高血压患者晨间血压升高的病因探讨

目的 寻找引起晨间血压升高的危险因素。方法 将高血压患者分为晨峰组和非晨峰组，检测血液中血浆肾素活性（PRA）、血管紧张素Ⅱ（AngⅡ）、醛固酮（ALD）、生长激素（GH）、皮质醇（COR）水平。分析晨峰睡-谷值与AngⅡ、ALD、GH、COR的相关性。结果 老年原发性高血压患者主要为低肾素型高血压。晨峰组与非晨峰组在性别、年龄、体质量指数（BMI）、血脂和高血压病程方面无显著性差异。晨峰组的AngⅡ、ALD均高于非晨峰组（P<0.05），血GH和COR也均显著增高（P<0.01）。 相关分析结果显示， 晨峰组的晨峰睡-谷值与AngⅡ（r=0.42， P<0.01 ）、ALD（r=0.28， P<0.05 ）、GH（r=0.45， P<0.01 ）、COR（r=0.32， P<0.01 ）均呈现正相关。结论 晨间血压升高与肾素血管紧张素系统激活密切相关，也与血液中生长激素、皮质醇浓度过高有密切关系。

Cause of morning surge hypertension

Objective To investigate risk factors for morning surge in hypertension. Methods 201 cases were divided into the morning surge group and the non-morning group. The levels of plasma rennin activity(PRA), angiotensin II(AngⅡ), aldosterone(ALD), growth hormone(GH) and cortisol(COR) were detected. The correlation between sleep trough morning surge variability and levels of AngⅡ, ALD, GH and COR were analyzed. Results AngⅡ and ALD levels in the morning surge group are higher than those in the non-morning group（P<0.05）, GH and COR levels were also higher（P<0.01）. Sleep-trough morning surge had positive correlations with levels of AngⅡ（r=0.42, P<0.01 ）, ALD（r=0.28, P<0.05 ）, GH（r=0.45, P<0.001 ） and COR（r=0.32, P<0.01）. Conclusion Morning surge hypertension is closely related to activation of the renin-angiotension system and levels of GH and COR.