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目的探讨原发性高血压(EH)合并2型糖尿病(T2DM)患者血压昼夜节律改变与靶器官损害的关系。方法选择2005-06-2008-12门诊和病房住院受试者495例,其中男性121例,女性374例,年龄40～79(65.7±10.0)岁,分为对照组(n=113)、EH组(n=199)、T2DM(n=73)及EH+T2DM(n=110),比较4组患者的一般临床资料及动态血压检测结果如24h平均收缩压(24hSBP)、24h平均舒张压(24hDBP)、白昼平均收缩压(dSBP)、白昼平均舒张压(dDBP)、夜间平均收缩压(nSBP)、夜间平均舒张压(nDBP)等,分析各组间收缩压和舒张压昼夜差值百分比(ΔSBP%、ΔDBP%)及靶器官损害的差异。结果①EH+T2DM组高密度脂蛋白胆固醇低于EH组[(1.08±0.30)比(1.20±0.31)mmol/L],三酰甘油高于EH组[(2.00±1.33)比(1.56±0.88)mmol/L,均P<0.01]。②EH+T2DM组24hSBP[(141.2±12.5)比(138.2±12.7)mmHg,P<0.05]、nSBP[(137.5±9.7)比(131.5±11.4)mmHg,P<0.01]均高于EH组,而24hDBP[(76.1±9.3)比(79.6±9.1)mmHg]、dDBP[(77.4±9.8)比(81.0±9.2)mmHg]低于EH组(均P<0.01);EH+T2DM组ΔSBP%、ΔDBP%值与对照组、T2DM组及EH组比较,差异有统计学意义(P<0.01);EH组ΔSBP%、ΔDBP%值均低于对照组,EH组ΔSBP%低于T2DM组。③EH+T2DM组发生靶器官损害的比例要高于其他各组[40.0%比31.5%、22.1%、8.8%,P<0.01]。④Logistic回归分析显示年龄(OR=1.136,95%CI1.079～1.195,P=0.001)、疾病种类(OR=1.662,95%CI1.138～2.428,P=0.009)是靶器官损害的危险因素,而ΔSBP%(OR=0.927,95%CI0.877～0.979,P=0.007)是靶器官损害的保护因素。结论 EH合并T2DM明显加重血压昼夜节律异常及靶器官功能损害。
Objective To investigate the relationship between circadian rhythm of blood pressure and target organ damage in patients with essential hypertension (EH) and type 2 diabetes mellitus (T2DM). Methods A total of 495 inpatients and ward inpatients from 2005-06 to 2008-12 were selected, including 121 males and 374 females, aged 40-79 years old (65.7 ± 10.0 years), divided into control group (n = 113), EH (N = 199), T2DM (n = 73) and EH + T2DM (n = 110). The clinical data of four groups were compared and the results of ambulatory blood pressure test such as 24 h mean systolic blood pressure (24hSBP), 24 h mean diastolic blood pressure 24h DBP, dSBP, dDBP, nSBP and nDBP were measured in each group. The differences of systolic and diastolic blood pressure (DBP) between the two groups were analyzed ΔSBP%, ΔDBP%) and target organ damage. Results Compared with EH group, the triglyceride level of high-density lipoprotein cholesterol in EH + T2DM group was significantly lower than that in EH group (1.08 ± 0.30 vs 1.20 ± 0.31 mmol / L, [2.00 ± 1.33 vs 1.56 ± 0.88 mmol / L, all P <0.01]. ② The values of 24hSBP [(141.2 ± 12.5) vs (138.2 ± 12.7) mmHg, P <0.05], and nSBP [(137.5 ± 9.7) vs (131.5 ± 11.4) mmHg, P <0.01] 24h DBP was significantly lower in EH + T2DM group than in EH group (P <0.01). The levels of ΔSBP% and ΔDBP in EH + T2DM group were significantly lower than those in EH group (76.1 ± 9.3 vs 79.6 ± 9.1 mmHg and 81.8 ± 9.2 mmHg vs There were significant differences between the two groups (P <0.01). The percentages of ΔSBP% and ΔDBP% in EH group were lower than those in control group, and those in EH group were lower than those in T2DM group. ③ The proportion of target organ damage in the EH + T2DM group was higher than that in other groups [40.0% vs 31.5%, 22.1%, 8.8%, P <0.01]. Logistic regression analysis showed that age (OR = 1.136,95% CI1.079-1.1915, P = 0.001), disease types (OR = 1.662,95% CI1.138-2.428, P = 0.009) were the risk factors of target organ damage, However, ΔSBP% (OR = 0.927, 95% CI0.877-0.979, P = 0.007) was the protective factor of target organ damage. Conclusions EH with T2DM significantly aggravates the abnormal circadian rhythm of blood pressure and the target organ dysfunction.