高血压患者血压昼夜节律与心脏损害的相关研究
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摘要
目的在高血压患者中,探讨血压昼夜节律与心脏损害的关系。方法从2017年11月到2018年11月,在华北理工大学附属医院就诊的原发性高血压患者中,随机选取212例作为研究对象,对其进行24h动态血压监测(ABPM),得出夜间血压下降率并分为两组:杓型组(≥10%,75例)和非杓型组(<10%,137例)。测量并记录左房内径(LA)、左室舒张末期内径(LVD)、左室后壁厚度(PWD)、舒张末期室间隔厚度(IVST),根据公式计算左室重量(LVM)、左室质量指数(LVMI)。分析血压昼夜节律与心脏损害的关系。结果非杓型组LVD、PWD、LVM、LVMI、LA均高于杓型组,差异均有统计学意义(P<0.05);非杓型组夜间收缩压(n-SBP)、夜间舒张压(n-DBP)均高于杓型组,差异均有统计学意义(P<0.05)。n-DBP为LVD、LVM的独立影响因素。结论非杓型高血压比杓型高血压更容易导致心脏损害,n-DBP是影响高血压患者心脏损害的独立因素。
Objective To investigate the relationship between circadian rhythm of blood pressure and cardiac damage in patients with primary hypertension. Methods Form November 2017 to November2018, 212 patients with primary hypertension were selected in North China University of Science and Technology Affiliated Hospital, and 24-hour ambulatory blood pressure monitoring(ABPM) were performed. According to nighttime blood pressure drop rate, all patients were divided into two groups:blood pressure drop rate≥10% in dipper group(75 cases) and <10% in non dipper group(137 cases). Heart ultrasound was used to measured the left atrial diameter(LA), left ventricular end-diastolic diameter(LVD), left ventricular posterior wall thickness(PWD), interventricular septum at the end of diastole(IVST), and left ventricular mass(LVM) and left ventricular mass index(LVMI) were calculated. Relationship between the circadian rhythm of blood pressure and heart damage was analyzed. Results The LVD, PWD, LVM, LVMI and LA of the non-dipper group were significantly higher than those of the dipper group(P<0.05). The nocturnal systolic pressure(n-SBP)and nocturnal diastolic pressure(n-DBP) of the non-dipper group were higher than those of the dipper group(P<0.05). n-DBP was an independent factor affecting LVD and LVM. Conclusion Nondipper hypertension is more likely to cause cardiac damage than dipper hypertension, and n-DBP should be an independent factor affecting cardiac damage in patients with hypertension.
Objective To investigate the relationship between circadian rhythm of blood pressure and cardiac damage in patients with primary hypertension. Methods Form November 2017 to November2018, 212 patients with primary hypertension were selected in North China University of Science and Technology Affiliated Hospital, and 24-hour ambulatory blood pressure monitoring(ABPM) were performed. According to nighttime blood pressure drop rate, all patients were divided into two groups:blood pressure drop rate≥10% in dipper group(75 cases) and <10% in non dipper group(137 cases). Heart ultrasound was used to measured the left atrial diameter(LA), left ventricular end-diastolic diameter(LVD), left ventricular posterior wall thickness(PWD), interventricular septum at the end of diastole(IVST), and left ventricular mass(LVM) and left ventricular mass index(LVMI) were calculated. Relationship between the circadian rhythm of blood pressure and heart damage was analyzed. Results The LVD, PWD, LVM, LVMI and LA of the non-dipper group were significantly higher than those of the dipper group(P<0.05). The nocturnal systolic pressure(n-SBP)and nocturnal diastolic pressure(n-DBP) of the non-dipper group were higher than those of the dipper group(P<0.05). n-DBP was an independent factor affecting LVD and LVM. Conclusion Nondipper hypertension is more likely to cause cardiac damage than dipper hypertension, and n-DBP should be an independent factor affecting cardiac damage in patients with hypertension.
引文
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[12]单海燕,李雪莲,李婉,等.老年高血压患者血压昼夜节律与炎症因子、尿微量白蛋白的相关性[J].中国老年学杂志,2014,34(2):337-339.
[13]Tosu AR,Demir S,Selcuk M,et al.Comparison of inflammatory markers in non-dipper hypertension vs.dipper hypertension and in normotensive individuals:uric acid,C-reactive protein and red blood cell distribution width readings[J].Postepy Kardiol Interwencyjnej,2014,10(2):98-103.
[14]Schillaci G,Verdecchia P,Borgioni C,et al.Lack of association between blood pressure variability and left ventricular mass in essential hypertension[J].Am J Hypertens,1998,11(5):515-522.
[15]Karakas MF,Buyukkaya E,Kurt M,et al.Assessment of left ventricular dyssynchrony in dipper and non-dipper hypertension[J].Blood Press,2013,22(3):144-150.
[16]卓德华,潘扬,曹宸,等.高血压病患者血压变异性及其与左室肥厚的关系[J].高血压杂志,2002,10(1):27-29.
[2]孙丽霞,王佳瑞,钟扬,等.24小时动态血压昼夜节律与微量白蛋白尿相关性研究[J].中国循环杂志,2014,29(3):176-180.
[3]孙文,刘基高,汪兰珍,等.老年高血压患者肾素活性、血管紧张素Ⅱ水平与动态血压关系的探讨[J].高血压杂志,1999,3(1):52-53.
[4]王中华,张剑,陈书山,等.原发性高血压患者血管紧张素Ⅱ和一氧化氮含量变化及与动态血压节律的关系[J].临床心血管病杂志,2003,19(8):458-460.
[5]吴波,张书富.慢性心衰左室重构、左室功能与脑利钠肽的相关性[J].中国实用内科杂志,2007,27(s2):55-57.
[6]Hsueh WA,Wyne K.Renin-Angiotensin-aldosterone system in diabetes and hypertension[J].J Clin Hypertens(Greenwich),2011,13(4):224-237.
[7]贡玉苗,张梅.血压近日节律及对靶器官的影响[J].中西医结合心血管病电子杂志,2016,4(12):105-106.
[8]寇惠娟,高登峰,马瑞,等.高血压患者血压昼夜节律与早期肾损害的关系[J].中华高血压杂志,2015,23(7):661-666.
[9]Gonenc A,Hacisevki A,Tavil Y,et al.Oxidative stress in patients with essential hypertension:a comparison of dippers and non-dippers[J].Eur J Intern Med,2013,24(2):139-144.
[10]Kaya MG,Yarlioglues M,Gunebakmaz O,et al.Platelet activation and inflammatory-response in patients with nondipper hypertension[J].Atherosclerosis,2010,209(1):278-282.
[11]Meric M,Soylu K,Avci B,et al.Evaluation of plasma chemerin levels in patients with non-dipper blood pressure pat-terns[J].Med Sci Monit,2014,20:698-705.
[12]单海燕,李雪莲,李婉,等.老年高血压患者血压昼夜节律与炎症因子、尿微量白蛋白的相关性[J].中国老年学杂志,2014,34(2):337-339.
[13]Tosu AR,Demir S,Selcuk M,et al.Comparison of inflammatory markers in non-dipper hypertension vs.dipper hypertension and in normotensive individuals:uric acid,C-reactive protein and red blood cell distribution width readings[J].Postepy Kardiol Interwencyjnej,2014,10(2):98-103.
[14]Schillaci G,Verdecchia P,Borgioni C,et al.Lack of association between blood pressure variability and left ventricular mass in essential hypertension[J].Am J Hypertens,1998,11(5):515-522.
[15]Karakas MF,Buyukkaya E,Kurt M,et al.Assessment of left ventricular dyssynchrony in dipper and non-dipper hypertension[J].Blood Press,2013,22(3):144-150.
[16]卓德华,潘扬,曹宸,等.高血压病患者血压变异性及其与左室肥厚的关系[J].高血压杂志,2002,10(1):27-29.
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