2025 年第 10 期 第 20 卷

高血压病合并射血分数保留型心力衰竭患者夜间收缩压与估算肾小球滤过率之间的关系

Association between nocturnal systolic blood pressure and estimated glomerular filtration rate in hypertensive patients with heart failure with preserved ejection fraction

作者：石福天李佳欣苏全斌余静

英文作者：Shi Futian Li Jiaxin Su Quanbin Yu Jing

单位：兰州大学第二医院心血管内科，兰州730000

英文单位：Department of Cardiology the Second Hospital Lanzhou University Lanzhou 730000 China

关键词：高血压病；射血分数保留型心力衰竭；夜间收缩压；估算肾小球滤过率

英文关键词：Hypertension;Heartfailurewithpreservedejectionfraction;Nocturnalsystolicbloodpressure;Estimationglomerularfiltrationrate

• 摘要：

• 目的 研究高血压病合并射血分数保留型心力衰竭（HFpEF）患者夜间收缩压(nSBP)与估算肾小球滤过率（eGFR）之间的关系。方法 回顾性选取2017年12月1日至2024年6月30日于兰州大学第二医院确诊为高血压病合并HFpEF患者305例。根据nSBP将患者分为高nSBP组(222例)、中nSBP组（69例）、低nSBP组（14例）。比较3组临床资料，采用Pearson或Spearman模型进行相关性分析，采用多因素线性回归分析影响eGFR的独立危险因素。结果 低nSBP组和中nSBP组各时段收缩压、舒张压均低于高nSBP组，且低nSBP组nSBP低于中nSBP组（均P＜0.05）。中nSBP组血肌酐水平低于高nSBP组和低nSBP组，eGFR水平高于高nSBP组和低nSBP组（均P＜0.05）。eGFR与高血压病合并HFpEF患者年龄、血尿酸、血肌酐均呈负相关（r=-0.247、-0.205、-0.606，均P＜0.05），与体重指数、心率、日间舒张压均呈正相关（r=0.179、0.173、0.116，均P＜0.05）。年龄、血肌酐、二尖瓣口舒张期血流频谱E峰速度/二尖瓣环舒张早期运动峰值速度比值、nSBP均是eGFR的独立危险因素（均P＜0.05）。结论 在高血压病合并HFpEF患者中，nSBP过高或过低都会导致eGFR降低。

• Objective To investigate the association between nocturnal systolic blood pressure (nSBP) and estimated glomerular filtration rate (eGFR) in hypertensive patients with heart failure with preserved ejection fraction (HFpEF). Methods A total of 305 hypertensive patients with HFpEF in the Second Hospital, Lanzhou University from December 1, 2017 to June 30, 2024 were retrospectively selected. According to nSBP, the patients were divided into high-nSBP group (222 cases), middle-nSBP group (69 cases), and low-nSBP group (14 cases). The clinical data of the three groups were compared, Pearson or Spearman model was used for correlation analysis, and multivariate linear regression was used to analyze the independent risk factors affecting eGFR. Results Systolic blood pressure and diastolic blood pressure in the low-nSBP group and the middle-nSBP group were lower than those in the high-nSBP group at each time point, and nSBP in the low-nSBP group was lower than that in the middle-nSBP group (all P<0.05). The level of serum creatinine in the middle-nSBP group was lower than that in the high-nSBP group and low-nSBP group, and the level of eGFR was higher than that in the high-nSBP group and low-nSBP group (all P<0.05). eGFR was negatively correlated with age, serum uric acid and serum creatinine (r=-0.247, -0.205, -0.606, all P<0.05), and positively correlated with body mass index, heart rate and daytime diastolic blood pressure in hypertensive patients with HFpEF (r=0.179, 0.173, 0.116, all P<0.05). Age, serum creatinine, the ratio of mitral E velocity to early diastolic mitral annular velocity, and nSBP were independent risk factors for eGFR (all P<0.05). Conclusion In patients with hypertension and HFpEF, either high or low nSBP will lead to a decrease in eGFR.