原发性高血压患者血压变异性与早期肾损害

目的探讨血压变异性(BPV)和原发性高血压患者早期肾损害的关系。方法根据尿白蛋白与尿肌酐比值(UACR)把181例原发性高血压患者分为两组,UACR≤30mg/g为单纯高血压组(A组,120例),UACR>30mg/g为合并早期肾损害组(B组,61例),行24h动态血压监测,BPV以血压标准差和变异系数表示,用Pearson相关分析和多元线性回归分析比较两组患者BPV和早期肾损害之间的关系。结果两组患者各个时段的血压均值差异无统计学意义(P>0.05);除白昼收缩压变异性外,A组和B组24h收缩压变异性标准差(13.6±3.0)比(15.3±4.1)mmHg;变异系数(0.11±0.02)比(0.12±0.03)]、24h舒张压变异性标准差(9.6±2.6)比(11.8±4.2)mmHg;变异系数(0.13±0.04)比(0.15±0.05)]、白昼舒张压变异性标准差(9.5±3.0)比(11.3±4.6)mmHg;变异系数(0.12±0.04)比(0.14±0.06)]、夜间收缩压变异性标准差(10.0±3.9)比(13.2±4.7)mmHg;变异系数(0.08±0.03)比(0.11±0.04)]和夜间舒张压变异性标准差(7.7±3.7)比(10.0±3.8)mmHg;变异系数(0.11±0.05)比(0.14±0.05)]差异均有统计学意义(均P<0.05)。Pearson相关分析显示UACR与24h收缩压变异性、24h舒张压变异性、白昼舒张压变异性、夜间收缩压变异性及夜间舒张压变异性呈正相关(均P<0.01)。多元线性回归分析显示UACR与夜间收缩压变异性、24h舒张压变异性、夜间舒张压水平和三酰甘油呈正相关(均P<0.05)。结论原发性高血压患者夜间收缩压变异性、24h舒张压变异性、夜间舒张压水平和三酰甘油与早期肾损害相关。

The relationship between blood pressure variability and early renal injury in patients with essential hypertension

Objective To observe the relationship between blood pressure variability (BPV) and early renal injury in patients with essential hypertension. Methods A total of 181 patients with essential hypertension were enrolled in this study. Urine albumin to creatinine ratio (UACR) was recorded, according to which patients were divided into two groups: the hypetension group (group A, n=120, UACR≤30 mg/g), and hypertension with early renal injury group (group B, n=61, UACR>30 mg/g). The 24 h ambulatory blood pressure monitoring was performed. Standard deviation(SD) and coefficient of variation(CV) of blood pressure were calculated as the BPV. Pearson correlation and multiple linear regression analysis were used to test the correlations between BPV and the early renal injury of the two groups. Results There were no statistical significance in mean systolic blood pressure and diastolic blood pressure of 24 h, daytime, and night-time of the two groups (P>0.05). The 24 hours systolic BPV (24hSBPV) SD (13.6±3.0) vs (15.3±4.1) mm Hg;CV (0.11±0.02) vs (0.12±0.03) ], 24 hours diastolic BPV (24hDBPV) SD (9.6±2.6) vs (11.8±4.2) mm Hg;CV (0.13±0.04) vs (0.15±0.05) ] ,diurnal diastolic BPV (dDBPV) SD (9.5±3.0) vs (11.3±4.6) mm Hg;CV (0.12±0.04) vs (0.14±0.06) ], nocturnal systolic BPV(nSBPV) SD (10.0±3.9) vs (13.2±4.7) mm Hg; CV (0.08±0.03) vs (0.11±0.04) ], and nocturnal diastolic BPV (nDBPV) SD (7.7±3.7) vs(10.0±3.8) mm Hg; CV (0.11±0.05) vs (0.14±0.05) ] of the two groups had significant differences except for the diurnal systolic BPV (all P<0.05). Pearson correlation analysis showed that UACR was positively correlated to the 24hSBPV, 24hDBPV, dDBPV, nSBPV, and nDBPV (all P<0.01). Multiple linear regression analysis showed that UACR was positively correlated to nSBPV, 24hDBPV, nocturnal diastolic blood pressure and triglyceride (all P<0.05). Conclusion The nSBPV, 24hDBPV, nocturnal diastolic blood pressure and triglyceride have correlations to early renal injury in the patients with essential hypertension.