血压昼夜节律与年轻高血压患者靶器官损伤的相关性

Association Between Blood Pressure Dipping Status and Target Organ Damage in Young Patients With Hypertension

目的:探讨血压昼夜节律与年轻高血压患者靶器官损伤的相关性。方法:研究纳入2012~2017年在中国医学科学院阜外医院高血压中心就诊的18~39岁原发性高血压住院患者1254例,根据夜间血压下降率是否≥10%分为杓型(n=499)和非杓型(n=755)两组,比较两组患者临床指标、血压及靶器官损伤的差异,分析夜间血压下降率与左心室肥厚、白蛋白尿的相关性。结果:两组患者诊室和日间收缩压差异无统计学意义(P>0.05),非杓型组24 h平均收缩压[133.0(123.0,144.0)mmHg(1 mmHg=0.133 kPa)vs.130.0(122.0,140.0)mmHg,P=0.001]、24 h平均舒张压[88.0(80.0,96.0)mmHg vs.84.0(77.0,91.0)mmHg,P<0.001]和夜间平均收缩压[129.0(118.0,140.0)mmHg vs.116.0(108.0,126.0)mmHg,P<0.001]、夜间平均舒张压[(84.8±12.6)vs.(75.1±11.0)mmHg,P<0.001]较杓型组升高;非杓型组左心室肥厚的程度和发生率[39.6(33.6,48.1)g/m2.7 vs.37.7(32.4,43.9)g/m2.7,P<0.001;22.8%vs.11.4%,P<0.001],尿微量白蛋白肌酐比及白蛋白尿发生率[19.1(7.9,42.5)mg/g vs.13.0(7.0,31.8)mg/g,P=0.001;33.7%vs.25.6%,P=0.003]也均高于杓型组。多因素回归分析显示,夜间血压下降率与身高标化的左心室质量、尿微量白蛋白肌酐比的自然对数、左心室肥厚独立相关(P均<0.05)。结论:年轻高血压患者中非杓型血压患者心肾靶器官损伤更加严重,夜间血压下降率与左心室肥厚程度及尿微量白蛋白肌酐比独立相关,是发生左心室肥厚的显著影响因素。

Objectives:To explore the association between dipping status of blood pressure(BP)and target organ damage in young patients with hypertension.Methods:A total of 1254 patients aged 18-39 years admitted to the Hypertension Center of Fuwai Hospital with essential hypertension from 2012 to 2017 were enrolled.Nondipping pattern was defined as a nighttime BP decrease rate of lower than 10%.The clinical characteristics,BP parameters and target organ damage were compared between patients with dipping and nondipping patterns;association of the nighttime BP decrease rate with left ventricular hypertrophy and albuminuria were analyzed.Results:No significant difference in clinic systolic BP(SBP)and daytime diastolic BP(DBP)was found between two groups(P>0.05).Compared with the dipping group,the nondipping group had higher 24-hour SBP(133.0[123.0,144.0]mmHg vs.130.0[122.0,140.0])mmHg,P=0.001),DBP(88.0[80.0,96.0]mmHg vs.84.0[77.0,91.0]mmHg,P<0.001),nighttime SBP(129.0[118.0,140.0]mmHg vs.116.0[108.0,126.0]mmHg,P<0.001),DBP([84.8±12.6]mmHg vs.[75.1±11.0]mmHg,P<0.001)as well as higher level and prevalence of left ventricular hypertrophy(39.6[33.6,48.1]g/m2.7 vs.37.7[32.4,43.9])g/m2.7,P<0.001;22.8%vs.11.4%,P<0.001),urine albumin-to-creatnine ratio(19.1[7.9,42.5]mg/g vs.13.0[7.0,31.8]mg/g,P=0.001)and albuminuria(33.7%vs.25.6%,P=0.003).In multivariable regression analysis,the nighttime BP decrease rate was independently associated with left ventricular mass normalized for height,logarithm of urine albumin-to-creatinine ratio,and left ventricular hypertrophy(P<0.05).Conclusions:In young patients with hypertension,those with nondipping pattern have higher risk of heart and kidney damage.The nighttime BP decrease rate is independently associated with the severity of left ventricular hypertrophy and urine albumin-to-creatinine ratio,and is a significant influence factor of left ventricular hypertrophy.