高血压患者治疗后血压昼夜节律及心脏结构改变相关性探究.doc

高血压患者治疗后血压昼夜节律及心脏结构改变相关性探究 　 作者：卞玲,吴士尧,许左隽,方鹤莺 【关键词】 超声心动图 　　【摘要】 目的 探讨高血压患者治疗后的血压昼夜节律与心脏结构改变的关系。方法 根据诊所血压控制水平将179例患者分为3组：Ⅰ组患者诊所血压控制满意（血压＜140/90mmHg）；Ⅱ组患者诊所血压未控制（血压≥140/90mmHg）但自测血压正常；Ⅲ组患者为顽固性高血压。应用24h动态血压监测和超声心动图观察并比较患者的血压昼夜节律与心脏结构、功能的特点。夜间血压下降率＜10%为非勺型组，≥10%为勺型组。结果 Ⅲ组的非勺型患者（66.7%）较Ⅰ组（44.4%）及Ⅱ组（48.0%）显著增多(P＜0.01)。Ⅲ组的左室肥厚患者（62.7%）较Ⅰ组（11.7%）及Ⅱ组（34.1%）显著增多(P＜0.01)。3组勺型和非勺型患者间的左室肥厚比较均差异无显著性。结论 治疗后的原发性高血压患者其血压控制水平、血压昼夜节律与心脏结构改变无相关性。 　　【关键词】 高血压;昼夜节律；动态血压监测；超声心动图 　　Study of relationship between a reduced nocturnal fall in blood pressure and more prominent cardiac alterations in treated essential hypertensive patients 　　【Abstract】 Objective To evaluate the relation between a reduced nocturnal fall in blood pressure and more prominent cardiac alterations in treated essential hypertensive patients.Methods One hundred seventy nine patients were performed ambulatory blood pressure monitoring (ABPM) and echocardiography.For the purpose of this study ABPM was carried-out in three subgroups with different clinic BP profile:1)patients with satisfactory BP control(BP＜140/90 mmHg；groupⅠ,n=50);2) patients with uncontrolled clinic BP(clinic BP values≥140 and/or 90 mmHg) but lower self-measured BP(group,n=72);3) patients with refractory hypertension，selected according to WHO/ISH guidelines definition(group,n=57).Results The prevalence of non-dippers was significantly lower in group Ⅲ ( 48.0%) and Ⅱ (44.4%) than in group Ⅲ (66.7%,P＜0.01 Ⅲ vs Ⅱ andⅠ).The prevalence of LVH 11.7% in groupⅠ,34.1% in group Ⅱ and 62.7% in group Ⅲ (P＜0.01 Ⅲ vs Ⅱ and Ⅰ).No differences in cardiac structure were found in relationship to dipping or non-dipping status in the three groups.Conclusion In treated essential hypertensive patients with or without BP control the extent of nocturnal BP decrease is not associated with an increase in LV mass or LVH prevalence；therefore, the non-dipping profile does not identify hypertensive patients with greater cardiac damage. 　　【Key words】 hypertension;circadian rhythm；am