隐匿性高血压人群血压昼夜节律特点及与十二时辰关系的横断面研究

Circadian Rhythm of Blood Pressure in Patients with Masked Hypertension and its Relationship with Twelve Two-hour Periods: A Cross-sectional Study

目的 探讨隐匿性高血压人群血压昼夜节律特点及其与十二时辰的关系,为隐匿性高血压的早期发现与干预提供依据。方法 纳入2022年1—12月于江苏省中医院动态血压室行24 h动态血压检查的受试者,根据其门诊血压测量值、24 h动态血压监测及随访调查结果,选择理想血压、隐匿性高血压人群及原发性高血压病患者,分别作为理想血压组、隐匿性高血压组、原发性高血压组,每组50例。收集各组受试者一般资料、诊室血压及24 h动态血压监测数据。比较各组受试者一般情况及血压昼夜节律[包括24 h平均收缩压(24h SBP)、白昼平均收缩压(d SBP)、夜间平均收缩压(n SBP)、24 h平均舒张压(24h DBP)、白昼平均舒张压(d DBP)、夜间平均舒张压(n DBP)],计算夜间血压下降率,根据夜间血压下降率判定昼夜节律分型。比较各组受试者血压变异性[包括24 h收缩压标准差(24h SBP-SD)、白昼收缩压标准差(d SBP-SD)、夜间收缩压标准差(n SBP-SD)、24 h舒张压标准差(24h DBP-SD)、白昼舒张压标准差(d DBP-SD)、夜间舒张压标准差(n DBP-SD)],并计算24 h收缩压变异系数(24h SBP-CV)、白昼收缩压变异系数(d SBP-CV)、夜间收缩压变异系数(n SBP-CV)、24 h舒张压变异系数(24h DBP-CV)、白昼舒张压变异系数(d DBP-CV)、夜间舒张压变异系数(n DBP-CV)。根据24h动态血压监测结果,计算并比较各组受试者十二时辰平均收缩压及舒张压。同时将原发性高血压病患者分为1、2、3级进一步分层比较。结果 隐匿性高血压组年龄显著高于原发性高血压组和理想血压组(P<0.01)。隐匿性高血压组、原发性高血压组患者体重指数(BMI)、吸烟及饮酒比例均高于理想血压组(P<0.05或P<0.01)。理想血压组杓型血压者49例(98.0%),非杓型血压者1例(2.0%);隐匿性高血压组杓型血压者2例(4.0%)、非杓型血压29例(58.0%)、反杓型血压19例(38.0%);原发性高血压组杓型血压者20例(40.0%)、非杓型血压23例(46.0%)、反杓型血压7例(14.0%)。与理想血压组比较,隐匿性高血压组、原发性高血压组杓型血压比例降低,非杓型及反杓型血压比例升高(P<0.01);与隐匿性高血压组比较,原发性高血压组杓型血压比例升高,反杓型血压比例降低(P<0.01)。与理想血压组比较,隐匿性高血压组n SBP、n DBP升高,子时、丑时、寅时、卯时平均SBP、平均DBP及亥时平均SBP升高,巳时平均DBP降低(P<0.01);原发性高血压组患者24h SBP、24h DBP、d SBP、d DBP、n SBP、n DBP、d SBP-SD、n SBP-SD、n DBP-SD升高,十二时辰平均SBP、平均DBP均升高,24h SBP-CV、24h DBP-CV、d DBP-CV降低(P<0.05或P<0.01)。与隐匿性高血压组比较,原发性高血压组24h SBP、24h DBP、d SBP、d DBP、n SBP、n DBP、24h DBP-SD、n DBP-SD升高,十二时辰平均SBP、平均DBP均升高,d DBP-CV降低(P<0.05或P<0.01)。原发性高血压组包括高血压病1级患者18例(36.0%),2级患者19例(38.0%),3级患者13例(26.0%),各级原发性高血压患者之间以上各指标比较差异无统计学意义(P>0.05)。结论 隐匿性高血压人群血压昼夜节律多呈非杓型及反杓型,且以子时、丑时、寅时及卯时血压异常升高为主。

Objective To explore the characteristics of circadian rhythm of blood pressure in patients with masked hypertension(MH)and its relationship with twelve two-hour peirods,providing a basis for early detection and intervention of MH.Methods Patients who underwent 24-hour ambulatory blood pressure examination in the ambulatory blood pressure room of Jiangsu Province Hospital of Chinese Medicine from January to December 2022 were enrolled,and according to their outpatient blood pressure measurements,24-hour ambulatory blood pressure monitoring and follow-up survey results,the MH,essential hypertension(EH)and normal blood pressure groups were classified,with 50 cases in each group.The general data,office blood pressure and 24-hour ambulatory blood pressure monitoring data were collected.The circadian rhythm of blood pressure including 24-hour average systolic blood pressure(24h SBP),daytime average systolic blood pressure(d SBP),nighttime average systolic blood pressure(n SBP),24-hour average diastolic blood pressure(24h DBP),daytime average diastolic blood pressure(d DBP),and nighttime average diastolic blood pressure(n DBP)were compared among the groups,and the nighttime blood pressure dipping percentage was calculated.The type of circadian rhythm was determined based on the nighttime blood pressure dipping percentage.The variability of blood pressure including 24h SBP standard deviation(24h SBP-SD),d SBP standard deviation(dSBP-SD),n SBP standard deviation(nSBP-SD),24h DBP standard deviation(24h DBP-SD),d DBP standard deviation(dDBP-SD),and n DBP standard deviation(nDBP-SD)were compared among groups,and the corresponding coefficient of variation(CV),that is,24h SBP-CV,d SBP-CV,n SBP-CV,24h DBP-CV,d DBP-CV and n DBP-CV,were calculated.Based on the 24-hour ambulatory blood pressure monitoring results,the twelve two-hour average SBP and DBP in each group were calculated and compared.Simultaneously,patients with EH were divided into grades 1,2,and 3 for further stratified analysis.Results The age of the MH group was significantly higher than that of the EH group and the normal blood pressure group(P<0.01).The body mass index(BMI)and the proportion of smoking and alcohol consumption in the MH group and the EH group were significantly higher than those in the normal blood pressure group(P<0.05 or P<0.01).In the normal blood pressure group,there were 49 dipper patterns(98.0%)and one non-dipper pattern(2.0%);in the MH group,there were two dipper patterns(4.0%),29 non-dipper patterns(58.0%)and 19 reverse-dipper patterns(38.0%);in the EH group,there were 20 dipper patterns(40.0%),23 non-dipper patterns(46.0%)and seven reverse-dipper patterns(14.0%).Compared to the normal blood pressure group,the groups of MH and EH had significantly decreased proportion of dipper pattern and increased proportion of non-dipper and reverse-dipper pattern(P<0.01);the proportion of dipper pattern in the MH group was lower than that in the EH group,while the proportion of reverse-dipper pattern was higher(P<0.01).Compared to those in the normal blood pressure group,n SBP and n DBP in the MH group,as well as the the average SBP and average DBP at Zi hour(子时,23:00-1:00),Chou hour(丑时,1:00-3:00),Yin hour(寅时,3:00-5:00),Mao hour(卯时,5:00-7:00)and average SBP at Hai hour(亥时,21:00-23:00)in the MH group increased,while the average DBP at Si hour(巳时,9:00-11:00)decreased(P<0.01);24h SBP,24h DBP,d SBP,d DBP,n SBP,and n DBP,d SBP-SD,n SBP-SD,n DBP-SD increased,as well as the average SBP and average DBP at twelve two-hour periods increased in the EH group,while the 24h SBP-CV,24h DBP-CV,and d DBP-CV in the EH group decreased(P<0.05 or P<0.01).The EH group had higher 24h SBP,24h DBP,d SBP,d DBP,n SBP,n DBP,24h DBP-SD and n DBP-SD,as well as higher average SBP and DBP at all twelve two-hour periods,and lower d DBP-CV than the MH group(P<0.05 or P<0.01).The EH group had 18 cases of grade 1(36.0%),19 cases of grade 2(38.0%)and 13 cases of grade 3(26.0%),with no significant differences among groups(P>0.05).Conclusion The circadian rhythm of blood pressure in MH patients are mostly non-dipper and reverse-dipper patterns,and the abnormal elevation of blood pressure is obvious at Zi hour,Chou hour,Yin hour and Mao hour(23:00-7:00).