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目的结合24小时平均血压(24hMBP)分析探讨接受降压治疗的高血压患者血压昼夜节律的影响因素。方法连续收集125例接受降压药物治疗的住院患者临床资料和动态血压监测结果,结合24hMBP和昼夜节律,将患者分为:正常24hMBP杓型组(正常组)、异常24hMBP杓型组、异常24hMBP非杓型组和正常24hMBP非杓型组,比较后3组间临床资料和动态血压监测结果存在的差异,并采用非条件Logistic逐步回归法分析动态血压的影响因素。结果异常24hMBP有90例(72.0%),昼夜节律异常106例(84.8%)。其中,正常24hMBP杓型2例(1.6%);异常24hMBP杓型组17例(13.6%);异常24hMBP非杓型组73例(58.4%);正常24hMBP非杓型组33例(26.4%)。合并肾脏疾病比例,异常24hMBP杓型或非杓型组均高于正常24hMBP非杓型组(P<0.05);合并糖尿病比例,昼夜节律异常者(非杓型)高于正常者(杓型),以正常24hMBP非杓型组最高(P<0.05);钙通道阻滞剂(CCB)的应用和每早一次的服用时间比例,正常24hMBP非杓型组亦高于异常24hMBP杓型组和非杓型组(P<0.05)。异常24hMBP杓型、异常24hMBP非杓型、正常24hMBP非杓型3组中动态血压异常程度以后者最严重。Logistic回归分析结果显示:合并肾脏病(OR=0.301,95%CI:0.124～0.729,P=0.008)、CCB应用(OR=2.191,95%CI:0.967～4.966,P=0.048)、每早一次的服药方法(OR=2.384,95%CI:1.017～5.591,P=0.046)是动态血压的影响因素。结论接受降压治疗的高血压住院患者昼夜节律异常率较高,合并肾脏病、服用CCB、每早一次的服药方式等均是动态血压的影响因素;结合24hMBP水平和昼夜节律的构成进行血压昼夜节律影响因素的分析和处理可能更加合理。
Objective To investigate the influencing factors of circadian rhythm of blood pressure in hypertensive patients undergoing antihypertensive treatment with 24-hour average blood pressure (24hMBP). Methods The clinical data and ambulatory blood pressure monitoring results of 125 hospitalized patients undergoing antihypertensive drug treatment were collected. The patients were divided into normal 24hMBP dipper group (normal group), abnormal 24hMBP dipper group, abnormal 24hMBP Non-dipper group and normal 24MBP non-dipper group. The differences of clinical data and ambulatory blood pressure monitoring results were compared between the three groups. The influencing factors of ambulatory blood pressure were analyzed by non-conditional logistic regression analysis. Results Abnormal 24MBP in 90 cases (72.0%), circadian rhythm abnormalities in 106 cases (84.8%). Among them, the normal 24hMBP dipper in 2 cases (1.6%); abnormal 24hMBP dipper group in 17 cases (13.6%); abnormal 24MBP non-dipper group in 73 patients (58.4%); normal 24hMBP non-dipper group of 33 patients (26.4% . The proportion of patients with abnormal renal disease in 24hMBP dipper or non-dipper group was higher than that of normal non-dipper 24hMBP group (P <0.05). The proportion of patients with diabetes mellitus and circadian rhythm abnormalities (non-dipper type) (P <0.05). The application of calcium channel blocker (CCB) and the proportion of time taken once a day, the normal 24MBP non-dipper group was also higher than the abnormal 24MBP dipper group and non-dipper group Dipper group (P <0.05). Abnormal 24MBP dipper type, abnormal 24hMBP non-dipper type, normal 24hMBP non-dipper type 3 group of the most severe degree of ambulatory blood pressure. The results of Logistic regression analysis showed that the incidence of nephropathy was significantly higher in patients with nephrotic syndrome (OR = 0.301, 95% CI: 0.124-0.729, P = 0.008) and CCB (OR = 2.191, 95% CI: 0.967-4.966, P = 0.048) (OR = 2.384, 95% CI: 1.017-5.591, P = 0.046) were the influencing factors of ambulatory blood pressure. Conclusion The abnormal rate of circadian rhythm is higher in hypertensive hospitalized patients undergoing antihypertensive treatment. The incidence of ambulatory blood pressure is higher in patients with nephrotic syndrome, taking CCB, taking medicine once a morning, etc. The combination of 24hMBP level and circadian rhythm Rhythm analysis and treatment of factors may be more reasonable.