夜间高血压患者临床治疗特征及相关影响因素分析

Analysis of clinical treatment characteristics and related influencing factors in patients with nocturnal hypertension

目的探讨夜间高血压(nocturnal hypertension,NH)患者临床治疗特征及相关影响因素。方法采用横断面研究方法,收集2021年1月至2022年12月于湖南医药学院第一附属医院体检并经动态血压监测诊断为夜间高血压的患者829例,同时收集患者的一般人口学资料、生化检验指标、24h动态血压监测数据及基础疾病等临床资料。根据患者不同用药治疗情况,将夜间高血压患者分为单药组(n=294)、双药联合组(n=400)和多药联合组(n=135),单药组应用血管紧张素转换酶抑制剂(ACEI)/血管紧张素Ⅱ受体拮抗剂(ARB)或钙拮抗剂,双药联合组应用ACEI/ARB联合钙拮抗剂,多药联合组应用ACEI/ARB、钙拮抗剂、β受体阻滞剂和利尿剂中的任意三种或四种联合。对三组患者的临床资料进行比较并分析其影响因素。结果NH患者经不同组合降压药物治疗后,三组患者的夜间收缩压(NSBP)、夜间舒张压(NDBP)较治疗前显著下降,差异有统计学意义(P<0.001)。治疗后的NSBP和NDBP下降幅度双药联合组(21.75%,20.06%)显著大于单药组(17.60%,15.26%)及多药联合组(18.23%,16.51%),差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,吸烟(OR=2.142,P=0.016)、肥胖(OR=1.563,P=0.029)、睡眠差(OR=1.412,P=0.040)、脑卒中(OR=1.806,P=0.021)及冠心病(OR=3.017,P=0.000)均为影响夜间高血压的危险因素。结论经治疗后三组患者均有效降低夜间血压,但ACEI/ARB联合钙拮抗剂降低夜间血压效果更优。戒烟、减肥、控制心脑血管疾病及改善睡眠质量是降低夜间血压的重要手段。

Objective To observe the clinical treatment characteristics and related influencing factors of patients with nocturnal hypertension(NH).Methods A cross-sectional study was conducted to collect 829 patients diagnosed with NH through ambulatory blood pressure monitoring at the First Affiliated Hospital of Hunan University of Medicine from January 2021 to December 2022.General demographic data,biochemical test indicators,24-hour ambulatory blood pressure monitoring data and clinical data on underlying diseases were also collected.According to the different types of medication treatment for patients,NH patients were divided into a single-drug group(n=294),a dual-drug combination group(n=400),and a multi-drug combination group(n=135).Angiotensin converting enzyme inhibitor(ACEI)/angiotensinⅡreceptor antagonist(ARB)or calcium antagonist was used in the single-drug group.ACEI/ARB combined with calcium antagonistdual were used in the doubledrug group,and any three or four combinations of ACEI/ARB,calcium antagonists,β-blockers and diuretics were used in multi-drug combination group.Compare the clinical data of three groups of patients and analyze their influencing factors.Results After treatment with different combinations of antihypertensive drugs,the nighttime systolic blood pressure(NSBP)and nighttime diastolic blood pressure(NDBP)of NH patients in the single-drug group,dual-drug combination group,and multi-drug combination group were significantly different from before treatment(all P<0.001);The decrease of NSBP and NDBP in the dual-drug combination group(21.75%,20.06%)was significantly higher than that in the single-drug group(17.60%,15.26%)and the multi-drug combination group(18.23%,16.51%),(P<0.05);Multivariate logistic regression analysis showed that smoking(OR=2.142,P=0.016),obesity(OR=1.563,P=0.029),poor sleep(OR=1.412,P=0.040),stroke(OR=1.806,P=0.021)and concomitant coronary heart disease(OR=3.017,P=0.000)were independent risk factors of nocturnal blood pressure.Conclusion All three groups of patients can effectively reduce nighttime blood pressure,but the combination of ACEI/ARB and calcium antagonists have a better effect on reducing nighttime blood pressure.Quitting smoking,losing weight,controlling cardiovascular and cerebrovascular diseases and improving sleep quality are important means of reducing nighttime blood pressure.