Changes in Plasma Angiotensin II and Circadian Rhythm of Blood Pressure in Hypertensive Patients with Sleep Apnea Syndrome Before and After Treatment

Objective To explore the changes in plasma angiotensin II （Ang Ⅱ） and circadian rhythm of blood pressure among hypertensive patients with sleep apnea syndrome （SAS） before and after continuous positive airway pressure （CPAP） or surgical treatment. Methods A total of 180 essential hypertension patients were enrolled in our study. The determination of plasma Ang Ⅱ concentration, ambulatory blood pressure （ABP）, and polysomnography （PSG） monitoring were performed before and 3 months after CPAP or surgical treatment. Results Patients were classified into three groups by their apnea-hypopnea index （AHI）： essential hypertension group （EH group, n=72; AHI〈5）, essential hypertension with mild SAS group （EH＋mild SAS group, n=60, 5≤AHI〈20）, and essential hypertension with moderate and severe SAS group （EH＋moderate-severe SAS group, n=48, AHI_〉20）. The concentrations of plasma AngⅡ in the above three groups were 13.42±3.27, 16.17±3.82, and 18.73±4.05 ng/mL respectively before treatment, and AngⅡ concentration in EH patients combined with SAS was significantly higher than that in EH group （all P〈0.05）. After treatment the values in the latter two groups significantly decreased to 14.67±2.56 and 15.03±3.41 ng/mL respectively （P〈0.05）. The incidence of non-dipper blood pressure curve in EH patients was 31.9%, and those in hypertensive patients with mild SAS and moderate-severe SAS were 51.7% and 58.3%, respectively before treatment. The incidence of non-dipper blood pressure curve in the EH patients with mild SAS was significantly higher than that of patients with EH alone （P〈0.05）. After CPAP treatment or surgery, the incidence of non-dipper blood pressure curve in the two SAS groups was significantly decreased to 38.3% and 39.6%, respectively （P〈0.05）. Conclusions Ang Ⅱ might play a role in blood pressure variability in patients with obstructive SAS. CPAP or surgical treatment can improve blood pressure disorder and decrease plasma Ang Ⅱ level in patients with obstructive SAS.

The Relationship between Abnormal Circadian Blood Pressure Rhythm and Risk of Readmission in Patients with Heart Failure with Preserved Ejection Fraction

Objective:Abnormal circadian blood pressure rhythm has been revealed to be associated with hypertensive target organ damage and cardiovascular events,but its association with readmission risk in patients with heart failure with preserved ejection fraction(HFpEF)remains unknown.We conducted a retrospective study to explore the relationship between circadian blood pressure rhythm and readmission risk in HFpEF patients.Methods:We retrospectively collected baseline and follow-up data on HFpEF patients who underwent ambulatory blood pressure monitoring(ABPM)from May 2015 to October 2019.Patient circadian blood pressure rhythms defi ned by ABPM were grouped as dipper,nondipper,or riser patterns.Univariate and multivariate linear regression analyses were performed to assess the association between circadian blood pressure rhythm and readmission risk.Results:A total of 122 patients were enrolled in this study.The mean age and ejection fraction were 69.87 years and 61.44%,respectively,with mean the N-terminal pro-B-type natriuretic peptide(NT-proBNP)level being 1048.15 pg/mL.There were signifi cant differences in the 24-hour systolic blood pressure(SBP),sleep SBP,and sleep diastolic blood pressure(DBP)among the three groups,where the 24-hour SBP,sleep SBP,and sleep DBP in the riser pattern group were markedly higher than in the dipper pattern group.Notably,serum NT-proBNP levels,the proportion of patients readmitted for heart failure and the mean number of admissions differed markedly among three groups.Instructively,multivariate linear regression analysis showed that the riser pattern was a signifi cant and independent risk factor for increased serum NT-proBNP level(β=929.16,95%confi dence interval 178.79–1679.53,P=0.016).In multivariate logistic regression analysis,the riser pattern was demonstrated to be a signifi cant risk factor for readmission(odds ratio 11.23,95%confi dence interval 2.01–62.67,P=0.006)in HFpEF patients.Conclusion:The riser blood pressure pattern is a potential risk factor for elevated serum NT-proBNP level and readmission in HFpEF patients.

老年高血压患者动态血压特点及其影响因素

目的观察老年高血压患者动态血压的特点,探讨老年高血压患者血压昼夜节律的影响因素。方法回顾性分析2021年1月至6月山西白求恩医院高血压门诊收治的符合条件的296例老年高血压患者(年龄≥60岁)的临床资料。根据血压昼夜节律将患者分为杓型组(56例)、非杓型组(134例)和反杓型组(106例)。收集患者一般资料,完善24 h动态血压监测、动脉硬化监测、24 h尿电解质及24 h尿微量白蛋白检测。采用SPSS 26.0统计软件进行数据分析。根据数据类型,分别采用单因素方差分析、Kruskal-Wallis H检验或χ^(2)检验进行组间比较。采用二分类logistic回归分析血压昼夜节律的影响因素。结果血压昼夜节律异常(非杓型组和反杓型血压组)患者比例明显高于血压节律正常(杓型组)患者比例(81.1%和18.9%);杓型组患者年龄低于非杓型组和反杓型组[68.00(65.00,70.00)和70.00(68.00,73.00),71.00(69.00,74.00)岁];杓型组吸烟比例明显低于非杓型组和反杓型组(7.1%和39.6%,47.2%),差异均有统计学意义(P<0.05)。杓型组、非杓型组和反杓型组夜间血压下降率依次递减[12.40%(10.70%,14.78%)、3.70%(1.58%,5.83%)和-4.50%(-8.00%,-2.30%)],差异有统计学意义(P<0.05)。反杓型组右肱-踝脉搏波传导速度(baPWV)高于非杓型组、杓型组[(1851.57±215.87)和(1747.81±244.65),(1687.00±201.61)cm/s];反杓型组左baPWV高于非杓型组、杓型组[(1869.13±232.15)和(1758.57±259.18),(1692.25±205.34)cm/s],差异均有统计学意义(P<0.05)。反杓型组24 h尿钠低于杓型组[83.00(59.00,114.75)和102.50(84.00,126.75)mmol/24 h];24 h尿微量白蛋白高于杓型组[48.25(36.33,61.64)和41.09(32.00,48.94)mg/24 h],差异均有统计学意义(P<0.05)。二分类logistic回归分析结果显示,年龄(OR=1.328,95%CI 1.178~1.496;P<0.001)和吸烟史(OR=14.953,95%CI 4.706~47.511;P<0.001)是老年高血压患者血压昼夜节律的独立危险因素;24 h尿钠(OR=0.988,95%CI 0.979~0.998;P=0.021)是老年高血压患者血压昼夜节律的独立保护因素。结论老年高血压患者血压昼夜节律异常发生率明显增高;年龄、吸烟史是老年高血压患者血压昼夜节律的独立危险因素,24 h尿钠是老年高血压患者血压昼夜节律的独立保护因素。

Effect of Chinese Herbal Medicine for Calming Gan(肝) and Suppressing Hyperactive Yang on Arterial Elasticity Function and Circadian Rhythm of Blood Pressure in Patients with Essential Hypertension

Objective：To observe the effect of Chinese herbal medicine for calming Gan（肝） and suppressing hyperactive yang（平肝潜阳,CGSHY） on arterial elasticity function and the circadian rhythm of blood pressure in patients with essential hypertension（EH）.Methods：Adopting a parallel,randomized design,sixty-four patients with EH of stagesⅠandⅡwere randomly divided into two groups according to a random number table,with 32 in each group.The patients in the treatment group were treated with CGSHY and those in the control group were treated with Enalapril.All patients were given 24-h ambulatory blood pressure monitoring（ABPM） before and after a 12-week treatment.Trough/peak（T/P） ratios of systolic and diastolic blood pressure（SBP DBP） of each group were calculated.The circadian rhythm of their blood pressure was observed at the same time. The changes in elasticity of the carotid artery in the patients,including stiffness parameter（β）,pressure-strain elastic modulus（Ep）,arterial compliance（AC）,augmentation index（Al）,and pulse wave velocity（PVWβ） were determined by the echo-tracking technique before and after a 12-week treatment.In the meantime,their levels of nitric oxide（NO） and endothelin-1（ET-1） were measured respectively.Results：After treatment,all parameters in the 24-h ABPM and the elasticity of the carotid artery（β,Ep,AC and PVWβ） were markedly improved,the level of NO was increased,and ET-1 was decreased in both groups as compared with values before treatment （P0.05 or P0.01）.Further,the improvements in the ratio of T/P of SBP DBP and in the level of NO and ET-1 in the treatment group were more significant than those in the control group（P0.05）.There were no significant differences in all parameters in the ABPM monitoring and the elasticity of the carotid artery,the recovery of blood pressure circadian rhythm,and the therapeutic effect of antihypertension in EH patients between the two groups （P0.05）.Conclusions：Chinese herbal medicine for CGSHY may lower the blood pressure smoothly and recover the circadian rhythm of blood pressure in EH patients.They may also improve the carotid elasticity of EH patients similar to that of Enalapril.The mechanism of action of Chinese herbs on EH might be related to the regulation of vascular endothelium function.

The circadian rhythm of blood pressure and the effect of salt intake in salt sensitive subjects

OBJECTIVE: To investigate the effect of salt intake on the circadian rhythm of blood pressure and the characteristics of ambulatory blood pressure (ABP) in salt-sensitive (SS) subjects. METHODS: Twenty-three normotensive subjects and forty-three patients with essential hypertension were included in this study. Salt sensitivity was determined with a chronic dietary salt loading test and an acute venous saline loading test, respectively. 24-hour ABP measurements were performed twice in normotensive subjects when they were on a high salt diet and when they had a low salt diet. Blood and urine samples were collected for measurement of plasma norepinephrine concentration (PNE), plasma renin activity (PRA), angiotensin II, aldosterone, erythrocyte sodium content and urinary sodium excretion. 24-hour ABP readings were also obtained in patients with essential hypertension when antihypertensive drugs were discontinued for at least 2 weeks. RESULTS: High salt intake attenuated the circadian rhythm of blood pressure in SS normotensive subjects, and the nocturnal decline in blood pressure was smaller in SS patients with essential hypertension than in salt-resistant (SR) patients. The level of PNE was higher and the suppression of PRA was smaller in SS subjects than in SR subjects when they had a high salt diet, and the urinary sodium excretion decreased and the erythrocyte sodium content increased significantly in SS subjects on high salt intake. CONCLUSIONS: High salt intake caused an abnormal circadian rhythm of blood pressure in SS subjects. The blunted nocturnal decline in blood pressure may be a characteristics of SS patients with essential hypertension.

Effects of plasma ghrelin, obestatin, and ghrelin/obestatin ratio on blood pressure circadian rhythms in patients with obstructive sleep apnea syndrome

Background Obstructive sleep apnea syndrome （OSAS） is strongly associated with obesity and with cardiovascular disease.Ghrelin and obestatin are two peptides from the same source but have opposite roles.Both of them can affect feeding and regulate vascular tune.The aim of this study was to investigate the relationship between plasma ghrelin,obestatin,the ratio of ghrelin and obestatin （G/O） and sleep parameters and blood pressure circadian rhythms in patients with OSAS.Methods This study enrolled 95 newly diagnosed over-weight OSAS patients （OSAS group）,30 body mass index （BMI）-match non-OSAS adults （over-weight group） and 30 non-OSAS normal weight adults （control group）.Polysomnography （PSG） was performed in the OSAS group and over-weight group.Blood pressure of all subjects was monitored by means of 24-hour ambulatory blood pressure monitoring.The concentration of plasma ghrelin and obestatin was detected by enzyme-linked immunosorbent assay （ELISA）.Results Plasma ghrelin levels in the OSAS group and over-weight group were significantly lower than that of the control group （P ＜0.05）.Plasma obestatin levels were lower in the over-weight group and OSAS group,but there was no significant difference among the three groups.The blood pressure in OSAS patients was higher,and there was a significant difference in all blood pressure parameters compared to the control group,and in the daytime average diastolic blood pressure （DBP）,nocturnal average systolic blood pressure （SBP） and DBP,DBP variability values as compared to over-weight subjects.Furthermore,there were significantly more non-dipper patterns of blood pressure （including hypertension and normotension） in the OSAS group than in the other two groups （P ＜0.01）.Correlation analysis showed that ghrelin levels had a significant correlation with BMI and nocturnal average DBP but not with PSG parameters.In contrast,the G/O ratio had a negative correlation with apnea-hypopnea index （AHI） （P ＜0.05）,as well as a strong positive correlation with the blood pressure variability values （P ＜0.01）.In multivariate analyses,AHI （P ＜0.05） and G/O （P ＜0.05）were independently related to SBP variability changes,while AHI （P ＜0.05）,G/O （P ＜0.01） and BMI （P ＜0.05） were independently related to DBP variability changes.Conclusions Our data show plasma ghrelin and obestatin levels were related to obesity in OSAS.Sleep apnea in OSAS patients could have led to an imbalance in G/O in the basis of obesity.Moreover,the imbalance may promote nighttime blood pressure elevation and affect blood pressure circadian disorder.

大学生中医体质与血压昼夜节律的相关性分析

目的调查长沙市某高校大学生中医体质分布特点,探讨中医体质与大学生血压昼夜节律的相关性。方法采用方便抽样方法,于2023年10月—2024年4月在长沙市某高校开展现况调查,对437名研究对象进行问卷调查、体格检查及动态血压监测。通过《中医体质调查量表》对研究对象进行中医体质判定,通过Pearson相关分析、Spearman相关分析和二元logistic分析中医体质与大学生动态血压及其昼夜节律的相关性。结果不同体质研究对象的身体质量指数(BMI)、24 h收缩压(SBP)、昼间SBP的差异有统计学意义(P<0.05)。其中24 h SBP正常高值有13人,异常13人,占总人数的5.9%;24 h舒张压(DBP)正常高值20人,异常7人,占总人数的6.2%;SBP昼夜节律呈非杓型183人,占总人数的41.9%;DBP昼夜节律呈非杓型88人,占总人数的20.1%。研究对象中,125例为平和质(28.6%),312例为偏颇体质(71.4%)。相关性分析表明,部分中医体质得分(如阳虚质、血瘀质、气虚质得分)与动态血压部分指标(24 h SBP、昼间SBP、夜间SBP等)存在显著相关性(P<0.05),但相关性均较弱。二元logistic回归分析结果显示:相对于平和质,阳虚质是个体出现非杓型SBP的危险因素(OR=1.977,95%CI:1.083~3.610,P=0.027),阴虚质是个体出现非杓型DBP的保护因素(OR=0.350,95%CI:0.135~0.950,P=0.030)。结论长沙市某高校大学生群体血压昼夜节律异常情况较为严重;相对于平和质,阳虚质是SBP昼夜节律异常的危险因素,阴虚质是DBP昼夜节律异常的保护因素。

基于子午流注理论探讨冠心病时间节律机制及中医药干预策略

冠心病是指冠状动脉粥样硬化导致心肌缺血、缺氧而引起的心脏病,以胸痛、心悸、呼吸困难为主要症状。时间节律是生物体的各种生理机能适应外界环境的昼夜变化而建立起的规律周期,是人类生物钟的重要机制,影响各类疾病。冠心病发病时间节律明显,时间节律振荡机制通过血压、褪黑素、血管内皮炎症因子、时间节律蛋白等来调控冠心病的发展。子午流注理论以中医时间医学理论为基础,以不同时辰经脉气血盛衰,调节人体脏腑气血开阖。子午流注理论干预冠心病发生与现代医学中的时间节律机制有着相似之处,本文主要以子午流注为切入点探究冠心病的时间节律机制,并从子午流注角度综述中医药干预冠心病时间节律的研究进展,为中医药治疗冠心病提供新思路。

血压节律和血压变异性对脑小血管病的影响

当今社会随着人们生活水平的提高和人口老龄化进程加快,脑小血管病已严重危害中老年人的生命健康和生活质量。高血压作为脑小血管病的重要危险因素越来越受到重视。然而,目前在高血压管理中,人们普遍关注血压水平的影响,往往忽视了血压变异性和血压节律的作用。本文阐述了脑小血管病的发病机制以及近年来关于血压变异性和血压节律的研究进展,并指出了深入研究血压变异性和血压节律对脑小血管病发生发展的影响等系列科学问题。

血压节律与水平和左心室舒张功能的相关性分析

目的 探讨原发性高血压患者的血压昼夜节律、不同血压水平与左室舒张功能之间的关系。方法 纳入解放军总医院第一医学中心心内科2022年1月~2023年4月收治的678例原发性高血压住院患者,所有患者均接受动态血压监测(ambulatory blood pressure monitoring, ABPM)和超声心动图检查。根据血压昼夜节律分为杓型血压组(n=46)、非杓型组(n=451)、反杓型组(n=181)。采用左房容积指数(left atrial volume index, LAVI)、二尖瓣口舒张早期血流峰值速度/二尖瓣环处侧壁和间隔舒张早期速度的平均值(E/e′)、二尖瓣环处侧壁和间隔舒张早期速度的平均值(e′)评估3组患者左室舒张功能。采用方差分析和多元线性回归分析诊室血压、24 h收缩压平均值(24 h-mSBP)、24 h舒张压平均值(24 h-mDBP)、日间收缩压平均值(D-mSBP)、日间舒张压平均值(D-mDBP)、夜间收缩压平均值(N-mSBP)、夜间舒张压平均值(N-mDBP)、24 h收缩压变异性(24-SBPV)、24 h舒张压变异性(24-DBPV)、日间收缩压变异性(D-SBPV),日间舒张压变异性(D-DBPV),夜间收缩压变异性(N-SBPV),夜间舒张压变异性(N-DBPV)与左室舒张功能之间的关系。结果 反杓型血压组的LAVI明显高于杓型血压组,差异有统计学意义(P<0.05)。多元线性回归的结果显示,24 h-SBP、D-mSBP和N-mSBP与LAVI独立相关(B=0.06,P<0.05);24 h-mSBP、D-mSBP、N-mSBP、诊室收缩压、24-SBPV、24-DBPV、D-SBPV和D-DBPV与E/e′独立相关(B=0.03、0.03、0.02、0.01、0.09、0.10、0.05、0.07,P<0.05);24 h-mSBP、24 h-mDBP、N-mDBP和诊室舒张压与e′独立相关(B=-0.01、-0.02、-0.02、-0.01,P<0.05)。结论 反杓型血压节律和收缩压平均值(mSBP)与左房扩大相关。mSBP及诊室收缩压均与左室舒张功能相关,且mSBP与左室舒张功能的相关性强于诊室血压。ABPM可用于早期识别高血压患者中左房扩大和左心室舒张功能障碍的高风险人群。

不同血压昼夜节律冠心病患者血清Irisin和Nrg4水平及与冠状动脉病变程度的相关性

目的 探讨血清Irisin和Nrg4在不同血压昼夜节律冠心病患者中的分布及与冠状动脉病变严重程度的相关性。方法 选择2020年3月至2023年3月就诊的冠心病患者265例,依据血压昼夜节律分为A组64例,B组123例,C组78例。通过倾向性评分匹配(propensity score matching,PSM)法按照1∶1匹配后每组58例,探讨血清Irisin和Nrg4在不同血压昼夜节律冠心病患者中的分布,多元线性回归分析血清Irisin和Nrg4与冠心病患者血压昼夜节律的关系。根据冠状动脉病变严重程度将患者分为轻度组(n=65),中度组(n=59)和重度组(n=50),Logistic回归分析血清Irisin和Nrg4与子痫前期和冠状动脉病变严重程度的关系,分析二者的交互作用。结果 不同血压昼夜节律冠心病患者在平均收缩压、糖尿病、LP-PLA2、Irisin和Nrg4之间的差异有统计学意义(P<0.05)。多元线性回归分析显示,血清Irisin和Nrg4与冠心病患者血压昼夜节律均呈负相关(P<0.05)。校正混杂因素后,血清Irisin和Nrg4与冠状动脉病变严重程度的OR分别为0.235(95%CI:0.078~0.724,P<0.05)和0.176(95%CI:0.025~0.260,P<0.05),Irisin和Nrg4是保护因素(P<0.05)。交互作用分析结果显示,血清Irisin和Nrg4存在相乘及相加交互作用。结论 血清Irisin和Nrg4水平与冠心病患者血压昼夜节律呈负相关,是冠状动脉病变严重程度的保护因素。

时间治疗学管理在原发性高血压患者治疗中的应用效果分析

目的:分析时间治疗学管理在原发性高血压患者治疗中的应用效果。方法:选取2021年8月—2023年5月北京市门头沟区医院及北京市海淀区万寿路社区卫生服务中心收治的原发性高血压患者130例作为研究对象,采用抽签法随机分成对照组与研究组,各65例。对照组常规用药,研究组采用时间治疗学用药管理。比较两组治疗效果。结果:治疗后,两组白天平均舒张压、白天平均收缩压、24 h平均舒张压、24 h平均收缩压、夜间平均收缩压、夜间平均舒张压低于治疗前,且研究组低于对照组,差异有统计学意义(P<0.05)。治疗后,研究组血压类型分布优于治疗前,且优于对照组,差异有统计学意义(P<0.001)。研究组治疗总有效率高于对照组,差异有统计学意义(P=0.042)。两组不良反应总发生率比较,差异无统计学意义(P=0.692)。结论:时间治疗学管理在原发性高血压患者治疗中的应用效果显著,可调节血压昼夜节律,稳定血压水平,且不增加不良反应。

原发性高血压患者昼夜血压节律变化对其颈动脉斑块和凝血因子及Hcy以及CRP水平的影响分析

目的:分析原发性高血压患者昼夜血压节律变化对其颈动脉斑块、凝血因子、同型半胱氨酸(Hcy)和C反应蛋白(CRP)水平的影响。方法:选取2021年1月—2023年12月在芜湖市眼科医院住院的原发性高血压患者160例,均采用24h无创性携带式血压监测仪对血压进行监测,依据《2020中国动态血压监测指南》将其分为杓型组和非杓型组,每组各80例。比较两组24h平均收缩压(24hSBP)、24h平均舒张压(24hDBP)、白昼平均收缩压(dSBP)、白昼平均舒张压(dDBP)、夜间平均收缩压(nSBP)、夜间平均舒张压(nDBP);采用颈动脉血管彩超测量颈动脉内膜中层厚度(IMT)、斑块类型(低回声、高回声);检测凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、D-二聚体(D-D)、Hcy和CRP等脑血管硬化相关指标,比较两组常见脑血管病危险因素的发生情况。结果:非杓型组24hSBP、24hDBP、dSBP、dDBP、nSBP、nDBP、FIB、Hcy、CRP水平和颈动脉IMT均高于杓型组,差异有统计学意义(P<0.05)。非杓型组颈动脉斑块和不稳定性斑块发生率高于杓型血压组,糖尿病、血脂异常和冠心病患病率均高于杓型血压组,差异有统计学意义(P<0.05)。结论:原发性高血压患者昼夜血压节律变异,尤其非杓型血压是交感神经亢进的标志,可促进Hcy升高,导致心脑血管事件发生。对原发性高血压患者昼夜血压节律变异早关注、早干预,可能是预防血管硬化的有效途径之一。

滋生青阳汤防治高血压早期肾损害的疗效及对血压昼夜节律影响

目的:观察孟河医派滋生青阳汤防治高血压早期肾损害的疗效及对血压昼夜节律影响。方法:将符合标准的80例确诊为高血压早期肾损害的患者随机分为观察组和对照组,每组各 40 例。对照组给予奥美沙坦氨氯地平常规治疗,观察组在对照组的基础上加用滋生青阳汤治疗。比较2组的临床疗效、中医症候疗效及胱抑素 C(Cys-C)、尿微量白蛋白(mALB)、尿β-微球蛋白水平。结果:观察组中医症候总有效率高于对照组,差异有统计学意义(P<0.05)。2组治疗前 Cys-C、尿β-微球蛋白及尿 mAlb 水平无明显差异(P>0.05);治疗8周后,观察组的 Cys-C 、尿β-微球蛋白及尿mAlb水平均低于对照组,差异有统计学意义(P<0.05)。2组组内比较,治疗 8周后对照组和观察组的Cys-C、尿β-微球蛋白及尿 mAlb 水平均低于治疗前,差异有统计学意义(P<0.05)。2组患者治疗前血压水平无差别,治疗后,观察组 24 h平均收缩压和 24 h平均舒张压水平低于对照组;2组患者治疗前血压昼夜节律无差别,治疗后,观察组杓型血压患者高于对照组,差异有统计学意义(P<0.05)。结论:滋生青阳汤联合西药常规治疗对早期高血压肾损害具有较好治疗效果,能够明显改善患者中医症状和肾功能,还可以调节血压昼夜节律,值得临床推荐。

中性粒细胞/淋巴细胞比值与原发性高血压患者24小时动态血压变异性及昼夜节律的关联

目的:探究中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)与原发性高血压患者24h动态血压变异性及血压昼夜节律的关联。方法:本研究纳入2020年1月至2021年1月,在解放军总医院第一医学中心门诊就诊的原发性高血压患者。使用标准差(standard deviation,SD)、变异系数(coefficient of variation,CV)和独立于均值的变异系数(variation independent of mean,VIM)评估患者的动态血压变异性。使用多元线性回归分析探究NLR与动态血压变异性的关联,并使用多因素Logistic回归分析探究NLR与发生非杓型或反杓型血压节律的关联。结果:研究共纳入936例原发性高血压患者,校正了相关混杂因素进行的多元线性回归分析显示,NLR与高血压患者的24h收缩压SD(B=0.25)、CV(B=0.98)、VIM(B=0.15)、舒张压CV(B=1.23),日间收缩压SD(B=0.62)、CV(B=1.11)、VIM(B=0.30)、舒张压CV(B=0.99),和夜间收缩压SD(B=0.69)、CV(B=1.39)、VIM(B=0.29)、舒张压SD(B=1.54)、CV(B=1.72)、VIM(B=0.42)均呈线性相关。多因素Logistic回归分析显示,与NLR第一分位组相比,第四分位组与出现收缩压非杓型或反杓型血压节律风险升高93%有关(OR=1.84,95%CI:1.11~3.03)。结论:NLR与原发性高血压患者动态血压变异性呈显著正相关,NLR升高与出现收缩压非杓型或反杓型血压节律风险升高显著相关。

对超杓型血压的认识及研究进展

超杓型血压作为一种常见的血压昼夜模式,在一般人群及高血压人群中均可观察到,但学界对超杓型血压的关注相对较少且暂未达成一致。目前报告的超杓型血压的患病率差异较大,与诊断标准及受试者特征相关。虽然大多数研究尚未确立超杓型血压与靶器官损害之间的关系,但它与主要不良心血管事件存在相关性。现就学界对超杓型血压的认识及研究进展做一综述。

福辛普利联合缬沙坦治疗肾性高血压的效果分析

目的:分析福辛普利联合缬沙坦治疗肾性高血压的效果。方法:选取2020年1月—2022年12月北京市昌平区马池口社区卫生服务中心收治的肾性高血压患者90例作为研究对象,依据信封法分为研究组与对照组,各45例。对照组采用缬沙坦治疗,研究组在对照组基础上采用福辛普利治疗。比较两组血压及肾功能。结果:治疗前,两组白昼平均收缩压(dSBP)、白昼平均舒张压(dDBP)、夜间平均收缩压(nSBP)、夜间平均舒张压(nDBP)、24 h平均收缩压(24 hSBP)、24 h平均舒张压(24 hDBP)、夜间血压负荷、白昼血压负荷比较,差异无统计学意义(P>0.05);治疗后,两组dSBP、dDBP、nSBP、nDBP、24 hSBP、24 hDBP、夜间血压负荷、白昼血压负荷低于治疗前,且研究组nSBP、nDBP、夜间血压负荷、白昼血压负荷低于对照组,差异有统计学意义(P<0.05)。治疗前,两组血清肌酐、尿素氮、24 h尿蛋白水平比较,差异无统计学意义(P>0.05);治疗后,两组血清肌酐、尿素氮、24 h尿蛋白水平低于治疗前,且研究组低于对照组,差异有统计学意义(P<0.05)。结论:福辛普利联合缬沙坦治疗肾性高血压的效果较好,可调节血压昼夜节律,改善肾功能。

老年高血压患者血压昼夜节律紊乱与心律失常及心率变异性的相关性分析

目的:分析老年高血压患者血压昼夜节律紊乱与心律失常及心率变异性的相关性。方法:选取2021年1月—2022年12月南宁市第一人民医院收治的老年高血压患者112例作为研究对象,根据血压昼夜节律变化将其分为杓型组(n=42)、非杓型组(n=36)、反杓型组(n=34)。收集三组心律失常发生情况及心率变异性情况,分析血压昼夜节律紊乱与心律失常及心率变异性的相关性。结果:非杓型组和反杓型组患者室性心律失常、房性心律失常发生率高于杓型组,反杓型组房性心律失常发生率高于非杓型组,差异有统计学意义(P<0.05)。非杓型组和反杓型组全部窦性心搏R-R间期标准差(SDNN)、每5minR-R间期平均值标准差(SDANN)、全程相邻R-R间期之差的平均方根(rMSSD)、相差>50ms的相邻R-R间期数占R-R间期总数的百分比(pNN50)水平低于杓型组,反杓型组SDNN、SDANN、rMSSD、pNN50水平低于非杓型组,差异有统计学意义(P<0.05)。Spearman相关分析结果显示,血压昼夜节律紊乱与室性心律失常、房性心律失常呈正相关,与SDNN、SDANN、rMSSD及pNN50呈负相关(P<0.05)。结论:老年高血压患者血压昼夜节律紊乱与心律失常和心率变异性存在相关性,临床应进行针对性干预以改善患者病情。

血压昼夜节律与妊娠期高血压患者胎盘早剥的相关性分析

目的探究血压昼夜节律与妊娠期高血压患者胎盘早剥的相关性,为临床提供参考。方法选取2018年1月至2022年12月广州市妇女儿童医疗中心收治的315例妊娠期高血压患者为研究对象进行回顾性分析,根据是否发生胎盘早剥将患者分为胎盘早剥组(71例)和无胎盘早剥组(244例)。收集两组患者的临床资料及24 h动态血压监测数据,比较两组患者血压昼夜节律类型,并分析24 h动态血压与胎盘早剥发生的相关性。结果胎盘早剥组患者剖宫产率高于无胎盘早剥组(P<0.05)。胎盘早剥组患者24 h平均动脉压(MAP)、夜间MAP、24 h舒张压平均值(mDBP)、白天mDBP、夜间mDBP、血压晨峰及最低血压均高于无胎盘早剥组(均P<0.05)。无胎盘早剥组患者血压昼夜节律分型主要为杓型和非杓型,胎盘早剥组患者主要为非杓型和反杓型,两组患者血压昼夜节律类型构成分布比较,差异有统计学意义(P<0.05)。Spearman相关性分析结果显示,24 h MAP、夜间MAP、24 h mDBP、白天mDBP、夜间mDBP、血压晨峰及最低血压与胎盘早剥发生均呈正相关(均P<0.05)。结论血压昼夜节律的改变与妊娠期高血压患者胎盘早剥的发生存在相关性,临床需给予重视。

多系统萎缩和帕金森病患者24 h动态血压特点分析

目的研究多系统萎缩(MSA)和帕金森病(PD)患者的24 h血压水平、变异性及昼夜节律情况。方法分析2016-01—2021-01北京天坛医院收治的82例MSA患者(MSA组)及年龄、性别1∶1匹配的82例PD患者(PD组)的临床资料及24 h动态血压参数。比较2组患者的血压水平、变异性及昼夜节律情况。结果(1)MSA组24 h最低收缩压(SBP)和夜间最低SBP高于PD组,差异有统计学意义(P<0.05)。(2)MSA组平均SBP夜间高于日间,平均舒张压(DBP)夜间高于日间,差异有统计学意义(P<0.05);PD组日间与夜间平均SBP、日间与夜间平均DBP比较,差异无统计学意义(P>0.05)。(3)MSA组伴直立性低血压比率高于PD组[55例(67.1%)比23例(28.0%)],伴晨峰血压增高患者比率低于PD组[10例(12.2%)比21例(25.6%)],差异有统计学意义(P<0.05)。(4)2组患者24 h/日间/夜间平均SBP和DBP、24 h/日间/夜间最高SBP和DBP、日间最低SBP和DBP、24 h最低DBP、夜间最低DBP、晨峰平均SBP和DBP比较,差异无统计学意义(P>0.05);2组24 h高血压[34例(41.5%)比34例(41.5%)]、日间高血压[18例(22.0%)比18例(22.0%)]及夜间高血压发生率[66例(80.5%)比59例(72.0%)]比较,差异无统计学意义(P>0.05)。2组24 h、日间及夜间平均SBP和DBP的变异率比较,差异无统计学意义(P>0.05)。2组患者血压节律均以反勺型最多见[56例(68.3%)比52例(63.4%)],其次为非勺型[23例(28.0%)比23例(28.0%)],勺型少见[3例(3.7%)比7例(8.5%)],差异无统计学意义(P>0.05)。结论MSA患者夜间血压明显高于日间血压、伴直立性低血压更多见,在与PD鉴别中具有重要意义。MSA和PD患者血压水平、变异性及昼夜节律较为相似,均表现为病理性昼夜节律,夜间高血压较为普遍。