对老年高血压患者血压节律影响因素的分析

发布时间：2018-05-21 20:23

本文选题：老年 + 高血压　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:收集老年高血压患者24小时动态血压节律类型资料,观察影响老年高血压患者血压节律的因素,有助于对老年高血压患者进行危险分级以指导临床用药,使患者的血压得到更好控制并尽可能恢复正常昼夜节律,从而降低心血管事件的发生率和病死率。方法:连续收集2014年9月——2017年3月在吉林大学中日联谊医院老年病科就诊,明确诊断为原发性高血压并行24小时动态血压监测的老年患者202例(男性85例,女性117例,年龄60~98岁,平均年龄80.28±7.23岁),记录24小时平均舒张压(24-hour diastolic blood pressure,24h DBP),24小时平均收缩压(24-hour systolic blood pressure,24h SBP),日间平均舒张压(daytime diastolic blood pressure,d DBP),日间平均收缩压(daytime systolic blood pressure,d SBP),夜间平均舒张压(nighttime diastolic blood pressure,n DBP)以及夜间平均收缩压(nighttime systolic blood pressure,n SBP),根据上述结果计算夜间血压下降率,并据此将研究对象根据血压节律分为杓型血压组(57例)、非杓型血压组(79例)、反杓型血压组(65例)、超杓型血压组(1例),记录各组的临床资料,分析影响老年高血压患者血压节律的危险因素,探究老年高血压患者血压夜间下降率与红细胞分布宽度(red cell distribution width,RDW)之间的相关性,同时计算RDW值诊断老年高血压患者异常血压节律的敏感性和特异性。采用SPSS 22.0统计软件分析结果。结果:1、非杓型组和反杓型组年龄、吸烟人数显著高于杓型组,差异具有统计学意义(p0.05),三组间性别差异无统计学意义(p0.05)。2、老老年组血压节律异常比例显著高于老年组(77%vs 63.3%),差异具有统计学意义(p0.05)。3、反杓型组和非杓型组合并糖尿病、血脂异常的比例及其RDW值、空腹血糖水平明显高于杓型组,非杓型组血脂异常比例明显高于反杓型组,差异均有统计学意义(p0.05)。4、单因素Logistic回归分析结果显示,年龄(OR=1.114,95%CI:1.063~1.167,p=0.000)、吸烟史(OR=3.126,95%CI:1.653~5.913,p=0.000)、糖尿病(OR=3.106,95%CI:1.412~6.833,p=0.005)、空腹血糖(OR=1.311,95%CI:1.117~1.539,p=0.001)、血脂异常(OR=4.283,95%CI:2.241~8.185,p=0.000)和RDW值(OR=1.810,95%CI:1.376~2.380,p=0.000)是引起老年高血压患者血压节律异常的危险因素;多因素Logistic回归分析中显示,年龄(OR=1.077,95%CI1.009~1.150,p=0.025)、空腹血糖(OR=1.220,95%CI:1.008~1.477,p=0.041)、血脂异常(OR=2.613,95%CI:1.100~6.206,p=0.03)以及RDW值(OR=2.250,95%CI:1.580~3.206,p=0.000)是引起老年高血压患者血压节律异常的独立危险因素。5、RDW值与夜间血压下降率呈负相关(r=-0.384,p=0.000)。6、RDW值预测诊断异常血压节律的最佳临界值为13.5,其敏感性为66.7%,特异性为71.9%。结论:1、非杓型组和反杓型组与杓型组相比,前两者的年龄、吸烟者比例均高于杓型组,但性别无显著差异。2、老老年组中异常血压节律明显高于老年组。3、非杓型组和反杓型组合并糖尿病、血脂异常的比例及RDW值和空腹血糖显著高于杓型组。4、年龄、吸烟史、糖尿病、空腹血糖、血脂异常及RDW值是引起老年高血压患者节律异常的危险因素;年龄、空腹血糖、血脂异常、RDW值是引起老年高血压患者节律异常的独立危险因素。5、RDW值与夜间血压下降率呈负相关,RDW值变化可作为早期推测高血压节律异常的预测因素,RDW值预测诊断异常血压节律的最佳临界值为13.5,其敏感性为66.7%,特异性为71.9%。
[Abstract]:Objective: to collect the data of the 24 hour ambulatory blood pressure rhythm type in elderly hypertensive patients, to observe the factors affecting the rhythm of blood pressure in elderly hypertensive patients, to help the elderly patients with hypertension risk classification to guide clinical medication, to make the patient's blood pressure better control and to restore the normal circadian rhythm, thus reducing cardiovascular events. Methods: the incidence and fatality rate of the part were collected continuously from September 2014 to March 2017 at the Department of geriatrics in the Sino Japanese Friendship Hospital of Jilin University. 202 elderly patients (85 men, 117 women, aged 60~98 years, 80.28 + 7.23 years old) were diagnosed as primary hypertension and 24 hour ambulatory blood pressure monitoring. The records were recorded for 24 hours. Average diastolic pressure (24-hour diastolic blood pressure, 24h DBP), average systolic pressure (24-hour systolic blood pressure, 24h SBP), mean day diastolic pressure, mean day systolic pressure, and mean night diastolic pressure. N DBP) and the mean night systolic blood pressure (nighttime systolic blood pressure, n SBP). According to the above results, the rate of nocturnal blood pressure drop was calculated. According to this, the subjects were divided into dipper blood pressure group (57 cases), non dipper type blood pressure group (79 cases), anti dipper type blood pressure group (65 cases), and the super dipper type blood pressure group (1 cases), and recorded the clinical data of each group. The risk factors of blood pressure rhythm in elderly hypertensive patients were analyzed, and the correlation between the rate of nocturnal blood pressure drop and red cell distribution width (RDW) in elderly hypertensive patients was investigated, and the sensitivity and specificity of RDW value in the diagnosis of abnormal blood pressure rhythm in elderly hypertensive patients were calculated by SPSS 22. Results: 1, the age of the non dipper group and the anti dipper type group was significantly higher than the dipper group. The difference was statistically significant (P0.05). There was no statistical significance between the three groups (P0.05).2, the abnormal proportion of blood pressure rhythm in old age group was significantly higher than that of the old group (77%vs 63.3%), the difference was statistically significant (P0.05).3, and the anti dipper group was statistically significant. The proportion of diabetes, diabetes, diabetes, the ratio of blood lipid abnormality and its RDW value, the level of fasting blood glucose was significantly higher than that in the dipper group. The abnormal proportion of blood lipid in the non dipper group was significantly higher than that in the anti dipper group (P0.05).4. The results of single factor Logistic regression analysis showed that age (OR=1.114,95%CI:1.063~1.167, p=0.000), smoking history (OR=3.12) 6,95%CI:1.653~5.913, p=0.000), diabetes (OR=3.106,95%CI:1.412~6.833, p=0.005), fasting blood glucose (OR=1.311,95%CI:1.117~1.539, p=0.001), dyslipidemia (OR=4.283,95%CI:2.241~8.185, p=0.000) and RDW (OR=1.810,95%CI:1.376~2.380, p=0.000) are the risk factors for abnormal blood pressure rhythm in elderly patients with hypertension; multifactor Logistic Regression analysis showed that age (OR=1.077,95%CI1.009~1.150, p=0.025), fasting blood glucose (OR=1.220,95%CI:1.008~1.477, p=0.041), dyslipidemia (OR=2.613,95%CI:1.100~6.206, p=0.03), and RDW value (OR=2.250,95%CI:1.580~3.206, p=0.000) were independent risk factors for abnormal blood pressure rhythm in elderly hypertensive patients.5, RDW and nocturnal blood The rate of pressure descending was negative correlation (r=-0.384, p=0.000).6, and the best critical value for predicting abnormal blood pressure rhythm was 13.5, its sensitivity was 66.7%, the specificity was 71.9%. conclusion: 1, the age of the non dipper group and the dipper group and the dipper group were higher than that of the dipper group, the proportion of the smokers was higher than that in the dipper group, but there was no significant difference in sex.2 and in the old age group. The rhythm of normal blood pressure was significantly higher than that of.3 in the elderly group. The proportion of abnormal blood lipid and RDW value and fasting blood glucose were significantly higher than that of.4 in the dipper group. Age, smoking history, diabetes, fasting blood glucose, dyslipidemia and RDW were the risk factors for abnormal rhythm of the elderly hypertensive patients; age, fasting blood glucose, blood lipid were different. Often, the RDW value is an independent risk factor.5 for abnormal rhythm of the elderly hypertensive patients. The RDW value is negatively correlated with the rate of nocturnal blood pressure drop. The change of RDW value can be used as a predictor of early prediction of abnormal hypertension rhythm. The best critical value of the RDW value prediction for abnormal blood pressure rhythm is 13.5, its sensitivity is 66.7%, and the specificity is 71.9%..
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1

【相似文献】