肾性高血压动态血压变化规律特点及其对心脏损害的研究

The study of the change character of ambulatory blood pressure and the heart damage in patients with renal hypertension

目的探讨肾性高血压患者动态血压变化规律特点及其对心脏的损害。方法选择性别、年龄、平均动脉压相匹配的两组患者共132例(即肾性高血压组88例和原发性高血压组44例),检查患者24h动态血压,并做心脏彩超计算患者心肌重量指数(LVMI),然后进行比较分析。结果肾性高血压组夜间血压下降不明显,71.59%患者动态血压曲线呈"非勺型",比原发性高血压组27.27%"非勺型"有显著增高;两组患者均有左室肥厚、心肌重量指数(LVMI)增高,其中肾性高血压组增高更显著(肾性高血压组男性121.1±3.5g/m2、女性108.6±6.2g/m2,原发性高血压组男性108.5±2.3g/m2、女性102.3±3.1g/m2);在肾性高血压组内动态血压"非勺型"比"勺型"患者LVMI明显增高,差异有统计学意义。结论大多数肾性高血压患者昼夜血压变化节律消失;在平均动脉压相同情况下,肾性高血压比原发性高血压对心肌损害大;肾性高血压中动态血压"非勺型"比"勺型"对心肌损害更大。

Objective Object： to explore the change character of ambulatory blood pressure and the heart damage in patients with renal hypertension. Methods The ambulatory blood pressure and the left ventricular mass index （LVMI） were analyzed in the patients with renal hypertension （n= 88） and essential hypertension （n=44）. The two groups were matched in gender, age and average mean arterial pressure. Results In the patients with renal hypertension ,the nocturnal pressure fall was less and the non-dipper phenomenon （71.59%）was more frequently seen than that （27.27%））with essential hypertension; the incidence of left ventricular hypertrophy and the value of left ventricular mass index（LVMI） were increased in both groups,especially in renal hypertension（man in renal hypertension 121.1±3.5g/ m^2 , femal in renal hypertension 108.6 ±6.2g/m^2 , man in essencial hypertension 108.5± 2.3g/m^2, femal in essencial hypertension 102.3 ± 3. 1g/m^2 ）; the value of left ventricular mass index（LVMI） was more higher in the non-dipper group with renal hypertention than in the dipper group, there was statistic significant difference between the two group. Conclusions the circadian rhythm of blood pressure was dissapered in most renal hypertension patients ; the heart damage in renal hypertension was more serious than in essencial hypertension with the same average mean arterial pressure;the non-dipper hypertension does more harm to heart than the dipper hypertension.