原发性高血压患者血压昼夜节律的影响因素分析

Factors influencing circadian rhythm of blood pressure in essential hypertension patients

目的探讨原发性高血压患者非杓型血压昼夜节律形成的危险因素。方法将患者按夜间平均动脉压下降率分为杓型组(49例)与非杓型组(83例),对患者行横断面调查,采用Logistic回归分析筛选影响因素。结果非杓型组夜间收缩压、舒张压、血压负荷及24h收缩压、收缩压负荷均高于杓型组(P<0.05);非杓组年龄>60岁、合并靶器官损害、超重和肥胖、睡眠质量差的患者比例均高于杓型组(P<0.05,P<0.01);Logistic回归也显示年龄增长(OR=1.071,95%CI1.027～1.117)、靶器官损害(OR=5.457,95%CI2.134～13.959)、体质指数>24kg/m2(OR=4.341,95%CI1.652～11.411)、睡眠质量差(OR=2.579,95%CI1.039～6.403)为原发性高血压患者血压昼夜节律异常的危险因素。结论应加强对老年人、有靶器官损害、超重和肥胖、睡眠质量差的原发性高血压患者的药物疗效监测和生活方式干预,以预防及早期预测异常血压昼夜节律的发生。

Objective To explore the risk factors on non-dipper circadian rhythm of blood pressure in essential hypertension patients. Methods A total of 132 diagnosed essential hypertension patients who admitted in the outpatient of our department from March to May 2010 were divided into 49 dippers and 83 non-dippers according to their nocturnal reduction rate of mean arterial pressure （MAP）. A cross-sectional survey was carried out on the patients, including the items such as body mass index （BMI）, medical history, target organ damage, salt intake and so on. Their ambulatory blood pressure was monitored for consecutive 25 h. Risk factors were screened out by Logistic regression analysis. Results Nocturnal systolic BP, diastolic BP, mean arterial pressure, BP load and 24-hour systolic BP, systolic BP load in non-dippers were higher than those in dippers （P0.05）. There were more patients older than 60, with target organ damage, being overweight and obese, and having good sleep quality in non-dippers than those in dippers （P0.05）. Binary logistic regression analysis showed that increased age （OR=1.071, 95%CI 1.027 to 1.117）, target organ damage （OR=5.457, 95%CI 2.134 to 13.959）, BMI≥24 kg/m2 （OR=4.341, 95%CI 1.652 to 11.411）, and bad sleep quality （OR=0.948, 95%CI 1.039 to 6.403） were major risk factors of abnormal circadian rhythm of blood pressure. Conclusion More attention should be paid on drug effect monitoring and life style intervention for the essential hypertension patients getting old, with target organ damage, BMI≥24 kg/m2, and/or bad sleep quality to prevent and predict non-dipping earlier.