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目的探讨血压昼夜节律与颈动脉内膜中膜厚度(IMT)的关系及不同时间服用长效钙拮抗剂左旋氨氯地平对原发性高血压患者异常血压昼夜节律的影响。方法对原发性高血压患者68例进行动态血压监测,分为杓型组(n=21)和非杓型组(n=47),采用高频超声探测双侧颈总动脉IMT,分析两组间颈总动脉IMT的差异,将非杓型组高血压患者47例随机分为左旋氨氯地平晨起服药组(n=24)和晚上服药组(n=23),2.5mg/d,治疗8周后再次进行动态血压监测。结果①非杓型组高血压患者IMT增厚(P<0.05);②晚上服药比晨起服药更能纠正血压昼夜节律的异常(由非杓型纠正为杓型:晨起服药组20.83%比晚上服药组52.17%,P<0.05)。结论血压昼夜节律异常可引起颈动脉IMT增厚,晚上服用左旋氨氯地平可以较好地纠正夜间的高负荷血压,使非杓型血压转变为杓型血压,更好地保护靶器官。
Objective To investigate the relationship between circadian rhythm of blood pressure and carotid intima - media thickness (IMT) and the effects of long - acting calcium antagonist levamlodipine on the abnormal blood pressure circadian rhythm in patients with essential hypertension. Methods Sixty-eight patients with essential hypertension were monitored by ambulatory blood pressure and divided into dipper group (n = 21) and non-dipper group (n = 47). The bilateral common carotid artery IMT was detected by high- 47 patients with non-dipper hypertensive patients were randomly divided into two groups: morning levamlodipine treatment group (n = 24) and nighttime medication group (n = 23), 2.5mg / d, After 8 weeks of treatment, ambulatory blood pressure monitoring was performed again. Results (1) IMT was thicker in non-dipper group (P <0.05); ② nighttime medication was more effective than early morning medication in correcting abnormal circadian rhythm of blood pressure (non-dipper corrected to dipper: 20.83% Night medication group 52.17%, P <0.05). Conclusion Abnormal circadian rhythm of blood pressure can cause carotid IMT thickened. Taking L-amlodipine at night can better correct the high blood pressure at night and turn non-dipper blood pressure into dipper blood pressure to better protect the target organ.