动态血压监测过程对老年高血压患者睡眠质量及血压监测结果的影响研究
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摘要
目的观察动态血压监测(ABPM)过程中夜间频繁测量血压是否会对老年受查者睡眠产生影响,从而可能干扰夜间血压的真实变化,使血压昼夜节律曲线产生偏移等结果。方法选择解放军第210医院干部病房于2010年3月至2012年3月收治的原发性高血压患者50例,患者入院后行两次ABPM检查:第一次行ABPM检查夜眠前不予药物干预睡眠(干预前组),第二次行ABPM检查于睡眠前给予阿普唑仑0.8 mg口服(干预后组)以模拟不受夜间ABPM干扰的睡眠情况。记录干预前后两次睡眠时间及觉醒次数,干预前后血压昼夜形态(杓型、非杓型、反杓型、深杓型),夜间收缩压下降率(NSBPRR),夜间舒张压下降率(NDBPRR),晨峰血压(MBPS),起床后2 h内收缩压平均值,夜间收缩压标准差(nSBP-SD),夜间舒张压标准差(nDBP-SD),夜间收缩压负荷值(nSBPL),舒张压负荷值(nDBPL)。结果患者两次行ABPM检查,干预前组与干预后组在睡眠时间及觉醒次数上比较差异有统计学意义(P<0.05);干预前后两组NSBPRR、NDBPRR、晨间收缩压均值、nSBP-SD、nSBPL、nDBPL的差异有统计学意义(P<0.05)。结论 ABPM检查过程可影响老年高血压患者夜间睡眠质量,从而造成患者夜间血压下降率减少、昼夜血压形态出现偏差、夜间收缩压变异性增大、夜间血压负荷值比例增高。
Objective To observe frequent blood pressure measuring at night during the ambulatory blood pressure monitoring( ABPM) effect on sleeping quality in the elderly patients,which may interfere with the real changes in blood pressure and shift the diurnal rhythm curve. Methods Fifty essential hypertensive patients admitted by Dalian PLA 210thHospital during Mar. 2010 and Mar. 2012 were included. The same patient had twice ABPM during five days. The first test did not receive any drugs intervention( before intervention group).While during the second test the patients were given tablets of Alpraolamum to simulate the sleeping without ABPM interference( after intervention group). Record data: sleep time and awake times at night in different conditions before and after interference by Alpraolamum during ABPM; four blood pressure diurnal rhythms( dipper,nondipper,anti-dipper,dark dipper),nighttime systolic and diastolic blood pressure reduction rates( NSBPRR,NDBPRR); morning blood pressure surge( MBPS),average systolic blood pressure in two hours after getting up,nighttime systolic and diastolic blood pressure standard deviation( nSBP-SD,nDBP-SD),nighttime systolic and diastolic blood pressure load( nSBPL,nDBPL). Results Significant differences in the sleep time and awake times during night between the two groups were observed( P < 0. 05); NSBPRR,NDBPRR,morning mean systolic blood pressure,nSBP-SD,nSBPL,nDBPL were significantly different between two groups( P < 0. 05).Conclusion ABPM examination may influence the sleeping quality of aged patients with hypertension,which may result in NSBPRR and NDBPRR shrink and shifted diurnal rhythm curve,increased nSBPV and nBPL.
Objective To observe frequent blood pressure measuring at night during the ambulatory blood pressure monitoring( ABPM) effect on sleeping quality in the elderly patients,which may interfere with the real changes in blood pressure and shift the diurnal rhythm curve. Methods Fifty essential hypertensive patients admitted by Dalian PLA 210thHospital during Mar. 2010 and Mar. 2012 were included. The same patient had twice ABPM during five days. The first test did not receive any drugs intervention( before intervention group).While during the second test the patients were given tablets of Alpraolamum to simulate the sleeping without ABPM interference( after intervention group). Record data: sleep time and awake times at night in different conditions before and after interference by Alpraolamum during ABPM; four blood pressure diurnal rhythms( dipper,nondipper,anti-dipper,dark dipper),nighttime systolic and diastolic blood pressure reduction rates( NSBPRR,NDBPRR); morning blood pressure surge( MBPS),average systolic blood pressure in two hours after getting up,nighttime systolic and diastolic blood pressure standard deviation( nSBP-SD,nDBP-SD),nighttime systolic and diastolic blood pressure load( nSBPL,nDBPL). Results Significant differences in the sleep time and awake times during night between the two groups were observed( P < 0. 05); NSBPRR,NDBPRR,morning mean systolic blood pressure,nSBP-SD,nSBPL,nDBPL were significantly different between two groups( P < 0. 05).Conclusion ABPM examination may influence the sleeping quality of aged patients with hypertension,which may result in NSBPRR and NDBPRR shrink and shifted diurnal rhythm curve,increased nSBPV and nBPL.
引文
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[14]Manning G,Rushton L,Donnelly R,et al.Variability of diurnal changes in ambulatory blood pressure and nocturnal dipping status in untreated hypertensive and normotensive subjects.Am J Hypertens,2000,13(9):1035-1038.
[15]Perk G,Ben-Arie L,Mekler J,et al.Dipping status may be determined by nocturnal urination[J].Hypertension,2001,37(2 Pt 2):749-752.
[16]赵玉红,杨洁,刘静.24h动态血压监测对老年患者睡眠影响的研究研究[J].现代中西医结合杂志,2011,20(2):168-169.
[17]陈洁霞,周江宁,刘荣玉.“杓型”与”非杓型”高血压患者的静息-活动和睡眠-觉醒昼夜节律[J].高血压杂志,2005,13(8):466-468.
[18]Staessen JA,Bieniaszewski L,Obrien E,et al.Nochturnal blood pressure fall on ambulatory monitoring in a large international database[J].Hypertension,1997,29(1):30-39.
[19]Kario K,Pickering TG,Umeda Y,et al.Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensions:a prospective study[J].Circulation,2003,107(10):1401-1406.
[2]Tropeano AI,Roudot-Thomval F,Badoual T,et al.Different effects of ambulatory blood pressure monitoring on subjective and objective sleep quality[J].Blood Press Monit,2006,11(6):315-320.
[3]中国高血压防治指南修订委员会.中国高血压指南(2005年修订版)[J].高血压杂志,2005,12(增):1-53.
[4]Jerrard-Dunne P,Mahmud A,Feely J.Circadian blood pressure variation:relationship between dipper status and measures of arterial stiffness[J].J Hypertens,2007,25(6):1233-1239.
[5]Ichhiara A,Kanesiro Y,Takemitsu T,et al.Ambulatory blood Pressure variability and brachial-ankle pulse wave velocity in untreated hypertensive patients[J].J Hum Hypertens,2006,20(7):529-536.
[6]朱志林,王静,刘红,等.老年高血压患者动态血压负荷值与靶器官损害相关性分析[J].临床心血管病杂志,2005,21(5):312.
[7]Fletcher EC.The relationship between systemic hypertension and obstructive sleep apnea:facts and theory[J].Am J Med,1995,98(2):118-128.
[8]张维忠.血压变异和晨峰的概念及其临床意义[J].中华心血管病杂志,2006,34(3):287.
[9]Oliver D,Daly F,Martin FC,et al.Risk factor sand risk assessment tools for falls in hospital in-patients:asystematic review[J].Age Ageing,2004,33(2):122-133.
[10]Kario K.Morning surge and variability in blood pressure:a new therapeutic target?[J].Hypertension,2005,45(9):485-486.
[11]Parati G,Pomidossi G,Albini F,et al.Relationship of 24-hour blood pressure mean and variability to severity of target-organ damage in hypertension[J].J Hypertens,1987,5(1):93-98.
[12]苏定冯,廖朝玉.血压波动性的研究[J].高血压杂志,2005,13(7):394-397.
[13]刘力生,王文,姚崇华.中国高血压防治指南(2009年基层版)[J].中华高血压杂志,2010,18(1):326-327.
[14]Manning G,Rushton L,Donnelly R,et al.Variability of diurnal changes in ambulatory blood pressure and nocturnal dipping status in untreated hypertensive and normotensive subjects.Am J Hypertens,2000,13(9):1035-1038.
[15]Perk G,Ben-Arie L,Mekler J,et al.Dipping status may be determined by nocturnal urination[J].Hypertension,2001,37(2 Pt 2):749-752.
[16]赵玉红,杨洁,刘静.24h动态血压监测对老年患者睡眠影响的研究研究[J].现代中西医结合杂志,2011,20(2):168-169.
[17]陈洁霞,周江宁,刘荣玉.“杓型”与”非杓型”高血压患者的静息-活动和睡眠-觉醒昼夜节律[J].高血压杂志,2005,13(8):466-468.
[18]Staessen JA,Bieniaszewski L,Obrien E,et al.Nochturnal blood pressure fall on ambulatory monitoring in a large international database[J].Hypertension,1997,29(1):30-39.
[19]Kario K,Pickering TG,Umeda Y,et al.Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensions:a prospective study[J].Circulation,2003,107(10):1401-1406.