高血压患者昼夜血压变化类型及降压治疗的影响  

Circadian Blood Pressure Changes and Their Response to Antihypertensive Intervention

作　　者：周国良[1] 冯瑞儿[1] 廖娅玲[1] 

机构地区：[1]广州医学院第二附属医院心内科,广东广州510260

出　　处：《广州医学院学报》2007年第5期24-26,共3页Academic Journal of Guangzhou Medical College

基　　金：广州医学院科研基金资助项目(03-k-41)

摘　　要：目的:采用动态血压评价治疗和未治疗高血压患者的昼夜血压变化类型、各型发生率及其与高血压分级的关系。方法:对本院门诊或住院的高血压患者作24 h动态血压记录,按文献报道的方法对记录结果进行昼夜血压变化分类,比较治疗与未治疗组间及各高血压级别间各类型血压发生率的差异。结果:全组1 087例患者收缩压与舒张压无夜间明显下降者分别达70%和66%,超勺型分别为3.5%和4.6%;治疗组反勺型发生率显著高于未治疗组(P<0.05),勺型发生率则显著低于未治疗组(P<0.01);高血压3级患者反勺型血压发生率显著增高(P<0.05);高血压晨峰发生率仅0.46%。结论:高血压患者多数为无明显夜间血压下降的非勺型或昼低夜高的反勺型,超勺型血压及高血压晨峰的发生率并不高。降压治疗后非勺型和反勺型增多而勺型减少,应更多地注意合理用药来控制夜间血压。Objective：To summarize on circadian blood pressure changes regarding their patterns, rate of these patterns and how they correlated with grades of hypertension, using 24-hour ambulatory blood pressure monitoring in treated vs untreated hypertensives. Methods： Twenty-four hour ambulatory blood pressure monitoring and classification of the patterns of circadian blood pressure changes were performed in a cohort of hospitalized patients and clinic visitors, according to the methods reported. The rates of patterns were compared between treated and untreated hypertensives stratified by grading of high blood pressure. Results： In all subjects （n = 1087 ） , evidenced nocturnal fall of systolic blood pressure was not found in 70% , nor did that of diastolic blood pressure in 66% ; 3.5% and 4.6% showed extreme dipper pattern of circadian change in systolic and diastolic BP, respectively. Compared with untreated subjects, more patients on treatment presented with reverse dipper pattern （P 〈 0.05 ） and less with dipper pattern （P 〈0.01 ）. Patients with Grade 3 hypertension were found with a higher rate of reverse dipper pattern （P 〈 0.05 ）. Morning surge of blood pressure was seen in only 0.46% of all patients. Conclusion： Most of hypertensive patients presented with nondipper pattern （no nocturnal systolic and diastolic BP falls） or reverse dipper pattern （low in the morning and high in the evening） of circadian blood pressure changes. Prevalence of morning surge in blood pressure and extreme-dipper pattern may be fairly low. Increase in nondipper or reverse dipper patterns and decrease in dipper pattern after antihypertensive treatment indicated that more attention should be given to proper control of nocturnal hypertension.

关 键 词：高血压 动态血压 高血压晨峰 勺型 

分 类 号：R544.1[医药卫生—心血管疾病]