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目的探讨老年高血压患者血压昼夜波动与肾小球滤过率(glomerular filtration rate,GFR)下降的关系。方法对178例老年高血压患者测定血清肌酐,以Cockroff-Gault公式计算GFR估测值(eGFR),根据eGFR≥90ml/(min·1.72 m~2)、60～89 ml/(min·1.72 m~2)、40～59 ml/(min·1.72 m~2)、<40 ml/(min·1.72 m~2)分为A组44例、B组59例、C组46例、D组29例,并行24 h动态血压监测,测定空腹血糖、TC、TG、LDL-C、HDL-C,计算体重指数。结果 A组、B组、C组和D组随着eGFR的下降,夜间收缩压、24 h脉压、昼间脉压、夜间脉压、收缩压晨峰逐渐升高;舒张压波动幅度、夜间收缩压下降率、夜间脉压下降率逐渐降低,差异有统计学意义(P<0.05)。Pearson相关分析显示,病程、夜间收缩压、收缩压晨峰、24 h脉压、夜间脉压及夜间舒张压下降率与eGFR呈负相关,夜间舒张压、舒张压波动幅度、夜间收缩压下降率、夜间脉压下降率与eGFR呈正相关(P<0.05,P<0.01)。结论血压昼夜节律和波动幅度的异常与eGFR下降密切相关,尤以夜间脉压增大为著。
Objective To investigate the relationship between circadian blood pressure fluctuation and glomerular filtration rate (GFR) decline in elderly patients with essential hypertension. Methods Serum creatinine was measured in 178 elderly hypertensive patients and the GFR estimated by Cockroff-Gault formula was calculated according to eGFR≥90ml / (min · 1.72 m ~ 2), 60 ~ 89 ml / (min · 1.72 m 44 cases in group A, 59 cases in group B, 46 cases in group C and 29 cases in group D Cases, parallel 24 h ambulatory blood pressure monitoring, fasting blood glucose, TC, TG, LDL-C, HDL-C, calculated body mass index. Results In group A, group B, group C and group D, with the decrease of eGFR, nighttime systolic pressure, 24 h pulse pressure, daytime pulse pressure, nocturnal pulse pressure and systolic pressure morning peak gradually increased; amplitude of diastolic blood pressure fluctuated at night Systolic blood pressure decreased rate of decline in nighttime pulse pressure decreased, the difference was statistically significant (P <0.05). Pearson correlation analysis showed that the course of disease, nocturnal systolic pressure, systolic pressure morning peak, 24 h pulse pressure, nocturnal pulse pressure and nocturnal diastolic pressure drop rate were negatively correlated with eGFR, nocturnal diastolic pressure, diastolic blood pressure amplitude, nocturnal systolic pressure drop rate (P <0.05, P <0.01). Conclusion The abnormal circadian rhythm and fluctuation of blood pressure are closely related to the decrease of eGFR, especially the increase of nocturnal pulse pressure.