中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
36期
2938-2942
,共5页
肾疾病%高血压%老年人%动态血压监测
腎疾病%高血壓%老年人%動態血壓鑑測
신질병%고혈압%노년인%동태혈압감측
Kidney diseases%Hypertension%Aged%Ambulatory blood pressure monitor
目的 研究老年慢性肾脏病(CKD)合并高血压患者的血压特点.方法 回顾性分析2010年1月至2012年12月于北京大学第一医院肾内科住院并接受了动态血压监测(ABPM)的CKD患者的临床资料,包括诊室血压(CBP)、年龄、性别、基础合并症(糖尿病、心血管疾病)、高血压治疗方案(联合用药、睡前用药)、估测的肾小球滤过率(eGFR)及尿蛋白定量,以年龄≥60岁为老年标准,分析老年CKD合并高血压患者血压特点及相关影响因素.结果 共337例患者纳入分析,其中94例(27.9％)为老性患者.与非老年患者相比,老年患者白大衣现象更常见[24.5％ (23/94)比12.3％(30/243),P=0.008];在收缩压水平相当的情况下,全天平均舒张压、白天及夜间舒张压更低(均P＜0.001);收缩压(P =0.023)及舒张压(P=0.002)的血压变异率更高,血压晨峰现象更多见[11.7％(11/94)比3.7％(9/243),P=0.009];反杓型血压节律比例更高[41.5％(39/94)比25.1％(61/243),P=0.004].增龄是白大衣现象(OR=1.024,95％CI:1.004 ～ 1.044,P=0.017)和反杓型血压节律(OR=1.016,95％ CI:1.001～1.032,P=0.037)的独立影响因素.结论 老年CKD合并高血压患者具有与非老年患者不同的血压特点.应重视ABPM的应用,优化老年CKD合并高血压患者的血压管理.
目的 研究老年慢性腎髒病(CKD)閤併高血壓患者的血壓特點.方法 迴顧性分析2010年1月至2012年12月于北京大學第一醫院腎內科住院併接受瞭動態血壓鑑測(ABPM)的CKD患者的臨床資料,包括診室血壓(CBP)、年齡、性彆、基礎閤併癥(糖尿病、心血管疾病)、高血壓治療方案(聯閤用藥、睡前用藥)、估測的腎小毬濾過率(eGFR)及尿蛋白定量,以年齡≥60歲為老年標準,分析老年CKD閤併高血壓患者血壓特點及相關影響因素.結果 共337例患者納入分析,其中94例(27.9％)為老性患者.與非老年患者相比,老年患者白大衣現象更常見[24.5％ (23/94)比12.3％(30/243),P=0.008];在收縮壓水平相噹的情況下,全天平均舒張壓、白天及夜間舒張壓更低(均P＜0.001);收縮壓(P =0.023)及舒張壓(P=0.002)的血壓變異率更高,血壓晨峰現象更多見[11.7％(11/94)比3.7％(9/243),P=0.009];反杓型血壓節律比例更高[41.5％(39/94)比25.1％(61/243),P=0.004].增齡是白大衣現象(OR=1.024,95％CI:1.004 ～ 1.044,P=0.017)和反杓型血壓節律(OR=1.016,95％ CI:1.001～1.032,P=0.037)的獨立影響因素.結論 老年CKD閤併高血壓患者具有與非老年患者不同的血壓特點.應重視ABPM的應用,優化老年CKD閤併高血壓患者的血壓管理.
목적 연구노년만성신장병(CKD)합병고혈압환자적혈압특점.방법 회고성분석2010년1월지2012년12월우북경대학제일의원신내과주원병접수료동태혈압감측(ABPM)적CKD환자적림상자료,포괄진실혈압(CBP)、년령、성별、기출합병증(당뇨병、심혈관질병)、고혈압치료방안(연합용약、수전용약)、고측적신소구려과솔(eGFR)급뇨단백정량,이년령≥60세위노년표준,분석노년CKD합병고혈압환자혈압특점급상관영향인소.결과 공337례환자납입분석,기중94례(27.9％)위로성환자.여비노년환자상비,노년환자백대의현상경상견[24.5％ (23/94)비12.3％(30/243),P=0.008];재수축압수평상당적정황하,전천평균서장압、백천급야간서장압경저(균P＜0.001);수축압(P =0.023)급서장압(P=0.002)적혈압변이솔경고,혈압신봉현상경다견[11.7％(11/94)비3.7％(9/243),P=0.009];반표형혈압절률비례경고[41.5％(39/94)비25.1％(61/243),P=0.004].증령시백대의현상(OR=1.024,95％CI:1.004 ～ 1.044,P=0.017)화반표형혈압절률(OR=1.016,95％ CI:1.001～1.032,P=0.037)적독립영향인소.결론 노년CKD합병고혈압환자구유여비노년환자불동적혈압특점.응중시ABPM적응용,우화노년CKD합병고혈압환자적혈압관리.
Objective To identify the characteristics of blood pressure (BP) in the elderly hypertensive patients with chronic kidney disease (CKD).Methods We retrospectively recruited 337 CKD patients who had been admitted into our renal unit during January 2010 to December 2012 and undergone clinical blood pressure (CBP) and ambulatory blood pressure (ABP) measurement with detailed clinical data.Those with age ≥60 years old (n =94) were designated as elderly patients and their BP data were compared with those of young-and middle-aged patients (＜ 60 years old,n =243).Logistic regression was adopted to analyze the independent risk factor for white-coat hypertension and reverse-dipper rhythm.Results Compared to those ＜ 60 y,the elder CKD patients had the following characteristics:(1) Higher prevalence of white-coat hypertension (24.5％ vs 12.3％,P =0.008).(2) Significantly lower diastolic blood pressure of average 24 h,daytime and nighttime by ambulatory monitoring of blood pressure (ABPM) (all P ＜ 0.001).(3) Higher BP variability with significant difference (all P ＜ 0.05) and more patients with morning surge (11.7％ vs 3.7％,P =0.009).(4) Higher prevalence of reverse-dipper circadian BP rhythm (41.5 ％ vs 25.1％,P =0.004).(5) Age was an independent predictor for white-coat hypertension (OR =1.024,95％ CI:1.004-1.044) and reverse-dipper circadian BP rhythm (OR =1.016,95％ CI:1.001-1.032).Conclusions The BP profile of elderly hypertensive CKD patients is different from that of young-and middle-aged patients.ABPM should be more commonly performed to improve BP treatment of elderly CKD patients.
