夜间收缩压(mm Hg) 夜间舒张压(mm Hg) 杓型组 32 127.13±11.76 70.83±2.97 128.86±11.88 71.43±2.63 118.64±11.82 68.78±2.86 异常昼夜节律组 96 126.89±11.84 71.02±2.87 129.15±11.26 71.65±2.95 138.97±11.95 78.78±2.89 统计量 0.112b 0.322b 0.125b 0.375b 8.357b 16.995b P值 0.911 0.748 0.901 0.708 < 0.001 < 0.001 注：a为χ2值，b为t值; 1 mm Hg=0.133 kPa。 
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表 2 2组老年高血压患者颈动脉IMT和斑块比较(x ±s)
组别 例数 斑块[例(%)] 左侧IMT(mm) 右侧IMT(mm) 杓型组 32 11(34.38) 0.93±0.21 0.95±0.24 异常昼夜节律组 96 71(73.96) 1.15±0.28 1.09±0.26 统计量 18.661a 4.075b 2.387b P值 < 0.001 < 0.001 0.008 注：a为χ2值，b为t值。
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表 3 非杓型组与反杓型组老年高血压患者一般资料、生化指标及动态血压比较(x ±s)
组别 例数 性别[例(%)] 吸烟史[例(%)] 高血压家族史[例(%)] 男性 女性 有 无 有 无 非杓型组 68 19(27.94) 49(72.06) 21(30.88) 47(69.12) 19(27.94) 49(72.06) 反杓型组 28 9(32.14) 19(67.86) 8(28.57) 20(71.43) 6(21.43) 22(78.57) 统计量 0.169a 0.050a 0.437a P值 0.681 0.823 0.509 组别 例数 年龄(岁) 高血压病程(年) BMI TC(mmol/L) 空腹血糖(mmol/L) TG(mmol/L) 非杓型组 68 71.62±2.68 13.68±1.73 23.26±2.36 4.39±0.12 5.15±0.26 1.19±0.21 反杓型组 28 71.91±2.86 13.89±1.91 23.12±2.65 4.43±0.26 5.21±0.27 1.13±0.25 统计量 0.691b 0.524b 0.255b 0.781b 1.016b 1.202b P值 0.406 0.601 0.799 0.441 0.312 0.232 组别 例数 24 h收缩压(mm Hg) 24 h舒张压(mm Hg) 昼间收缩压(mm Hg) 昼间舒张压(mm Hg) 夜间收缩压(mm Hg) 夜间舒张压(mm Hg) 非杓型组 68 127.12±11.63 70.92±2.64 128.86±11.88 71.29±2.95 121.85±11.82 65.78±2.82 反杓型组 28 126.81±11.78 71.21±2.96 129.15±11.92 71.72±2.96 139.87±11.92 81.85±2.81 统计量 0.118b 0.472b 0.109b 0.649b 6.773b 25.483b P值 0.906 0.638 0.913 0.518 < 0.001 < 0.001 注：a为χ2值，b为t值。
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表 4 非杓型组与反杓型组老年高血压患者颈动脉IMT和斑块比较(x ±s)
组别 例数 左侧斑块[例(%)] 右侧斑块[例(%)] 左侧IMT (mm) 右侧IMT (mm) 非杓型组 68 37(54.41) 12(17.65) 1.14±0.25 1.07±0.13 反杓型组 28 16(57.14) 6(21.43) 1.21±0.21 1.12±0.11 统计量 0.060a 0.186a 1.303b 1.778b P值 0.807 0.666 0.196 0.079 注：非杓型组左右两侧斑块检出率比较，χ2=19.939, P < 0.001，左右两侧IMT比较，t=2.049, P=0.042;反杓型组左右两侧斑块检出率比较，χ2=7.487, P=0.006，左右两侧IMT比较，t=2.009, P=0.049。a为χ2值，b为t值。
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