个体化降压干预异常血压昼夜节律对高血压合并冠心病患者血压及左室肥厚的影响  

Effect of individualized antihypertensive therapy on the blood pressure and left ventricular hypertrophy of hypertensive patients with coronary heart disease

作　　者：刘同波[1] 李瑶 姚思宇 汪驰 王淼 刘杰[2] 石亚君[2] 薛浩[2] Liu Tongbo;Li Yao;Yao Siyu;Wang Chi;Wang Miao;Liu Jie;Shi Yajun;Xue Hao(Medical Big Data Center of Chinese PLA General Hospital,Beijing 100853,China;Department of Cardiology of Chinese PLA General Hospital,Beijing 100853,China;School of Medicine,Nankai University,Tianjin 300071,China)

机构地区：[1]解放军总医院医疗大数据中心,北京100853 [2]解放军总医院心血管内科,北京100853 [3]南开大学医学院,天津300071

出　　处：《中华医学杂志》2019年第13期977-982,共6页National Medical Journal of China

基　　金：国家自然科学基金(81570383);首都市民健康培育项目(Z141100002114029).

摘　　要：目的探讨个体化降压干预异常血压昼夜节律对高血压合并冠心病患者预后的影响。方法连续入选2014年9月至2015年12月在解放军总医院住院的高血压合并冠心病不稳定性心绞痛患者中血压节律异常的患者650例,根据24 h动态血压监测结果将患者分为非杓型组(夜间血压下降<10%)(n=259),反杓型组(夜间血压较白昼上升)(n=391)。服用短效降压药物者改为长效或缓释降压药物;已经服用长效或缓释将药物者,改为夜间给药或者夜间加用一次降压药物。患者记录睡前、晨起家庭自测血压,每3个月门诊随访一次,记录诊室血压,1年后根据24 h动态血压监测评估治疗对血压昼夜节律的影响,根据患者超声心动图结果计算左室重量指数评估治疗对左室肥厚的影响。结果个体化治疗1年后两组患者诊室血压与24 h各时段血压均有降低,非杓型和反杓型血压组分别有44%、57%恢复为正常杓型血压节律类型。基线为左室肥厚者在非杓型、反杓型组分别有44%、48%恢复正常。LVMI在非杓型、反杓型两组中分别为治疗前后[(59±12)kg/m^2.7比(48±10)kg/m^2.7;P<0.01]、[(63±13)kg/m^2.7比(48±11)kg/m^2.7;P<0.01]。结论个体化降压干预异常血压昼夜节律能有效降低高血压合并冠心病患者全天各时段血压,并能有效逆转左室肥厚。Objective To investigate the effect of individualized antihypertensive therapy on the blood pressure and left ventricular hypertrophy (LVH) of hypertensive patients with coronary heart disease (CHD). Methods We conducted a prospective study from Sep. 2014 to Dec. 2015 in Chinese PLA General Hospital. A total of 650 patients complicated with non-dipper or reverse-dipper hypertension and CHD were enrolled. All the participants were divided into non-dipper (n=259) and reverse-dipper (n=391) group according to their 24h ambulatory blood pressure monitoring (ABPM) reports. Patients who took short-acting antihypertensives changed their medicine to long-acting ones. Patients who had already taken long-acting antihypertensives switched to nighttime or added antihypertensives at night. Self-measured home blood pressure was recorded before going to bed and in the morning. All patients were regularly followed up by face-to-face surveys and clinic BP was recorded every 3 months. After 1 year′s follow-up, the effect of individualized antihypertensive treatment on circadian rhythm of blood pressure was evaluated by 24h ABPM. The effect of individualized antihypertensive treatment on LVH was evaluated by echocardiography. Results After 1 year′s individualized antihypertensive therapy, the clinic BP and 24h ABPM of the patients were decreased. BP rhythm in 44% of the non-dipper and 57% of the reverse-dipper patients restored to normal. LVH were returned to normal in 44% of the non-dipper patients and and 48% of the reverse dipper patients, respectively. Left ventricular mass index (LVMI) were (59±12) kg/m^2.7 vs (48±10) kg/m^2.7 (P<0.01), and (63±13) kg/m^2.7 vs (48±11) kg/m^2.7 (P<0.01) respectively in non-dipper and reverse-dipper group before and after individualized antihypertensive treatment. ConclusionIndividualized antihypertensive intervention of abnormal blood pressure circadian rhythm can effectively restore the circadian rhythm of blood pressure and reverse LVH in hypertensive patients with CHD.

关 键 词：昼夜节律 个体化降压 高血压 冠心病 肥大 左心室 

分 类 号：R544.1[医药卫生—心血管疾病]