高血压病合并阻塞性睡眠呼吸暂停低通气综合症患者血压季节性变化规律研究

Seasonal variation of blood pressure in patients with hypertension complicated with obstructive sleep apnea syndrome

目的:比较高血压合并阻塞性睡眠呼吸暂停低通气综合症(OSAS)患者及原发性高血压患者的动态血压季节变化,总结两组血压的季节性变化规律及差异。方法:研究采用回顾性研究的方法,入选高血压合并OSAS患者174例,并匹配原发性高血压患者348例。男性354例,女性168例,年龄(48.0±13.8)岁,分析冬季、夏季平均血压情况、血压晨峰现象等。结果:与原发性高血压患者相比,高血压合并OSAS患者的男性比例(78.2%vs. 62.6%,P<0.001)更高,BMI[(29.47±4.17)vs.(27.47±4.01)kg/m2,P<0.001]更大,使用的降压药种数(2.17 vs. 1.99,P<0.001)更多,冬季24 h平均收缩压[(134.9±17.4)vs.(131.9±12.6)mmHg,P=0.042]及冬季晨峰率(52.3%vs. 38.5%,P=0.034)更高。原发性高血压患者和高血压合并OSAS患者血压均呈现季节性变化。两组冬季24 h平均收缩压和舒张压均显著高于夏季;高血压合并OSAS患者冬季夜间收缩压[冬128.0±19.8)vs.(夏120.8±14.7)mmHg,P=0.007]和舒张压[(冬81.4±14.4)vs.(夏76.3±11.4)mmHg,P=0.010]也显著高于夏季,在原发性高血压患者中差异无统计学意义。高血压合并OSAS患者冬季晨峰出现比率显著高于夏季(52.3%vs. 30.7%,P=0.034),在原发性高血压患者中差异无统计学意义。多元线性回归分析显示性别、OSAS和季节(OR分别为0.6、1.3、1.7,P均<0.05)是影响晨峰的主要因素。结论:高血压病合并OSAS患者与原发性高血压患者24小时血压节律存在明确的季节性变化。不同于原发性高血压患者,高血压病合并OSAS患者夜间血压存在明显季节变异,在高血压病合并OSAS患者的治疗中应考虑季节性血压变化的规律,依据季节性血压变化规律进行药物调整,将有助于患者的血压达标。

Objective: To compare the difference of blood pressure between winter and summer in patients with hypertension complicated with OSAS, and to explore the seasonal variation of blood pressure in patients with hypertension complicated with OSAS. Methods: 174 patients with hypertension complicated with OSAS were enrolled retrospectively, and 348 patients with essential hypertension were enrolled. All patients, aged(48.0 ± 13.8)years, received 24-hour ambulatory blood pressure monitoring and sleep monitoring. The average blood pressure, morning surge blood pressure in winter and summer were analyzed. Results: Compared with patients with essential hypertension, the proportion of male patients with hypertension complicated with OSAS was higher(78.2% vs. 62.6%, P<0.001), BMI was higher [(2.947±4.17) vs.(27.47±4.01)kg/m2, P<0.001], the number of antihypertensive agents used was higher(2.17 vs. 1.99,P<0.001), and the mean winter 24-hour systolic blood pressure was higher[(134.9 ± 17.4)vs.(131.9 ± 12.6)mmHg, P=0.042] and the morning surge rate in winter(52.3% vs. 38.5%, P=0.034)were higher. The blood pressure of patients with essential hypertension and patients with hypertension complicated with OSAS showed seasonal changes. 24 h mean systolic blood pressure and diastolic blood pressure in winter were significantly higher than those in summer. Winter nocturnal systolic blood pressure in patients with hypertension complicated with OSAS [(winter 128.0 ± 19.8)vs.(Summer 120.8 ± 14.7)mmHg, P=0.007] and diastolic blood pressure [winter 81.4 ± 14.4)vs.(76.3 ± 11.4)mmHg in summer, P=0.010] was also significantly higher than that in summer, and there was no significant difference in patients with essential hypertension. The incidence of morning peak in patients with hypertension complicated with OSAS in winter was significantly higher than that in summer(52.3% vs. 30.7%, P=0.034), and there was no significant difference in patients with essential hypertension. Multiple linear regression analysis showed that gender, OSAS and season(OR=0.6;1.3;1.7, P<0.05) was the main factor affecting the morning peak. Conclusions: There were definite seasonal variations in 24-hour blood pressure rhythm between patients with hypertension complicated with OSAS and patients with essential hypertension. Different from patients with essential hypertension, nocturnal blood pressure of patients with hypertension complicated with OSAS showed significant seasonal variation. In the treatment of patients with hypertension complicated with OSAS, the pattern of seasonal blood pressure change should be considered. Drug adjustment according to the law of seasonal blood pressure change will help patients’ blood pressure reach the standard.