中老年高血压合并2型糖尿病患者空腹血糖对血压昼夜节律的影响

Effect of fasting blood glucose on circadian rhythm of blood pressure in middle-aged and elderly patients with hypertension and type 2 diabetes

目的探讨空腹血糖水平对合并2型糖尿病的中老年高血压患者血压昼夜节律的影响。方法选取2017年1月—2019年10月首都医科大学宣武医院综合科原发性高血压住院患者311例,根据有无2型糖尿病分为对照组(n=151)及观察组(n=160),比较2组血糖、血脂水平,进行24 h动态血压监测,分析空腹血糖对血压昼夜节律的影响。结果观察组空腹血糖(FPG)、糖化血红蛋白(HbA1c)高于对照组,24小时收缩压(24 h SBP)、日间收缩压(DSBP)、夜间收缩压(NSBP)高于对照组,NSBP下降率低于对照组(t/P=82.908/0.000、4.921/0.027、9.633/0.002、7.392/0.007、12.583/0.000、6.682/0.010),2组的昼夜节律构成比例不同,差异有统计学意义(χ2/P=6.765/0.034)。在杓型组、非杓型组及反杓型组中,空腹血糖水平及糖尿病比例逐渐升高(t/P=6.904/0.001,χ2/P=6.765/0.034)。Logistic回归分析发现,空腹血糖水平升高是昼夜节律异常的危险因素[OR(95%CI)=1.157(1.016~1.318),P=0.028]。结论合并2型糖尿病中老年高血压患者发生血压昼夜节律异常的风险高于未合并2型糖尿病患者,空腹血糖水平升高是其发生血压昼夜节律异常的危险因素。

Objective To explore the effect of fasting blood glucose level on the circadian rhythm of blood pressure in middle-aged and elderly hypertensive patients with type 2 diabetes.Methods Selected from January 2017 to October 2019,311 patients with primary hypertension in the General Department of Xuanwu Hospital,Capital Medical University.According to the presence or absence of type 2 diabetes,they were divided into control group(n=151)and observation group(n=160).Compare the levels of blood glucose and blood lipids in the two groups,conduct 24-hour ambulatory blood pressure monitoring,and analyze the effect of fasting blood glucose on the circadian rhythm of blood pressure.Results The fasting blood glucose(FPG)and glycosylated hemoglobin(HbA1c)of the observation group were higher than those of the control group.The 24-h SBP,daytime systolic blood pressure(DSBP)and night systolic blood pressure(NSBP)were higher than those of the control group,and the night systolic blood pressure decrease rate was lower than that of the control group.The ratio of the circadian rhythm of the two groups is different,the difference is statistically significant(t/P=82.908/0.000,4.921/0.027,9.633/0.002,7.392/0.007,12.583/0.000,6.682/0.010,χ2/P=6.765/0.034).In the dipper group,non-dipper group and anti-dipper group,the fasting blood glucose level and the proportion of diabetes gradually increased(t/P=6.904/0.001,χ2/P=6.765/0.034).Logistic regression analysis found that elevated fasting blood glucose level is a risk factor for abnormal circadian rhythm[OR(95%CI=1.157(1.016 to 1.318),P=0.028)].Conclusion Middle-aged and elderly hypertensive patients with type 2 diabetes have a higher risk of abnormal blood pressure circadian rhythms than those without type 2 diabetes.Elevated fasting blood glucose levels are a risk factor for abnormal blood pressure circadian rhythms.