肾实质性高血压患者动态血压变化的临床意义

目的:探讨肾实质性高血压患者动态血压昼夜变化的临床意义。方法:对50例临床诊断为肾实质性高血压患者的临床诊断进行分组:肾功能不全代偿期组20例;肾功能不全失代偿期组17例;肾功能衰竭期组13例;另选健康体检中动态血压监测正常者30例为对照组。获取4组对象白昼平均收缩压和舒张压、夜间平均收缩压和舒张压、24小时平均收缩压和舒张压、夜间/白昼平均收缩压和舒张压、平均动脉压及收缩压负荷值与舒张压负荷值。结果:(1)肾实质性高血压3组各项参数均高于对照组,昼夜曲线消失,但未见反勺型;(2)肾实质性高血压3组各项参数相互之间经方差检验有明显差别。尤其是收缩压与舒张压负荷值,在肾功能不全失代偿期组明显升高,在肾功能衰竭期组已超过60%。(3)肾实质性高血压各组之间收缩压负荷值、舒张压负荷值及平均动脉压存在显著差异。结论:肾实质性高血压患者血压昼夜节律消失,当肾功能失代偿时,血压负荷值及MAP随着肾功能的进一步恶化而升高。

The Clinical Significance of Daytime and Nighttime Blood Pressure Changes in Patients with Renal Parenchymal Hypertension

Objective: To study the clinical significance of daytime and nighttime blood pressure changes in patients diagnosed with renal parenchymal hypertension (RPH). Methods: Subgrouping 50 patients of diagnosed RPH into renal insufficiency compensatory period (RICP) of 20 cases, with an average age of 55±7.88 years old, renal insufficiency decompensated period (RIDP) of 17 cases, with an average age of 56±12.9 years old, renal failure (RF) of 13 cases, with an average age of 53±10.34 years old. Normal group was composed with 30 individuals selected from the healthy people with normal ambulatory blood pressure (ABPM).The Spacelab 90207, a non-invading ambulatory blood pressure monitor, was used to obtain indexes including 24-hour mean systolic blood pressure (24 h SBP), 24-hour mean diastolic blood pressure (24 h DBP), daytime mean systolic blood pressure(dSBP), daytime mean diastolic blood pressure (dDBP), nighttime mean systolic blood pressure (nSBP), nighttime mean diastolic blood pressure (nDBP), nSBP/dSBP, nDBP/dDBP, mean arterial pressure (MAP), systolic blood pressure load, and diastolic blood pressure load. Results: 1. In comparison to the normal group, three subgroups with RPH projected higher values in all indexes. 2. Standard Deviations among these 3 RPH subgroups were obviously different. It was particularly different in systolic and diastolic loads, where the RIDP higher, and RF of 60% higher. 3. The statistical analysis resulted from one-on-one comparison between RPH subgroups showed that SBP, DBP and MAP were significantly different, while other indexes had no statistical differences. Conclusions: The rhythms of day and night changes of blood pressure in RPH sufferings disappeared. The values of blood pressure load and MAP in renal decompensated rise along with the deterioration of renal function. Effective control of blood pressure load and MAP may slow down this deterioration.