高龄高血压患者反杓型血压与白蛋白尿的相关性

Correlation of reversed dipper blood pressure and albuminuria in very old patients with hypertension

目的探讨高龄高血压患者白蛋白尿与血压节律异常的关系。方法选取2012年6月至2013年6月在北京友谊医院住院的70例高龄高血压患者，收集临床资料、尿白蛋白排泄率以及动态血压监测结果。根据尿检结果将其分为白蛋白尿组（n=32）和非白蛋白尿组（n=38）。比较两组之间的白昼平均收缩压（dSBP）和舒张压（dDBP）、夜间平均收缩压（nSBP）和舒张压（nDBP），以及夜间收缩压和舒张压下降率、血压变异曲线。结果白蛋白尿组与非白蛋白尿组问比较，年龄、性别、糖尿病发生率、超敏C反应蛋白、左室射血分数等方面均无明显差异（P〉0．05）。与非白蛋白尿组比较，白蛋白尿组患者估测肾小球滤过率（eGFR）明显下降（P〈0．05）。动态血压监测结果显示两组患者dSBP和dDBP均在正常范围，且无明显差异（P〉0．05），但白蛋白尿组nSBP明显升高（P〈0．01）。两组患者非杓型血压节律的发生率无显著差异，白蛋白尿组患者的反杓型曲线比例更高（P〈0．01）。结论夜间收缩压升高，即反杓型血压节律，与高龄高血压患者白蛋白尿和eGFR下降高度相关。

Objective To investigate the correlation of albuminuria with ambulatory blood pressure pattern in the very old patients with hypertension. Methods Seventy very old hypertensive subjects admitted to Beijing Friendship Hospital from June 2012 to June 2013 were enrolled in this study. Their clinical data, urinary albumin excretion rate, ambulatory 24-hour blood pressure monitoring results were collected. The patients were divided into albuminuria group （n = 32） and non-albuminuria group（n = 38） according to the results of urinary test. Day systolic blood pressure（dSBP） and day diastolic blood pressure（dDBP）, night systolic blood pressure（nSBP） and night diastolic blood pressure（nDBP） were compared between the 2 groups. Night blood pressure descend and blood pressure pattern were also observed in the 2 groups. Results There was no significant difference in the age, gender, diabetes incidence, high sensitivity C reactive protein, ejection fraction between the 2 groups（P 〉 0.05）. Estimated glomerular filtration rate（eGFR） was significantly lower in albuminuria group than in the non-albuminuria group（P 〈 0.05）. Ambulatory 24-hour blood pressure monitoring indicated that the dSBP and dDBP were normal in the 2 groups, without significant difference（P 〉 0.05）. The albuminuria group had significantly higher nSBP than the non-albuminuria group （P 〈 0.01）. There was no significant difference in the non-dipper blood pressure between the 2 groups, but the albuminuria group had higher rate of reversed dipper blood pressure（P 〈 0.01）. Conclusion Increased nSBP, that is, the reversed dipper blood pressure pattern, is closely related to albuminuria and decreased eGFR in the very old patients with hypertension.