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

摘要： 背景　高血压是心血管系统的高发疾病且病因复杂多样，其中焦虑与高血压互相影响，二者密切相关。焦虑对高血压的影响，可能主要表现在影响血压的波动性，即影响血压变异性（BPV）。内皮素-1（ET-1）与一氧化氮（NO）被认为是影响血管舒缩功能较强的因子，焦虑可以影响ET-1、NO的分泌。目的　分析焦虑对老年高血压患者BPV、ET-1、NO的影响，探讨BPV、ET-1、NO之间的相关性，为老年高血压伴焦虑患者的早期干预及治疗提供理论依据。方法　选择2016年11月—2017年6月于滨州医学院附属医院住院的老年高血压患者120例（男51例，女69例）为研究对象，记录患者一般情况并检测血ET-1、NO，对所有患者进行动态血压监测及Zung焦虑自评量表（SAS）评估，根据SAS评分将患者分为高血压无焦虑组（EH组）、高血压轻度焦虑组（EH＆LA组）及高血压中重度焦虑组（EH＆SA组）。比较3组患者BPV、ET-1及NO水平，并分析高血压伴焦虑患者BPV、ET-1、NO之间的相关性。BPV以血压标准差（SD）表示。结果　EH＆LA组24 h、昼间、夜间收缩压标准差（24 hSBPSD、dSBPSD、nSBPSD）及夜间舒张压标准差（nDBPSD）高于EH组，EH＆SA组高于EH＆LA组；EH＆LA组血清ET-1水平高于EH组，EH＆SA组高于EH＆LA组；EH＆LA组血清NO水平低于EH组，EH＆SA组低于EH＆LA组，差异均有统计学意义（P<0.05）。老年高血压伴焦虑患者血清ET-1水平与BPV指标（24 hSBPSD、dSBPSD、nSBPSD、nDBPSD）呈正相关（r值分别为0.506、0.443、0.666、0.642，P<0.05）；NO与BPV指标无相关性（P>0.05）。结论　焦虑对老年高血压患者BPV、ET-1、NO有影响，且焦虑程度越明显，BPV越大，血清ET-1水平越高，而NO水平越低。焦虑可能通过增加BPV进一步加重高血压患者的血管内皮损害。早期识别老年高血压患者的焦虑状况并根据患者的焦虑程度选择抗焦虑治疗或许可以延缓内皮功能的损害，改善老年高血压患者的病情进展及预后。

关键词: 焦虑, 高血压, 血压变异性, 内皮素-1, 一氧化氮, 老年人