Study on circadian blood pressure rhythmandrelated influencing factors in outpatients

doi:10.16150/j.1671-2870.2019.03.013

Abstract

Abstract:

Objective: Based on an electronic reporting system of ambulatory blood pressure monitoring (ABPM), the circadian blood pressure rhythm and related influencing factors in outpatients were analyzed. Methods: From February 2017 to February 2018, 5 545 outpatients with eligible ABPM data in the Shuoyun electronic reporting system were recruited. Of them there were 2 524 males and 3 021 females, with an average age of (53±14.3) years. The rate of nocturnal systolic blood pressure(SBP) decrease was calculated, according to which the circadian rhythm was categorized into four types:reverse-dipper, non-dipper, dipper and extreme-dipper. Results: The number of dippers was the most (2 323, 41.9%), followed by non-dippers (2 318, 41.8%), and the reverse-dippers (532, 9.6%) and extreme-dippers (372, 6.7%) were much less. The reverse-dippers were the oldest [average age, (60.2±13.3) years], and the dippers were the youngest [(50.9±14.1) years]. The nighttime SBP, ambulatory arterial stiffness index (AASI), the proportion of concomitant diseases (diabetes, stroke, myocardial infarction) and the prevalence of hypertension of the reverse-dippers were higher than the others (P<0.05); the prevalence of hypertension in dippers was lower than the others.The average daytime SBP of the extreme-dippers was higher (P<0.05) than the others, while the nighttime SBP, AASI were lower(P<0.05) than the others. There were no significant differences in body mass index, proportion of taking antihypertensive drugs and hyperlipidemia among the groups (P>0.05). Logistic regression analysis showed that women, aging, diabetes mellitus and hypertension were risk factors for abnormal circadian rhythm, and patients taking antihypertensive drugs and smokers tended to be dippers (P<0.05). Conclusions: In outpatients of the Hypertension Clinic, around half have abnormal circadian blood pressure rhythm. Female, aging, the presence of diabetes and hypertension were risk factors, while patients on antihypertensive medication and smokers were more likely to be dippers.

Key words: Ambulatory blood pressure monitoring, Reverse-dipper, Non-dipper, Dipper, Extreme-dipper, Circadian rhythm

CLC Number:

R544.1

HUANG Jianfeng, SHENG Changsheng, HUANG Qifang, CHENG Yibang, GUO Qianhui, ZHANG Dongyan, WANG Jiguang, LI Yan. Study on circadian blood pressure rhythmandrelated influencing factors in outpatients[J]. Journal of Diagnostics Concepts & Practice, 2019, 18(03): 313-318.

Figures/Tables 3

References 24

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项目	反杓型	非杓型	杓型	超杓型	P值
人数	532（9.6）	2 318（41.8）	2 323（41.9）	372（6.7）	/
年龄（岁）	60.2±13.3^c)	53.4±14.3^c)	50.9±14.1	52.9±13.7^a)	<0.001
男性	191（35.9）^c)	1 038 (44.8)^a)	1 118 (48.1)	177(47.6)	<0.001
24 h平均收缩压(mmHg)	130.2±14.5^b)	128.1±12.5	127.9±11.9	129.9±12.3^b)	<0.001
24 h平均舒张压(mmHg)	81.7±10.8	83.1±11.0	82.6±10.6	82.9±10.8	0.046
白天平均收缩压(mmHg)	128.5±14.2^c)	130.5±12.8^c)	133.2±12.5	138.5±13.2^c)	<0.001
白天平均舒张压(mmHg)	81.6±11^c)	85.4±11.4^c)	86.8±11.2	89.0±11.6^b)	<0.001
夜间平均收缩压(mmHg)	135.8±15.9^c)	123.1±12.4^c)	114.3±10.9	106.8±10.5^c)	<0.001
夜间平均舒张压(mmHg)	82.7±11.2^c)	77.8±10.6^c)	72.0±9.7	66.5±9.3^c)	<0.001
24 h平均心率（次/分）	71.3±9.0^c)	73.1±8.6	73.4±8.7	73.1±8.6	<0.001
夜间收缩压下降率	-0.06±0.05^c)	0.06±0.03^c)	0.14±0.03	0.23±0.03^c)	<0.001
AASI	0.57±0.16^c)	0.51±0.18^c)	0.44±0.17	0.41±0.14^c)	<0.001
体质量指数（kg/m²）	24.7±3.3	24.5±3.4	24.4±3.3	24.3±3.1	0.244
吸烟	84（15.8）	276(11.9)^b)	338(14.6)	62(16.7)	<0.001
糖尿病病史	75（14.1）^c)	203(8.8)^b)	148(6.4)	26(7.0)	<0.001
高血压	511（96.1）^c)	1 991(85.9)^c)	1 773(76.3)	308(82.8)^c)	<0.001
高血压服用降压药	84（16.4）^a)	381(19.1)	370(20.9)	66(21.4)	0.114
卒中病史	76（14.3）^c)	202(8.7)^a)	161(6.9)	24(6.5)	<0.001
心肌梗死病史	9（1.7）^b)	17(0.7)	11(0.5)	0	<0.010
高脂血症病史	119(22.4)	479(20.7)	463(19.9)	78(21.0)	0.641

项目	反杓型	非杓型	杓型	超杓型	P值
24 h平均收缩压（mmHg）
模型1	130.90±0.54^c)	128.20±0.26	127.67±0.26	129.86±0.64^a)	<0.001
模型2	130.54±0.53^c)	128.15±0.25	127.77±0.25	129.95±0.63^b)	<0.001
24 h平均舒张压（mmHg）
模型1	84.00±0.43^c)	83.22±0.20^c)	81.96±0.20	82.82±0.50	<0.001
模型2	83.94±0.42^c)	83.22±0.20^c)	81.98±0.20	82.78±0.50	<0.001
白天平均收缩压（mmHg）
模型1	129.23±0.56^c)	130.56±0.26^c)	133.03±0.26	138.42±0.66^c)	<0.001
模型2	128.88±0.55^c)	130.52±0.26^c)	133.14±0.26	138.51±0.65^c)	<0.001
白天平均舒张压（mmHg）
模型1	84.13±0.44^b)	85.60±0.21	86.14±0.21	88.92±0.52^c)	<0.001
模型2	84.08±0.44^c)	85.60±0.21	86.15±0.21	88.87±0.52^c)	<0.001
夜间平均收缩压（mmHg）
模型1	136.31±0.53^c)	123.09±0.25^c)	114.14±0.25	106.73±0.62^c)	<0.001
模型2	135.97±0.52^c)	123.09±0.24^c)	114.24±0.25	106.81±0.61^c)	<0.001
夜间平均舒张压（mmHg）
模型1	84.59±0.42^c)	77.95±0.20^c)	71.49±0.20	66.37±0.49^c)	<0.001
模型2	84.56±0.41^c)	77.96±0.19^c)	71.50±0.20	66.32±0.49^c)	<0.001
24 h平均心率（次/分）
模型1	72.55±0.37	73.18±0.17	73.01±0.17	73.06±0.43	0.478
模型2	72.51±0.37	73.19±0.17	73.02±0.17	73.02±0.43	0.420
AASI
模型1	0.54±0.01^c)	0.51±0.00^c)	0.45±0.00	0.41±0.01^c)	<0.001
模型2	0.54±0.01^c)	0.51±0.00^c)	0.45±0.00	0.41±0.01^c)	<0.001

变量	Β值	SE	Wald χ²	P值	OR值	95%CI
女性（1是,0否）	0.158	0.063	6.348	0.012	1.172	1.036~1.325
年龄（ +10岁）	0.192	0.022	74.592	<0.001	1.212	1.160~1.266
吸烟（1是,0否）	-0.193	0.089	4.736	0.030	0.825	0.694~0.981
糖尿病（1是,0否）	0.341	0.109	9.839	0.002	1.407	1.137~1.742
高血压（1是,0否）	0.930	0.077	144.867	<0.001	2.533	2.178~2.947
使用降压药（1是,0否）	-0.324	0.079	16.840	<0.001	0.723	0.620~0.844