Zhang W, Zhu H, Yao S Y, Li Y, Liu J, Xue H
Department of Cardiology, Chinese People's Liberation Army General Hospital, People's Liberation Army Institute of Cardiovascular Disease，Beijing 100039，China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2017 Jul 24;45(7):585-590. doi: 10.3760/cma.j.issn.0253-3758.2017.07.007.
To define the characteristic of circadian rhythm of blood pressure in unstable angina pectoris (UAP)patients with hypertension and its effects on the cardiovascular events. It was a prospective study.Based on coronary angiographic results, 742 consecutive hospitalized UAP patients with hypertension and 89 consecutive hospitalized hypertensive patients were recruited between September 2014 and December 2015 in this study. Clinical data and the results of 24-hour ambulatory blood pressure monitoring (ABPM) were analyzed. The total prevalence of hypertension in UAP is about 77.1%(742/962) in our cohort. The decrease of night-time systolic and diastolic blood pressure in UAP patients complicated with hypertension was lower than that in hypertensive patients (<0.05). The prevalence of dipper, non-dipper and reverse dipper pattern was 12.4%(92/742), 34.9%(259/742) and 52.7%(391/742) in UAP patients complicated with hypertension, 18.0%(16/89), 48.3%(43/89) and 33.7%(30/89) in hypertensive patients. Obviously, the abnormal circadian rhythm of blood pressure was more significant in UAP patients with hypertension than in hypertensive patients, characterized by higher reverse dipper pattern in UAP patients with hypertension compared to patients with hypertension(=0.00), similar results were evidenced among the male and female patients and patients with various ages. Subgroup analysis showed that except similar results on the incidence of reverse dipper pattern in controlled blood pressure aged less than 45 years old, the incidence of reverse dipper pattern was all significantly higher in UAP patients complicating with hypertension than in hypertensive patients independent no matter blood pressure controlled or not (all <0.05). After adjustment for sex, age, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and other risk factors, binary logistic regression analysis showed that reverse dipper pattern was independently associated with UAP(=1.53, 95% 1.12-2.61). This finding suggests that UAP patients with hypertension often have abnormal circadian rhythm, characterized by higher reverse dipper circadian pattern. Elevated nocturnal blood pressure is independently related to UAP.
为明确不稳定型心绞痛（UAP）合并高血压患者的血压昼夜节律特点及其对心血管事件的影响。本研究为前瞻性研究。基于冠状动脉造影结果，于2014年9月至2015年12月期间，连续纳入742例住院的UAP合并高血压患者以及89例连续住院的高血压患者。分析临床资料及24小时动态血压监测（ABPM）结果。在我们的队列中，UAP患者中高血压的总患病率约为77.1%（742/962）。UAP合并高血压患者夜间收缩压和舒张压的下降幅度低于高血压患者（<0.05）。UAP合并高血压患者中勺型、非勺型和反勺型模式的患病率分别为12.4%（92/742）、34.9%（259/742）和52.7%（391/742），高血压患者中分别为18.0%（16/89）、48.3%（43/89）和33.7%（30/89）。显然，UAP合并高血压患者的血压昼夜节律异常比高血压患者更显著，其特点是UAP合并高血压患者的反勺型模式高于高血压患者（=0.00），在男性和女性患者以及不同年龄段患者中均有类似结果。亚组分析显示，除45岁以下血压控制患者反勺型模式发生率相似外，无论血压是否控制UAP合并高血压患者的反勺型模式发生率均显著高于高血压患者（均<0.05）。在调整性别、年龄、甘油三酯、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇等危险因素后，二元逻辑回归分析显示反勺型模式与UAP独立相关（=1.53，95% 1.12 - 2.61）。这一发现表明，UAP合并高血压患者常存在异常的昼夜节律，其特点是反勺型昼夜模式较高。夜间血压升高与UAP独立相关。
