| 摘要: |
| 目的 结合24小时平均血压(24hMBP)分析探讨接受降压治疗的高血压患者血压昼夜节律的影响因素。方法 连续收集125例接受降压药物治疗的住院患者临床资料和动态血压监测结果 ,结合24hMBP和昼夜节律,将患者分为:正常24hMBP杓型组(正常组)、异常24hMBP杓型组、异常24hMBP非杓型组和正常24hMBP非杓型组,比较后3组间临床资料和动态血压监测结果 存在的差异,并采用非条件Logistic逐步回归法分析动态血压的影响因素。结果 异常24hMBP有90例(72.0%),昼夜节律异常106例(84.8%)。其中,正常24hMBP杓型2例(1.6%)；异常24hMBP杓型组17例(13.6%)；异常24hMBP非杓型组73例(58.4%)；正常24hMBP非杓型组33例(26.4%)。合并肾脏疾病比例,异常24hMBP杓型或非杓型组均高于正常24hMBP非杓型组(P<0.05)；合并糖尿病比例,昼夜节律异常者(非杓型)高于正常者(杓型),以正常24hMBP非杓型组最高(P<0.05)； 钙通道阻滞剂(CCB) 的应用和每早一次的服用时间比例,正常24hMBP非杓型组亦高于异常24hMBP杓型组和非杓型组(P<0.05)。异常24hMBP杓型、异常24hMBP非杓型、正常24hMBP非杓型3组中动态血压异常程度以后者最严重。Logistic回归分析结果 显示: 合并肾脏病(OR=0.301,95%CI:0.124~0.729,P=0.008)、CCB应用(OR=2.191,95%CI:0.967~4.966,P=0.048)、每早一次的服药方法 (OR=2.384,95%CI:1.017~5.591,P=0.046)是动态血压的影响因素。结论 接受降压治疗的高血压住院患者昼夜节律异常率较高,合并肾脏病、服用CCB、每早一次的服药方式等均是动态血压的影响因素；结合24hMBP水平和昼夜节律的构成进行血压昼夜节律影响因素的分析和处理可能更加合理。 |
| 关键词: 高血压 抗高血压药 动态血压监测 24小时平均血压 昼夜节律 危险因素 |
| DOI：10.3724/SP.J.1008.2012.053 |
| 投稿时间：2011-11-03修订日期：2012-01-10 |
| 基金项目: |
|
| Factors affecting ambulatory blood pressures in treated hypertensive patients |
| LI Xi-lin*,HUANG Li-na,CAO Wei-bin |
(Department of Emergency Medicine, No. 85 Hospital of PLA, Shanghai 200052, China
*Corresponding author.) |
| Abstract: |
| Objective To explore the factors affecting the circadian rhythm of blood pressure in treated hypertensive patients. Methods Based on the clinical data, ambulatory blood pressure, 24-hour mean blood pressure (24hMBP) and circadian rhythm, 125 consecutive patients receiving antihypertensive treatment were divided into the following groups: normal 24hMBP and dipper type (typeⅠ), abnormal 24hMBP and dipper type(typeⅡ), abnormal 24hMBP and non-dipper type(typeⅢ), and normal 24hMBP and non-dipper type (type Ⅳ). The clinical data and ambulatory blood pressure of the latter three groups were compared. Non-conditional Logistic regression was used to analyze the factors for ambulatory blood pressure. Results Ninety patients had abnormal 24hMBP (72.0%), and 106 (84.8%) had abnormal circadian rhythm. Among these cases, 2 (1.6%) patients had typeⅠ, 17 (13.6%) had typeⅡ, 73 (58.4%) had type Ⅲ, and 33 (26.4%) had type Ⅳ. The incidence of kidney disease in patients with abnormal 24hMBP was significantly higher than those with normal 24hMBP (P<0.05). The incidence of diabetes mellitus in patients with abnormal circadian rhythm (non-dipper type) was higher than those with normal circadian rhythm (dipper type), with the highest incidence seen in patients of type Ⅳ (P<0.05); the rates of calcium channel blocker (CCB) use and a daily morning dose administration in type Ⅳ patients were higher than those in type Ⅱ and type Ⅲ patients (P<0.05). Type Ⅳ group had the most severe abnormal ambulatory blood pressure among the latter three groups. Logistic regression analysis showed that complication with renal diseases (OR=0.301,95%CI:0.124~0.729, P=0.008), use of CCB (OR=2.191,95%CI: 0.967~4.966,P=0.048), and administration of a morning dose (OR=2.384,95%CI: 1.017~5.591,P=0.046) were the factors of ambulatory blood pressure. Conclusion Abnormal circadian rhythm of blood pressure is high in patients receiving antihypertensive treatment. Complication with kidney diseases, use of CCB, and a daily morning dose are the factors for ambulatory blood pressure, indicating it is be reasonable to analyze factors for circadian rhythm by combining the 24hMBP and the components of circadian rhythm. |
| Key words: hypertension antihypertensive agents ambulatory blood pressure monitoring 24-hour mean blood pressure circadian rhythm risk factors |
