原发性高血压合并醒后脑卒中与血压昼夜节律的相关性研究

Correlation between wake-up stroke in patients with essential hypertension and blood pressure circadian rhythm

目的通过对原发性高血压患者醒后脑卒中(WUS)与非醒后脑卒中(non-WUS)血压昼夜节律、24 h动态血压特点对比分析,探讨WUS与血压的关系。方法回顾性分析2017年9月至2019年9月首都医科大学附属北京友谊医院收治的原发性高血压合并急性脑梗死患者108例,按照卒中发病时间将患者分为两组:WUS组43例和nonWUS组65例。比较两组的24 h动态血压、血压昼夜节律,探讨WUS与血压昼夜节律的关系。结果①WUS组夜间收缩压(160.88±16.85 mm Hg)、夜间舒张压(92.63±8.00 mm Hg)均明显高于non-WUS组(153.91±16.77 mm Hg,89.00±9.46 mm Hg),差异均有显著性(P<0.05);WUS组日间平均脉压(72.00±12.25 mmHg)、夜间平均脉压(68.25±10.24 mm Hg)和24 h平均脉压(70.00±11.13 mm Hg)明显高于non-WUS组(67.86±8.65 mm Hg,63.78±10.79 mmHg,65.19±8.56 mm Hg),差异均有显著性(P<0.05);②WUS组血压昼夜节律异常者占88.37%,以反杓型和非杓型为主;non-WUS组血压昼夜节律异常者占69.23%,以非杓型为主(P<0.01)。结论WUS与昼夜节律相关,以反杓型和非杓型为主,同时WUS日间、夜间和24小时平均脉压大、夜间收缩压和舒张压较高。

Objective To explore the correlation between wake-up stroke(WUS)and blood pressure circadian rhythm by comparing the characteristics of blood pressure circadian rhythm and 24 h ambulatory blood pressure monitoring(ABPM)in essential hypertension patients with WUS and non-WUS.Methods 108 patients with essential hypertension complicated with acute ischemic stroke admitted to Beijing Friendship Hospital,Capital Medical University from September 2017 to September 2019 were analyzed retrospectively.They were divided into two groups according to the onset time of stroke:the WUS group and non-WUS group.The ABPM and blood pressure circadian rhythm of the two groups were compared to explore the relationship between WUS and blood pressure circadian rhythm.Results①The night-time systolic blood pressure and diastolic blood pressure in the WUS group(160.88±16.85 mm Hg,92.63±8.00 mm Hg)were significantly higher than those in the non-WUS group(153.91±16.77 mm Hg,89.00±9.46 mm Hg),and the differences were significant(P<0.05);the day-time mean pulse pressure,night-time mean pulse pressure and 24 h mean pulse pressure in the WUS group(72.00±12.25 mmHg,68.25±10.24 mmHg,70.00±11.13 mmHg)were significantly higher than those in the non-WUS group(67.86±8.65 mm Hg,63.78±10.79 mm Hg,65.19±8.56 mmHg),and the differences were significant(P<0.05).②In the WUS group,patients with abnormal blood pressure circadian rhythm accounted for 88.37%,mainly in non-dipper and reverse-dipper shapes;in the non-WUS group,patients with abnormal blood pressure circadian rhythm accounted for 69.23%,mainly in non-dipper shape(P<0.01).Conclusion WUS is related to blood pressure circadian rhythm,mainly in non-dipper and reverse-dipper shapes.Meanwhile,the day-time,night-time and 24 h mean pulse pressure,the night-time systolic and diastolic blood pressure were higher in WUS.