原发性高血压病合并亚临床靶器官损伤患者血压昼夜节律特点及短期血压变异性与亚临床靶器官损伤的关系研究

Characteristics of Blood Pressure Circadian Rhythm in Patients with Essential Hypertension and Subclinical Target Organ Damage and the Relationship between Short-term Blood Pressure Variability and Subclinical Target Organ Damage

背景近年国外大量研究显示,高血压患者正常血压昼夜节律的消失及短期血压变异性(BPV)增高与靶器官损伤(TOD)、不良心血管预后密切相关,而国内相似研究较少。目的探讨原发性高血压病合并亚临床TOD患者血压昼夜节律特点及短期BPV与亚临床TOD的关系。方法本研究为横断面研究。选取2017年1月—2018年1月在北京市垂杨柳医院心内科住院的原发性高血压病患者212例为研究对象,按照患者是否合并亚临床TOD将其分为合并亚临床TOD组112例和未合并亚临床TOD组100例。比较两组患者一般资料、血压、亚临床TOD相关指标、血压昼夜节律、短期BPV参数。采用多因素Logistic回归分析探讨原发性高血压病患者合并亚临床TOD的影响因素。结果合并亚临床TOD组患者24 h平均收缩压(SBP)、日间平均SBP、夜间平均SBP、左心室质量指数(LVMI)、尿微量白蛋白与尿肌酐比值高于未合并亚临床TOD组,估算肾小球滤过率(e GFR)低于未合并亚临床TOD组,颈-股动脉脉搏波传导速度(cf-PWV)快于未合并亚临床TOD组(P <0.05)。合并亚临床TOD组患者表现为非勺型血压模式,未合并亚临床TOD组患者表现为勺型血压模式。合并亚临床TOD组患者夜间SBP下降率低于未合并亚临床TOD组(P <0.05)。合并亚临床TOD组患者24 h SBP标准差(SD)、日间SBP SD、夜间SBP SD、24 h SBP变异系数(CV)、日间SBP CV、SBP加权标准差(WSD)、SBP实际变异均值(ARV)大于未合并亚临床TOD组(P <0.05)。多因素Logistic回归分析结果显示,24 h平均SBP[OR=1.129,95%CI(1.049,1.215)]、日间平均SBP[OR=0.854,95%CI(0.783,0.931)]、夜间SBP下降率[OR=0.663,95%CI(0.493,0.891)]是原发性高血压病患者合并亚临床TOD的影响因素(P <0.05)。结论原发性高血压病合并亚临床TOD患者的24 h血压昼夜节律受损,同时伴有短期BPV增高;本研究尚未发现原发性高血压病患者短期BPV与其合并亚临床TOD有关。

Background In recent years,a large number of foreign studies have shown that the disappearance of normal circadian rhythm of blood pressure and the increase of short-term blood pressure variability(BPV)in patients with hypertension are closely related to target organ damage(TOD)and poor cardiovascular prognosis,but there are few similar domestic studies.Objective To investigate the characteristics of blood pressure circadian rhythm in patients with essential hypertension and subclinical TOD and the relationship between short-term BPV and subclinical TOD.Methods This is a crosssectional study.A total of 212 patients with essential hypertension who were hospitalized in the Department of Cardiology of Beijing Chuiyangliu Hospital from January 2017 to January 2018 were selected.According to whether the patients were combined with subclinical TOD,they were divided into subclinical TOD group(112 cases)and non subclinical TOD group(100 cases).General information,blood pressure,subclinical TOD related indexes,circadian rhythm of blood pressure and short-term BPV parameters were compared between the two groups.Multivariate Logistic regression analysis was used to explore the influencing factors of subclinical TOD in patients with essential hypertension.Results The 24-hour mean systolic blood pressure(SBP),day-time mean SBP,night-time mean SBP,left ventricular mass index(LVMI),and the ratio of urine microalbumin to urine creatinine in the subclinical TOD group were higher than those in the non subclinical TOD group,the estimated glomerular filtration rate(eGFR)in the subclinical TOD group was lower than that in the non subclinical TOD group,the carotid-femoral pulse wave velocity(cf-PWV)in the subclinical TOD group was faster than that in the non subclinical TOD group(P<0.05).Non dipper blood pressure pattern was investigated in the patients of subclinical TOD group,while dipper blood pressure pattern was investigated in the patients of non subclinical TOD group.The decline rate of SBP at night in patients of subclinical TOD group was lower than that in patients of non subclinical TOD group(P<0.05).The 24 h SBP standard deviation(SD),daytime SBP SD,nighttime SBP SD,24 h SBP coefficient of variation(CV),daytime SBP CV,SBP weighted standard deviation(WSD)and SBP actual mean variation(ARV)of patients in subclinical TOD group were higher than those of patients in non subclinical TOD group(P<0.05).Multivariate Logistic regression analysis showed that 24 h mean SBP[OR=1.129,95%CI(1.049,1.215)],daytime mean SBP[OR=0.854,95%CI(0.783,0.931)]and nighttime SBP decline rate[OR=0.663,95%CI(0.493,0.891)]were the influencing factors of patients with essential hypertension complicated with subclinical TOD(P<0.05).Conclusion The 24 h circadian rhythm of blood pressure in patients with essential hypertension complicated with subclinical TOD is impaired,and accompanied by increase of short-term BPV.This study has not found that short-term BPV in patients with essential hypertension is associated with subclinical TOD.