高血压患者血压昼夜节律、B型脑钠肽与左心室肥厚的关系

Relationships of Blood Pressure Circadian Rhythm and Brain Natriuretic Peptide with Left Ventricular Hypertrophy in the Patients with Primary Hypertension

目的探讨原发性高血压患者血压昼夜节律、B型脑钠肽(BNP)与左心室肥厚(LVH)的关系。方法纳入349例原发性高血压患者(74例有LVH,275例无LVH)进行超声心动图检测及24 h动态血压监测,计算左心室重量指数(LVMI)、夜间血压下降率、24 h动脉脉压(24 h PP)及动态脉压指数(PPI)。根据昼夜血压变异性将研究对象分为超杓型组(n=7)、杓型组(n=77)、非杓型组(n=173)及反杓型组(n=92)。采集患者一般资料及空腹血样,测定血糖、血脂、血尿素氮、血肌酐、胱抑素C、血尿酸及BNP水平。结果 LVH高血压的3级高血压所占比例(85.1%比46.9%;χ~2=34.428,P<0.001)、24 h平均收缩压(134 mm Hg比129 mm Hg;t=3.175,P=0.002)(1 mm Hg=0.133 k Pa)、白天平均收缩压(134 mm Hg比130 mm Hg;t=2.197,P=0.029)、夜间平均收缩压(132 mm Hg比121 mm Hg;t=4.763,P<0.001)、24 h PP(57 mm Hg比52 mm Hg;t=4.120,P<0.001)及PPI(0.43比0.41;t=3.335,P=0.001)均显著高于非LVH高血压患者,而夜间血压下降率[(1.30±8.02)%比(5.68±7.25)%;t=-4.510,P<0.001]显著低于对照组。LVH高血压患者BNP(87.8 pg/ml比28.8 pg/ml;t=2.170,P=0.034)和LVMI(135.1 g/m^2比88.7 g/m^2;t=15.285,P<0.001)均显著高于非LVH患者。超杓型组、杓型组、非杓型组及反杓型组高血压患者的BNP水平差异无统计学意义(P=0.137),而LVMI差异有统计学意义(P=0.001),其中反杓型组患者的LVMI显著高于杓型组(100.3 g/m^2比86.3 g/m^2;t=4.335,P<0.001)和非杓型组(100.3 g/m^2比93.7 g/m^2;t=1.987,P=0.048),非杓型组患者的LVMI显著高于杓型组(93.7 g/m^2比86.3 g/m^2;t=2.693,P=0.008)。多因素线性相关及Logistic回归分析显示,BNP和高血压分级水平与LVMI相关。结论高血压LVH与血压昼夜节律减弱或消失、血压分级水平密切相关,并伴随血浆BNP升高。

Objective To investigate the relationships of blood pressure circadian rhythm and brain natriuretic peptide（ BNP） with left ventricular hypertrophy（ LVH） in patients with primary hypertension.Methods Totally 349 patients（ 74 with LVH and 275 without LVH） with primary hypertension were enrolled in this study.Echocardiography was performed to determine left ventricular mass index（ LVMI） using the Devereux formula.The nocturnal blood pressure decline rate,24-hour blood pressure（ 24 h PP; especially 24 h mean systolic blood pressure,24 h SBP） and blood pressure index（ PPI） were determined by 24 h-ambulatory blood pressure monitoring.These 349 hypertensive patients were divided into four groups including supper-dipper group（ defined as≥20%,n = 7）,dipper group（ defined as 10%-20%,n = 77）,non-dipper group（ defined as 0-10%,n =173）,and anti-dipper group（ defined as〈 0,n = 92）.The baseline demographic characteristics of patients were collected.Fasting blood sugar,blood lipids,blood urea nitrogen,serum cretinine,cystatin C,uric acid,and plasma BNP level were measured.Results The patients with LVH（ n = 74） had significantly higher percentage of grade 3 hypertension（ 85.1% vs.46.9%; χ~2= 34.428,P〈0.001）,24 h SBP（ 134 mm Hg vs.129 mm Hg; t = 3.175,P = 0.002）（ 1 mm Hg = 0.133 k Pa）,daytime-mean SBP（ 134 mm Hg vs.130 mm Hg;t = 2.197,P = 0.029）,night-mean SBP（ 132 mm Hg vs.121 mm Hg; t = 4.763,P〈0.001）,and 24 h PP（ 57 mm Hg vs.52 mm Hg; t =4.120,P〈0.001） and PPI（ 0.43 vs.0.41; t = 3.335,P = 0.001） and lower nocturnal blood pressure decline rate [（ 1.30 ± 8.02） % vs.（ 5.68 ± 7.25） %; t =-4.510,P〈0.001]than the non-LVH patients（ n = 275）.The LVH hypertensive group had significantly higher BNP level（ 87.8 pg/ml vs.28.8 pg/ml; t = 2.170,P = 0.034） and LVMI（ 135.1 g/m^2 vs.88.7 g/m^2; t = 15.285,P〈0.001） than the control group.No significant difference was observed in the BNP level among supper-dipper,dipper,non-dipper and anti-dipper groups（ P = 0.137）.However,the difference was statistically significant in the LVMI（ P =0.001）.Additionally,patients in the anti-dipper group had significantly higher LVMI than those in the dipper patients（ 100.3 g/m^2 vs.86.3 g/m^2; t = 4.335,P〈0.001） and non-dipper（ 100.3 g/m^2 vs.93.7 g/m^2; t =1.987, P = 0.048）.Patients in the non-dipper group had significantly higher LVMI than those in the dipper group（ 9 3.7 g/m^2 vs.8 6.3 g/m^2; t = 2.693,P = 0.008）.The multivariate linear correation analysis and logistic regressions analysis suggested a significant correlation of LVMI with BNP and the grade of hypertension.Conclusion With the increasing of plasma BNP level, the left ventricular hypertrophy is closely related to abnormal blood pressure circadian rhythm and the grade of hypertension in primary hypertensive patients.