原发性高血压患者血压晨峰与颈动脉粥样硬化

The Association between Morning Blood Pressure Surge and Carotid Atherosclerosis in Patients with Essential Hypertension

目的探讨原发性高血压患者血压晨峰现象与颈动脉粥样硬化的关系。方法对入选的137例原发性高血压患者行24 h动态血压监测(24 h ABPM),根据监测结果,将患者分为晨峰组75例和非晨峰组62例,两组均进行颈动脉超声检查,测量颈总动脉内膜中层厚度(CCA-I MT),观察有无斑块形成,比较两组CCA-I MT及颈动脉斑块的差别。结果①晨峰组CCA-I MT(1.34±0.13)mm显著大于非晨峰组(0.98±0.43)mm,P<0.05;②CCA-I MT与年龄(r=0.276,P=0.001)、24 h平均收缩压(r=0.344,P<0.01)、空腹血糖(r=0.431,P<0.01)、低密度脂蛋白(LDL)(r=0.333,P<0.01)及血压晨峰(r=0.822,P<0.01)呈正相关;③多元线性回归分析证明,年龄、病程、体质量指数(BMI)、24 h平均收缩压、24 h平均舒张压、空腹血糖、LDL、总胆固醇、三酰甘油、高密度脂蛋白(HDL)、血压晨峰、CCA-I MT与血压晨峰和LDL有关,其中血压晨峰对CCA-I MT指标值影响最多;④与非晨峰组比较,晨峰组颈动脉斑块严重程度明显增高[平均秩次,晨峰组:78.25比非晨峰组:57.81,P<0.01]。结论血压晨峰似与颈动脉粥样硬化有关,治疗高血压的同时重视晨峰血压的控制有重要意义。

Objective To investigate the association between morning blood pressure surge（MBPS） and carotid atherosclerosis in patients with essential hypertension. Methods According to the results of 24 h ambulatory blood pressure monitoring, 137 patients were classified as the morning BP surge group （MBPS group, n=75）, and non-surge group （NMBPS group, n=62）. Patients underwent carotid ultrasound and the intima-medial thickness （CCA IMT） and plaques were examined. Results （1） The CCA-IMT of the MBPS group was significantly thicker than that the NMBPSgroup [CCAIMT, MBPS group （1.34±0.13） mm vs NMBPS group （0.98±0.43） mm, P〈0.05]; （2） Pearson relation analysis showed that CCA IMT level positively correlated with age （r〈0. 276, P 0.001）, the average of 24 hSBP （r=0.344, P〈0.01）, FPG （r=0.431, P〈0.01）, LDL （r=0.333, P〈0.01） and MBPS （r=0. 822, P〈0.01） ; （3） After adjusting for age, duration, BMI, 24 h SBP, 24 h DBP, blood glucose, lipid profiles, multiple regression analysis showed that MBPS and LDL remained as predisposing risk factors for CCA-IMT levels; （4） Compared with the NMBPS group, was significantly higher [mean rank order, MBPS group： the severity of carotid arteries plaque of the MBPS group 78.25 vs NMBPS group： 57.81, P〈0.01]. Conclusion The study showed that MBPS was closely related with carotid atherosclerosis in patients with essential hypertension suggesting it is justified for concurrent inhibition of morning BP surge in the treatment of high blood pressure.