青年原发性高血压患者治疗前后动态血压监测的临床分析

目的探讨青年原发性高血压患者降压治疗前后动态血压水平及昼夜节律变化。方法对95例青年原发性高血压患者给予降压药物治疗,比较治疗前后24 h动态血压监测指标:血压平均值、脉压平均值、血压负荷、血压昼夜节律。结果青年原发性高血压患者白天、夜间收缩压/舒张压均高于正常值,治疗后均显著下降,差异有统计学意义(P<0.05)。治疗前白天收缩压和舒张压负荷分别为30%和36%,夜间收缩压和舒张压负荷分别为28%和32%;治疗后分别为降至4%、3%和3%、4%,差异有统计学意义(P<0.01)。治疗前血压昼夜节律异常(非勺型)者高达81.1%(77/95)。治疗后收缩压和舒张压夜间血压下降率较治疗前均有明显增加,差异具有统计学意义(P<0.05),但血压昼夜节律由非勺型转变为勺型仅占19.5%(15/77)。结论青年原发性高血压患者经降压药物治疗后全天血压均值和血压负荷均有显著降低,夜间血压下降率也明显增加,但只能使部分患者的血压恢复到正常昼夜节律。

Clinical study of ambulatory blood pressure monitoring before and after treatment in youth with essential hypertension

Objective To investigate the characteristics of ambulatory blood pressure levels and circadian rhythm in the youth with essential hypertension（EH） before and after treatment.Methods 95 young patients with EH were treated with antihypertensive drugs.Four indexes of 24-hour ambulatory blood pressure monitor were measured and compared before and after treatment,including mean blood pressure,mean pulse pressure,blood pressure load and blood pressure circadian rhythm.Results Systolic pressure and diastolic pressure in EH patients were all higher than the normal value in the whole day but decreased obviously（P 0.05） after the treatment.Before the treatment,the systolic pressure load was 30%and the diastolic pressure load was 36%in daytime;which was 28%and 32%at night.After the treatment,the systolic pressure load decreased to 4%in daytime and 3%at night;the diastolic pressure load decreased to 3%in daytime and 4%at night.The differences were statistically significant（P 0.01）.The patients with abnormity in circadian rhythm of blood pressure（nondipper） account for 81.1%（77/95 ） before the treatment.The decrease rates of systolic pressure and diastolic pressure during the night were all increased obviously（P 0.05） after the treatment.However,there was only 19.5%（15/77） nondipper blood pressure circadian rhythms changing into dippers.Conclusion After treatments young EH patients had much lower mean blood pressure and blood pressure load in the whole day.Decrease rate of blood pressure during the night increased obviously,whereas only a part of patients recovered to normal blood pressure circadian rhythms.