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目的:以血压负荷和血压变异性为观察指标,探讨原发性高血压(EH)患者 24h平稳降压对靶器官保护的临床意义。方法:对114例EH患者和22例正常人(对照组)进行24h无创性动态血压监测,EH患者按靶器官损害(TOD)程度分为3期,以及根据左室质量指数(LVMI)分为伴左室肥厚(LVH)和不伴 LVH(NLVH)组。结果:①EH患者LVMI与全天、白天、夜间平均收缩压(mSBP)、SBP负荷及其变异性呈正相关(P<0.01),与夜间 SBP 变异性相关性最强( r = 0. 45, P < 0.01);②24hSBP 负荷< 25%者 TOD 发生率低于≥25%者(27.3%∶71.4%,P<0.01);24 hSBP变异性<11.9者TOD发生率显著低于≥11.9者(28.1%∶88.0%,P<0.01)。结论:24 hSBP负荷及其变异性增大同样是高血压LVH的危险因素;降低 24 h尤其夜间 SBP负荷及其变异性可实现24 h平稳降压,有助于更好地保护靶器官。
OBJECTIVE: To investigate the clinical significance of steady-state antihypertensive effect on target organ protection in patients with essential hypertension (EH) with the indexes of blood pressure load and blood pressure variability. Methods: Noninvasive ambulatory blood pressure monitoring was performed on 114 EH patients and 22 normal controls (control group) for 24 hours. EH patients were divided into three phases according to the degree of target organ damage (TOD), and according to the left ventricular mass index (LVMI) With left ventricular hypertrophy (LVH) and without LVH (NLVH) group. Results: ① LVMI was positively correlated with all-day, daytime and nighttime mean systolic blood pressure (SBP), SBP load and its variability (P <0.01), and nighttime SBP variability was the strongest (r = 0.45, P <0.01). ② The incidence of TOD was significantly lower than that of ≥11.9 (28.1%) when the 24 h SBP load was lower than 25%, the incidence of TOD was lower than 25% (27.3% vs 71.4%, P <0.01) : 88.0%, P <0.01). CONCLUSION: The increase of 24-hSBP load and its variability is also a risk factor for LVH in hypertensive patients. Decreasing 24-h SBN load and its variability at night can stabilize blood pressure 24 hours and help to better protect the target organ.