高血压合并2型糖尿病患者血压昼夜节律与靶器官损害的相关性

Relationship between circadian rhythm of blood pressure and target organ damage in essential hypertensive patients with type 2 diabetes mellitus

目的探讨原发性高血压(EH)合并2型糖尿病(T2DM)患者血压昼夜节律改变与靶器官损害的关系。方法选择2005-06-2008-12门诊和病房住院受试者495例,其中男性121例,女性374例,年龄40～79(65.7±10.0)岁,分为对照组(n=113)、EH组(n=199)、T2DM(n=73)及EH+T2DM(n=110),比较4组患者的一般临床资料及动态血压检测结果如24h平均收缩压(24hSBP)、24h平均舒张压(24hDBP)、白昼平均收缩压(dSBP)、白昼平均舒张压(dDBP)、夜间平均收缩压(nSBP)、夜间平均舒张压(nDBP)等,分析各组间收缩压和舒张压昼夜差值百分比(ΔSBP%、ΔDBP%)及靶器官损害的差异。结果①EH+T2DM组高密度脂蛋白胆固醇低于EH组[(1.08±0.30)比(1.20±0.31)mmol/L],三酰甘油高于EH组[(2.00±1.33)比(1.56±0.88)mmol/L,均P<0.01]。②EH+T2DM组24hSBP[(141.2±12.5)比(138.2±12.7)mmHg,P<0.05]、nSBP[(137.5±9.7)比(131.5±11.4)mmHg,P<0.01]均高于EH组,而24hDBP[(76.1±9.3)比(79.6±9.1)mmHg]、dDBP[(77.4±9.8)比(81.0±9.2)mmHg]低于EH组(均P<0.01);EH+T2DM组ΔSBP%、ΔDBP%值与对照组、T2DM组及EH组比较,差异有统计学意义(P<0.01);EH组ΔSBP%、ΔDBP%值均低于对照组,EH组ΔSBP%低于T2DM组。③EH+T2DM组发生靶器官损害的比例要高于其他各组[40.0%比31.5%、22.1%、8.8%,P<0.01]。④Logistic回归分析显示年龄(OR=1.136,95%CI1.079～1.195,P=0.001)、疾病种类(OR=1.662,95%CI1.138～2.428,P=0.009)是靶器官损害的危险因素,而ΔSBP%(OR=0.927,95%CI0.877～0.979,P=0.007)是靶器官损害的保护因素。结论 EH合并T2DM明显加重血压昼夜节律异常及靶器官功能损害。

Objective To study the relationship between the circadian rhythm changes of blood pressure and target organ damage in essential hypertensive（EH） patients with type 2 diabetes mellitus（T2DM）. Methods During Jun 2005 to Dec 2008,495 cases of outpatients and inpatients（121 male,374 female） ,aged from 40 to 79 （65.7±10.0） years were involved. Subjects were divided into 4 groups： essential hypertension（EH, n= 199）, （T2DM, n=73）, essential hypertension with type 2 diabetes mellitus [ Eli＋T2DM, n = 110） , and normal control [ NC, n=113 ）. Clinical data and ambulatory blood pressure monitoring indices of 24-hour mean systolic blood pressure（24hSBP） ,24- hour mean diastolic blood pressure（24hDBP）, diurnal mean systolic blood pressure （dSBP）, diurnal mean diastolic blood pressure （ dDBP）, nocturnal mean systolic blood pressure （nSBP）, nocturnal mean diastolic blood pressure （nDBP）, were compared among the four groups. The percentage differences between dSBP and nSBP（ASBP%）, between dDBP and nDBP （ADBPM）, and target organ damage among groups were analyzed. Results ① EH ＋ T2DM patients showed decreased high density lipoprotein cholesterol （HDL-C） and increased triglyceride（TG）levels as compared with EH cases [（1. 08±0.30） vs （1. 20±0.31） mmol/L, （2. 00±1.33） vs （1. 56±0.88） mmol/L, all P〈0.01]. ②24hSBP and nSBP were significantly higher while 24hDBP and dDBP were lower in EH ＋ T2DM group than those in EH group [24hSBP（141.2±12.5） vs （138.2±12.7）mmHg,P〈0.05; nSBP（137. 5±9. 7） vs （131.5±11.4）mm Hg; 24hDBP（76.1±9. 3） vs （79.6±9. 1）mm Hg; dDBP（77. 43±9. 8） vs （81.0±9.2）mm Hg,all P〈0.01]. ASBP% and ADBPM decreased significantly in EH-t-T2DM group compared to those in EH group, in T2DM group and in NC group（P〈0.01）. △SBP% and △DBP% were significantly reduced in EH group compared with NC group（P〈0.01）. ASBP% dropped significantly in EH group compared with that in T2DM group （P〈0.01）. The incidence of target organ damage in EH＋T2DM group was significantly higher compared to that in other groups（40.0% vs 31.5% vs 22.1% vs 8.8% （P〈0.01）. ④Age（OR=1. 136, 95% CI 1.079-1. 195, P=0. 001） and kinds of disease （OR=1. 662, 95% CI=1. 138-2. 428,P=0. 009） were risk factors while △SBP% （OR=0. 927,95% CI 0. 877-0. 979, P= 0. 007） was protective factor of target organ damage by logistic regression analysis. Conclusion Hypertension complicated with type 2 diabetes meltitus aggravated abnormality of the circadian rhythm of blood pressure and the degree of target organ damage.