原发性高血压患者血压昼夜节律与蛋白尿的关系研究

目的探讨原发性高血压患者血压昼夜节律与蛋白尿的关系以及降低夜间血压对蛋白尿的影响，为高血压肾小动脉硬化患者蛋白尿的治疗提供理论依据。方法对80例原发性高血压合并蛋白尿患者随机平均分为两组，两组患者均每日分别于晨起或睡前口服氯沙坦50～100mg治疗12周，两组患者治疗前后分别检测空腹血糖、清蛋白、血脂、肌酐、钾、钠，24h尿白蛋白定量，进行24h动态血压监测，观察不同服药时间对血压节律的影响，以及血压节律的变化对蛋白尿的影响。结果两组患者治疗后夜间收缩压比较，差异有统计学意义（P〈0．01），治疗后两组非杓型患者比例间差异有统计学意义（P〈0．01），两组患者间治疗前24h尿蛋白水平比较差异无统计学意义（P〉0．05）．治疗后两组24h尿蛋白水平比较，差异有统计学意义（P〈0．01），原发性高血压患者24h尿蛋白水平与夜间平均收缩压水平呈正相关（r=0．233，P〈0．05）。结论原发性高血压患者血压昼夜节律的异常会加重肾脏损害，睡前服用氯沙坦可有效控制夜间血压水平．显著降低尿蛋白水平，减轻靶器官损害。

Relationship between Circadian Rhythm of Blood Pressure and Albuminuria in Patients with Primary Hypertension

Objective To investigate the relationship between circadian rhythm of blood pressure and albuminuria in patients with primary hypertension.Methods Totally 80 patients with primary hypertension were randomly and equally divided into group A and group B.All patients received losartan(50-100mg/d)as a monotherapy either on awakening(group A)or at bedtime(group B).Before and after 12 weeks of treatment,blood pressure was measured by ambulatory monitoring for 24 consecutive hours.Meanwhile,24-hour urinary albumin...