高血压患者昼夜血压变异的临床分析

目的:24小时动态血压监测是评估血压昼夜变异性的重要方法之一。夜间血压下降异常将导致患者心血管疾病的发病风险显著增加。本研究旨在观察目前正在接受降压治疗的高血压群体的血压昼夜变异性并找出影响夜间血压下降的潜在因素。方法:在高血压群体中开展24小时动态血压监测,根据夜间血压下降的幅度,将受试者分为杓型、非杓型、超杓型和反杓型。分析这4类群体的临床特征如年龄、体重指数、高血压病程、血生化指标、心脏大小及合并症等情况并将相关的数据与杓型血压组进行比较。结果:在入选的460例高血压患者中,共有193人表现为杓型血压(42%);267人(58%)出现昼夜血压异常变化,其中非杓型115人(占25%),超杓型133人(占29%),反杓型占19人(占4%)。血脂异常、超重、腹型肥胖及既往心梗、脑梗的病史及冠心病病史各组间比较没有统计学差异。结论:在高血压群体中有超过一半的患者存在昼夜血压变异。夜间血压下降幅度与患者的年龄呈负相关。高血压病程长短以及有无合并高脂血症、肥胖、糖尿病、冠心病等在各组间没有差异。

Objectives:Evaluation of circadian blood pressure(BP)rhythm is an important element of ambulatory BP monitoring(ABPM).Abnormal nocturnal fall in BP substantially increases the risk of cardiovascular diseases.The aim of this study is to analyze the circadian BP profile in a population of treated hypertensives and identification of factors affecting variability of nocturnal fall in BP.Methods:24-hour ABPM was performed in hypertensive patients.Based on nocturnal fall pattern,four subgroups were identified:dippers,non-dippers,extreme dippers,and risers.Comorbidities were assessed,and data obtained in all groups were compared with the dipper profile group.Results:We analyzed 460 patients.A dipper profile was noted in 42%of patients.Abnormal circadian BP profile was observed in 58%of patients,including a non-dipper profile in 25%of patients,an extreme dipper profile in 29%of patients,and a riser profile in 4%of patients.No significant differences in the rates of dyslipidaemia,excessive body weight,abdominal obesity,previous myocardial infarction,previous stroke,and coronary artery disease were seen between the groups.Conclusions:An abnormal circadian BP profile was found in over 50%of hypertensive patients.A negative correlation was found between nocturnal BP fall and the patient age.No differences were found between groups with different circadian BP pattern regarding duration of hypertension and the presence of dyslipidaemia,obesity,diabetes,or coronary artery disease.