肾实质性高血压的血压昼夜变化的临床分析研究

Clinical Analysis of the Diurnal Variation of Blood Pressure in Renal Essential Hypertension

目的研究分析肾实质性高血压患者血压昼夜变化的临床意义。方法100例肾实质性高血压患者分成三组:肾功能代偿期患者为1组:氮质血症期患者为2组;尿毒症期患者为3组;40例正常个体为对照组。各组病例凡服用降压药者,均停用1周后,进行测试。仪器采用美国Spacelabs 90207无创性携带式血压监测仪,获取24 h平均收缩压(24hSBP)和舒张压(24hDBP),白昼平均收缩压(dSBP)和舒张压(dDBP),夜间平均收缩压(nSBP)和舒张压(nDBP),夜间/白昼平均收缩压(n/dSBP)和舒张压(n/dDBP),平均动脉压(MAP)及血压负荷总值进行统计学处理。结果①肾实质性高血压三组各项参数均高于对照组;②肾实质性高血压三组各项参数相互之间经方差检验有明显差别。尤其是收缩压与舒张压负荷值,在肾功能失代偿期明显升高,在尿毒症组已超过60%。③肾实质性高血压各组之间,各项数据之间的关系进一步作各均数两两比较的统计学处理,SBP负荷值,DBP负荷值及MAP三项参数,在肾实质性高血压的三组之间均存在显著差异,而其他参数则差别无统计学上的意义。结论肾实质性高血压患者血压昼夜节律消失,当肾功能失代偿时血压负荷值及MAP随着肾功能的进一步恶化而升高。有效控制血压负荷值,可能延缓肾功能恶化的速度。

Objective To study the clinical significance of blood pressure diurnal changes in patients with renal essential hypertension.Methods One hundred patients with renal parenchymal hypertension were divided into three groups:one with renal compensatory period:two with azotemia;three with uremic disease;and 40 normal controls.All groups of patients who took antihypertensive drugs were stopped after one week of testing.The instrument uses the US Spacelabs 90207 non-invasive portable blood pressure monitor to obtain 24-hour mean systolic blood pressure(24 h SBP)and diastolic blood pressure(24 h DBP),mean systolic blood pressure(d SBP)and diastolic blood pressure(d DBP),and nighttime average systolic blood pressure(n SBP).Diastolic blood pressure(n DBP),night/white mean systolic blood pressure(n/d SBP)and diastolic blood pressure(n/d DBP),mean arterial pressure(MAP)and total blood pressure load were statistically processed.Results(1)The parameters of renal parenchymal hypertension were higher than those of the control group.(2)The parameters of the three groups of renal hypertension were significantly different from each other by variance test.In particular,systolic blood pressure and diastolic blood pressure load values increased significantly in renal decompensation,and exceeded 60%in the uremic group.(3)The relationship between the various data of renal parenchymal hypertension was further statistically treated with the mean of each pair,SBP load value,DBP load value and MAP three parameters,in renal parenchymal hypertension There were significant differences between the three groups,while other parameters were not statistically significant.Conclusion The circadian rhythm of blood pressure disappears in patients with renal essential hypertension.When renal function is decompensated,the blood pressure load value and MAP increase with the further deterioration of renal function.Effective control of blood pressure load values may delay the rate of deterioration of renal function.