不同血压控制水平对高龄患者脑血流量及脑萎缩风险的影响^*

Effects of different blood pressure control strategies on cerebral blood flow and risk of cerebral atrophy in elderly patients

摘要

目的 探究不同血压控制策略对高龄患者脑血流量及脑萎缩风险的影响。方法 选择2022年6月—2023年12月新疆维吾尔自治区人民医院诊治的原发性高血压患者(年龄≥80岁)200例作为研究对象,按照随机数字表法分为观察组和对照组,每组各100例。所有患者根据不同血压控制水平进行干预,要求观察组收缩压≤120 mmHg(1 mmHg=0.133 kPa),对照组收缩压为120~140 mmHg。对两组患者进行为期1年的随访,分析达标时及达标1年后患者脑血流量及脑萎缩相关情况。结果 截至2024年12月31日达标1年后,完成随访137例,其中对照组66例、观察组71例。观察组患者干预后收缩压及舒张压均低于对照组(P<0.001)。两组患者血压控制后大脑前动脉(ACA)、大脑中动脉(MCA)、大脑后动脉(PCA)、俯卧经枕窗检测椎动脉(VA)的平均血流速度(Vm)、最大血流速度(Vs)及血管搏动指数(PI)比较差异均无统计学意义(P>0.05);达标1年后,对照组及观察组患者各脑血管Vm、Vs、PI值均较达标时降低,且观察组Vm、Vs及PI均低于对照组(P<0.05)。达标1年后,观察组脑白质病变(WML)体积与达标时比较差异无统计学意义(P>0.05);达标1年后,对照组患者WML体积大于达标时,且对照组患者WML体积大于观察组(P<0.05)。两组患者脑卒中类疾病、急性冠脉综合征、肝肾功能损伤及缺血性晕厥发生情况比较差异均无统计学意义(P＞0.05)。结论 强化降压治疗会降低高龄患者脑血流量,避免其脑容量减少及WML体积增加,且安全性相对较好。

Abstract

Objective To investigate the effects of different blood pressure control strategies on cerebral blood flow and cerebral atrophy risk in elderly patients. Methods A total of 200 patients (aged ≥80 years) with primary hypertension, diagnosed and treated at the People's Hospital of Xinjiang Uygur Autonomous Region between June 2022 and December 2023, were selected as the study subjects. They were randomly divided into an observation group and a control group using a random number table, with 100 patients in each group. All patients received interventions based on different blood pressure control targets: the observation group was required to achieve a systolic blood pressure ≤120 mmHg(1 mmHg=0.133 kPa), while the control group was to maintain a systolic blood pressure between 120 mmHg and 140 mmHg. Both groups were followed up for one year to analyze cerebral blood flow and cerebral atrophy status at the time of target achievement and one year thereafter. Results As of December 31, 2024, one year after reaching the target standard, 137 cases completed follow-up, including 66 in the control group and 71 in the observation group. The systolic blood pressure and diastolic blood pressure of patients in the observation group after intervention were significantly lower than those in the control group (P <0.001). There were no statistically significant differences in the mean flow velocity (Vm), peak systolic velocity (Vs), pulsatility index (PI) of the anterior cerebral artery (ACA), middle cerebral artery (MCA), posterior cerebral artery (PCA), and vertebral artery (VA) detected via the transoccipital window in the prone position between the two groups after blood pressure control (P > 0.05). One year after reaching the standard, the Vm, Vs, and PI values of each cerebral vessel decreased in both the control and observation groups compared to the values at the time of standard achievement, and the Vm, Vs, and PI in the observation group were lower than those in the control group (P < 0.05). One year after standard achievement, there was no statistically significant difference in white matter lesion (WML) volume in the observation group compared to that at the time of standard achievement (P > 0.05). However, one year after standard achievement, the WML volume in the control group was greater than that at the time of standard achievement, and the WML volume in the control group was also greater than that in the observation group (P < 0.05). There were no statistically significant differences between the two groups in the incidence of stroke-related diseases, acute coronary syndrome, hepatic or renal impairment, or ischemic syncope (P > 0.05). Conclusion Intensive antihypertensive therapy can reduce cerebral blood flow, prevent brain volume decreasing and WML volume increase in elderly patients, and the safety is relatively good.

关键词

高血压 / 高龄患者 / 脑血流量 / 脑萎缩

Key words

Hypertension / Elderly patients / Cerebral blood flow / Brain atrophy