睡眠呼吸暂停综合征高血压患者治疗前后血浆血管紧张素II及血压昼夜节律的变化

Changes in plasma angiotensin II and circadian rhythm of blood pressure in hypertensive patients with sleep apnea syndrome before and after treatment.

作者信息

Wang Hai-ling, Wang Yu, Zhang Ying, Chen Yun-dai, Wang Xin-chun, Liu Zhi-xuan, Jing Guo-li, Tong Hai-feng, Tian Yuan, Liu Qing-zeng

机构信息

Department of Heart and Circulation, 263 Clinical Department of Beijing PLA General Hospital , Beijing 101149, China.

出版信息

Chin Med Sci J. 2011 Mar;26(1):9-13. doi: 10.1016/s1001-9294(11)60013-8.

DOI:10.1016/s1001-9294(11)60013-8

PMID:21496417

Abstract

OBJECTIVE

To explore the changes in plasma angiotensin II (Ang II) and circadian rhythm of blood pressure among hypertensive patients with sleep apnea syndrome (SAS) before and after continuous positive airway pressure (CPAP) or surgical treatment.

METHODS

A total of 180 essential hypertension patients were enrolled in our study. The determination of plasma Ang II concentration, ambulatory blood pressure (ABP), and polysomnography (PSG) monitoring were performed before and 3 months after CPAP or surgical treatment.

RESULTS

Patients were classified into three groups by their apnea-hypopnea index (AHI): essential hypertension group (EH group, n = 72; AHI< 5), essential hypertension with mild SAS group (EH+mild SAS group, n = 60, 5 ≤ AHI < 20), and essential hypertension with moderate and severe SAS group (EH + moderate-severe SAS group, n = 48, AHI ≥ 20). The concentrations of plasma Ang2 in the above three groups were 13.42 ± 3.27, 16.17 ± 3.82, and 18.73 ± 4.05 ng/mL respectively before treatment, and Ang2 concentration in EH patients combined with SAS was significantly higher than that in EH group (all P < 0.05). After treatment the values in the latter two groups significantly decreased to 14.67 ± 2.56 and 15.03 ± 3.41 ng/mL respectively (P < 0.05). The incidence of non-dipper blood pressure curve in EH patients was 31.9%, and those in hypertensive patients with mild SAS and moderate-severe SAS were 51.7% and 58.3%, respectively before treatment. The incidence of non-dipper blood pressure curve in the EH patients with mild SAS was significantly higher than that of patients with EH alone (P < 0.05). After CPAP treatment or surgery, the incidence of non-dipper blood pressure curve in the two SAS groups was significantly decreased to 38.3% and 39.6%, respectively (P < 0.05).

CONCLUSIONS

Ang II might play a role in blood pressure variability in patients with obstructive SAS. CPAP or surgical treatment can improve blood pressure disorder and decrease plasma Ang II level in patients with obstructive SAS.

摘要

目的

探讨阻塞性睡眠呼吸暂停综合征（SAS）高血压患者持续气道正压通气（CPAP）或手术治疗前后血浆血管紧张素II（Ang II）及血压昼夜节律的变化。

方法

共纳入180例原发性高血压患者。在CPAP或手术治疗前及治疗后3个月进行血浆Ang II浓度测定、动态血压（ABP）及多导睡眠图（PSG）监测。

结果

根据呼吸暂停低通气指数（AHI）将患者分为三组：原发性高血压组（EH组，n = 72；AHI<5）、轻度SAS原发性高血压组（EH+轻度SAS组，n = 60，5≤AHI<20）和中重度SAS原发性高血压组（EH+中重度SAS组，n = 48，AHI≥20）。治疗前上述三组血浆Ang2浓度分别为13.42±3.27、16.17±3.82和18.73±4.05 ng/mL，合并SAS的EH患者Ang2浓度显著高于EH组（均P<0.05）。治疗后后两组的值分别显著降至14.67±2.56和15.03±3.41 ng/mL（P<0.05）。EH患者非勺型血压曲线发生率为31.9%，轻度SAS和中重度SAS高血压患者治疗前分别为51.7%和58.3%。轻度SAS的EH患者非勺型血压曲线发生率显著高于单纯EH患者（P<0.05）。CPAP治疗或手术后，两个SAS组的非勺型血压曲线发生率分别显著降至38.3%和39.6%（P<0.05）。