隐匿性高血压人群血压昼夜节律特点及与十二时辰关系的横断面研究  

Circadian Rhythm of Blood Pressure in Patients with Masked Hypertension and its Relationship with Twelve Two-hour Periods: A Cross-sectional Study

作　　者：王灵丽 刘鸣 王明春 赵舒梅 龚晓燕 傅梦玉 袁霄 刘兰英 WANG Lingli;LIU Ming;WANG Mingchun;ZHAO Shumei;GONG Xiaoyan;FU Mengyu;YUAN Xiao;LIU Lanying(Affiliated Hospital of Nanjing University of Chinese Medicine/Jiangsu Province Hospital of Traditional Chinese Medicine,Nanjing,210029;The First Clinical Medical College,Nanjing University of Chinese Medicine;Institute of Health and Wellness,Jiangsu Open University)

机构地区：[1]南京中医药大学附属医院/江苏省中医院,江苏省南京市210029 [2]南京中医药大学第一临床医学院 [3]江苏开放大学健康养生研究所

出　　处：《中医杂志》2024年第14期1469-1477,共9页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(82274632);江苏省中医高血压病临床医学创新中心重点项目(k2021j17-4);南京市2022年度科技发展计划(202205050);江苏省中医院高峰人才项目(y2021rc14,y2021rc15);南京中医药大学自然科学基金(XZR2020007)。

摘　　要：目的 探讨隐匿性高血压人群血压昼夜节律特点及其与十二时辰的关系,为隐匿性高血压的早期发现与干预提供依据。方法 纳入2022年1—12月于江苏省中医院动态血压室行24 h动态血压检查的受试者,根据其门诊血压测量值、24 h动态血压监测及随访调查结果,选择理想血压、隐匿性高血压人群及原发性高血压病患者,分别作为理想血压组、隐匿性高血压组、原发性高血压组,每组50例。收集各组受试者一般资料、诊室血压及24 h动态血压监测数据。比较各组受试者一般情况及血压昼夜节律[包括24 h平均收缩压(24h SBP)、白昼平均收缩压(d SBP)、夜间平均收缩压(n SBP)、24 h平均舒张压(24h DBP)、白昼平均舒张压(d DBP)、夜间平均舒张压(n DBP)],计算夜间血压下降率,根据夜间血压下降率判定昼夜节律分型。比较各组受试者血压变异性[包括24 h收缩压标准差(24h SBP-SD)、白昼收缩压标准差(d SBP-SD)、夜间收缩压标准差(n SBP-SD)、24 h舒张压标准差(24h DBP-SD)、白昼舒张压标准差(d DBP-SD)、夜间舒张压标准差(n DBP-SD)],并计算24 h收缩压变异系数(24h SBP-CV)、白昼收缩压变异系数(d SBP-CV)、夜间收缩压变异系数(n SBP-CV)、24 h舒张压变异系数(24h DBP-CV)、白昼舒张压变异系数(d DBP-CV)、夜间舒张压变异系数(n DBP-CV)。根据24h动态血压监测结果,计算并比较各组受试者十二时辰平均收缩压及舒张压。同时将原发性高血压病患者分为1、2、3级进一步分层比较。结果 隐匿性高血压组年龄显著高于原发性高血压组和理想血压组(P<0.01)。隐匿性高血压组、原发性高血压组患者体重指数(BMI)、吸烟及饮酒比例均高于理想血压组(P<0.05或P<0.01)。理想血压组杓型血压者49例(98.0%),非杓型血压者1例(2.0%);隐匿性高血压组杓型血压者2例(4.0%)、非杓型血压29例(58.0%)、反杓型血压19例(38.0%);原发性高血压组杓型血�Objective To explore the characteristics of circadian rhythm of blood pressure in patients with masked hypertension(MH)and its relationship with twelve two-hour peirods,providing a basis for early detection and intervention of MH.Methods Patients who underwent 24-hour ambulatory blood pressure examination in the ambulatory blood pressure room of Jiangsu Province Hospital of Chinese Medicine from January to December 2022 were enrolled,and according to their outpatient blood pressure measurements,24-hour ambulatory blood pressure monitoring and follow-up survey results,the MH,essential hypertension(EH)and normal blood pressure groups were classified,with 50 cases in each group.The general data,office blood pressure and 24-hour ambulatory blood pressure monitoring data were collected.The circadian rhythm of blood pressure including 24-hour average systolic blood pressure(24h SBP),daytime average systolic blood pressure(d SBP),nighttime average systolic blood pressure(n SBP),24-hour average diastolic blood pressure(24h DBP),daytime average diastolic blood pressure(d DBP),and nighttime average diastolic blood pressure(n DBP)were compared among the groups,and the nighttime blood pressure dipping percentage was calculated.The type of circadian rhythm was determined based on the nighttime blood pressure dipping percentage.The variability of blood pressure including 24h SBP standard deviation(24h SBP-SD),d SBP standard deviation(dSBP-SD),n SBP standard deviation(nSBP-SD),24h DBP standard deviation(24h DBP-SD),d DBP standard deviation(dDBP-SD),and n DBP standard deviation(nDBP-SD)were compared among groups,and the corresponding coefficient of variation(CV),that is,24h SBP-CV,d SBP-CV,n SBP-CV,24h DBP-CV,d DBP-CV and n DBP-CV,were calculated.Based on the 24-hour ambulatory blood pressure monitoring results,the twelve two-hour average SBP and DBP in each group were calculated and compared.Simultaneously,patients with EH were divided into grades 1,2,and 3 for further stratified analysis.Results The age of the MH group was sig

关 键 词：隐匿性高血压 昼夜节律 非杓型血压 反杓型血压 原发性高血压 十二时辰 血压变异性 

分 类 号：R259[医药卫生—中西医结合]