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《Academic Journal of Second Military Medical University》 2012-01
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Factors affecting ambulatory blood pressures in treated hypertensive patients

LI Xi-lin,HUANG Li-na,CAO Wei-bin Department of Emergency Medicine,No.85 Hospital of PLA,Shanghai 200052,China  
Objective To explore the factors affecting the circadian rhythm of blood pressure in treated hypertensive patients. Methods Based on the clinical data, ambulatory blood pressure, 24-hour mean blood pressure (24hMBP) and circadian rhythm, 125 consecutive patients receiving antihypertensive treatment were divided into the following groups: normal 24h MBP and dipper type (type Ⅰ ), abnormal 24hMBP and dipper type(type Ⅱ ), abnormal 24hMBP and non-dipper type(type Ⅲ), and normal 24hMBP and non-dipper type (type Ⅳ). The clinical data and ambulatory blood pressure of the latter three groups were compared. Non-conditional Logistic regression was used to analyze the factors for ambulatory blood pressure.Results Ninety patients had abnormal 24hMBP (72. 0%), and 106 (84. 8~%) had abnormal circadian rhythm. Among these cases, 2 (1.6%) patients had type Ⅰ , 17 (13.6%) had typeⅡ , 73 (58.4%) had type Ⅲ, and 33 (26.4%) had type Ⅳ. The incidence of kidney disease in patients with abnormal 24hMBP was significantly higher than those with normal 24hMBP (P0.05). The incidence of diabetes mellitus in patients with abnormal circadian rhythm (non-dipper type) was higher than those with normal circadian rhythm (dipper type), with the highest incidence seen in patients of type IV (P0.05) ; the rates of calcium channel blocker (CCB) use and a daily morning dose administration in type Iv patients were higher than those in type Ⅱ and type Ⅲ patients (P0.05). Type Ⅳ group had the most severe abnormal ambulatory blood pressure among the latter three groups. Logistic regression analysis showed that complication with renal diseases (OR=0.301,95%CI:0.124~0.729, P=0.008), use of CCB (OR=2. 191,95 ~%CI: 0. 967~4. 966 ,P=0. 048), and administration of a morning dose (OR=2. 384,95% CI: 1.017~5. 591 ,P=0. 046) were the factors of ambulatory blood pressure. Conclusion Abnormal circadian rhythm of blood pressure is high in patients receiving antihypertensive treatment. Complication with kidney diseases, use of CCB, and a daily morning dose are the factors for ambulatory blood pressure, indicating it is be reasonable to analyze factors for circadian rhythm by combining the 24hMBP and the components of circadian rhythm.
【CateGory Index】: R544.1
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