目的 探讨血压控制相对稳定的高血压疗养员动态血压特征,分析血压调节功能受损的发生现状及独立危险因素,为该群体高血压精细化健康管理与疗养康复提供循证依据。方法 选取某部疗养中心91例血压控制相对稳定的原发性高血压患者,行24 h动态血压监测(ABPM),收集一般资料及动态血压多维度指标。依据非勺型/反勺型节律、夜间收缩压负荷升高、血压变异性增大判定血压调节功能受损,采用单因素及多因素logistic回归分析危险因素。结果 91例研究对象中,血压调节功能受损72例,占79.12%。勺型18例(19.78%),非勺型56例(61.54%),反勺型17例(18.68%),夜间收缩压平均下降率为(3.44±6.31)%。受损组夜间收缩压、夜间收缩压负荷、年龄≥60岁及血压昼夜节律异常占比高于正常组(P＜0.05)。多因素logistic回归分析证实,入组基线水平下夜间收缩压负荷升高(OR=1.132,P=0.010)、24 h收缩压变异系数增高(OR=3.008,P=0.020)、血压昼夜节律异常(OR=18353.043,P=0.010),是血压调节功能受损的独立危险因素。结论 ABPM多维度指标可作为评估血压控制质量、识别高危人群的核心手段,高血压管理应从“数值达标”向“功能、节律、质量达标”转型。
Abstract
Objective To explore the ambulatory blood pressure features of the hypertensive convalescents with relatively well-controlled blood pressure, and to analyze the current status and independent risk factors of impaired blood pressure regulation function, so as to provide evidence-based support for precise rehabilitation and health management of hypertension in this population. Methods A total of 91 patients with primary hypertension and relatively well-controlled blood pressure were recruited from a convalescent center. All subjects underwent 24-hour ambulatory blood pressure monitoring (ABPM), and general clinical data and multi-dimensional ABPM indicators were collected. Impaired blood pressure regulation function was determined by non-dipping/reverse-dipping circadian rhythm, elevated nocturnal systolic blood pressure load, and increased blood pressure variability. Univariate and multivariate Logistic regression analyses were performed to identify the risk factors. Results Among the 91 study subjects, 72 cases were identified with impaired blood pressure regulation function, with a prevalence rate of 79.12%. Specifically, dipping(18 cases), non-dipping(56 cases) and reverse-dipping(17 cases) rhythms accounted for 19.78%, 61.54% and 18.68% respectively, with a mean nocturnal systolic blood pressure decline rate of (3.44±6.31)%. The impaired group had significantly higher proportions of elevated nocturnal systolic blood pressure, increased nocturnal systolic blood pressure load, age≥60 years, and abnormal blood pressure circadian rhythm compared with the normal group (P<0.05). Multivariate Logistic regression analysis confirmed that elevated nocturnal systolic blood pressure load (OR=1.132, P=0.010), increased 24-hour systolic blood pressure coefficient (OR=3.008, P=0.020), and abnormal blood pressure circadian rhythm (OR=18 353.043, P=0.010) at baseline were independent risk factors for impaired blood pressure regulation function. Conclusions Multi-dimensional ABPM indicators can serve as a core means to evaluate the quality of blood pressure control and identify high-risk populations. Hypertension management should shift from“numerical compliance”to“function, rhythm, and quality compliance”.
关键词
动态血压监测 /
疗养 /
高血压 /
血压调节功能 /
昼夜节律 /
精细化管理
Key words
ambulatory blood pressure monitoring /
convalescence /
hypertension /
blood pressure regulation function /
circadian rhythm /
precision management
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