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目的 应用脉搏波传导速度(PWV)、踝臂指数(ABI)和颈动脉内膜中层厚度(IMT)评价老年单纯收缩期( ISH)高血压在杓型与非杓型血压昼夜节律变化时的血管健康状况.方法 按照动态血压仪检测结果,分为非杓型组(74例)、杓型组(78例)和正常血压组(72例),观察试验组和对照组baPWV、ABI、IMT.结果 非杓型组肱-踝脉搏波速度(baPWV)、IMT值显著高于杓型组( baPWV1801.61±314.27,1658.67±274.80,P＜0.01;IMT 0.96±0.22,0.87±0.19,p＜0.05),ABI值显著低于杓型组(1.03±0.17,1.12±0.18,P＜0.01).当baPWV＞1400 cm/s、ABI＜0.9时,三组检出数依次为61例、59例、41例,以及18例、9例、5例,差异有统计学意义(x2=12.57,P＜0.0I；x2 =9.74,P＜0.01)；三组颈动脉斑块检出数依次为43例、32例、18例,差异有统计学意义(x2=16.49,P＜0.01).结论 老年ISH患者易出现外周动脉损害,非杓型高血压尤为明显,无创性baPWV、ABI、IMT指标可较好的评价血管健康状态.

Objective To evaluate the relation of circadian blood pressure rhythm with vascular status in elderly patients with isolated systolic hypertension.Methods Ankle-brachial index (ABI),brachial-ankle pulse wave velocity (baPWV) and carotid intima-media thickness (IMT) were measured in 74 elderly patients with non-dipper hypertension (non-dipper group)、78 elderly patients with dipper hypertension ( dipper group),and 72 healthy controls ( control group).Results In comparison with the dipper group,baPWV and IMT of the non-dipper group were significantly increased [ baPWV (1801.61± 314.27) vs (1658.67±274.80) (cm/s)],P＜0.01; IMT:(0.96 ±0.22) vs (0.87 +0.19) (mm),(P＜0.05),while ABI of the non-dipper group was decreased (1.03 ±0.17 vs1.12 ±0.18,P＜0.01).Identification rate was significantly different among 3 groups when baPWV ＞1400 cm/s (x2 =12.57,P ＜0.01) or ABI ＜0.9 ( x2 =9.74,P ＜0.01).The detection of carotid plaques was also significantly different ( x2 =16.49,P ＜ 0.01).Conclusions These findings suggest that vascular damage could be found in elderly patients with isolated systolic hypertension,especially in those with non-dipper hypertension.ABI,baPWV and IMT measurement may be helpful for the assessment of vascular status.