原发性高血压血瘀证患者血压变异性的临床研究

Clinical research of blood pressure variability in essential hypertension patients with blood stasis syndrome

目的 探讨原发性高血压血瘀证患者的血压变异性.方法 纳入2011年2月至2013年2月福建省立医院原发性高血压患者220例,根据是否存在血瘀及血瘀的程度分为非血瘀证组68例,轻度血瘀证组67例,重度血瘀证组85例.对患者行24 h动态血压监测,比较3组血压变异性、昼夜节律及血压负荷差异;分析血瘀证独立危险因素.结果 24 h收缩压标准差（24 h SBPSD）、24 h舒张压标准差（24 hDBPSD）、白天收缩压标准差（dSBPSD）、白天舒张压标准差（dDBPSD）、夜间收缩压标准差（nSBPSD）和夜间舒张压标准差（nDBPSD）在非血瘀证组、轻度血瘀证组和重度血瘀证组依次升高[9.98 （8.30,11.89）、11.68 （9.96, 13.64）、13.18 （10.66, 15.51） mmHg（1 mmHg =0.133 kPa）;8.02 （6.61, 9.31）、8.37（6.97, 10.13）、9.36 （7.75, 10.94） mmHg;9.22 （7.83, 10.91）、11.43 （9.52, 13.89）、13.14 （9.90,15.54） mmHg;7.42 （6.29, 8.66）、8.32 （6.80, 9.96）、9.00 （7.29, 11.25） mmHg;8.04 （6.38, 10.20）、9.77 （8.03, 11.84）、12.22 （9.65, 14.42） mmHg;（7.1±2.5）、（7.4±2.6）、（8.6±3.2）mmHg];24 hSBPSD、dSBPSD、nSBPSD各组两两比较差异均有统计学意义,24 h DBPSD和nDBPSD重度血瘀证组大于非血瘀证组和轻度血瘀证组,dDBPSD轻度和重度血瘀证组大于非血瘀证组,差异有统计学意义（P＜0.05）.非血瘀证组血压昼夜节律勺型构成比高于轻度血瘀证组和重度血瘀证组[27.9％（19/68）比6.0％（4/67）、7.1％ （6/85）]（P＜0.01）.24 h收缩压负荷（24 h SBPL）、白天收缩压负荷（dSBPL）和夜间收缩压负荷（nSBPL）在非血瘀证组、轻度血瘀证组和重度血瘀证组依次升高[12.31％ （0.00％,39.80％）、20.60％ （5.71％, 52.50％）、34.40％ （21.70％,70.70％）;6.56％ （0.00％, 32.14％）、17.86％ （3.13％,37.50％）、27.80％ （12.70％, 65.35％）;18.20％ （0.00％, 65.93％）、36.40％ （12.50％, 75.00％）、57.14％ （26.79％,87.50％）];两两比较24 h SBPL和dSBPL重度血瘀证组高于非血瘀证组和轻度血瘀证组,差异有统计意义（P＜0.05）,nSBPL各组间差异均有统计学意义（均P＜0.05）.校正相关危险因素后,nSBPSD和夜间舒张压下降率为血瘀证的独立危险因素[比值比（OR）=1.412,95％置信区间（CI）：1.096 ～1.820,P＜0.01;OR=1.211,95％ CI：1.062 ～1.381,P＜0.01].结论 血压变异性增大是高血压血瘀证的独立危险因素。

Objective To explore the blood pressure variability in essential hypertension patients with blood stasis syndrome （BSS）.Methods Totally 220 patients with essential hypertension from February 2011 to February 2013, including 68 cases without BSS （non-BSS group）, 67 cases with mild BSS （mild BSS group） and 85 cases with severe BSS （severe BSS group） , were enrolled.The pressure variability, circadian rhythms of blood pressure and blood pressure load were compared among groups;the independent risk factors of BSS were analyzed.Results The 24 h systolic blood pressure standard deviation （24 h SBPSD） , 24 h diastolic blood pressure standard deviation （24 h DBPSD）, day systolic blood pressure standard deviation （dSBPSD）, day diastolic blood pressure standard deviation （dDBPSD）, night systolic blood pressure standard deviation （nSBPSD） , night diastolic blood pressure standard deviation （nDBPSD） were sequentially increased in non-BSS group, mild BSS group and severe BSS group [9.98 （8.30, 11.89）, 11.68 （9.96, 13.64）, 13.18 （10.66, 15.51） mmHg;8.02 （6.61,9.31）, 8.37 （6.97, 10.13）, 9.36 （7.75, 10.94） mmHg;9.22 （7.83, 10.91）, 11.43 （9.52, 13.89）,13.14 （9.90, 15.54） mmHg;7.42 （6.29, 8.66）, 8.32 （6.80, 9.96）, 9.00 （7.29, 11.25） mmHg;8.04（6.38, 10.20）, 9.77 （8.03, 11.84）, 12.22 （9.65, 14.42） mmHg;（7.1±2.5）, （7.4±2.6）, （8.6±3.2） mmHg];the 24 h SBPSD, dSBPSD, nSBPSD were significantly different between one and the other group, the 24 h DBPSD and nDBPSD in severe BSS group were significantly higher than those in non-BSS group and mild BSS group, the dDBPSD in mild and severe BSS group was significantly higher than in non-BSS group （P 〈 0.05）.The proportion of spoon type circadian rhythms in non-BSS group was significantly higher than that in mild and severe BSS group [27.9% （19/68） vs 6.0% （4/67）, 7.1% （6/85）] （P 〈0.01）.The 24 h systolic blood pressure load （24 h SBPL） , day systolic blood pressure load （dSBPL） and night systolic blood pressure load （nSBPL） were sequentially increased in non-BSS group, mild BSS group and severe BSS group [12.31% （0.00%, 39.80%）, 20.60% （5.71%, 52.50%）, 34.40% （21.70%, 70.70%）;6.56% （0.00%,32.14%）, 17.86% （3.13%, 37.50%）, 27.80% （12.70%, 65.35%）;18.20% （0.00%, 65.93%）,36.40% （12.50%, 75.00%）, 57.14% （26.79%, 87.50%）];the 24 h SBPL and dSBPL in severe BSS group were significantly higher than those in non-BSS group and mild BSS group, the nSBPL was significantly different between one and the other group （P 〈 0.05）.After adjustment of relative factors, the nSBPSD and nDBPRR were independent risk factors of BSS [odds ratio （OR） =1.412, 95% confidence interval （CI） ： 1.096-1.820, P 〈0.01;OR =1.211,95% CI： 1.062-1.381, P 〈0.01].Conclusion Increased blood pressure variability is an independent risk factor of BSS in essential hypertension