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应用24h动态血压监测(ABPM)了解老年原发性高血压晨峰现象对主要靶器官结构及功能的潜在损害。114例老年原发性高血压患者根据24h动态血压监测分为晨峰组和非晨峰组,均常规检查血脂谱,空腹血糖,放免法测定尿微量白蛋白,计算体重指数(BMI)、左室质量指数(LVMI)、颈总动脉(CCA-IMT)和颈内动脉内膜中层厚度(ICA-IMT)、心电图测量计算QT离散度(QTcd)。晨峰组的24h、白昼、夜间平均收缩压均显著高于非晨峰组动态血压监测水平(P<0.05),而且晨峰组的睡-谷晨峰变异幅度增高有统计学意义(P<0.05)。晨峰组的LVMI、CCA-IMT、ICA-IMT、QTcd和尿微量白蛋白指标均高于非晨峰组(P<0.01)。两组在BMI、血脂谱、血糖差异无统计学意义。清晨高血压是老年原发性高血压病的一个不可忽视的潜在危险因素。长期晨间血压负荷升高使得机体全天处于血压高负荷状态,更易使心肌重构肥厚和心电生理特征改变,增加心律失常发生率;加速动脉粥样硬化斑块形成。因此遏制老年原发性高血压患者的晨峰高反应是降压达标和减缓靶器官损害的关键环节。
24h ambulatory blood pressure monitoring (ABPM) was used to understand the potential damage to the structure and function of major target organs in the morning peak of senile essential hypertension. One hundred and seventy-one elderly patients with essential hypertension were divided into morning peak group and non-morning peak group according to 24-hour ambulatory blood pressure monitoring. Blood lipid profile, fasting blood glucose and fasting blood glucose were measured routinely. Urinary microalbuminuria was measured by radioimmunoassay. BMI, (LVMI), common carotid artery (CCA-IMT) and internal carotid artery intima-media thickness (ICA-IMT) and QT dispersion were calculated by electrocardiogram. The average systolic blood pressure at 24h, daytime and night at morning peak was significantly higher than that at non-morning peak (P <0.05), and the amplitude of variation of sleep-valley morning peak was significantly higher in morning peak (P <0.05) . The scores of LVMI, CCA-IMT, ICA-IMT, QTcd and urinary albumin in morning peak group were higher than those in non-morning peak group (P <0.01). There was no significant difference in BMI, blood lipid profile and blood glucose between the two groups. Early morning hypertension is a potential risk factor for senile essential hypertension. Long-term high blood pressure in the morning so that the body is in high blood pressure conditions throughout the day, more likely to make myocardial hypertrophy and changes in electrophysiological characteristics, increase the incidence of arrhythmia; accelerate the formation of atherosclerotic plaques. Therefore, to curb senile essential hypertension in patients with high morning peak response is to step down blood pressure and target organ damage is a key link.