非杓型血压的临床特点及相关因素分析

目的:研究非杓型血压的临床特点和相关因素,以提高非杓型血压的知晓率和治疗率。方法:选择原发性高血压或其他心脏疾病并发原发性高血压,并排除严重并发疾病的患者。收集临床资料,并行血生化、心电图、心超等辅助检查。所有患者进行24小时动态血压监测,将夜间平均血压与白天比较,无下降者,为反杓型血压组,下降超过10%,为杓型血压组,下降不超过10%,为非杓型血压组,并分析其临床特点。结果:共55例入选,所有患者均为高血压Ⅱ级或Ⅲ级,杓型血压者19例(35%),非杓型者22例(40%),反杓型者14例(25%),广义非杓型血压共36例(占65%)。不同血压节律组间比较,年龄、冠心病史、脑卒中史、血浆尿素氮及夜间收缩压、舒张压差异有显著性。Logistic回归提示冠心病史、脑卒中史、血浆尿素氮增高为血压昼夜节律异常的影响因素。结论:住院高血压病患者中非杓型血压的发生率较高,冠心病、脑卒中、血浆尿素氮增高的患者是非杓型血压的相关因素。

Clinical characteristics and relative factors of nondipping hypertension

AIM：To study the clinical manifestations and relative factors of nondipping hypertension in order to improve its diagnosis and treatment. METHODS： Patients with primary hypertensive or other cardiovascular diseases without severe complications were selected. After collecting clinical data including laboratory blood sample analysis, electrocardiograph （ECG） and echocardiogram examination, all patients underwent a 24-h ambulatory blood pressure monitoring （ABPM） procedure. Nocturnal blood pressures （BP） were compared with diurnal BPs. Dipping hypertension was defined if the mean nocturnal reduction of BP was 10% or above, whereas nondipping BP was defined if the reduction was 〈 10%. The anti-dipper BP was defined if there was no drop in nocturnal BP. Clinical manifestations of these types were compared. RESULTS： Among the 55 selected patients diagnosed with class 2 or 3 hypertension, dipping hypertension, nondipping hypertension and anti-dipping hypertension were detected in 19 （35%）, 22 （40%） and 14 （25%） cases, respectively. Statistical significance was found among the three groups in aspects such as age, historical episode of coronary disease or stroke, blood serum urea nitrogen （BUN） level, and mean nocturnal systolic/diastolic blood pressure （SBPn/DBPn）. Logistic regression analysis indicated that history of coronary diseases or stroke and high BUN level were contributing factors to the abnormal circadian rhythms of BP. CONCLUSION： Morbidity of nondipping hypertension is relatively high in hospitalized patients. Coronary disease, stroke and high level BUN are defined as its relative factors.