高血压患者血压昼夜节律变化的临床意义

Clinical Significance of Diurnal Rhythmic Fluctuations of Blood Pressures in Hypertensions

目的:探讨高血压患者血压昼夜均值波动的节律与临床意义。方法:对112例高血压患者根据超声心动图(ultra-sonic cardiography,UCG)检查结果分成3组,其中UCG显示左室肥大30例,均伴单纯收缩压升高(isolated systolic hyperten-sion,ISH)或收缩压和舒张压均升高(miscellaneous systolic and diastolic hypertension,MDH),平均年龄(58±12.1)岁,为LVH组;UCG正常的ISH患者48例为ISH组,平均年龄(62±15.2)岁;UCG正常的MDH患者34例为MDH组,平均年龄(51±12.0)岁。另选健康体检者中动态血压监测(ambulatory blood pressure monitoring,ABPM)正常的30例为对照组,平均年龄(54±10.3)岁。获取4组研究对象的24 h平均收缩压(24-hour mean systolic blood pressure,24 hSBP)和舒张压(24-hourmean diastolic blood pressure,24 h DBP)、白昼平均收缩压(daytime mean systolic blood pressure,dSBP)和舒张压(daytimemean diastolic blood pressure,dDBP)、夜间平均收缩压(nighttime mean systolic blood pressure,nSBP)和舒张压(nighttimemean diastolic blood pressure,nDBP)、夜间/白昼平均收缩压比值(nSBP/dSBP)和舒张压比值(nDBP/dDBP)、收缩压负荷值与舒张压负荷值。结果:(1)正常组和ISH组血压均值波动都具有昼夜规律性,但其曲线有所不同;MDH组夜间血压下降幅度减小,LVH组昼夜规律不明显;(2)ISH组、MDH组与LVH组24 hSBP、dSBP、nSBP均高于对照组,而以ISH组及LVH组更为显著(P<0.001);(3)MDH组与LVH组nDBP/dDBP均显著高于对照组;(4)LVH组nSBP/dSBP比值及nDBP/dDBP比值显著高于对照组;(5)SBP负荷值LVH组大于MDH组,DBP负荷值LVH组小于MDH组。结论:高血病患者应积极随访动态血压监测,以观察血压升高的水平及昼夜节律的变化,并有针对性地进行干预,这对降低心脑血管疾病发生的风险有重要意义。

Objective：To investigate the diurnal rhythms of blood pressure fluctuations in hypertension patients. Methods： A total of 112 hypertension patients were divided into 3 groups. The group of isolated systolic hypertension（ISH） had 48 patients, the group of miscellaneous systolic and diastolic hypertension （MDH） had 34 patients, and the group of hypertension with left ventricular hypertrophy（LVH） had 30 patients. Meanwhile, 30 cases of normal blood pressure were selected as a control group. The data of 24 hour mean systolic blood pressure （24 hSBP）, 24-hour mean diastolic blood pressure（24 hDBP） ,daytime mean systolic blood pressure （dSBP）, daytime mean diastolic blood pressure（dDBP） nighttime mean systolic blood pressure （nSBP）, nighttime mean diastolic blood pressure（nDBP）, nSBP/dSBP, nDBP/dDBP, systolic load and diastolic load were col- lected in all groups. Results： （1） Diurnal rhythms of mean blood pressure values were found in both control group and ISH group, but formalities are somehow different; whereas no obvious diurnal rhythms were found in L~＇H group. （2） Mean values of 24 hSBP, dSBP and nSBP in groups of ISH, MDH and LVH were higher than those in the control group, and with great statistical significance in groups of ISH and LVH （P〈0. 001）. （3） nDBP/dDBP ratio was found higher in MDH group and LVH group than in the control group. （4） nSBP/dSBP ratio and nDBP/dDBP ratio were higher in LVH group than those in the control group. （5） Systolic blood pressure （SBP） load values were greater in LVH group than in MDH group and values of diastolic blood pressure（DBP） load were less in LVH group than in MDH group. Conclusions： Proactive follow-up in ambulato- ry blood pressure monitoring （ABPM） of hypertensions for tracking blood pressures and its diurnal rhythmic fluctuations in particular, has great clinical significance in reducing incidences of cardiovascular and cerebral diseases through timely medical interventions.