摘要【目的】探讨原发性高血压患者的血压昼夜节律、血压变异性与踝肱指数(ABI)的相关性。【方法】选择2021年9月至2023年12月在本院就诊的176例原发性高血压患者,根据ABI的检测结果将患者分为硬化组(n=90)和非硬化组(n=86),根据血压昼夜节律将患者分为杓型组(n=48)、非杓型组(n=94)和反杓型组(n=34)。比较非硬化组与硬化组动态血压指标[24 h 收缩压(24hSBP)、日间收缩压(dSBP)、夜间收缩压(nSBP),以及24 h 舒张压(24hDBP)、日间舒张压(dDBP)、夜间舒张压(nDBP)]、血压变异性指标[24 h收缩压标准差(24hSSD)、24 h舒张压标准差(24hDSD)、日间收缩压标准差(dSSD)、日间舒张压标准差(dDSD)、夜间收缩压标准差(nSSD)、夜间舒张压标准差(nDSD)],计算收缩压下降率(ΔSBP％)、舒张压夜间下降率(ΔDBP％)。采用Pearson分析血压昼夜节律与外周动脉粥样硬化的相关性,采用多因素Logistic回归分析外周动脉粥样硬化的影响因素。【结果】硬化组 24hSBP、dSBP、nSBP、24hSSD、24hDSD、dSSD、nSSD、nDSD高于非硬化组,ΔSBP％低于非硬化组,差异有统计学意义(P<0.05)。非杓型组、反杓型组ABI显著低于杓型组,差异有统计学意义(P<0. 05)。Pearson相关分析显示, ABI与ΔSBP％呈负相关(r=－0.406,P=0.044)。Logistic回归分析显示,24hSSD、nSSD升高是外周动脉粥样硬化发生的危险因素(P<0.05)。【结论】血压的异常昼夜节律及变异性是导致动脉粥样硬化的重要因素,而对血压变化的正确分析是预防和干预动脉粥样硬化的有效措施。
Abstract：【Objective】To investigate the relationship between blood pressure circadian rhythm, blood pressure variability and ankle-brachial index (ABI) in patients with essential hypertension.【Methods】A total of 176 patients with essential hypertension admitted to our hospital from September 2021 to December 2023 were selected and divided into sclerotic group (n=90) and non-sclerotic group (n=86) according to the detection results of anklebrachial index (ABI). Patients were divided into arytenoid group (n=48), non-arytenoid group (n=94) and reverse arytenoid group (n=34) according to circadian rhythm of blood pressure. The non-sclerotic group and the sclerotic group were compared in terms of the ambulatory blood pressure index [24 h systolic blood pressure (24hSBP), daytime systolic blood pressure (dSBP), night systolic blood pressure (nSBP), and 24 h diastolic blood pressure (24hDBP), daytime diastolic blood pressure (dDBP), night diastolic blood pressure (nDBP)] and the indicators of blood pressure variability [24 h standard deviation of systolic blood pressure (24hSSD), 24 h standard deviation of diastolic blood pressure (24hDSD), standard deviation of diastolic blood pressure (dSSD), standard deviation of diastolic blood pressure (dDSD), standard deviation of nocturnal systolic blood pressure (nSSD), standard deviation of nocturnal diastolic blood pressure (nDSD)]. The decreasing rate of systolic blood pressure (ΔSBP%) and the decreasing rate of diastolic blood pressure at night (ΔDBP%) were calculated. Pearson was used to analyze the correlation between circadian rhythm of blood pressure and peripheral atherosclerosis, and multiple Logistic regression was used to analyze the influencing factors of peripheral atherosclerosis.【Results】24hSBP, dSBP, nSBP, 24hSSD, 24hDSD, dSSD, nSSD, nDSD in hardening group were higher than those in non-hardening group, and ΔSBP% was lower than that in non-hardening group, the difference was statistically significant (P<0.05). ABI of non-arytenoid group and reverse arytenoid group was significantly lower than that of arytenoid group, and the difference was statistically significant (P<0.05). Pearson correlation analysis showed that ABI was negatively correlated with ΔSBP%, the difference was statistically significant (r=-0.406,P=0.044). Logistic regression analysis showed that the increase of 24hSSD and nSSD was a risk factor for peripheral atherosclerosis (P<0.05).【Conclusion】Abnormal circadian rhythm and variability of blood pressure are important factors leading to atherosclerosis, and correct analysis of blood pressure variation is an effective measure to prevent and intervene atherosclerosis.
[1] 俞杨,渠井泉,顾海平.老年人群高血压发病特点及动态血压监测在疾病管理中的作用[J].医学临床研究,2024,41(9):1305-1307. [2] RAYNER B.The effect of lercanidipine or lercanidipine/enalapril combination on blood pressure in treatment-naive patients with stage 1 or 2 systolic hypertension[J].Pragmat Obs Res,2019, 10: 9-14. [3] HUANG Q F, YANG W Y, ASAYAMA K, et al. Ambulatory blood pressure monitoring to diagnose and manage hypertension[J].Hypertension,2021,77(2):254-264. [4] TAHER Z A, KHAYYAT W W, BALUBAID M M, et al. The effect of blood pressure variability on the prognosis of hypertensive patients[J].Anatol J Cardiol,2019,22(3): 112-116. [5] 《中国高血压防治指南修订》委员会.中国高血压防治指南2010[J].中华心血管病杂志,2011,39(7):579-616. [6] PELTONEN E, LAIVUORI M, VAKHITOV D, et al. The cardiovascular-mortality-based estimate for normal range of the ankle-brachial index (ABI)[J].J Cardiovasc Dev Dis,2022,9(5):147. [7] ZHOU Y, LI P, LUAN J W, et al. Study on blood pressure rhythm in hypertensive patients with Yin deficiency syndrome and a random forest model for predicting hypertension with Yin deficiency syndrome[J].J Tradit Chin Med,2024,44(3): 564-571. [8] DAHLE N,ÄRNLÖV J,LEPPERT J, et al. Nondipping blood pressure pattern predicts cardiovascular events and mortality in patients with atherosclerotic peripheral vascular disease[J].Vasc Med,2023,28(4): 274-281. [9] CHANG J C, XIAO R, MEYERS K E, et al.Nocturnal blood pressure dipping as a marker of endothelial function and subclinical atherosclerosis in pediatric-onset systemic lupus erythematosus[J].Arthritis Res Ther,2020,22(1):129. [10] ROUXINOL-DIAS A L, GONÇALVES M L, RAMALHO D, et al. comparison of blood pressure variability between 24 h ambulatory monitoring and office blood pressure in diabetics and nondiabetic patients: a cross-sectional study[J].Int J Hypertens,2022,2022: 1022044. [11] WU D,LI C Y,CHEN Y J. Influence of blood pressure variability on early carotid atherosclerosis in hypertension with and without diabetes[J].Medicine (Baltimore),2016, 95(24): e3864. [12] NUYUJUKIAN D S, ZHOU J J, KOSKA J, et al. Refining determinants of associations of visit-to-visit blood pressure variability with cardiovascular risk: results from the ACCORD trial[J].J Hypertens,2021,39(11): 2173-2182. [13] NWABUO C C, YANO Y, MOREIRA H T, et al. Association between visit-to-visit blood pressure variability in early adulthood and myocardial structure and function in later life[J].JAMA Cardiol,2020, 5(7): 1-8.
2025, Vol. 42 
