高血压患者动态血压变化与糖代谢异常55例分析

目的 探讨糖代谢异常对高血压患者动态血压变化的影响。方法 对55例既往无糖尿病的高血压患者行24小时动态血压监测和糖耐量试验（OGTT），根据OGTT分为糖耐量正常（NGT）、糖耐量减低（IGT）和新发现2型糖尿病（2-DM）3组。结果 从NGT至IGT至2-DM，非杓型血压发生率逐渐增高（分别为52．17％、64．70％和80．00％，P〈0．01），且2-DM患者夜间高血压的发生率较NGT及IGT显著增加（分别为13．04％、17．64％和33．33％，P〈0．01）；IGT组的24小时舒张压负荷、24小时舒张压和夜间舒张压均显著低于NGT组和2-DM组（P〈0．05），且脉压增大；并且发现，从NGT至IGT至2-DM过程中，胰岛素抵抗指数逐渐增加（分别为1．41、1．66和1．92，P〈0．05），胰岛素敏感指数在IGT阶段较NGT增高（39．90比33．83，P〈0．05），而到2-DM阶段较NGT下降（27．15比33．83，P〈0．05）；Logistic回归分析显示，影响脉压的主要因素为餐后血糖。结论 糖代谢异常的高血压惠者其24h血压的昼夜节律紊乱，其中以IGT患者的舒张压降低和脉压增大为著，而脉压增大与餐后血糖及血浆胰岛素水平相关。

Change of ambulatory blood pressure and abnormality of glycometabolism in 55 patients with hypertension

Objective To discuss the effects of the glycometabolism abnormality on the ambulatory blood pressure in patients with hypertension.Methods Fifty patients with hypertension without diagnostic diabetes accepted 24 h ambulatory blood pressure monitoring and oral glucose tolerance test(OGTT).According to the results of OGTT,the patients were divided into three groups: the group with normal glucose tolerance(NGT),the group with impaired glucose tolerance(IGT) and the group with new diagnostic type 2 diabetes(2DM).Results According to the sequence from NGT,IGT to 2-DM,the incidence of non-dipper blood pressure increased gradually((52.17)%,(64.70)%,(80.00)%,P<(0.01)).The incidence of high blood pressure at night in the patients with 2-DM increased significantly compared with that in NGT and ICT group((13.04)%,(17.64)%,(33.33)%,P<(0.01)).The 24 h diastolic blood pressure(DBP) load,24 h DBP and DBP at night in the group of IGT were lower than those in the group of NGT and 2-DM(P<(0.05)),and the pulse pressure(PP) in the group of IGT was augmented.Moreover,the insulin resistance index(IRI) was increasing gradually according to the sequence from NGT,IGT,to 2-DM.And the insulin sensitivity index(ISI) was augmenting in the stage of IGT than that in the stage of NGT((39.90) vs(33.83),P<(0.05)),but decreasing in the stage of 2-DM than that in the stage of NGT((27.15) vs(33.83)P<(0.05)).The results of logistic regression analysis showed that the main factor which influenced PP was postprandial blood sugar.Conclusion The temporal rhythm of 24 h blood pressure of the hypertension patients with glycometabolism abnormality was disturbed,and the debasement of DBP and augmentation of PP in the patients with IGT were significant.PP augmentation correlated with postprandial blood sugar and plasma insulin level.