正常血压高值患者血压变异性与肾功能损害的关系

Relationship between blood pressure variability and renal function damage in patient with prehypertension

目的观察正常血压高值患者血压变异性(BPV)的变化及其与血清肌酐(sCr)的关系,探讨正常血压高值患者BPV对肾功能的影响。方法按照2010年中国高血压防治指南将180例高血压患者根据血压水平分入理想血压组(NT组)、正常血压高值组(PH组)和高血压组(EH组),每组60例。行动态血压(ABP)监测,ABP参数包括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),BPV参数包括24h收缩压变异系数(24hSBPV)、24h舒张压变异系数(24hDBPV)、白昼收缩压变异系数(dSBPV)、白昼舒张压变异系数(dDBPV)、夜间收缩压变异系数(nSBPV)、夜间舒张压变异系数(nDBPV)。分析sCr与BPV的关系。结果 NT组、PH组和EH组的sCr水平分别为(69.2±15.5)、(76.6±14.9)、(83.7±18.2)μmol/L,用协方差分析校正年龄、性别、血脂、血糖等因素对sCr的影响后,PH组的sCr显著高于NT组(P<0.05),EH组显著高于NT组和PH组(P值均<0.01)。PH组的所有ABP和BPV参数均显著高于NT组(P值分别<0.01、0.05),EH组显著高于NT组和PH组(P值均<0.01)。多元线性回归分析结果显示,调整年龄、性别、体质指数、血脂、血糖等因素后,NT组的sCr与24hSBPV呈正相关[标准偏回归系数(β’)=0.231,P=0.049];PH组的sCr与24hSBPV(β’=0.347,P<0.001)、24hDBPV(β’=0.248,P=0.042)、dSBPV(β’=0.268,P=0.028)、nSBPV(β’=0.252,P=0.039)呈正相关;EH组的sCr与24hSBPV(β’=0.381,P<0.001)、24hDBPV(β’=0.279,P=0.017)、dSBPV(β’=0.368,P<0.001)、dDBPV(β’=0.272,P=0.021)、nSBPV(β’=0.294,P=0.009)、nDBPV(β’=0.263,P=0.031)呈正相关。结论正常血压高值患者的BPV明显异常,且与肾功能损害相关。

Objective To investigate the change of blood pressure variability （BPV） and the relationship between serum creatinine （sCr） and BPV in prehypertensive patients, and to explore the effect of BPV on renal function. Methods A total of 180 patients were recruited according to the revised edition 2010 guideline for prevention and treatment of hypertension in China and divided into three groups： 60 normotensive subjects （NT group）, 60 prehypertensive patients （PH group） and 60 hypertensive patients （EH group）. Ambulatory blood pressure （ABP） parameters were monitored, including the average 24-hour systolic blood pressure （24hSBP）, 24- hour diastolic blood pressure （24hDBP）, daytime systolic blood pressure （dSBP）, daytime diastolic blood pressure （dDBP）, nighttime systolic blood pressure （nSBP） and nighttime diastolic blood pressure （nDBP）. BPV parameters, including 24-hour systolic blood pressure variability （24hSBPV）, 24-hour diastolic blood pressure variability （24hDBPV）, daytime systolic blood pressure variability （dSBPV）, daytime diastolic blood pressure variability （dDBPV）, nighttime systolic blood pressure variability （nSBPV） and nighttime diastolic blood pressure variability （nDBPV） , were determined. The relationship between sCr and BPV were analyzed. Results The concentration of sCr was （69.2± 15.5）μmol/L, （76.6± 14.9）μmol/L and （83.7± 18.2）μmol/L in NT, PH and EH groups, respectively. After adjustment of age, sex, serum lipid and serum glucose with covariance analysis,the concentration of sCr in PH group was significantly higher than that in NT group （P 〈0. 05）, and the concentration of sCr in EH group was significantly higher than that in NT and PH groups （both P〈0.01）. The ABP parameters and nDBP and BPV parameters in PH group were significantly higher than those in NT group （P〈0.01 or 0.05）, and these parameters in EH group were significantly higher than those in NT and PH groups （all P〈 0.01）. Multiple linear regression analysis showed that after adjustment of age, sex, body mass index （BMI）, serum lipid and serum glucose, sOr was positively correlated with 24hSBPV in NT group （standard partial regression coefficient was 0. 231, P =0. 049） sOr was positively correlated with 24hSBPV, 24hDBPV, dSBPV and nSBPV in PH group （standard partial regression coefficient were 0. 347, 0. 248, 0. 268 and 0.252, respectively, P value were 〈0. 001, 0. 042, 0. 028 and 0. 039, respectively） ~ sCr was positively correlated with 24hSBPV, 24hDBPV, dSBPV, dSBPV, dDBPV, nSBPV and nDBPV in EH group （standard partial regression coefficient were respectively 0. 381, 0.279, 0. 368, 0.272, 0.294 and 0. 263, P value were respectively 0.001, 0. 017, 〈0. 001, 0. 021, 0. 009 and 0. 031）. Conclusion Obvious abnormality of BPV exist in prehypertensive patients and renal function damage is correlated with BPV.