住院老年高血压患者伴发餐后低血压的临床观察

发布时间：2018-05-15 18:48

  本文选题：餐后低血压 + 原发性高血压　； 参考：《中华高血压杂志》2017年02期

【摘要】：目的观察住院老年原发性高血压患者餐后血压变化,探讨餐后低血压(PPH)临床特点及其与心、肾等靶器官损害的相关性。方法选取2013年3月至2014年10月大连医科大学附属第一医院高血压病房住院治疗的老年原发性高血压患者191例,行24h动态血压监测,根据PPH诊断标准分为PPH组(n=153)和非PPH组(NPPH组,n=38),探讨PPH临床特点及相关因素。行心脏超声、肾功能检查,探讨PPH对心脏及肾脏损害的影响。结果住院老年原发性高血压患者191例中,153例在不同餐次出现至少一次PPH,PPH总发生率80.1%。早餐及午餐PPH发生率高于晚餐(P0.05);早餐、午餐餐后收缩压下降幅度大于晚餐[(18.3±14.9)、(20.3±14.6)比(15.5±13.0)mm Hg,均P0.05],三餐后舒张压下降幅度差异无统计学意义(P0.05)。不同年龄组PPH发生率差异无统计学意义,但80~89岁高龄老年组早餐后收缩压下降幅度较60~69岁低龄老年组增大[(26.3±12.1)比(16.8±15.0)mm Hg,P0.05]。根据三餐的餐前收缩压之和取平均值分为3组,餐前平均收缩压较高的C组(≥160mm Hg)与B组(140~160mm Hg)的PPH发生率高于收缩压较低的A组(140mm Hg)(P0.05);且C组和B组三餐后收缩压下降幅度高于A组。多因素Logistic回归分析显示,三餐餐前平均收缩压是PPH发生的独立影响因素(OR1.050,95%CI 1.021~1.079)。PPH组左心室质量指数大于NPPH组(P0.05),而PPH组与NPPH组在肾功能方面的差异无统计学意义。结论住院老年原发性高血压患者的PPH发生率为80.1%,三餐中以早餐及午餐PPH发生率较高,晚餐PPH发生率最低;三餐餐前平均收缩压是住院老年原发性高血压患者PPH发生的独立影响因素;PPH的发生可能会引起住院老年原发性高血压患者左心室结构的改变。
[Abstract]:Objective to observe the changes of postprandial blood pressure (PPH) in elderly patients with essential hypertension (EH), and to explore the relationship between PPH and heart, kidney and other target organ damage. Methods 191 elderly patients with essential hypertension in hypertension ward of the first affiliated Hospital of Dalian Medical University from March 2013 to October 2014 were selected for 24 hours ambulatory blood pressure monitoring. According to the diagnostic criteria of PPH, the patients were divided into PPH group (n = 153) and non-PPH group (n = 38). The clinical features and related factors of PPH were discussed. The effects of PPH on heart and kidney damage were studied by echocardiography and renal function examination. Results the total incidence of PPH was 80.1 in 153 of 191 inpatients with essential hypertension at least once at different meals. The incidence of PPH in breakfast and lunch was higher than that in dinner (P 0.05), and the decrease of systolic blood pressure after breakfast was greater than that in dinner [18.3 卤14.9g 20.3 卤14.6] compared with 15.5 卤13.0)mm Hg (P0.05). There was no significant difference in the decrease of diastolic blood pressure (P 0.05). There was no significant difference in the incidence of PPH among different age groups, but the decrease of systolic blood pressure (SBP) after breakfast in the aged group aged 80 to 89 was higher than that in the young group aged 60 ~ 69 years [26.3 卤12.1 vs 16.8 卤15.0)mm Hg0. 05]. According to the sum of preprandial systolic blood pressure at three meals, they were divided into three groups. The incidence of PPH in group C (鈮，

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