The24-hour Ambulatory Blood Pressure Monitoring Analysis Of Elderly And Very Elderly Hypetrensive Patients

Objective: To understand the24-hour ambulatory blood pressure rhythmtype of elderly and very elderly patients with essential hypertension (EH).Bycomparing the ambulatory blood pressure rhythm of EH between the variousgroups and observing the proportion of variability of blood pressure,we couldindicate the medication of clinical hypertension.Methods: collected the24-hour ambulatory blood pressure monitoringdata of196hypertensive patients aged above60,in Bethune First Hospital ofJilin University Medical Center and divided them into elderly group(aged60~79) and the very elderly group（aged80~95）, then applied the SPSS17.0software to process these data,compared the elderly group with the the veryelderly group between24h SBP(24-hour systolic blood pressure),24h DBP(24-hour diastolic blood pressure), d SBP (mean daytime systolic blood pressure),d DBP (diastolic daytime average), n SBP (mean systolic blood pressure atnight), n DBP (diastolic blood pressure at night on average), MBPS (morningblood pressure surge) and the proportion of dipper,non-dipper, anti-dipperand ultra-dipper blood pressure rhythm,calculated the proportion of isolatedsystolic hypertension.Finally, divided all of the subjects into morning bloodpressure surge group(MBPS≧35mm Hg) and non morning blood pressure surge group(MBPS＜35mm Hg) according to the morning blood pressuresurge.These date of two groups were compared in24h SBP,24h DBP, d SBP, dDBP, n SBP, n DBP, then we analyzed their mutual relations.Results: The24h SBP of elderly group was lower than the very elderlygroup, which difference was statistically significant(P=0.007<0.05). The24hDBP of elderly group was higher than the very elderly group, which differencewas statistically significant(P <0.001,).The d SBP of older group was higherthan the very elderly group, which difference was not statisticallysignificance(P=0.502>0.05,), the d DBP of age group was higher than thevery elderly group, which difference of the two groups was statisticallysignificant (P <0.001). The n SBP of elderly group was higher than the veryelderly group,which difference was statistically significant (P <0.01). The nDBP of older group was higher than the very elderly group,which differenceof the two groups is statistical significance (P=.048<0.05,seen from Table4.2,4.3).The proportion of the dippers, non-dippers, anti-dipper, and ultra-dipperblood pressure rhythm in elderly group respectively was24.3%,47.7%,26.2%,1.9%.The proportion of the four types of blood pressure rhythm in the veryelderly group were9.0%,49.4%,41.6%and0%. Compared the proportion ofthe four blood pressure rhythm type in the two groups, which difference wasstatistically significant(P=0.008<0.01). Between the two groups each ofblood pressure rhythm type was compared.Between the two dipper circadian rhythm group, which difference was statistically significant (P=0.005<0.0083,).By comparing of non-dippers, anti-dipper, ultra-dippers patters, P valueswere0.805,0.023,0.195,respectively, which difference was not statisticallysignificant.The proportion of the abnormal blood pressure rhythm in the elderlygroup is lower than the very elderly group,these two groups compares P=0.005<0.0083, the difference was statistically significant (seen from Table4.5,4.6,4.7).The proportion of isolated systolic hypertension in the elderly group andthe very elderly group was60.7%and84.3%respectively.By comparing thetwo groups, which difference was statistically significant (P <0.01). Theproportion of the morning blood pressure surge in elderly and very elderlygroup was respectively29.0%,31.5%, which difference was not statisticallysignificant (P=0.705>0.05,Table4.8shows).We could see from Table4.10, the proportion of the morning bloodpressure surge in elderly group was lower than the very elderly group, whichdifference was not statistically significant (P=0.705>0.05,). Divided all of thesubjects into the morning blood pressure surge group(MBPS≧35mm Hg) andnon morning blood pressure surge group(NMBPS＜35mm Hg) according tothe morning blood pressure.The24h SBP, d SBP, n SBP in morning bloodpressure surge group was higher than the non morning blood pressure surgegroup, which difference was statistically significant(P <0.01). The24h DBP and the d DBP,in the morning blood pressure surge group were higher than that inthe non morning peak group, P values were0.013、0.006,which the differencewere considered statistically significant. The n DBP in the non morning bloodpressure surge group is lower than the morning blood pressure surge, P=0.695,which the difference was not statistically significant.Conclusions1.The elderly patients have high systolic blood pressure,and low diastolicblood pressure,which increases by age.2.The proportion of abnormal circadian rhythm type increases with the agein elderly hypertensive patients.3.In elderly hypertensive patients,the proportion of isolated systolichypertension increases by age.4.Morning blood pressure surge is associated with elevated SBP andDBP,which is increased by age.