硝苯地平控释片治疗轻、中度高血压患者清晨尿钠水平与血压达标状态的研究

Study on morning urine sodium concentration and blood pressure control in patients with mild and moderate hypertension treated by nifedipine controlled released tablet

目的分析清晨尿钠水平与经硝苯地平控释片治疗的轻、中度高血压患者诊室血压及动态血压达标状态的关系。方法在全国不同省份的8家医院中,从2015年10月至2018年6月顺序入选轻、中度高血压患者143例,经硝苯地平控释片治疗8周,检测患者入选时的基线清晨尿钠水平,按照清晨尿钠水平三分位数将患者均分为低尿钠组、中尿钠组及高尿钠组。采用多因素Logistic回归,分析清晨尿钠水平与治疗8周后患者的诊室血压及动态血压的达标情况的关系。结果共143例患者入选本研究,男性85例,女性58例,平均年龄(53.90±12.30)岁。清晨尿钠平均水平为184(120.00~392.00)mmol·L^(-1)。高尿钠组患者基线诊室收缩压/舒张压,基线24 h平均、日间平均、夜间平均收缩压/舒张压均显著高于其他2组患者(均P<0.05)。经过8周降压治疗后,高尿钠组患者的诊室收缩压/舒张压,24 h平均、日间平均、夜间平均收缩压/舒张压较基线下降率均显著高于其他2组患者;24 h平均血压、日间平均血压达标率均显著高于其他2组患者(均P<0.05)。多因素Logistic回归分析显示,清晨尿钠水平每升高10 mmol·L^(-1),诊室血压达标率增加12%,24 h平均血压、日间平均血压、夜间平均血压达标率分别增加14%、12%和5%(均P<0.05)。三分位数分组分析显示,与低尿钠组相比,中、高尿钠组诊室血压达标率增加3.53倍(OR:4.53,95%CI:1.04~19.75);中、高尿钠组24 h平均血压达标率增加4.56倍(OR:5.56,95%CI:2.06~15.01);中、高尿钠组日间平均血压达标率增加3.89倍(OR 4.89,95%CI:1.87~12.77);中、高尿钠组夜间平均血压达标率分别1.85倍(OR:2.85,95%CI:0.80~10.20)(P<0.05)。结论清晨尿钠水平与经硝苯地平控释片治疗的轻、中度高血压患者的诊室血压及动态血压达标率独立正相关,检测清晨尿钠水平有助于更好地评估硝苯地平控释片的治疗效果。

Objective To analyze the relationship between morning urine sodium concentration and office blood pressure and ambulatory blood pressure in patients with mild and moderate hypertension treated by nifedipine controlled released tablet.Methods We enrolled 143 patients with mild and moderate hypertension from 8 hospitals in different provinces of China from October 2015 to June 2018.They were treated by nifedipine controlled released tablet for 8 weeks.The baseline morning urine sodium concentration at the time of enrollment was measured.According to the triquantile of morning urine sodium concentration,the patients were divided into low level urine sodium group,medium level urine sodium group and high level urine sodium group.Logistic regression analysis was used to analyze the relationship between morning urine sodium concentration with office blood pressure and ambulatory blood pressure after 8 weeks.Results 143 patients were enrolled in this study,including 85 males and 58 females,with an average age of(53.90±12.30)years.The average level of urine sodium concentration was 184(120.00-392.00)mmol·L^(-1).The baseline systolic/diastolic office blood pressure,24 h average,day time average and night time average systolic/diastolic blood pressure in the group with high level urine sodium were significantly higher than those in the other two groups(all P<0.05).After 8 weeks of antihypertensive treatment,the decrease rates of systolic/diastolic office blood pressure,24 h average,day time average and night time average systolic/diastolic blood pressure in the group with high level urine sodium were significantly higher than those in the other two groups.The controlled rates of 24h average blood pressure and day time average blood pressure in the group with high level urine sodium were significantly higher than those in the other two groups(all P<0.05).Multivariate logistic regression analysis showed that every 10mmol·L^(-1)increase of morning urine sodium concentration was associated with 12%increase of the controlled rate of office room blood pressure.Every 10 mmol·L^(-1)increase of morning urine sodium concentration was associated with14%,12%and 5%increase of the controlled rates of 24 h average blood pressure,day time average blood pressure and night time average blood pressure respectively(all P<0.05).Compared with the group with low level urine sodium,the controlled rates of office room blood pressure in the medium and high level urine sodium groups increased by 3.53 times(OR:4.53,95%CI:1.04-19.75);the 24 hour average blood pressure controlled rates in the medium and high level urine sodium groups increased by 4.56 times(OR:5.56,95%CI:2.06-15.01);the average day time blood pressure controlled rates in the medium and high level urine sodium groups increased by 3.89 times(OR:4.89,95%CI:1.87-12.77);the average night time blood pressure controlled rates in the medium and high level urine sodium groups increased by 1.85 times(OR:2.85,95%CI:0.80-10.20)(P<0.05).Conclusion The morning urine sodium concentration is significantly correlated with the controlled rates of office room blood pressure and ambulatory blood pressure in patients with mild and moderate hypertension treated with nifedipine controlled released tablet.The testing for morning urine sodium concentration is helpful to evaluate the effect of nifedipine controlled released tablet.