CAJ | 학술논문

目的：评价老年高血压患者的诊间血压变异性（blood pressure variability, BPV）与血管内皮功能之间的关系。方法入选174例老年原发性高血压患者，每月门诊测量患者血压，随访12个月，计算每例研究对象随访期间的平均收缩压（SBP）、平均舒张压（DBP）及其标准差、变异系数。随访结束后行超声检查评估血管内皮功能，计算肱动脉的内皮依赖性血流介导的血管舒张功能（flow-mediated vasodilation, FMD）、非内皮依赖性硝酸甘油介导的血管舒张功能（nitroglycerine-mediated vasodilation, NMD）及FMD/NMD，分别按FMD%及FMD/NMD分为内皮功能正常组和内皮功能下降组，比较基线特征及BPV情况。采用多元线性回归分析BPV对血管内皮功能的影响。结果按FMD/NMD分组显示内皮功能下降组的FMD%低于内皮功能正常组,NMD%及血压变异性指标均高于内皮功能正常组，差异均有统计学意义（P<0.05）。内皮功能正常组使用钙离子拮抗剂的比率高于内皮功能下降组（79.55%比63.95%，P<0.05）。多元线性回归分析显示调整年龄、BMI和血压水平之后，BPV与FMD/NMD显著负相关（P<0.05）。结论 FMD/NMD较FMD能更好的反应血管内皮功能，BPV升高的老年高血压病患者存在内皮功能不全。
목적：평개노년고혈압환자적진간혈압변이성（blood pressure variability, BPV）여혈관내피공능지간적관계。방법입선174례노년원발성고혈압환자，매월문진측량환자혈압，수방12개월，계산매례연구대상수방기간적평균수축압（SBP）、평균서장압（DBP）급기표준차、변이계수。수방결속후행초성검사평고혈관내피공능，계산굉동맥적내피의뢰성혈류개도적혈관서장공능（flow-mediated vasodilation, FMD）、비내피의뢰성초산감유개도적혈관서장공능（nitroglycerine-mediated vasodilation, NMD）급FMD/NMD，분별안FMD%급FMD/NMD분위내피공능정상조화내피공능하강조，비교기선특정급BPV정황。채용다원선성회귀분석BPV대혈관내피공능적영향。결과안FMD/NMD분조현시내피공능하강조적FMD%저우내피공능정상조,NMD%급혈압변이성지표균고우내피공능정상조，차이균유통계학의의（P<0.05）。내피공능정상조사용개리자길항제적비솔고우내피공능하강조（79.55%비63.95%，P<0.05）。다원선성회귀분석현시조정년령、BMI화혈압수평지후，BPV여FMD/NMD현저부상관（P<0.05）。결론 FMD/NMD교FMD능경호적반응혈관내피공능，BPV승고적노년고혈압병환자존재내피공능불전。
Objective To assess the relationship between visit-to-visit blood pressure (BP) variability (BPV) and vascular endothelial function in a cohort of elderly hypertensive patients. Methods A total of 174 elderly patients with essential hypertension were included in the study. The participants had their office BP measured during the 12-month follow-up. Right brachial artery diameter was assessed at rest, during reactive hyperemia (flow- mediated dilation, FMD), and after nitroglycerin administration (nitroglycerin- mediated dilation, NMD). The participants were divided into two groups according to FMD%or FMD/NMD ratio. The correlations between BPV and endothelial function were analyzed by univariate analysis and multiple linear regression analysis. Results The participants classified as having a decreased endothelial function according to FMD/NMD ratio had significantly lower FMD%and higher BPV and NMD%(P<0.05). The percentage of CCBs use in normal endothelial function group was significantly higher than that in decreased endothelial function group (79.55%vs 63.95%, P<0.05). Multiple linear regression analysis revealed a significant negative association between FMD/NMD ratio and BPV, and this association remained significant after adjustment for age, body mass index, and mean BP levels. Conclusions FMD/NMD ratio is a better marker of endothelial function than FMD, and an increased visit-to-visit variability of BP is associated with a decreased endothelial function.