原发性高血压患者血压昼夜节律、血压变异性与动脉粥样硬化的相关性研究

Association of blood pressure circadian rhythm and variability with atherosclerosis in patients with essential hypertension

目的:探讨原发性高血压患者的血压昼夜节律、血压变异性与动脉粥样硬化的关系。方法:入选原发性高血压患者120例,行24 h动态血压监测,根据血压昼夜节律分为杓型组(n=22)、非杓型组(n=36)和反杓型组(n=62)。分析比较3组的血压变异性、冠心病发生率及颈动脉斑块检出率。结果:反杓型组的24 h收缩压标准差(24hSSD)、24 h舒张压标准差(24hDSD)、白昼收缩压标准差(dSSD)、白昼舒张压标准差(dDSD)、24 h收缩压变异系数(24hSBP-CV)、夜间收缩压变异系数(nSBP-CV)均低于杓型组;反杓型组的24hDSD、dDSD、24hDBP-CV低于非勺型组;反杓型组冠心病发生率及颈动脉斑块检出率较杓型组明显升高(P均<0.05)。结论:原发性高血压患者血压昼夜节律异常对动脉粥样硬化进展可能有促进作用。

Objective： To investigate the association of blood pressure circadian rhythm and variability with atherosclerosis in patients with essential hypertension. Methods： 120 patients diagnosed as essential hypertension were divided into dipper group（n = 22）, non-dipper group（n = 36）and reverse dipper group （n = 62） according to the circadian rhythm determined by ambulatory blood pressure monitoring（ABPM）. Blood pressure variability and the incidences of coronary heart disease and carotid atherosclerosis in three groups were analyzed. Results： 24 hours systolic blood pressure standard difference （24hSSD）, 24 hours diastolic blood pressure standard difference （24hDSD）, day systolic blood pressure standard difference （dSSD）, day diastolic blood pressure standard difference （dDSD）, 24 hours systolic blood pressure coefficient of variation （24hSBP-CV）and night systolic blood pressure coefficient of variation （nSBP-CV）in reverse dipper group were lower than those in dipper group （P〈0. 05）while 24hDSD, dDSD, 24 hours diastolic blood pressure coefficient of variation （24hDBP-CV） in reverse dipper group were lower than those in non-dipper group（P〈0. 05）. The incidences of coronary heart disease and carotid atherosclerosis in reverse dipper group were higher than those in dipper group（P〈 0. 05）. Conclusion： Abnormal blood pressure circadian rhythm could contribute to the development of carotid atherosclerosis in patients with essential hypertension.