工作年龄男性动脉高血压患者的心血管风险取决于动脉压昼夜变化情况

Nataliia M. Pryplavko, Anatolii M. Kravchenko
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All patients underwent ambulatory BP monitoring (ABPM), according to the results of which the following diurnal BP profiles were identified: 23 (28%) patients – normal (optimal) level of nocturnal decrease in BP («dipper»; daily index (DI) 10-20%); 10 (12%) – excessive nocturnal lowering of BP («over-dipper»; DI >20%); 38 (46%) – insufficient nocturnal lowering of BP («non-dipper»; DI <10%); and 12 (14%) patients had an inverted diurnal curve («night-peaker»; DI <0%). Results and discussion. According to the SCORE scale, the CVR profile in «dipper» group (n=23) was as follows: low – 6 (26%) patients; moderate – 15 (65%); and high – 2 (9%). Among 10 patients of «over-dipper» group, 7 had low, 2 – moderate, and 1 – high CVR. In «non-dipper» group (n=38), there were 4 (11%) patients with low CVR, 10 (26%) with moderate, 14 (37%) with high, and 10 (26%) with very high CVR. 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引用次数: 0

摘要

目的:研究患有动脉高血压(AH)的工作年龄男性心血管风险(CVR)与不同类型昼夜血压(BP)曲线之间的关系。 材料和方法。研究对象包括 83 名工作年龄男性(平均年龄为 48±2 岁)动脉高血压 II 期、2 期和 3 期患者。使用 SCORE 量表评估了未来 10 年因心血管疾病死亡的风险。所有患者都接受了动态血压监测(ABPM),根据监测结果确定了以下昼夜血压曲线:23(28%)名患者--夜间血压下降水平正常(最佳)("糖尿病患者";每日指数(DI)10-20%);10(12%)名患者--夜间血压下降过多("过度糖尿病患者";DI >20%);38(46%)名患者--夜间血压下降不足("非糖尿病患者";DI <10%);12(14%)名患者的昼夜血压曲线倒置("夜间糖尿病患者";DI <0%)。 结果与讨论根据 SCORE 量表,"夜鸣 "组(23 人)的 CVR 曲线如下:低--6 人(26%);中--15 人(65%);高--2 人(9%)。在 10 名 "过量饮水 "组患者中,7 名患者的 CVR 值较低,2 名患者为中度,1 名患者为高度。在 "不过度节食 "组(38 人)中,4 人(11%)的 CVR 值较低,10 人(26%)的 CVR 值中等,14 人(37%)的 CVR 值较高,10 人(26%)的 CVR 值极高。同时,在 "夜语 "组的 12 名患者中,7 人的 CVR 非常高,3 人高,2 人中等(总 P<0.001)。与 "夜尿 "组和 "过度夜尿 "组(样本数=33)相比,"不夜尿 "组和 "夜尿 "组(病理血压曲线;样本数=50)中出现高 CVR 的频率更高:分别为 34% 对 9%。同时,与 "非低血压者 "和 "夜尿者 "组(分别为 24% 和 8%)相比,"低血压者 "和 "过度低血压者 "组的特点是中度(52%)和低 CVR(39%)患者较多。最后,所有 17 名高 CVR 患者的昼夜血压曲线均异常("不跳水 "和 "讲夜话 "组合计为 34%)(总体 p<0,001)。 结论通过 ABPM 可以确定,60% 患有 2 度和 3 度 AH 的工作年龄男性的病理血压曲线属于 "不跳 "和 "夜鸣 "类型。根据 SCORE 诊断,夜间血压升高或昼间血压下降不足的人在未来 10 年内心血管死亡的风险较高。非夜间血压升高型 "和 "夜间血压降低型 "患者需要更积极的药物治疗,并通过 ABPM 进行复查,以控制夜间血压的正常化。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
CARDIOVASCULAR RISK AMONG MEN OF WORKING AGE WITH ARTERIAL HYPERTENSION DEPENDING ON THE ARTERIAL PRESSURE DIURNAL PROFILE
Aim: to investigate the relationship between cardiovascular risk (CVR) and different types of diurnal blood pressure (BP) profile among men of working age with arterial hypertension (AH). Materials and methods. The study included 83 men of working age (average age 48±2 years) with II stage, 2 and 3 degrees of AH. The risk of death due to cardiovascular diseases during the next 10 years was assessed using the SCORE scale. All patients underwent ambulatory BP monitoring (ABPM), according to the results of which the following diurnal BP profiles were identified: 23 (28%) patients – normal (optimal) level of nocturnal decrease in BP («dipper»; daily index (DI) 10-20%); 10 (12%) – excessive nocturnal lowering of BP («over-dipper»; DI >20%); 38 (46%) – insufficient nocturnal lowering of BP («non-dipper»; DI <10%); and 12 (14%) patients had an inverted diurnal curve («night-peaker»; DI <0%). Results and discussion. According to the SCORE scale, the CVR profile in «dipper» group (n=23) was as follows: low – 6 (26%) patients; moderate – 15 (65%); and high – 2 (9%). Among 10 patients of «over-dipper» group, 7 had low, 2 – moderate, and 1 – high CVR. In «non-dipper» group (n=38), there were 4 (11%) patients with low CVR, 10 (26%) with moderate, 14 (37%) with high, and 10 (26%) with very high CVR. At the same time, 7 out of 12 patients of «night-peaker» group showed very high CVR, 3 – high, and 2 – moderate (overall p<0,001). The frequency of patients with high CVR was higher in the pooled «non-dipper» and «night-peaker» group (pathological BP profile; n=50), as compared to the pooled «dipper» and «over-dipper» group (n=33): 34% vs. 9%, respectively. At the same time, the pooled «dipper» and «over-dipper» group was characterized by the higher frequency of patients with moderate (52%) and low CVR (39%), in contrast to the pooled «non-dipper» and «night-peaker» group (24% and 8%, respectively). Finally, all 17 patients with very high CVR had an abnormal diurnal BP profile (34% in the pooled «non-dipper» and «night-peaker» group) (overall p<0,001). Conclusions. It was established that, according to ABPM, 60% of men of working age with the AH of II stage, 2- and 3-degrees, had pathological BP profiles of the «non-dipper» and «night-peaker» types. Individuals diagnosed with nocturnal rise or insufficient diurnal BP decrease have a higher risk of cardiovascular death in the next 10 years according to SCORE. Patients with a «non-dipper» and «night-peaker» diurnal BP profiles require more aggressive drug therapy and re-examination with ABPM to control the normalization of the diurnal BP profile.
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