2025 年第 4 期 第 20 卷

午后血压与高血压病患者靶器官损害的相关性分析

Correlation analysis between afternoon blood pressure and target organ damage in patients with hypertension

作者：赵天竹程文立

英文作者：Zhao Tianzhu Cheng Wenli

单位：首都医科大学附属北京安贞医院心内高血压二病区，北京100029

英文单位：The Second Ward of Intracardiac Hypertension Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：高血压病；动态血压监测；午后血压；靶器官损害

英文关键词：Hypertension;Ambulatorybloodpressuremonitoring;Afternoonbloodpressure;Targetorgandamage

• 摘要：

• 目的 探讨午后血压水平与高血压病患者靶器官损害的相关性，为血压管理提供新临床依据。方法 选取首都医科大学附属北京安贞医院高血压中心2022年1—12月招募的接受动态血压监测的高血压病患者252例。根据午后收缩压三等分水平将患者分为低午后血压组、中午后血压组、高午后血压组，各84例。采用多因素Logistic回归分析评估午后收缩压与左心室肥厚、蛋白尿及动脉硬化的关联。通过亚组分析验证该关联在不同年龄、性别及吸烟、饮酒状态患者中的交互作用。结果 多因素Logistic回归分析结果显示，与低午后血压组相比，高午后血压组左心室肥厚、蛋白尿、动脉硬化损害程度更重，且校正年龄、性别等因素后仍然存在（均P＜0.05）。将午后收缩压作为连续变量分析，校正混杂因素后，左心室肥厚（比值比=1.07，95%置信区间：1.04~1.11）、蛋白尿（比值比=1.05，95%置信区间：1.02~1.07）、动脉硬化（比值比=1.04，95%置信区间：1.02~1.06）损害程度随午后收缩压升高而增加（均P＜0.05）。亚组分析显示，午后收缩压与靶器官损害的关系在不同性别、年龄、吸烟及饮酒状况的亚组中保持一致，未发现显著交互作用（均P＞0.05）。结论 高血压病患者午后收缩压水平与靶器官损害呈显著正相关，且在不同人群亚组中具有一致性，提示午后血压监测对评估高血压病患者靶器官损害风险具有重要临床意义。

• Objective To explore the correlation between afternoon blood pressure level and target organ damage in patients with hypertension, and to provide a new clinical basis for blood pressure management. Methods A total of 252 hypertensive patients who received ambulatory blood pressure monitoring were recruited from the hypertension center of Beijing Anzhen Hospital, Capital Medical University from January to December 2022. According to the third level of afternoon systolic blood pressure, the patients were divided into low afternoon blood pressure group, middle afternoon blood pressure group and high afternoon blood pressure group, with 84 cases in each group. Multivariate Logistic regression analysis was used to evaluate the association of afternoon systolic blood pressure with left ventricular hypertrophy, proteinuria and arteriosclerosis. Subgroup analysis was used to verify the interaction effect of this association in patients with different age, gender, smoking and drinking status. Results Multivariate Logistic regression analysis showed that compared with the low afternoon blood pressure group, the high afternoon blood pressure group had more severe left ventricular hypertrophy, proteinuria, and arteriosclerosis damage, which still existed after adjusting for age, gender and other factors (all P<0.05). Afternoon systolic blood pressure was analyzed as a continuous variable. After adjusting for confounding factors, the degree of left ventricular hypertrophy (odds ratio=1.07, 95% confidence interval: 1.04-1.11), proteinuria (odds ratio=1.05, 95% confidence interval: 1.02-1.07) and arteriosclerosis (odds ratio=1.04, 95% confidence interval: 1.02-1.06) damage increased with the increase of afternoon systolic blood pressure (all P<0.05). Subgroup analysis showed that the association between afternoon systolic blood pressure and target organ damage was consistent across subgroups of gender, age, smoking and drinking status, and no significant interaction was found (all P>0.05). Conclusions  The afternoon systolic blood pressure level is positively correlated with target organ damage in hypertensive patients, which is consistent in different population subgroups, suggesting that afternoon blood pressure monitoring is of great clinical significance in assessing the risk of target organ damage in hypertensive patients.