2型糖尿病合并原发性高血压病患者血压晨峰影响因素分析

Influence Factors of Morning Blood Pressure Surge in Type 2 Diabetes Mellitus Patients with Essential Hypertension

目的:探讨2型糖尿病(T2DM)合并原发性高血压病(EH)患者血压晨峰(MBPS)的影响因素。方法:检测60例T2DM合并EH患者的MBPS、血脂、血糖、空腹C肽及糖化血红蛋白(Hb A1c),采取三分位法根据MBPS值将其分为晨峰1组(MBPS≤15 mm Hg)、晨峰2组(15 mm Hg<MBPS≤20 mm Hg)及晨峰3组(MBPS>20 mm Hg),根据降压方案将其分为降压方案1组(未用药)、降压方案2组[使用钙离子通道阻滞剂(CCB)]和降压方案3组[使用肾素-血管紧张素Ⅱ受体阻滞剂/肾素-血管紧张素酶转换酶抑制剂(ARB/ACEI)];根据患者是否吸烟分为不吸烟组和吸烟组,使用方差分析和t检验分析各组间MBPS的差异,再使用Pearson相关及多元回归分析各指标与MBPS的相关性。结果:MBPS晨峰1、2、3组间空腹C肽比较,差异具有统计学意义(P=0.035);血脂、血糖及Hb A1c的差异无统计学意义(P>0.05);降压方案和吸烟各分组间MBPS分别比较,差异均有统计学意义(P<0.05),多元线性回归显示,未用降压药组、CCB组及ARB/ACEI组间MBPS呈下降趋势(P<0.05),吸烟组MBPS高于不吸烟组(P<0.05)。结论:T2DM合并EH患者的MBPS与降压药物种类及是否吸烟存在一定的相关性。

Objective： To investigate the influence factors of morning blood pressure surge（ MBPS）in type 2 diabetes mellitus（ T2DM） patients with essential hypertension（ EH）. Methods： Levels of MBPS,blood lipids,blood glucose,fasting plasma C-peptide and Hb A1 c were recorded in 60 patients with T2 DM and EH. According to the levels of MBPS,patients were divided into group 1（ MBPS ≤15 mm Hg）,group 2（ 15 mm Hg MBPS≤20 mm Hg） and group 3（ MBPS 20 mm Hg）. According to the antihypertensive scheme,patients were divided into group 1（ no medication）,group 2（ using CCB）,group 3（ using ARB / ACEI）. According to smoking status,patients were divided into group 1（ no smoking） and group 2（ smoking）. The relationship between the MBPS and above parameters was analyzed. Results： Among the MBPS groups,there were significant differences in fasting plasma Cpeptide（ P = 0. 035）,while there was no significant difference in blood glucose,blood lipids and Hb A1c（ P〈0. 05）. Among the antihypertensive medication groups,there were significant differences in MBPS（ P〈0. 05）,as well as in smoking status groups. Multiple regression analysis showed that MBPS in no medication group,CCB group and ARB / ACEI group had the declining trend. MBPS was higher in smoking group than no smoking group. Conclusions： In patients with T2 DM and EH,MBPS was correlated with antihypertensive drugs and smoking status.