关键词: 焦虑, 高血压, 血压变异性, 内皮素-1, 一氧化氮, 老年人

Abstract: Background　Hypertension is a high-risk disease of cardiovascular system with complicated and diverse causes.Anxiety and hypertension are closely related and affect each other.The effects of anxiety on hypertension may be mainly manifested in the fluctuation of blood pressure，that is，the influence on blood pressure variability（BPV）．Endothelin-1（ET-1）and nitric oxide（NO）are considered to be the most potent factors affecting vasomotor function，and anxiety can affect the secretion of ET-1 and NO.Objective　To analyze the effects of anxiety on BPV，ET-1 and NO in elderly patients with hypertension，and to explore the correlation among BPV，ET-1 and NO in order to provide a theoretical basis for the early intervention and treatment of elderly hypertensive patients with anxiety.Methods　A total of 120 elderly hypertensive patients（51 males and 69 females）hospitalized in the Binzhou Medical University Hospital from November 2016 to June 2017 were selected as the study subjects.The general condition of the patients was recorded and ET-1 and NO were measured.All patients were monitored by ambulatory blood pressure monitoring and assessed by Zung Self-rating Anxiety Scale（SAS）．The patients were divided into hypertension-no anxiety group（EH group），hypertension-mild anxiety group（EH＆LA group）and hypertension-severe anxiety group（EH＆SA group）according to the scores of SAS.The levels of BPV，ET-1 and NO in three groups were compared，and the correlation between BPV and ET-1 and NO was analyzed.BPV was expressed as standard deviation（SD）of blood pressure.Results　The 24 h，diurnal and nocturnal systolic blood pressure standard deviation（24 hSBPSD，dSBPSD，nSBPSD）and nocturnal diastolic blood pressure standard deviation（nDBPSD）were highest in EH & SA group followed by EH & LA group and EH group（P<0.05）．ET-1 level in EH & SA group was highest followed by EH & LA group and EH group，while NO level in EH & SA group was lowest followed by EH & LA group and EH group（P<0.05）．Serum ET-1 level was positively correlated with BPV index（24 hSBPSD，dSBPSD，nSBPSD，nDBPSD）in elderly hypertensive patients with anxiety（r=0.506，0.443，0.666，0.642；P<0.05），while NO level was not correlated with BPV index（P>0.05）．Conclusion　Anxiety has an effect on BPV，ET-1 and NO in elderly patients with hypertension and the greater the degree of anxiety，the higher the level of serum ET-1 and the lower the level of NO.Anxiety may further aggravate vascular endothelial damage in patients with hypertension by increasing BPV.Early identification of anxiety in elderly patients with hypertension and selection of antianxiety therapy according to anxiety level may delay the damage of endothelial function and improve the progress and prognosis of elderly patients with hypertension.

Key words: Anxiety, Hypertension, Blood pressure variation, Endothelin-1, Nitric oxide, Aged