高血压患者血压昼夜节律异常的原因分析

Analysis of the reasons of abnormal circadian blood pressure in patients with hypertension

目的探讨高血压患者血压昼夜节律异常的原因。方法通过对452例原发性高血压患者进行动态血压监测,根据夜间血压下降率分为四组:夜间血压下降率>20%为超勺型组;10%≤夜间血压下降率≤20%为勺型组;0≤夜间血压下降率<10%为非勺型组;夜间血压下降率<0为反勺型组。收集实验室检查结果和临床资料,分析血压昼夜节律异常发生的可能原因。结果非勺型组年龄为(66.0±14.5)岁,反勺型组年龄为(70.7±11.3)岁,勺型组为(62.4±14.0)岁,非勺型组和反勺型组同勺型组比较,差异均有统计学意义(分别为P<0.05和P<0.000)。非勺型组脑卒中发病率27.6%,与勺型组相比,差异有统计学意义(P<0.05);反勺型组冠心病发病率52.8%、脑卒中发病率32.8%,与勺型组相比,差异均有统计学意义(P均<0.01);Logistic回归显示,高龄、体重指数增加、肌酐升高(OR=1.045、1.116、1.030,P<0.05)同反勺型昼夜节律相关。结论高龄、体重指数增加、肌酐升高可能参与反勺型血压节律形成。

Objective To explore the reasons of abnormal circadian blood pressure in patients with hypertension.Methods Based on ambulatory blood pressure monitoring,452 patients with essential hypertension were grouped according to nocturnal blood pressure fall rate,fall rate 20% for the ultra-dipper hypertension,10% ≤ fall rate≤ 20% for the dipper group,0 ≤ fall rate 10% for the non-dipper group,fall rate 0 for the anti-dipper group.And we collect laboratory results and clinical data,and then analyze the correlation between abnormal blood pressure rhythm and target organ damage and the reasons of abnormal circadian blood pressure in patients with hypertension.Results The ages in the group of dipper,non-dipper and anti-dipper were 62.4±14.0 years old,66.0±14.5 years old and 70.7±11.3 years old,respectively,and the difference was statistically significant.The incidence of stroke in non-dippers was 27.6%,the difference was statistically significant when compared with the incidence in dippers;the incidence of coronary heart disease and stroke in anti-dipper were 52.8% and 32.8%,respectively,and the difference was statistically significant when compared with those in the dipper.Logistic regression shows that old age,increase of BMI and elevation of creatine were associated with anti-dippers.Conclusion Age,increasing of BMI and elevation of creatine may be involved in the formation of anti-dipper blood pressure rhythm.