中青年原发性高血压患者晨峰血压与血压变异性的关系

Morning blood pressure surge and blood pressure variability in young and middle-aged essential hypertensive patients

目的探讨中青年原发性高血压患者晨峰血压与血压变异性的关系。方法收集2011年11月至2015年1月在北京大学人民医院高血压病房住院,既往未治疗或已停止降压药物治疗4周以上,且同时完善了24 h动态血压监测和动态心电图监测的160例中青年原发性高血压患者,分析其24 h动态血压和动态心电图监测结果。根据晨峰血压水平是否超过28.67 mmHg(所有患者晨峰血压水平的最高四分位水平)分为晨峰血压增高组(44例)和非晨峰血压增高组(116例)进行组间比较。结果与非晨峰血压增高组相比,晨峰血压增高组患者24 h收缩压变异性、24 h舒张压变异性、夜间收缩压变异性、夜间舒张压变异性均增大,这4个血压变异性指标与晨峰血压之间的相关系数分别为0.325、0.315、0.316和0.286(均为P<0.001);应用Logistic逐步回归分析校正了24 h收缩压水平、日间收缩压水平和血压节律等影响晨峰血压的因素后,除夜间舒张压变异性与晨峰血压的相关性消失外,24 h收缩压变异性、24 h舒张压变异性、夜间收缩压变异性与晨峰血压的相关性仍显著存在,OR值分别为2.43(1.06~5.59)、2.23(1.16~4.30)、1.32(1.06~1.64)。结论对于中青年原发性高血压患者,昼夜血压下降程度、24 h血压变异性和夜间血压变异性均与晨峰血压明显相关。与舒张压变异性相比,收缩压变异性与晨峰血压的相关性更强。24 h收缩压水平、日间收缩压水平和晨峰心率水平也在一定程度上影响着晨峰血压。

Objective To investigate the association between morning blood pressure surge and blood pressure variability in young and middle-aged essential hypertensive patients. Methods Between November 2011 and January 2015,in the ward of hypertension in Peking University People＇s Hospital,a total of 160 young and middle-aged essential hypertensive patients who were never treated or didn＇ t receive medical treatment in recently four weeks underwent 24 h ambulatory blood pressure monitoring and ambulatory electrocardiogram recording. All patients were divided into the MBPS group,which was defined as having the highest quartile of morning BP increase from sleep（ ≥28. 67 mmHg; n = 44） and the non-MBPS group（ 28. 67 mmHg; n = 116）. And then we compared all indexes between these two groups. Results Compared with patients in non-MBPS group,those in MBPS group had higher 24 h SBP variability（ 24 h-SBPBPV）,24 hours diastolic blood pressure（ DBP） variability（ 24 h-DBP-BPV）,nighttime SBP variability（ nSBP-BPV） and nighttime DBP variability（ n-DBP-BPV）. And their correlation coefficients with MBPS were0. 325,0. 315,0. 316 and 0. 286 respectively（ all P 0. 001）. After adjustments for factors associated with MBPS[such as 24 hours mean systolic blood pressure（ 24 h-SBP）,daytime mean systolic blood pressure（ dSBP） profile and the circadian BP pattern]these correlations still existed significantly,except for n-DBP-BPV,OR are respectively 2. 43（ 1. 06-5. 59）,2. 23（ 1. 16-4. 30）,1. 32（ 1. 06-1. 64）. Conclusions In young and middle-aged essential hypertensive patients,the day-night SBP dipping,24 h-BPV and n-BPV have significant association with MBPS. Compared with DBP-BPV,SBP-BPV are more correlated with MBPS. Moreover,24 h-SBP,d-SBP and MHRS also have an effect on MBPS to some extent.