2021 年第 6 期 第 16 卷

原发性高血压合并代谢综合征患者的动态血压特点研究

Study on characteristics of ambulatory blood pressure in patients with essential hypertension complicated with metabolic syndrome

作者：曾荣1郑恪扬1闫家富1王佐广2穆以璠1史静1程文立1

英文作者：Zeng Rong1 Zheng Keyang1 Yan Jiafu1 Wang Zuoguang2 Mu Yifan1 Shi Jing1 Cheng Wenli1

单位：1首都医科大学附属北京安贞医院高血压科100029；2首都医科大学附属北京安贞医院北京市心肺血管疾病研究所高血压研究室100029

英文单位：1Department of Hypertension Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Department of Hypertension Research Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China

关键词：原发性高血压；代谢综合征；动态血压监测；昼夜节律

英文关键词：Essentialhypertension;Metabolicsyndrome;Ambulatorybloodpressuremonitoring;Circadianrhythm

• 摘要：

• 目的 分析原发性高血压合并代谢综合征（MS）患者的动态血压特点。方法 连续选取2012年6月至2015年12月首都医科大学附属北京安贞医院高血压科住院的1 457例原发性高血压患者的临床资料进行回顾性分析。根据是否合并MS分为MS组（1 100例）和非MS组（357例）。比较 2组一般资料、实验室指标以及24 h动态血压监测结果。分析原发性高血压患者杓型血压的影响因素。结果 MS组男性比例、体重指数、腰围以及吸烟史、糖尿病和高脂血症比例均高于/大于非MS组［60.1%（661/1 100）比41.2%（147/357）、(28±4)kg/m2比（25±4)kg/m2、（100±9）cm比（90±11）cm、40.6%（447/1 100）比22.7%（81/357）、40.6%（447/1 100）比3.9%（14/357）、85.3%（938/1 100）比59.4%（212/357）］，差异均有统计学意义（均P＜0.01）。MS组血肌酐、血尿酸、三酰甘油、C反应蛋白、空腹血糖、餐后2 h血糖水平均高于非MS组，高密度脂蛋白胆固醇水平低于非MS组，差异均有统计学意义（均P＜0.05）。MS组24 h收缩压、日间收缩压、夜间收缩压及舒张压均高于非MS组，夜间收缩压下降百分率及舒张压下降百分率均低于非MS组［（4.6±7.7）%比（5.8±8.1）%、（7.1±7.8）%比（8.1±8.4）%］，差异均有统计学意义（均P＜0.05）。MS组杓型血压比例低于非MS组［8.9%(98/1 100)比68.1%(243/357)］，差异有统计学意义（χ2=4.32，P=0.04）。Logistic回归分析结果显示，女性（比值比=0.72，95%置信区间：0.56~0.92，P＜0.01）、高龄（比值比=0.97，95%置信区间：0.97~0.98，P＜0.01）及合并MS（比值比=0.75，95%置信区间：0.57~0.98，P=0.04）的原发性高血压患者杓型血压的概率更低。结论 合并MS的原发性高血压患者伴随更多的心血管疾病危险因素，血压水平更高。女性、高龄、合并MS的原发性高血压患者杓型血压的概率较低，易出现昼夜血压节律异常。

• Objective To investigate the characteristics of ambulatory blood pressure in patients with essential hypertension complicated with metabolic syndrome(MS). Methods From June 2012 to December 2015, clinical data of 1 457 patients with essential hypertension hospitalized in Department of Hypertension, Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed. They were divided into MS group(1 100 cases) and non-MS group(357 cases) according to whether they had MS or not. General data, laboratory indicators and the result of 24 h ambulatory blood pressure monitoring were compared between the two groups. The influencing factors for dipper blood pressure in patients with essential hypertension were analyzed. Results The rate of male, body mass index, waist, and rates of smoking history, diabetes mellitus and hyperlipidemia in MS group were higher than those in non-MS group ［60.1%（661/1 100） vs 41.2%（147/357）, (28±4)kg/m2 vs （25±4)kg/m2, （100±9）cm vs （90±11）cm, 40.6%（447/1 100） vs 22.7%（81/357）, 40.6%（447/1 100） vs 3.9%（14/357）, 85.3%（938/1 100） vs 59.4%（212/357）］(all P<0.01). The levels of serum creatinine, serum uric acid, triacylglycerol, C-reactive protein, fasting plasma glucose and 2 h postprandial glucose in MS group were higher than those in non-MS group, and high-density lipoproteins cholesterol level in MS group was lower than that in non-MS group(all P<0.05). The 24 h systolic blood pressure(SBP), daytime SBP, and nocturnal SBP and diastolic blood pressure(DBP) in MS group were higher than those in non-MS group, and the percentage of nocturnal SBP decreasing and percentage of nocturnal DBP decreasing in MS group were lower than those in non-MS group［(4.6±7.7)% vs (5.8±8.1)%, (7.1±7.8)% vs (8.1±8.4)%］(all P<0.05). The rate of dipper blood pressure in MS group was lower than that in non-MS group［8.9%(98/1 100) vs 68.1%(243/357)］(χ2=4.32， P=0.04). Logistic regression analysis showed that female (odds ratio=0.72, 95% confidence interval: 0.56-0.92， P＜0.01), elderly (odds ratio=0.97, 95% confidence interval: 0.97-0.98, P＜0.01) and complicated with MS (odds ratio=0.75, 95% confidence interval: 0.57-0.98， P=0.04) in patients with essential hypertension had lower probability of dipper blood pressure. Conclusions  Essential hypertensive patients complicated with MS have more cardiovascular risk factors and higher level of blood pressure. Patients with essential hypertension who were female, elderly and complicated with MS have lower probability of dipper blood pressure, and are likely to have abnormal circadian blood pressure rhythm.