高血压合并慢性肾脏病患者的动态血压分析

目的 探讨原发性高血压合并慢性肾功能不全后动态血压的变化特点.方法 对28例单纯原发性高血压患者(A组)和25例合并慢性肾脏功能不全的高血压患者(B组)进行动态血压监测.结果 ①血压比较:24 h舒张压B组高于A组[(80.9±13.4)mm Hg比(70.3±15.6)mm Hg,P＜0.05)];B组夜间的收缩压与舒张压均高于A组[(160.2±17.8)mm Hg比(140.3±25.9)mm Hg和(82.6±16.1)姗Hg比(68.8±20.2)mm Hg,P＜0.01].②血压变异性比较:B组24 h收缩压变异性和舒张压变异性均高于A组[(13.5±3.9)mm Hg比(11.3±2.1)mm Hg和(9.2±1.2)mm Hg比(8.3±1.8)mm Hg,P＜0.05],B组夜间的收缩压与舒张压变异性均高于A组[(14.9±3.3)mm Hg比(9.3±2.1)mm Hg和(9.7±2.4)mm Hg比(8.0±2.2)mm Hg,P＜0.01)].③血压趋势比较:A组血压趋势以非勺型为多,占64.3%(18/28),反勺型占10.7%(3/28);而B组反勺型占48.0%(12/25),非勺型占40.0%(10/25).结论 肾性因素参与的高血压患者血压趋势紊乱,夜间血压及变异性明显增加,均可成为肾功能继续恶化和心脑血管事件发生的重要因素.

Circadian blood pressure analysis in hypertensive patients with chronic renal insufficiency

Objective To investigate the circadian blood pressure(BP)rhythm in hypertensive patients with chronic renal insufficiency.Methods Circadian blood pressure(BP)rhythm was studied by ambulatory 24-h monitoring among hypertensive(n=25,group B)patients with stable progression of chronic renal insufficiency,and among patients with essential hypertension(n=28,group A)without renal disease.Results ①The 24-h diastolic BP and nocturnal systolic and diastolic BP of group B were significantly higher than those of group A[(80.9±13.4)mmHg vs[70.3±15.6)mm Hg,(160.2±17.8)mm Hg vs(140.3+25.9)mm Hg,(82.6±16.1)mm Hg vs(68.8±20.2)mm Hg,P＜0.05)].②Blooa pressure variability(BPV)of 24 hour systolic and diastolic BP of group B was higher than group A[(13.5±3.9)mm Hg vs(11.3±2.1)mm Hg and(9.2±1.2)mm Hg vs(8.3±1.8)mm Hg,P＜0.05).BPV of nocturnal systolic and diastolic BP in group B was signitleantly higher than group A [(14.9±3.3)mm Hg vs(9.3±2.1)mm Hg and (9.7±2.4)mm Hg vs(8.0±2.2)mm Hg,P＜0.01)].③The 24-h profile of BP of group A showed more non-dipper according for 64.3%(18/28),reverse-dipper according for 10.7%(3/28),but which was 40.O%(10/25)and 48.0%(12/25).Conclusion The renal patients show a disturbance in the 24-h profile of BP,higher indexes of noetttrnal BP and a greater nocturnal variability,which may be important factor for event of cardiovascular disease and renal insufficiency.