原发性高血压患者血压变异性与高尿酸血症的关系

目的 探讨原发性高血压患者血压变异性（BPV）与高尿酸血症的相关性。方法 纳入197例原发性高血压患者并根据其是否伴高尿酸血症分为无高尿酸血症组（143例）和高尿酸血症组（54例）；根据血清尿酸（SUA）水平四分位数分为Q1组SUA≤282.35 μmol/L（49例），Q2组282.35 μmol/L406.65 μmol/L（49例）。所有患者入院3 d内完成24 h动态血压监测。收集2组患者一般资料、生化指标和血压相关指标并进行比较；采用LASSO回归筛选高尿酸血症预测因子；多因素Logistic回归分析高尿酸血症的影响因素。结果 原发性高血压患者高尿酸血症的患病率为27.4%。与无高尿酸血症组比较，高尿酸血症组男性占比及高血压分级更高，体质量指数（BMI）、三酰甘油（TG）、血肌酐（Scr）、血尿素氮（BUN）及血尿酸（SUA）水平升高，糖化血红蛋白（HbA1c）、高密度脂蛋白胆固醇（HDL-C）、尿酸排泄分数（FEUA）及估算肾小球滤过率（eGFR）降低（P<0.05）。随着高血压分级增加，Q2组占比逐渐下降，而Q4组占比逐渐上升，趋势变化差异有统计学意义（χ²_趋势=4.578，P<0.05）。与无高尿酸血症组比较，高尿酸血症组日间收缩压平均值（DDBPX）、夜间收缩压平均值（NDBPX）、舒张压的加权标准差（DBPwSD）及心率变异性（HRV）均升高（P<0.05）。以LASSO回归筛选出的高血压分级、DBPwSD、TG、eGFR、FEUA作为自变量，Logistic回归分析结果显示DBPwSD、TG水平升高为高尿酸血症的危险因素，eGFR、FEUA升高为高尿酸血症的保护因素。结论 舒张期BPV是原发性高血压患者发生高尿酸血症的独立危险因素。

Relationship between blood pressure variability and hyperuricemia in patients with essential hypertension

Objective To analyze the relationship between blood pressure variability (BPV) and hyperuricemia in patients with essential hypertension. Methods A total of 197 patients with essential hypertension were divided into the non-hyperuricemia group (n=143) and the hyperuricemia group (n=54) according to whether they were accompanied by hyperuricemia. The participants were divided into four groups according to the serum uric acid (SUA) quartile, the group Q1 (n=49) with SUA≤282.35 μmol/L, the group Q2 (n=50) with 282.35 μmol/L < SUA≤332.40 μmol/L, the group Q3 (n=49) with 332.40 μmol/L < SUA≤406.65 μmol/L, the group Q4 (n=49) with SUA > 406.65 μmol/L. All patients completed 24-hour ambulatory blood pressure monitoring within 3 days of admission. The general data, biochemical indexes and blood pressure related indexes were collected and compared between the two groups. LASSO regression was used to screen the predictors of hyperuricemia. Multivariate Logistic regression analysis was used to test risk factors of hyperuricemia. Results The prevalence of hyperuricemia in patients with essential hypertension was 27.4%. Compared with the non-hyperuricemia group, the proportion of males and hypertension grade were higher in the hyperuricemia group, and the levels of body mass index (BMI), triglyceride (TG), serum creatinine (Scr), blood urea nitrogen (BUN) and uric acid (SUA) were increased. Glycated hemoglobin A1c (HbA1c), high density lipoprotein cholesterol (HDL-C), uric acid excretion fraction (FEUA) and estimated glomerular filtration rate (eGFR) were decreased in the hyperuricemia group (P<0.05). With the increase of hypertension grade, the proportion of the Q2 group gradually decreased, while the proportion of the Q4 group gradually increased, and the difference in trend change was statistically significant (χ²=4.578, P<0.05). Compared with the non-hyperuricemia group, the mean daytime diastolic blood pressure (DDBPX), mean nighttime diastolic blood pressure (NDBPX), weighted standard deviation of diastolic blood pressure (DBPwSD) and heart rate variability (HRV) were significantly increased in the hyperuricemia group (P<0.05). LASSO regression was used to select hypertension grade, DBPwSD, TG, eGFR and FEUA as independent variables. Logistic regression analysis demonstrated that elevated levels of DBPwSD and TG were risk factors for hyperuricemia, and elevated levels of eGFR and FEUA were protective factors for hyperuricemia. Conclusion Diastolic BPV is an independent risk factor for hyperuricemia in hypertensive patients.