继发性高血压24小时动态血压研究

Ambulatory blood pressure monitoring in secondary hypertension

目的研究继发性高血压（ＳＨ）２４小时动态血压变化。方法应用美国Ｓｐａｃｅｌａｂｓ９０２０７动态血压监测仪观察了８０例ＳＨ２４小时动态血压并与年龄、性别相配对的８０例高血压病（ＥＨ）患者进行比较。结果ＳＨ患２４小时血压节律与ＥＨ患者不同，ＳＨ患者夜间血压下降不明显，夜间血压明显高于ＥＨ患者（Ｐ＜００１）；ＳＨ患者夜间血压负荷在６０％左右，而ＥＨ患者夜间血压负荷则在１５％左右；ＳＨ患者与ＥＨ患者２４小时血压曲线：白昼（６：００～２２：００）曲线呈重叠、交叉状态，而夜间（２２：００～６：００）曲线呈分离状态，ＥＨ夜间曲线段明显降低。ＳＨ组非杓型明显多于ＥＴ组（Ｐ＜００１）。ＳＨ患者夜间血压／日间血压的比值大于９０％的例数明显多于ＥＨ患者。结论２４小时动态血压监测显示夜间血压下降不明显，夜间血压负荷在５０％以上，呈非杓型，夜间血压／日间血压的比值大于９０％，提示有ＳＨ可能，应作进一步检查。

Objective To observe 24h ambulatory blood pressure in patients with secondary hypertension Methods The 24h ambulatory blood pressure of patients with secondary hypertension (SH, n=80) and patients with essential hypertension (EH) matched in age and sex were compared Results The diurnal blood pressure rhythm of SH was different from that of EH In patients with SH, the nocturnal blood pressure fall was less and the nighttime average blood pressure was higher than that in patients with EH The nighttime blood pressure load in SH was sixty percent, however, it was fifteen percent in EH The diurnal curves in patient with SH and EH overlapped at daytime and separated from each other at nighttime The curves in patients with EH decreased obviously at nighttime The nondipper phenomenon was more frequently seen in SH than in EH (P<001) The ratio of nighttime BP/daytime BP over ninety percent was more frequently found in SH than in EH Conclusion Noninvasive ABPM is a useful method in screening SH In hypertension patients, if the ABPM shows less nighttime blood pressure fall, a nondipper curve pattern, high nighttime blood pressure load, and nighttime BP/daytime BP ratio over ninety percent, SH should be suspected and need to be further investigated