不稳定性心绞痛合并高血压患者血压昼夜节律研究

Circadian blood pressure characteristics in hospitalized unstable angina pectoris patients with hypertension

目的 探讨不稳定性心绞痛合并高血压患者血压昼夜节律的特点及其与不稳定性心绞痛的关系.方法 本研究为前瞻性研究.入选2014年9月至2015年12月在解放军总医院门诊诊断为不稳定性心绞痛收住院行冠状动脉造影的患者共1 101例.根据冠状动脉造影结果,排除单纯不稳定性心绞痛患者220例以及冠状动脉造影正常且无高血压者50例,将剩余患者分为两组,即不稳定性心绞痛合并高血压组742例和单纯高血压组89例.入选患者均行24 h动态血压监测,根据夜间血压下降率分为勺型、非勺型、反勺型,比较两组患者血压昼夜节律分布差异,采用二分类logistic回归分析血压昼夜节律与不稳定性心绞痛的关系,并进一步调整年龄、性别、体重指数、血压、血糖、血清总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯等传统心血管危险因素的影响.结果 入选的不稳定性心绞痛患者中742例[77.1％ （742/962）]合并高血压.不稳定性心绞痛合并高血压组患者夜间收缩压和舒张压下降幅度均低于单纯高血压组（P均〈0.05）.不稳定性心绞痛合并高血压组血压勺型、非勺型和反勺型的患者分别有92例（12.40％）、259例（34.90％）和391例（52.70％）,单纯高血压组患者血压勺型、非勺型和反勺型的患者分别有16例（18.00％）、43例（48.30％）和30例（33.70％）,可见不稳定性心绞痛合并高血压组患者血压反勺型的比例明显高于单纯高血压患者（P=0.00）,进一步对两组行不同性别和不同年龄分层发现同样趋势.另外,对两组患者血压控制[收缩压〈 140 mmHg（1 mmHg =0.133 kPa）且舒张压〈90 mmHg]及未控制[收缩压〉 140 mmHg和（或）舒张压〉90 mmHg]进行亚组分析发现,除在血压控制组年龄〈45岁的反勺型患者中两组差异无统计学意义外,其余无论血压控制与否按性别和年龄分层不稳定性心绞痛合并高血压组患者血压反勺型的比例均明显高于单纯高血压组（P均〈0.05）.二分类logistic回归分析结果显示调整了传统的心血管危险因素后,反勺型血压与不稳定性心绞痛独立相关（OR=1.53,95％ CI1.12 -2.61,P=0.013）.结论 不稳定性心绞痛患者多合并高血压,此类患者反勺型血压节律者较多.另外,夜间血压升高与不稳定性心绞痛独立相关.

Objective To define the characteristic of circadian rhythm of blood pressure in unstable angina pectoris （UAP）patients with hypertension and its effects on the cardiovascular events.Methods It was a prospective study.Based on coronary angiographic results,742 consecutive hospitalized UAP patients with hypertension and 89 consecutive hospitalized hypertensive patients were recruited between September 2014 and December 2015 in this study.Clinical data and the results of 24-hour ambulatory blood pressure monitoring （ABPM） were analyzed.Results The total prevalence of hypertension in UAP is about 77.1% （742/962） in our cohort.The decrease of night-time systolic and diastolic blood pressure in UAP patients complicated with hypertension was lower than that in hypertensive patients （P 〈0.05）.The prevalence of dipper,non-dipper and reverse dipper pattern was 12.4% （92/742）,34.9% （259/742） and 52.7%（391/742） in UAP patients complicated with hypertension,18.0% （16/89）,48.3% （43/89） and 33.7%（30/89） in hypertensive patients.Obviously,the abnormal circadian rhythm of blood pressure was more significant in UAP patients with hypertension than in hypertensive patients,characterized by higher reverse dipper pattern in UAP patients with hypertension compared to patients with hypertension （P =0.00）,similar results were evidenced among the male and female patients and patients with various ages.Subgroup analysis showed that except similar results on the incidence of reverse dipper pattern in controlled blood pressure aged less than 45 years old,the incidence of reverse dipper pattern was all significantly higher in UAP patients complicating with hypertension than in hypertensive patients independent no matter blood pressure controlled or not （all P 〈 0.05）.After adjustment for sex,age,triglyceride,low-density lipoprotein cholesterol,highdensity lipoprotein cholesterol,and other risk factors,binary logistic regression analysis showed that reverse dipper pattern was independently associated with UAP （OR =1.53,95% CI 1.12-2.61）.Conclusions This finding suggests that UAP patients with hypertension often have abnormal circadian rhythm,characterized by higher reverse dipper circadian pattern.Elevated nocturnal blood pressure is independently related to UAP.