徐州市12~17岁青少年高血压患者的血压变异性研究

Study on Blood Pressure Variability in Adolescents with Hypertension from 12 to 17 Years Old in Xuzhou City

目的了解徐州市12~17岁青少年高血压患者血压波动的特征。方法 2018年10月至11月,采用整群随机抽样调查纳入徐州市12~17岁青少年高血压患者697例(男性451例,女性246例),进行24 h动态血压监测(24hABPM),获取血压变异系数(CV)、晨峰血压以及血压昼夜节律等数据。结果青少年高血压患者白天收缩压变异系数(SBPCV)大于及夜间(P<0.05)。与非晨峰高血压组比较,晨峰高血压组的白天心率[(81.7±9.0)次/min比(80.1±7.7)次/min]更快;24 h收缩压变异系数(24hSBPCV)[12.1%(10.7%~13.6%)比10.7%(9.3%~12.27%)]、24 h舒张压变异系数(24hDBPCV)[19.5%(16.2%~21.5%)比17.2%(14.9%~20.4%)]、夜间收缩压变异系数(nSBPCV)[10.5%(8.7%~12.8%)比8.2%(6.3%~10.8%)]、夜间舒张压变异系数(nDBPCV)[16.1%(12.9%~20.1%)比14.4%(11.2%~18.2%)]更大,差异有统计学意义(P<0.01)。血压昼夜节律呈勺型者最多(349例,50.1%),其次为非勺型(292例,41.9%),反勺型(34例,4.9%)和超勺型(22例,3.2%)较少。多元线性回归分析结果显示,年龄(B=-0.186、-0.178)和肥胖(B=0.532、0.736;均P<0.05)是24hSBPCV和白天SBPCV的影响因素;年龄(B=0.314、0.451;P<0.05)是夜间SBPCV和夜间DBPCV的影响因素;性别(B=-0.786、-0.945)、年龄(B=-0.697、-0.534)及肥胖(B=1.213、1.729;均P<0.05)是24hDBPCV和白天DBPCV的影响因素。结论晨峰高血压者的白天心率更快。青少年高血压的昼夜节律以勺型、非勺型为主。年龄、性别、肥胖为青少年血压变异系数的影响因素。

Objective To investigate the characteristics of blood pressure fluctuations in adolescents with hypertension aged 12~17 years in Xuzhou. Methods From October to November 2018, 697 adolescent hypertensive patients aged 12-17 years in Xuzhou were selected for 24-hour ambulatory blood pressure monitoring(24 hABPM) to obtain blood pressure coefficient of variation(CV), morning peak blood pressure, and blood pressure circadian rhythm. Results Among 697 adolescents with hypertension, there were 451 males and 246 females. The coefficient of variation of systolic blood pressure(SBPV) in adolescents with hypertension during the day was greater than that at night(P<0.05). Compared with the non-morning peak hypertension group, the daytime heart rate of the morning peak hypertension group [(81.7±9.0) beats/min vs.(80.1±7.7) beats/min] was faster and the difference was statistically significant(P<0.05);the coefficient of variation of 24 h systolic blood pressure(24 hSBPCV) [12.1%(10.7%~13.6%) was greater 10.7%(9.3%~12.27%)] and so was the coefficient of variation of 24 h diastolic blood pressure(24 hDBPCV) [19.5%(16.2%~21.5%) vs 17.2%(14.9%~20.4%)] and the difference was statistical Significance(P<0.01);nocturnal systolic blood pressure variation coefficient(nSBPCV)was greater [10.5%(8.7%-12.8%) vs. 8.2%(6.3%-10.8%)] and night diastolic blood pressure variation coefficient(nDBPCV) [16.1%( 12.9%~20.1%) was larger than 14.4%(11.2%~18.2%)] and the difference was statistically significant(P<0.01). In term of the circadian rhythm of blood pressure, dipper type was most(349 cases, 50.1%),followed by non-dipper type(292 cases, 41.9%), reverse dipper type(34 cases, 4.9%) and super-dipper type( 22 cases, 3.2%). The results of multiple linear regression analysis showed that age(B=-0.186,-0.178) and obesity(B=0.532, 0.736;both P<0.05) were the influencing factors of 24 hSBPCV and daytime SBPCV;age(B=0.314, 0.451;P<0.05) was the influencing factor of night SBPCV and night DBPCV;gender(B=-0.786,-0.945), age(B=-0.697,-0.534) and obesity(B=1.213, 1.729;both P<0.05) were the influencing factors of 24 DBPCV and DBPCV during the day. Conclusion People with morning peak hypertension have a faster daytime heart rate. The circadian rhythm of adolescent hypertension is mainly dipper type and non-dipper type. Age, gender and obesity are all the influencing factors of the coefficient of variation of blood pressure in adolescents.