作者：陈雯1 ，丁雯 1 ，李冰雪 2 ，张雪芳 3

单位：

1.210046 江苏省南京市，南京中医药大学护理学院　2.476000 河南省商丘市，商丘工学院　3.210001 江苏省南京市，南京中医药大学附属南京中医院质量管理办公室

Units：

1.School of Nursing，Nanjing University of Chinese Medicine，Nanjing 210046，China2.Shangqiu Institute of Technology，Shangqiu 476000，China3.Quality Management Office，Nanjing Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Traditional Chinese Medicine，Nanjing 210001，China

关键词：

高血压；老年人；焦虑；抑郁；血压变异性；Meta 分析

Keywords：

Hypertension；Elderly；Anxiety；Depression；Blood pressure variability；Meta-analysis

CLC：

DOI：

10.12114/j.issn.1008-5971.2021.00.004

Funds：

摘要：

背景　随着人口老龄化逐渐加重，老年原发性高血压病患者焦虑、抑郁发生率升高，近年关于老年原发性高血压病患者负性情绪与血压相关性的研究较多，但结论并不一致，临床尚缺乏循证医学研究证明老年原发性高血压病患者焦虑、抑郁情绪与血压的关系。目的　系统评价焦虑和 / 或抑郁情绪对老年原发性高血压病患者血压的影响。方法　计算机检索 PubMed、Web of Science、Medline、EBSCO、中国知网、万方数据知识服务平台、维普网及中国生物医学文献数据库，检索时间为建库至 2019 年 10 月。观察组为老年原发性高血压病伴焦虑和 / 或抑郁情绪患者，对照组为老年原发性高血压病无焦虑、抑郁情绪患者。比较两组患者血压变异性（BPV）指标、动态血压指标、非杓型血压节律发生率，并采用 Begg 秩相关分析、漏斗图评价结局指标的发表偏倚。结果　最终纳入文献 19 篇，共包含 2 240 例患者，其中对照组 1 150 例，观察组 1 090 例。Meta 分析结果显示，观察组患者 24 h 收缩压标准差（24 h SBPSD）〔平均差（MD）=1.07，95%CI（0.49，1.65）〕、昼间收缩压标准差（dSBPSD）〔MD=2.20，95%CI（1.09，3.31）〕、夜间收缩压标准差（nSBPSD）〔MD=0.85，95%CI（0.53，1.16）〕、昼间收缩压变异系数（dSBP-CV）〔MD=3.23，95%CI（0.67，5.79）〕、24 h 收缩压（24 h SBP）〔MD=9.47，95%CI（6.03，12.90）〕、24 h 舒张压（24 h DBP）〔MD=4.71，95%CI（2.63，6.78）〕、 昼 间 收 缩 压（dSBP）〔MD=7.65，95%CI（4.86，10.43）〕、昼间舒张压（dDBP）〔MD=2.76，95%CI（1.48，4.05）〕、 夜间收缩压（nSBP）〔MD=8.45，95%CI（5.42，11.48）〕和夜间舒张压（nDBP）〔MD=4.49，95%CI（2.23，6.76）〕均高于对照组（P ＜ 0.05）；两组患者非杓型血压节律发生率比较，差异无统计学意义〔OR=1.63，95%CI（0.89，3.00），P=0.12〕。采用逐一排除法进行敏感性分析，发现 MD 值未见明显变化，表明本 Meta 分析结果的稳定性较好。结论　本 Meta 分析结果表明，焦虑和 / 或抑郁情绪可增加老年原发性高血压病患者动态血压变化幅度和BPV，尤其是收缩压变异性，与非杓型血压节律可能无关系。

Abstract：

Background　With the aggravating aging of population，the incidence of anxiety and depression in elderly patients with essential hypertension also increased.Recently，there are many studies on the correlation between negative emotions and blood pressure in elderly patients with essential hypertension，but the conclusion is contradictory.Evidence-based medical research for the relationship between anxiety，depression，and blood pressure in elderly patients with essential hypertension is limited clinically.Objective　To systematically assess the impact of anxiety and/or depression on blood pressure in elderly patients with essential hypertension. Methods　Electronic databases of PubMed，Web of Science，Medline，EBSCO，CNKI，WanFang Data，VIP and CMB were searched up to October 2019.The observation group was for elderly patients with essential hypertension with anxiety and/or depression，while the control group was whom without it. Blood pressure variability（BPV），ambulatory blood pressure（ABP） and incidence of non-dipper blood pressure rhythm were compared between the two groups，and publication bias of outcome indicators was evaluated by the Begg rank correlation method and funnel diagram.Results　A total of 19 studies involving 2 240 cases were included（control group for 1 150 cases and observation group for 1 090 cases）.The results of Meta-analysis showed that，compared with control group，24 h systolic blood pressure standard deviation（24 h SBPSD）〔MD=1.07，95%CI（0.49，1.65）〕，diurnal systolic blood pressure standard deviation（dSBPSD）〔MD=2.20，95%CI（1.09，3.31）〕，diurnal systolic blood pressure variation coefficient（dSBP-CV）〔MD=3.23，95%CI（0.67，5.79）〕，24 h systolic blood pressure（24 h SBP）〔MD=9.47，95%CI（6.03，12.90）〕，24 h diastolic blood pressure（24 h DBP）〔MD=4.71，95%CI（2.63，6.78）〕，diurnal systolic blood pressure（dSBP）〔MD=7.65，95%CI（4.86，10.43）〕，diastolic blood pressure（dDBP）〔MD=2.76，95%CI（1.48，4.05）〕，night systolic blood pressure（nSBP）〔MD=8.45，95%CI（5.42，11.48）〕and night diastolic blood pressure（nDBP）〔MD=4.49，95%CI（2.23，6.76）〕 were higher in observation group（P ＜ 0.05）；there was no statistical difference in the incidence of non-dipper blood pressure rhythm between the two groups〔OR=1.63，95%CI（0.89，3.00），P=0.12〕.Conclusion　With the results of this meta-analysis，anxiety and/or depression can elevate the ambulatory blood pressure andBPV for elderly patients with essential hypertension，especially in the variability of systolic blood pressure，may not be relatedto the non-dipper blood pressure rhythm.

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