摘要
目的探讨不同年龄原发性高血压患者血压变异性与血浆肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮水平的相关关系。方法回顾性分析2015年12月至2017年12月间于河南省人民医院高血压科诊断为轻中度原发性高血压的患者,检测血脂、空腹血糖、肾功能、尿酸、卧立位PRA、AngⅡ、醛固酮水平(检测前均暂时停用所有影响PRA水平的降压药物),并同时行24 h动态血压监测。排除继发性高血压后,最终符合入选条件者共300例,按照年龄分为3组:青年组(18~44岁)100例,中年组(45~64岁)110例和老年组(≥65岁)90例,比较3组间PRA、AngⅡ、醛固酮水平与血压变异性的关系。结果PRA随着年龄增长呈逐渐降低趋势,青年组患者卧立位PRA[分别为1.30(0.60~2.15),3.45(1.23~6.38)μg/(L·h)]较中年组[0.50(0.20~0.90),1.20(0.60~2.70)μg/(L·h)]和老年组[0.30(0.20~0.30),0.40(0.30~0.80)μg/(L·h)]明显升高(P<0.05);且中年组患者卧立位PRA较老年组也明显升高(P<0.05)。青年组卧立位醛固酮水平较中年和老年组明显升高。老年组患者24 h收缩压变异系数(24hSBPCV)、白天收缩压和舒张压变异系数(dSBPCV和dDBPCV)、夜间收缩压变异系数(nSBPCV)较青年组和中年组高(均P<0.05)。Spearman相关分析显示,青年组患者,24hSBPCV与卧立位PRA、AngⅡ、醛固酮水平相关(P<0.05);dSBPCV与卧位PRA、立位AngⅡ、卧立位醛固酮水平相关(P<0.05);24hDBPCV、dDBPCV与卧立位PRA、醛固酮水平相关(P<0.05)。中年组患者,24hSBPCV、dSBPCV与卧立位PRA、AngⅡ、醛固酮水平相关(P<0.05);24hDBPCV与卧立位PRA、卧位AngⅡ、卧立位醛固酮水平相关(P<0.05);dDBPCV与卧位PRA、AngⅡ水平相关(P<0.05);nSBPCV与立位PRA、卧立位AngⅡ及醛固酮水平相关(P<0.05);nDBPCV与卧立位PRA水平相关(P<0.05)。老年组患者,只有24hDBPCV、nDBPCV与卧立位AngⅡ水平相关,dDBPCV与立位AngⅡ,nSBPCV与立位醛固酮水平相关(均P<0.05)。结论中青年轻中度原发性高血压患者血压变异性与血浆肾素血管紧张素醛固酮系统(RAAS)水平相关,血浆RAAS水平是血压变异性增加的危险因素之一。
Objective To study the correlation between blood pressure variability(BPV)and plasma renin activity(PRA),angiotensinⅡ(AngⅡ),aldosterone levels in patients with essential hypertension.Methods A total of 300 patients with mild to moderate essential hypertension diagnosed in the Department of Hypertension of Henan Provincial People’s Hospital from December 2015 to December 2017 were analyzed retrospectively.The blood lipids,fasting blood glucose,renal function,uric acid,renin-angiotensin-aldosterone levels were detected(temporarily discontinued all antihypertensive drugs affecting plasma renin activity levels before detection)and blood pressure was measured by 24-hour ambulatory blood pressure monitoring.Based on age,the subjects were divided into three groups:100 patients aged 18-44 years(young group),110 patients aged 45-64 years(middle-aged group)and 90 patients aged over 65 years(elderly group).The relationships between blood pressure variability and the PRA,AngⅡ,aldosterone levels were compared among the three groups.Results The PRA level gradually decreased with age.In the young group,the supine and upright position PRA was 1.30(0.60-2.15),3.45(1.23-6.38)μg/(L·h),which was significantly higher than those in the middle-aged group[0.50(0.20-0.90),1.20(0.60-2.70)μg/(L·h)]and elderly group[0.30(0.20-0.30),0.40(0.30-0.80)μg/(L·h)].The supine and upright position aldosterone levels in the young group was significantly higher than those in the middle-aged group and elderly group.Coefficient of variation(CV)of 24-hour systolic blood pressure(24 hSBPCV),CV of 24-hour diastolic blood pressure(24 hDBPCV),CV of daytime systolic blood pressure(dSBPCV),CV of daytime diastolic blood pressure(dDBPCV)and CV of nighttime systolic blood pressure(nSBPCV)in the elderly group were higher than those in the young group and the middle-aged group,among which 24 hSBPCV,dSBPCV,dDBPCV and nSBPCV increased significantly(all P<0.05).Spearman correlation analysis showed that in the young group,24 hSBPCV was significantly correlated with the levels of PRA,AngⅡand aldosterone in supine and upright position(all P<0.05),dSBPCV was significantly correlated with the levels of PRA in supine position,AngⅡin upright position and aldosterone in supine and upright position,24 hDBPCV,dDBPCV were correlated with PRA,aldosterone in supine and upright position(all P<0.05).In the middle-aged group,24 hSBPCV and dSBPCV were significantly correlated with PRA,AngⅡand aldosterone levels in supine and upright position,24 hDBPCV was significantly correlated with PRA,aldosterone in supine and upright position and AngⅡin supine position(all P<0.05),dDBPCV was significantly correlated with horizontal PRA and AngⅡlevels(all P<0.05),nSBPCV was significantly correlated with PRA in orthostatic position,AngⅡand aldosterone in supine and upright position(all P<0.05),CV of nighttime systolic blood pressure(nDBPCV)was correlated with PRA level in supine and upright position(all P<0.05).But in the elderly group,only 24 hDBPCV and nDBPCV were correlated with the AngⅡlevel in supine and upright position,dDBPCV correlated with AngⅡin upright position,nSBPCV correlated with aldosterone in upright position(all P<0.05).Conclusion There is a correlation between blood pressure variability and plasma renin-angiotensin-aldosterone system(RAAS)in young and middle-aged patients with mild to moderate essential hypertension.Plasma RAAS levels is one of the risk factors for BPV.
作者
樊彩妮
赵海鹰
田丹丹
王浩
FAN Cai-ni;ZHAO Hai-ying;TIAN Dan-dan;WANG Hao(Department of Hypertension,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou Henan 450003,China)
出处
《中华高血压杂志》
CAS
CSCD
北大核心
2019年第12期1172-1178,共7页
Chinese Journal of Hypertension
基金
河南省科技厅科技攻关项目(132102310189,182102311235).
作者简介
通信作者:王浩,E-mail:doctorwanghao@126.com
