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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(P<0.05);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P<0.05],三餐后舒张压下降幅度差异无统计学意义(P>0.05)。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,P<0.05]。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)(P<0.05);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(P<0.05),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。
Objective To observe the changes of postprandial blood pressure (BP) in hospitalized elderly patients with essential hypertension and to explore the clinical features of postprandial hypotension (PPH) and its relationship with target organ damage such as heart and kidney. Methods A total of 191 elderly patients with essential hypertension admitted to the First Affiliated Hospital of Dalian Medical University from March 2013 to October 2014 were enrolled in this study. They were monitored by ambulatory 24h blood pressure monitoring and divided into PPH group (n = 153) and non-PPH group (NPPH group, n = 38), to explore the clinical features of PPH and related factors. Line cardiac ultrasound, renal function tests to explore the impact of PPH on heart and kidney damage. Results Of the 191 hospitalized elderly patients with essential hypertension, 153 patients had at least one PPH at different meals, and the total incidence of PPH was 80.1%. The incidence of PPH in breakfast and lunch was higher than that in dinner (P <0.05), and the decrease in postprandial systolic blood pressure after breakfast and lunch was greater than that in dinner [(18.3 ± 14.9) and (20.3 ± 14.6) vs (15.5 ± 13.0) mm Hg, respectively, P < 0.05], after three meals of diastolic blood pressure decreased no significant difference (P> 0.05). There was no significant difference in the incidence of PPH among different age groups. However, the decrease of systolic BP after breakfast in 80-89 years old group was (26.3 ± 12.1) vs (16.8 ± 15.0) mm Hg , P <0.05]. According to the sum of pre-meal systolic blood pressure of three meals averages, the incidence of PPH was higher than that of group C (≥ 160 mm Hg) and group B (140 ~ <160 mm Hg) Group A (<140 mm Hg) (P <0.05); Group C and Group B decreased their postprandial systolic blood pressure more than Group A. Multivariate Logistic regression analysis showed that the average pre-meal systolic pressure of three meals was an independent influencing factor of PPH (OR1.050, 95% CI 1.021 ~ 1.079). The left ventricular mass index in PPH group was higher than that in NPPH group (P <0.05), while there was no significant difference in renal function between PPH group and NPPH group. Conclusions The incidence of PPH in hospitalized elderly patients with essential hypertension is 80.1%. The incidence of PPH in breakfast and lunch is the highest among three meals and the lowest is PPH in dinner. The average pre-meal mean systolic pressure of three meals is the primary high The independent influencing factors of PPH occurred in blood pressure patients. The occurrence of PPH may cause the changes of left ventricular structure in hospitalized elderly patients with essential hypertension.