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诊所血压正常的高龄老年高血压患者夜间低血压现象分析
Nocturnal hypotension in very elderly hypertensive patients with normal office blood pressure
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DOI:
作者:
李远方1,西雁1,钱菊英,葛均波
Li Yuanfang1, Xi Yan1, Qian Juying, Ge Junbo
作者单位:
复旦大学附属中山医院心内科,上海市心血管病研究所
Department of Cardiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Cardiovascular Diseases.
关键词:
高龄;高血压病;低血压;动态血压监测
very elderly; hypertension; hypotension; ambulatory blood pressure monitoring.
摘要:
背景:目前对于初始收缩压(SBP)≥160mmHg的高龄(年龄≥80岁)老人,指南推荐降压治疗,目标血压是150/80mmHg。血压进一步降低对于高龄老人是否安全仍有争议。 目的: 这是一项横断面观察性研究,评估诊所血压控制在140/90mmHg以下的80岁以及以上年龄的高血压患者夜间低血压现象(nocturnal hypotension ,NHP)的发生率、相关因素,并探索能预测夜间低血压现象的动态血压监测(ambulatory blood pressure monitoring,ABPM)指标临界值。 方法: 入选我院心内科老年病房连续住院的52例诊所血压低于140/90mmHg的高龄高血压患者,36例男性,16例女性。平均年龄86.2±4.8岁(80~99岁)。行动态血压监测,分析有NHP患者的血压特点、服用降压药情况及其影响因素,并与无NHP患者比较。NHP的定义为夜间平均动脉压(MAP)低于70mmHg。 结果:52例患者的诊所血压平均125±12/69±8 mmHg,高血压病史19.6±14.4年。平均使用降压药物2.02±1.98种。动态血压监测提示,其中41例(78.8%)存在NHP,NHP的次数占总监测次数的中位值为4.5% (0~38.5%)。按是否有NHP将患者分为两组,两组的临床特征无显著性差异,诊所舒张压(DBP)无显著性差异。但有NHP组的动态血压值,包括24小时平均血压值,白天平均血压值,夜间平均血压值以及夜间最低血压值,均低于无夜间低血压组患者( P<0.05),诊所SBP也低于无NHP者(123.3±12.7 比131.8±3.4,P=0.02)。有NHP者服用更多的降压药物(2.22±0.91 比1.27±0.90, P=0.004),偏相关分析提示,夜间DBP最低值与降压药物种类呈中等强度负相关(r=-0.487,P=0.002)。研究发现24小时SBP< 140 mmHg和/或24小时DBP< 72 mmHg 能较好预测夜间低血压现象,总符合率92.3%,P=0.000。 结论:诊所血压低于140/90mmHg的高龄老年高血压患者中,夜间低血压现象普遍。这些患者诊所血压并不低于正常值,有必要进行动态血压检查。在这个脆弱的人群中,应界定合适的降压目标值及进行适当强度的降压治疗。 关键词:高龄;高血压病;低血压;动态血压监测
Abstract Background:Antihypertensive treatment is recommended for very elderly patients with an initial systolic blood pressure(SBP)≥160mmHg to achieve a target of 150/80 mmHg. Whether it is safe to further reduce blood pressure (BP) is under debate. Objectives: To evaluate the presence of nocturnal hypotension (NHP) and possible associated factors in hypertensive patients 80 years of age or older with office BP under 140/90 mmHg, and to explore the cut-off value in ambulatory blood pressure monitoring (ABPM) that can predict episode of NHP. Methods: A total of 52 in-hospital hypertensive patients( 36 male, 16 female, mean age 86.2±4.8 years) with office blood pressure under 140/90mmHg were enrolled in this cross-sectional observational study. Ambulatory blood pressure monitoring(ABPM)was recorded and analyzed. The NHP was defined as the mean nocturnal blood pressure less than 70 mmHg. The characteristics of the blood pressure, clinical patterns and antihypertensive drugs is compared between patients with NHP episodes and those without. Results: The mean office blood pressure of the patients was 125±12/69±8mmHg with a history of hypertension of 19.6±14.4 years. The mean number of anti-hypertensive drugs was 2.02±1.98. Episodes of NHP were observed in 41 patients(78.8%). The middle value of percentage of NHP recordings among total recordings is 4.5%(0~38.5%).There was no significant difference in clinical characteristics between the patients with and without NHP. Compared with the patients without NHP, patients with NHP had significantly lower mean 24-h BPs, mean daytime BPs, mean nighttime BPs and lowest nocturnal BPs. Clinical SBP was lower in patients with NHP(123.3±12.7 versus 131.8±3.4, P=0.02),while clinical DBP showed no significant difference between two groups. Patients with NHP were treated with more antihypertensive drugs(2.22±0.91 vs. 1.27±0.90, P=0.004). Number of hypertensive drugs is negatively correlated to the lowest nocturnal diastolic BP(DBP, r=-0.487,P=0.002). A cutoff value of 24-h SBP≤ 140 mmHg and/or 24-h DBP < 72 mmHg predicts NHP episode with good efficacy(coincidence rate=92.3%,P=0.000). Conclusions: Episodes of NHP are common in very elderly hypertensive patients with office BP under 140/90 mmHg. It is necessary to define the target BP levels in this frail population. Key Words: very elderly; hypertension; hypotension; ambulatory blood pressure monitoring.
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