原发性高血压中医证候类型与24h动态血压水平的关系研究

Relationship between TCM syndrome types of primary hypertension and 24 h ambulatory blood pressure

目的探讨原发性高血压中医证候类型与24 h动态血压水平的关系。方法收集254例原发性高血压患者的中医证候资料,并对患者进行动态血压监测,分析中医证候类型与血压监测的各项指标间的关系。结果肝火亢盛型多年龄偏低,病程较短,24 h平均脉压最低,夜间血压下降率最大,昼夜血压曲线"非杓型"发生率最低,昼夜节律基本存在。痰湿壅盛型BMI最高,24 h平均收缩压及舒张压均最高,24 h平均脉压、昼夜血压曲线"非杓型"发生率略高于肝火亢盛型。阴阳两虚型24 h平均脉压最高,夜间血压下降率最小,昼夜血压曲线"非杓型"发生率最高,昼夜节律基本消失。阴虚阳亢型及瘀血内阻型24 h平均脉压、昼夜血压曲线"非杓型"发生率均较肝火亢盛型高,但较阴阳两虚型低,其中瘀血内阻型24 h平均脉压、昼夜血压曲线"非杓型"发生率均高于阴虚阳亢型。结论 24 h血压水平和血压昼夜节律在原发性高血压不同中医辨证分型患者中分布存在差异,可作为高血压辨证分型的参考指标。

Objective To investigate the relationship between TCM Syndrome types of primary hypertension and 24 h ambulatory blood pressure. Methods The TCM syndrome data of 254 cases of primary hypertension patients were collected, to whom ambulatory blood pressure monitoring was applied, the relationship between the types of TCM syndromes and the indicators of blood pressure monitoring were analyzed. Results Those with hyperactivity of liver fire were younger with shorter duration of disease, lowest 24 h average pulse pressure, mostly decreased nocturnal blood pressure rate, and lowest occurrence rate of circadian blood pressure curve ＂non dippers＂, and circadian rhythm basically existed. Those with excessive phlegm dampness had got highest BMI, highest 24-hour average systolic blood pressure and diastolic blood pressure, the highest average pulse pressure in 24 hours, incidence of circadian blood pressure curve ＂non dippers＂ slightly higher than that of type of hyperactivity of liver fire. Those with deficiency of both yin and yang had got highest 24-hour average pulse pressure, the lowest decreased rate of nighttime blood pressure, the highest occurrence rate of circadian blood pressure curve ＂non dippers＂, circadian rhythm nearly disappeared. Those with Yin deficiency and yang hyperactivity and interior obstruction of blood stasis had got higher occurrence of 24-hour average pulse pressure and circadian blood pressure curve ＂non dippers＂ compared with that of hyperactivity liver fire, but lower than that of deficiency of both yin and yang, the occurrence rate of 24-hour average pulse pressure and circadian blood pressure curve ＂non dippers＂ rate in interior obstruction of blood stasis type were higher than those of yin deficiency and hyperactivity of yang type. Conclusion The distribution of 24 h blood pressure and blood pressure circadian rhythm are differently distributed with TCM syndrome differentiation in primary hypertension patients, which can be used as an auxiliary means of syndrome differentiation of hypertension and reference index.