持续性心房颤动对原发性高血压患者血压昼夜节律的影响

Effect of Persistent Atrial Fibrillation on Circadian Rhythm of Blood Pressure in Patients With Essential Hypertension

目的：探讨持续性心房颤动（房颤）对原发性高血压患者血压昼夜节律变化的影响。方法：选取2013-01至2014-01我院就诊患者173例,将其分为原发性高血压组（高血压组,n=88）,持续性房颤合并原发性高血压组（房颤合并高血压组,n=85例）。分析所有患者基线资料,并用Logistic回归分析影响持续性房颤合并原发性高血压患者的危险因素。结果：与高血压组比较,房颤合并高血压组白天平均舒张压、白天最小收缩压、白天最小舒张压、24 h平均舒张压均显著降低,夜间最大收缩压显著升高及舒张压反杓型比例显著升高（P均〈0.05）;两组白天平均收缩压、白天最大收缩压、白天最大舒张压、24 h平均收缩压、夜间平均收缩压、夜间平均舒张压、夜间最大舒张压、夜间最小收缩压、夜间最小舒张压及收缩压反杓型比例差异无统计学意义（P均〉0.05）。多因素Logistic回归分析显示,夜间最大收缩压与持续性房颤合并高血压显著相关（比值比=1.038,95%可信区间：1.014-1.062,P〈0.01）。结论：持续性房颤可导致原发性高血压患者白天血压显著下降,而夜间血压下降不明显。

Objective： To explore the effect of persistent atrial fibrillation （AF） on circadian rhythm of blood pressure （BP） in patients with essential hypertension （EH）. Methods： A total of 173 EH patients treated in Gansu Provincial Hospital from 2013-02 to 2014-01were studied. The patients were divided into 2 groups： EH group, n=88 and Persistent AF combining EH group, n=85. The baseline information was studied and the risk factors of persistent AF combining EH were investigated by multivariate logistic regression analysis. Results： Compared with EH group, the Persistent AF combining EH group showed decreased average daytime DBP, minimum daytime SBP, minimum daytime DBP and the average 24-hour DBP, while increased maximum nighttime SBP and the percentage of reverse dipper in DBP, all P〈0.05. There were no significant differences for the average of daytime SBP, maximum daytime SBP, maximum daytime DBP, the average 24-hour SBP, average nighttime SBP, average nighttime DBP, maximum nighttime DBP, minimum nighttime SBP, minimum nighttime DBP and the percentage of reverse dipper in SBP between 2 groups, all P〉0.05. Multivariate logistic regression analysis indicated that the maximum nighttime SBP was obviously related to persistent AF combining EH （OR=1.038, 95 CI 1.014-1.062, P=0.001）. Conclusion： Persistent AF may incur daytime BP dropping, such change was not obviously observed for nighttime BP in EH patients.