A型和B型行为模式原发性高血压患者的动态血压水平以及昼夜节律波动的变化

Change of ambulatory blood pressure level and circadian rhythm in patients with A-type and B-type behavior pattern primary hypertension

目的:比较具有A型和B型行为特征的原发性高血压患者24h动态血压、心率、血压昼夜下降百分比及节律形态分布的差异。方法:①选择2001-01/2005-01在汕头市中心医院及湘潭市第一人民医院心内科门诊就诊或住院的原发性高血压患者255例,男139例,女116例;年龄31～74岁,平均(53±14)岁;病程1～13年,平均(4.8±1.2)年。均知情同意,并自愿接受问卷评估。②原发性高血压患者255例行为类型评估采用A型行为问卷(分为时间紧迫感,争强好胜,怀有戒心和敌意和真实性核对3个分量表,共有60个小题。时间紧迫感和争强好胜,怀有戒心和敌意两个分量表的评分总和为A型行为总分,总分≥31分为A型行为,≤23分为B型行为,24～30分为中间型)。测评时间在入院后1周内。③动态血压监测使用无创便携式动态血压监测仪,日间(6:00～22:00)每15min测试1次,夜间(22:00～次日6:00)每30min测试1次,共记录80次。所采集数据经自动分析后,分别自动打印出24h、日间、上下午和夜间5个时段收缩压、舒张压和心率的平均值。夜间血压下降百分率=白天血压均值-夜间血压均值/白天血压均值。夜间血压平均值比日间下降10%以上称之为杓型改变,夜间血压平均值比日间下降<10%称之为非杓型改变。动态血压监测也在体检期间进行。④组间计量和计数资料差异性测定分别采用t和χ2检验。结果:纳入原发性高血压患者255例完成问卷评估,A型行为问卷总分≥31分73例(A型行为组),总分≤23分106例(B型行为组)进入结果分析。①24h和日间及夜间血压、心率比较:A型行为组24h平均收缩压、24h平均舒张压、白天平均收缩压、白天平均舒张压均明显高于B型行为组(149±22),(92±32),(153±25),(94±25)mmHg,1mmHg=0.133kPa;(140±29),(89±19),(140±30),(90±21)mmHg,t=2.457～2.958,P<0.05～0.01,但两组24h平均心率和白天平均心率差异不明显(P>0.05)。两组夜间平均收缩压、夜间平均舒张压和夜间平均心率差异不明显(P>0.05)。②血压昼夜下降百分比及节律形态分布:A型行为组平均收缩压夜间比白天下降百分比、平均舒张压夜间比白天下降百分比均明显低于B型行为组(7.24±2.55)%,(6.69±2.23)%;(9.49±1.98)%,(8.35±1.92)%,t=2.637,2.423,P<0.05);而A型行为组平均收缩压非杓型改变和平均舒张压非杓型改变患者构成比明显高于B型行为组(74.0%,70.0%;39.6%,33.0%,χ2=5.027,4.839,P<0.05)。结论:A型行为模式对原发性高血压患者24h动态血压、心率、血压昼夜下降百分比及节律形态分布的影响程度大于B型行为模型。

AIM： To analyze the influence of A-type and B-type behavior pattern to the difference of 24-hour ambulatory blood pressure, heart rate, decreased percentage of circadian rhythm and distribution of rhythm form in patients with primary hypertension.METHODS： ① Totally 255 patients with primary hypertension from cardiac out-patient clinic （OPD） and inpatient ＂care in Shantou Central Hospital and Xiangtan First People＇s Hospital from January 2001 to January 2005 were recruited. They were 139 male and ll6 female , aged 31 to 74 years with the average of （53±14） years; course of disease of 1 to 13 years with the average of （4.8±1.2）. The informed consent was obtained and the patients accept the questionnaire willingly.②The questionnaire of A-type behavior pattern was underwent in the 255 cases with primary hypertension （ divided as time hot, complete and hostility and check of reality）, totally 60 questions . A-type behavior total score was made up of time hot and complete , hostility two subscale scores, totally scores ≥ 31 scores was A-type behavior, ≤ 23 scores was B-type behavior, 24-30 was middle type）. Measuring time was within 1 week after hospitalization.③portable ambulatory blood pressure monitor was used to measure ambulatory blood pressure,once every 15 minutes at day time （6：00 to 22：00）,once every 30 minutes at night （22：00 to 6：00 next day）, totally 80 times.Mean value of systolic pressure,diastolic pressure and heart rate at 24 hours,in the day, in the morning and in the afternoon were printed automatically after the data were analyzed automatically.The decreasing percentage of blood pressure=mean value of blood value at night-mean value of blood value at night/mean value of blood value at day time.The ratio of mean value of blood pressure at night to that at daytime more than 10% was called arytenoids change. The ratio of mean value of blood pressure at night to that at daytime 〈 10% was called non-arytenoids change. Ambulatory blood pressure level was measured during physical examination. ④t test and analysis of variance were used for measurement among the groups and data difference.RESULTS： Totally 255 recruited patients with primary hypertension complete questionnaire evaluation. Behavior questionnaire scores ≥31 scores （73 eases） （A type group） , Behavior questionnaires ≤ 23 scores （106 cases） （B-type behavior group） all the cases entered the result analysis.①Comparison of blood pressure and heart rate among 24 hours,day time and at night ： Mean systolic pressure and mean diastolic pressure in 24 hours, mean systolic pressure ,mean diastolic pressure during daytime in A-type behavior was significantly higher than that in the B-type behavior group [（149±22）,（92±32）,（153±25）,（94±25） mm Hg; （140±29）,（89±19）,（140±30）,（90±21） mm Hg, t=2.457-2.958,P〈 0.05-0.01], but there was no significant difference of mean heart rate in the 24 hours and mean heart rate at day time （P 〉 0.05）.There was no obvious difference of mean systolic pressure at night, mean diastolic pressure at night and mean heart rate at night （P 〉 0.05）. ②The decreasing percentage of circadian blood pressure and distribution of rhythm form ： the decreasing rate of systolic pressure at night to daytime, and decreasing rate of mean diastolic pressure at night to daytime in A-type behavior group was significantly lower than that in the B-type behavior group [（7.24±2.55）%,（6.69±2.23）%;（9.49±1.98）%, （8.35±1.92）% ,t =2.637,2.423,P 〈 0.05], Ratio of nonarytenoids between mean systolic pressure and mean diastolic pressure was obviously higher in the A-type behavior group than that in the B-type behavior group （74.0%,70.0%;39.6%,33.0%,χ^2=5.027,4.g39,P 〈 0.05）.CONCLUSION： Effect of A-type behavior pattern on ambulatory blood pressure , heart rate, decreasing percent of circadian hlood pressure and rhythm form distribution in patients with primary hypertension was greater than that of B-type behavior group.