24h平均血压、血压昼夜节律与长期药物治疗的高血压患者肾脏损害的相关性研究

Correlation Study of 24 Hours Average Blood Pressure,Circadian Rhythm and Long-Term Drug Treatment on Renal Damage in Hypertensive Patients

目的探讨24 h平均血压、血压昼夜节律对高血压患者肾脏损害的影响。方法分析2017年11月至2019年11月我院就诊的300例长期使用降压药物的高血压患者临床资料,分为24 h平均血压正常昼夜节律正常组(组1)、24 h平均血压正常昼夜节律异常组(组2)、24 h平均血压控制欠佳昼夜节律正常组(组3),24 h平均血压控制欠佳昼夜节律异常组(组4)四组,分析血压昼夜节律与颈动脉斑块情况、脑血管疾病发作情况、心血管疾病发作情况的关系,分析各组患者肌酐、尿素氮、尿蛋白及肌酐清除率变化情况。结果多元Logistic回归分析显示,血压昼夜节律与脑梗死、脑出血、冠心病、动脉粥样硬化、慢性肾衰竭独立相关(P<0.05);肌酐、尿素氮组4与组1各组间比较,差异有统计学意义(P<0.05),其余各组间比较差异无统计学意义;尿蛋白在组2、3与组1比较差异有统计学意义(P<0.05),组2与组3比较差异有统计学意义(P<0.05),组4与组1、2、3各组间比较差异有统计学意义(P<0.05);e GFR组2、3与组1比较差异有统计学意义(P<0.05)。结论长期降压治疗的高血压患者,血压昼夜节律与24 h平均血压共同参与肾脏损害的发生;与24 h平均血压比较,血压昼夜节律异常影响尿蛋白漏出更大,高血压患者不仅要重视血压的达标,更要关注血压昼夜节律的恢复。

Objective To explore the effects of 24-hour average blood pressure and circadian rhythm on renal damage in hypertension patients.Methods From November 2017 to November 2019,300 patients with long-term use of antihypertensive drugsin our hospital were analyzed,and they were divided into 4 groups:normal 24 h average blood pressure andcircadian rhythm group(group 1),normal 24 h average blood pressure and abnormal circadian rhythm group(group 2),poorly controlled 24 h average blood pressure and normal circadian rhythm group(group 3),poorly controlled 24 h average blood pressure and abnormal circadian rhythm group(group 4).Relationships between circadian rhythm and carotid plaque condition,onset of cerebrovascular and cardiovascular disease were analyzed.Changes in creatinine,urea nitrogen,urine protein and creatinine clearance rate were analyzed.Results Multivariate Logistic regression analysis showed that circadian rhythm of blood pressure was independently related to cerebral infarction,cerebral hemorrhage,coronary heart disease,atherosclerosis and chronic renal failure(P<0.05).Difference of creatinine and urea nitrogen between group 4 and group 1 were statistically significant(P<0.05),and there was no significant difference between other groups.There was statistically significant difference in urine protein among groups 2,3 and group 1(P<0.05).There was significant difference between group 2 and group 3(P<0.05).Differences among group 4 and groups 1,2,3 were statistically significant(P<0.05).There were statistically significant differences of eG FR among groups 2,3 and group1(P<0.05).Conclusion For hypertensive patients who needed long-term antihypertensive therapy,circadian rhythm of blood pressure and 24-hour average blood pressure are jointly involved in kidney damage.Compared with 24-hour average blood pressure,abnormal circadian rhythms could affect urine protein leakage more.Hypertensive patients should pay attention to achievement and recovery of circadian rhythm.