老年肥胖型正常高值血压患者24h-动态血压变异特点及与动脉僵硬度的相关性研究

摘要 目的：探讨老年肥胖型正常高值血压患者24h-动态血压变异特点及与动脉僵硬度的相关性。方法：选择2018年1月~2020年5月期间在我院住院的老年正常高值血压患者174例作为研究对象，根据腰围分为腹型肥胖组（n=85）和非腹型肥胖组（n=89）。所有受试者监测24h-动态血压包括24h平均收缩压（24h-SBP）、白昼平均舒张压（dDBP）、24h平均舒张压（24h-DBP）、夜间平均收缩压（nSBP）、白昼平均收缩压（dSBP）、夜间平均收缩压（nDBP）、血压变异系数（CV）]和颈-桡动脉脉搏传导速度（crPWV），分析24h-动态血压变异性、节律性特点和crPWV的影响因素。结果：腹型肥胖组患者非杓型血压、24h-SBP-CV、24h-DBP-CV、dSBP-CV、nSBP-CV、夜间SBP下降率以及crPWV均高于非腹型肥胖组（P<0.05），腹型肥胖组患者动脉僵硬度增高发生率高于非腹型肥胖组患者（P<0.05）。控制混杂因素后，腹型肥胖组患者腰围与夜间SBP下降率（r=0.338）、24h-SBP-CV（r=0.279）、24h-DBP-CV（r=0.259）、dSBP-CV（r=0.208）、nSBP-CV（r=0.317）、crPWV（r=0.543）呈正相关性（P<0.05）。经多元线性回归分析结果显示，腰围、LDL-C、夜间SBP下降率、24h-SBP-CV和nSBP-CV是crPWV的重要影响因素（P<0.05）。结论：腹部脂肪沉积对老年正常高值血压患者24h动态血压变异性和动脉僵硬度有显著影响，部分24h-动态血压参数与动脉僵硬度有关，控制腰围对预防动脉硬化有着重要的意义。

Characteristics of 24-hour Ambulatory Blood Pressure Variability and Its Correlation Study with Arterial Stiffness in Elderly Obese Patients with High Normal Blood Pressure

ABSTRACT Objective: To investigate the characteristics of 24-hour ambulatory blood pressure variability and its correlation with arterial stiffness in elderly obese patients with high normal blood pressure. Methods: 174 elderly patients with normal high-value blood pressure who were hospitalized in our hospital from January 2018 to May 2020 were selected as study subjects, and divided into abdominal obesity group (n=85) and non-abdominal obesity group (n=89) according to the waist circumference. The 24h-ambulatory blood pressure including 24h systolic blood pressure (24h-SBP), daytime mean diastolic blood pressure (dDBP), 24h systolic blood pressure (24h-DBP), nighttime mean systolic blood pressure (nSBP), daytime mean systolic blood pressure (dSBP), nighttime mean systolic blood pressure (nDBP), blood pressure coefficient of variation (CV)] and carotid-radial pulse wavevelocity (crPWV) in all subjects were monitored. The variability and rhythm of 24-hour ambulatory blood pressure and the influencing factors of crPWV were analyzed. Results: The non-dipper blood pressure, 24h-SBP-CV, 24h-DBP-CV, dSBP-CV, nSBP-CV, nighttime SBP decrease rate and crPWV of patients in abdominal obesity group were higher than those in non-abdominal obesity group (P<0.05). The incidence of increased arterial stiffness in abdominal obesity group was higher than that in non-abdominal obesity group (P<0.05). After controlling for confounding factors, waist circumference of patients in the abdominal obesity group were positively correlated with the nighttime SBP decrease rate (r=0.338), 24h-SBP-CV (r=0.279), 24h-DBP-CV (r=0.259), dSBP-CV (r=0.208), nSBP-CV (r=0.317) and crPWV (r=0.543) (P<0.05). The results of multiple linear regression analysis showed that the waist circumference, LDL-C, the decrease rate of nighttime SBP, 24h-SBP-CV and nSBP-CV were the influence factors of crPWV (P<0.05). Conclusion: Abdominal fat deposition has a significant effect on 24h-ambulatory blood pressure variability and arterial stiffness in elderly patients with normal high-value blood pressure, some parameters of 24h-ambulatory blood pressure are related to arterial stiffness. Waist circumference control is of great significance for preventing atherosclerosis.