高血压患者24h动态血压的昼夜规律及变异性研究

目的 探讨原发性高血压（EH）患者血压昼夜规律及血压波动程度即变异性的临床意义.方法 回顾分析65例EH患者24 h动态血压（24 h ABPM）监测报告.将65例EH患者分为两组：一组为高血压伴左心室肥大（LVH）30例,另一组为高血压不伴左心室肥大35例.选择同期健康体检者30名为正常血压对照组.对下列参数进行分析：①24 h平均收缩压（24 h SBP）与舒张压（24 h DBP）;②白昼平均收缩压（dSBP）与舒张压（dDBP）;③夜间平均收缩压（nSBP）与舒张压（nDBP）;④24 h收缩压标准差（24 h SSD）与舒张压标准差（24 h DSD）;⑤白昼收缩压标准差（dSSD）与舒张压标准差（dDSD）;⑥夜间收缩压标准差（nSSD）和舒张压标准差（nDSD）;⑦夜间/白昼平均收缩压比值（nSBP/dSBP）与舒张压比值（nDBP/dDBP）.结果 高血压伴LVH组与正常对照组或高血压无LVH组比较,24 h各时间段的血压均值及血压变异性差异有统计学意义（P＜0.01）,血压昼夜（清醒/睡眠）规律性不明显,nSBP/dSBP比值显著高于对照组（P＜0.01）.高血压无LVH组与正常对照组比较,血压均值差异有统计学意义（P＜0.01）,血压大多有较明显昼夜（清醒/睡眠）变化规律,血压变异性比较除白昼收缩压变异性有明显差异外,其余差异无统计学意义.结论 高血压不合并靶器官损害时,血压的变异性不显著,有明显昼夜规律性;高血压合并靶器官损害时,血压的变异性增大,无明显昼夜规律性,nSBP/dSBP比值明显增高.利用这些指标可评估高血压患者是否有靶器官损害,以便更有效地控制血压,减少并发症.

24 h ambulatory blood pressure pattern and variability in hypertensive patients

Objective To explore the 24 h blood pressure pattern in patients with essential hypertension （EH） and the clinical significance of the blood pressure variability. Methods 24 h ambulatory blood pressure monitoring （24 h ABPM） reports of 65 cases of EH were reviewed and analyzed. The 65 cases were divided into two groups, one with 30 cases of hypertension with left ventrieular hypertrophy （LVH） and the other with 35 cases of hypertension without LVH. 30 people for health examination was enrolled as control group in the same period and accepted 24 h ABPM. The following parameters were analyzed. （1）24-hour mean systolic blood pressure （24 h SBP） and diastolic blood pressure （24 h DBP）. （2）mean daytime systolic blood pressure （dSBP） and diastolic （dDBP）. （3）night mean systolic blood pressure （nSBP） and diastolic blood pressure （nDBP）. （4）24 hour systolic blood pressure standard deviation （24 h SSD） and diastolic blood pressure standard deviation （24 h DSD）. （5）day- time systolic blood pressure standard deviation （dSSD） and diastolic blood pressure standard deviation （dDSD）. （6） night systolic blood pressure standard deviation （nSSD） and diastolic blood pressure standard deviation （nDSD）. （7）night/day ratio of the average systolic blood pressure （nSBP/dSBP） and diastolic blood pressure ratio （nDBP/ dDBP）. Results Compared with that of the normal control group or hypertension without LVH group, the mean value of blood pressure and blood pressure variability （Hypertension with LVH group） of each phase of 24 h were significantly different（P〈0.05）, day and night blood pressure （awake/sleep） was without obvious regularity, nS- BP/dSBP ratio was significantly higher than that of the normal control group （P〈0.05）. In comparison with the normal control group, the mean blood pressure of hypertension without LVH group was significantly different （P〈 0.05）, day and night blood pressure （awake/sleep） was with obvious regularity, daytime systolic blood pressure variability was significantly different, while the others without obvious difference. Hence no statistical significance. Conclusion Blood pressure variability of hypertension without target organ damage has no significantly different, and has circadian regularity. Blood pressure variability of hypertension with target organ damage increases without a clear circadian regularity, hut n SBP/d SBP ratio is significantly increases. So, blood pressure variability and circadian regularity maybe used to assess whether patients with hypertension have target organ damage, then to guide more effectively control of blood pressure and reducing complications.