Abstract:

Objective　To investigate the correlation between early morning hypertension and cerebrovascular reserve function (CVR) in elderly population during 24 h ambulatory blood pressure monitoring. Methods　A total of 300 elderly subjects who came to Jinan Maternal and Child Health Care Hospital for 24 h ambulatory blood pressure monitoring from January to December 2021 were retrospectively selected and were divided into group A, group B, and group C according to the monitoring results. There were 158 hypertensive patients with elevated blood pressure in the morning in group A, 88 males and 70 females, aged (66.02±4.35) years. There were 74 hypertensive patients with normal blood pressure in the morning in group B, including 41 males and 33 females, aged (65.42±4.42) years. There were 68 patients with normal blood pressure in group C, including 37 males and 31 females, aged (65.77±4.38) years. With the mean of breath holding index of bilateral middle cerebral artery <0.69% as reduced CVR, and the mean of breath holding index ≥0.69% as normal CVR, 300 subjects were divided into a CVR reduced group (52 cases) and a CVR normal group (248 cases). The clinical data and CVR indexes among group A, B, and C were compared, the general data of the CVR reduced group and the CVR normal group were compared, and unifactor analysis, multi-factor analysis, and correlation analysis were performed. F test, independent sample t test, χ² test, logistic regression analysis, and Pearson correlation analysis were used. Results　Among the 300 elderly subjects monitored for 24 h ambulatory blood pressure, there were 158 (52.67%) hypertensive patients with elevated blood pressure in the morning, 74 (24.67%) hypertensive patients with normal blood pressure in the morning, and 68 (22.67%) patients with normal blood pressure. The systolic blood pressure (24 h mean, daytime mean, and nighttime mean) and morning peak index of the 3 groups were as follow: group A > group B > group C (all P<0.05). The diastolic blood pressure (24 h mean, daytime mean, and nighttime mean) of the 3 groups were as follow: group A > group B and group C (all P<0.05), there were no statistically significant differences between group B and group C (all P>0.05). CVR: group A [(21.37±7.89)%] < group B [(25.58±8.14)%] < group C [(28.56±8.10)%] (all P<0.05). Breath holding index: group A [(0.89±0.23) %] < group B [(1.13±0.21) %] and group C [(1.20±0.24) %] (both P<0.05); there was no statistically significant difference in the breath holding index between group B and group C (P>0.05). Pulsation index: group A [(1.49±0.36)] > group B [(1.15±0.31)] and group C [(1.06±0.29)] (both P<0.05); there was no statistically significant difference in the pulsation index between group B and group C (P>0.05). In the CVR reduced group, the age [(73.14±3.21) years old], morning systolic blood pressure [(132.42±9.64) mmHg (1 mmHg=0.133 kPa)], and morning diastolic blood pressure [(68.85±6.59) mmHg] were higher than those in the CVR normal group [(64.28±4.36) years old, (121.58±7.26) mmHg, and (65.36±7.23) mmHg] (all P<0.05). Logistic regression analysis showed that age, morning systolic blood pressure, and morning diastolic blood pressure were all influencing factors for the decrease of CVR (all P<0.05). The morning systolic blood pressure was negatively correlated with breath holding index (P<0.05), and positively correlated with pulsation index (P<0.05). The morning diastolic blood pressure was negatively correlated with breath holding index (P<0.05), and positively correlated with pulsation index (P<0.05). Conclusions　In 24 h ambulatory blood pressure monitoring in elderly population, early morning hypertension patients had lower CVR and breath-holding index and higher pulsation index. Early morning systolic blood pressure and early morning diastolic blood pressure are negatively correlated with breath-holding index and positively correlated with pulsation index.

Key words:

24 h ambulatory blood pressure monitoring, Early morning hypertension, Cerebrovascular reserve function, Breath-holding index,  , Pulsation index, Early morning systolic blood pressure, Early morning diastolic blood pressure

摘要：

目的　研究老年人群24 h动态血压监测中清晨高血压与脑血管储备功能（CVR）的相关性。方法　回顾性选取2021年1月至12月到济南市妇幼保健院行24 h动态血压监测的300例老年受试者，依据监测结果分为A组、B组和C组。A组158例为清晨血压升高的高血压患者，男88例，女70例，年龄（66.02±4.35）岁；B组74例为清晨血压正常的高血压患者，男41例，女33例，年龄（65.42±4.42）岁；C组68例为血压正常者，男37例，女31例，年龄（65.77±4.38）岁。以两侧大脑中动脉屏气指数均值<0.69%为CVR减低，屏气指数均值≥0.69%为CVR正常，将300例受试者分为CVR降低组（52例）和CVR正常组（248例）。比较A、B、C 3组患者的临床资料，CVR指标；比较CVR降低组、CVR正常组一般资料，行单因素分析、多因素分析和相关性分析。采用F检验、独立样本t检验、χ²检验、logistic回归分析和Pearson相关性分析。结果　300例24 h动态血压监测的老年受试者，清晨血压升高的高血压患者158例，占52.67%；清晨血压正常的高血压患者74例，占24.67%；血压正常者68例，占22.67%。3组收缩压（24 h均值、日间均值、夜间均值）、晨峰指数：A组>B组>C组（均P<0.05）；舒张压（24 h均值、日间均值、夜间均值）：A组>B组、C组（均P<0.05），B组、C组舒张压比较，差异均无统计学意义（均P>0.05）。CVR：A组［（21.37±7.89）%］<B组［（25.58±8.14）%］<C组［（28.56±8.10）%］（均P<0.05）；屏气指数：A组［（0.89±0.23）%］<B组［（1.13±0.21）%］、C组［（1.20±0.24）%］（均P<0.05），B组、C组屏气指数比较，差异无统计学意义（P>0.05）；脉动指数：A组［（1.49±0.36）］>B组［（1.15±0.31）］、C组［（1.06±0.29）］（均P<0.05），B组、C组脉动指数比较，差异无统计学意义（P>0.05）。CVR降低组年龄［（73.14±3.21）岁］、清晨收缩压［（132.42±9.64）mmHg］（1 mmHg=0.133 kPa）、清晨舒张压［（68.85±6.59）mmHg］均高于CVR正常组［（64.28±4.36）岁、（121.58±7.26）mmHg、（65.36±7.23）mmHg］（均P<0.05）。logistic回归分析结果显示：年龄、清晨收缩压、清晨舒张压均为CVR降低的影响因素（均P<0.05）。清晨收缩压与屏气指数呈负相关（P<0.05），与脉动指数呈正相关（P<0.05）；清晨舒张压与屏气指数呈负相关（P<0.05），与脉动指数呈正相关（P<0.05）。结论　老年人群24 h动态血压监测中清晨高血压患者占比较大，清晨高血压患者CVR、屏气指数较低，脉动指数较高，清晨收缩压、清晨舒张压均与屏气指数呈负相关，与脉动指数呈正相关。

关键词:

24 h动态血压监测, 清晨高血压, 脑血管储备功能, 屏气指数, 脉动指数, 清晨收缩压, 清晨舒张压