2023 年第 8 期 第 18 卷

焦虑抑郁情绪对高血压病患者血压变异性及血管内皮细胞功能的影响

Effects of anxiety and depression on blood pressure variability and vascular endothelial cell function in patients with hypertension

作者：张海娟田国祥翟玉翠姚璐武云涛

英文作者：Zhang Haijuan Tian Guoxiang Zhai Yucui Yao Lu Wu Yuntao

单位：解放军总医院第七医学中心老年医学科二区，北京100700

英文单位：The Second Ward Department of Geriatric Medicine the Seventh Medical Center of PLA General Hospital Beijing 100700 China

关键词：高血压病；焦虑抑郁；血压变异性；动态血压；血管内皮细胞功能

英文关键词：Hypertension;Anxietyanddepression;Bloodpressurevariability;Ambulatorybloodpressure;Vascularendothelialcellfunction

• 摘要：

• 目的 探究焦虑抑郁情绪对高血压病患者血压变异性及血管内皮细胞功能的影响。方法 入选2015年1月至2018年12月于解放军总医院第七医学中心就诊的高血压病患者155例，根据患者是否伴有焦虑抑郁情绪分为观察组（57例，合并焦虑抑郁情绪）和对照组（98例，未合并焦虑抑郁情绪）。比较2组24 h动态血压监测(ABPM)参数［24 h平均收缩压（24 h SBP）、24 h平均舒张压（24 h DBP）、白天平均收缩压（dSBP）、白天平均舒张压（dDBP）、夜间平均收缩压（nSBP）、夜间平均舒张压（nDBP）］、血压变异性指标［24 h收缩压变异系数（24 h SBPCV）、24 h舒张压变异系数（24 h DBPCV）、白天收缩压变异系数（dSBPCV）、白天舒张压变异系数（dDBPCV）、夜间收缩压变异系数（nSBPCV）、夜间舒张压变异系数（nDBPCV）］、血压节律类型和血管内皮功能指数（RHI），并评价RHI与ABPM参数和血压变异性指标的相关性。结果 观察组ABPM参数24 h SBP、24 h DBP、dSBP、dDBP、nSBP、nDBP均高于对照组，血压异常节律比例高于对照组，血压变异性指标24 h SBPCV、24 h DBPCV、dSBPCV、dDBPCV、nSBPCV、nDBPCV均高于对照组，RHI明显低于对照组［（1.17±0.39）比（2.12±0.18）］，2种或多种降压药物联合使用率高于对照组（均P＜0.01）。RHI与所有ABPM参数、血压变异性指标均呈负相关（均P＜0.05）。结论 高血压病合并焦虑抑郁患者血压变异性大，血管内皮功能障碍加重，焦虑抑郁情绪、血压变异性增加可能会造成血管内皮细胞功能损伤加重。

• Objective To explore the effects of anxiety and depression on blood pressure variability and vascular endothelial cell function in patients with hypertension. Methods  From January 2015 to December 2018, 155 patients with hypertension admitted to the Seventh Medical Center of PLA General Hospital were selected, and they were divided into observation group (57 cases with anxiety and depression) and control group (98 patients without anxiety and depression) according to whether combined with anxiety and depression. The 24 h ambulatory blood pressure monitoring (ABPM) parameters in the two groups ［24 h mean systolic blood pressure (24 h SBP), 24 h mean diastolic blood pressure (24 h DBP), daytime mean systolic blood pressure (dSBP), daytime mean diastolic blood pressure (dDBP), nighttime mean systolic blood pressure (nSBP) and nighttime mean diastolic blood pressure (nDBP)］, blood pressure variability indicators ［24 h systolic blood pressure variability coefficient (24 h SBPCV), 24 h diastolic blood pressure variability coefficient (24 h DBPCV), daytime systolic blood pressure variability coefficient (dSBPCV), daytime diastolic blood pressure variability coefficient (dDBPCV), nighttime systolic blood pressure variability coefficient (nSBPCV), nighttime diastolic blood pressure variability coefficient (nDBPCV)］, blood pressure rhythm and vascular endothelial function index (RHI) were compared. The correlation between RHI and ABPM parameters and blood pressure variability indicators were evaluated. Results The ABPM parameters of 24 h SBP, 24 h DBP, dSBP, dDBP, nSBP and nDBP in the observation group were higher than those in the control group, the proportion of abnormal blood pressure rhythms was higher than that in the control group, the blood pressure variability indicators of 24 h SBPCV, 24 h DBPCV, dSBPCV, dDBPCV, nSBPCV and nDBPCV were higher than those in the control group, and the RHI was significantly lower than that in the control group［(1.17±0.39) vs (2.12±0.18)］, the combined use rate of two or more antihypertensive drugs was higher than that in the control group (all P＜0.01). RHI was negatively correlated with all ABPM parameters and blood pressure variability indicators (all P＜0.05). Conclusion Patients with hypertension combined with anxiety and depression have greater blood pressure variability and aggravated vascular endothelial dysfunction, and increased anxiety and depression mood, as well as blood pressure variability, may cause further damage to the vascular endothelial cell function.