治疗性生活方式干预对高血压病患者动态血压参数的影响

目的:探讨治疗性生活方式干预对轻中度高血压病患者动态血压参数的影响。方法: 收集246例轻中度高血压病患者，随机分为治疗性生活方式干预组（干预组）130例和对照组116例。在降压药物治疗的基础上，干预组进行严格的饮食、锻炼等生活方式干预，对照组进行常规生活方式干预。所有受试者干预前后进行动态血压检测。结果: 干预1年后，干预组24 h、夜间(n)平均血压及白昼(d)收缩压(SBP)下降幅度均显著高于对照组［分别为24hSBP（22±6） mmHg(1 mmHg=0133 kPa) vs.(15±5) mmHg、nSBP(26±14) mmHg vs.(17±10) mmHg、24hDBP(10±7) mmHg vs.(8±5) mmHg、nDBP(11±7) mmHg vs.(9±6) mmHg和dSBP(20±8) mmHg vs.(14±7) mmHg，均P<005］；白昼、夜间的收缩压负荷值下降幅度干预组显著高于对照组［分别为(30±14)mmHg vs.(25±14)mmHg和(43±24)mmHg vs.(31±18)mmHg，均P<005］；血压杓型转归率及血压达标率干预组均显著高于对照组(26% vs. 10%和85% vs. 63%，均P<001)。结论: 治疗性生活方式干预显著降低了24 h（尤其是夜间）血压均值及收缩压负荷，有助于恢复患者的血压昼夜节律。

Effect of therapeutic lifestyle intervention on ambulatory blood pressure in patients with hypertension

AIM:To investigate the effect of therapeutic lifestyle intervention on the ambulatory blood pressure in hypertensive patients. METHODS: Two hundred and forty six hypertensive patients were randomly divided into two groups: therapeutic lifestyle intervention group (n=130) with mandatory lifestyle intervention (low salt dietary and exercise) and control group (n=116) with routine lifestyle intervention. All subjects were given antihypertensive agents and 24 h ambulatory blood pressure monitoring (ABPM) was performed in all subjects before and after the intervention. RESULTS: After 1 year treatment, decreased levels of 24 h, nighttime blood pressure and daytime systolic blood pressure in intervention group were significantly higher than those in control group ［24 h SBP (22±6) mmHg (1 mmHg=0133 kPa) vs. (15±5) mmHg, nSBP (26±14) mmHg vs.(17±10) mmHg, 24 h DBP (10±7) mmHg vs.(8±5) mmHg, nDBP (11±7) mmHg vs.(9±6) mmHg, dSBP (20±8) mmHg vs.(14±7) mmHg, all P<005］. The decreased levels of daytime and nighttime SBP load (dSBP load and nSBP load) in intervention group were also significantly higher than those in control group ［(30±14) mmHgvs.(25±14) mmHg (43±24) mmHg vs.(31±18) mmHg, all P<005］. The outcome rate of dipper blood pressure and compliance rate of blood pressure in intervention group were significantly higher than those in control group (26% vs. 10% and 85% vs. 63%, all P<001). CONCLUSION: Therapeutic lifestyle interventions significantly lower the average blood pressure, especially the night blood pressure and systolic blood pressure load in patients with essential hypertension. Therapeutic lifestyle interventions may have some beneficial effects on the restoration of circadian rhythm.