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Correlation between 24-hour Urinary Sodium Excretion and the Status of Blood Pressure Control in Patients with Resistant Hypertension: A Single-center Cross-sectional Study
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摘要:
目的 分析24 h尿钠排泄与难治性高血压(resistant hypertension，RH)患者诊室血压及家庭自测血压(home blood pressure monitoring，HBPM)达标状态的关系。 方法 通过北京协和医院心内科门诊RH数据库，收集2017年10月至2018年3月间在北京协和医院心内科门诊就诊的RH患者临床资料，进行横断面调查。检测患者24 h尿钠，记录患者同期诊室血压、HBPM水平及临床用药情况，以所有患者24 h尿钠水平四分位数为分界点，将研究对象分为低尿钠、低-中尿钠、中-高尿钠及高尿钠4组。采用多因素Logistic回归，分析影响RH血压达标状态的危险因素。 结果 共202例RH患者入选本研究，男性107例，女性95例，平均年龄(59.87±16.30)岁。24 h尿钠平均水平为(198.92±96.59)mmol，年轻患者及体质量指数高者尿钠水平更高(P均＜0.001)。随尿钠升高，降压药物的服用种类显著增多(P=0.001)，早晨及上午的HBPM达标率低(P=0.040, 0.032)。多因素Logistic回归分析显示，24 h尿钠水平与诊室血压(OR=2.356, 95% CI:1.004~5.533, P=0.049)，HBPM早晨血压(OR=2.408, 95% CI:1.026~5.650, P=0.030)及HBPM上午血压(OR=2.299, 95% CI:1.031~5.129, P=0.033)达标状态独立相关，而与下午及夜间HBPM血压达标状态无显著相关(P均＞0.05)。 结论 24 h尿钠是RH患者诊室血压及HBPM早晨及上午血压达标的独立相关因素，限制钠盐摄入对减少RH患者血压波动、促进血压达标有重要作用。 Abstract:Objective To study the correlation between 24-hour urinary sodium excretion and the controlling status of office blood pressure (BP) and home blood pressure monitoring (HBPM) in patients with resistant hypertension (RH). Methods A cross-sectional study was performed based on the RH patient database in Peking Union Medical College Hospital. All RH patients treated in the Cardiology Clinic, Peking Union Medical College Hospital from October 2017 to March 2018 were enrolled. Twenty-four-hour urinary sodium excretion (24h-UNa) was examined to estimate daily sodium intake. Office BP, HBPM (4 measurements daily: before medicine in the morning, 10 a.m., 4 p.m., and before sleeping at night, respectively), and the types of antihypertensive drugs were recorded. Based on the quartile method for 24h-UNa excretion, all enrolled patients were stratified into four groups: low 24h-Una, low-mid 24h-UNa, mid-high 24h-UNa, and high 24h-Una groups. Multiple Logistic regression analysis was used to analyze the correlation of independent factors with the rate of BP control. Results Totally 202 subjects were recruited, 107 men, 95 women, aged (59.87±16.30) years, and the 24h-UNa was (198.92±96.59) mmol. Patients with higher urine-sodium excretion were younger and with a higher body mass index (P < 0.001). The number of antihypertensive drugs increased significantly with the increase of urinary sodium level (P=0.001). High urine sodium excretion was associated with the reduced BP control rate for HBPM in the morning and at 10 a.m.. Multivariate Logistic regression analysis showed that 24h-UNa was independently associated with the target achievement of office BP (OR=2.356, 95% CI:1.004-5.533, P=0.049), morning HBPM (OR=2.408, 95% CI:1.026-5.650, P=0.030), and 10 a.m. HBPM (OR=2.299, 95% CI:1.031-5.129, P=0.033), while not with the 4 p.m. and night HBPM. Conclusions 24h-UNa is an independent risk factor for the control rates of office BP and morning HBPM in RH patients. Restriction of sodium salt intake plays an important role in reducing BP fluctuation and improving BP control. 利益冲突 无 -
表 1 202例难治性高血压患者一般临床资料
人群特征 总体(n=202) 低尿钠组(n=50) 低-中尿钠组(n=51) 中-高尿钠组(n=51) 高尿钠组(n=50) P值 年龄(x±s，岁) 59.87±16.30 66.04±13.32 63.70±14.93 55.74±14.80 49.00±16.30 ＜0.01 男性[n(%)] 107(53.0) 21(42.0) 24(47.1) 30(58.8) 32(64.0) 0.059 BMI(x±s，kg/m2) 25.03±4.26 25.62±4.12 25.67±2.68 27.69±3.00 30.34±5.97 ＜0.01 腰围(x±s，cm) 94.68±11.00 89.00±8.64 92.04±7.46 97.44±8.56 102.19±11.57 ＜0.01 吸烟[n(%)] 24(11.9) 3(6.0) 5(9.8) 6(11.8) 10(20.0) 0.075 饮酒[n(%)] 27(13.4) 4(8.0) 8(15.7) 5(9.8) 10(20.0) 0.135 卒中[n(%)] 19(9.4) 3(6.0) 9(17.6) 4(7.8) 3(6.0) 0.070 糖尿病[n(%)] 62(30.7) 8(16.0) 23(45.1) 15(29.4) 16(32.0) ＜0.01 空腹血糖(x±s，mmol/L) 6.96±2.54 6.82±3.42 6.37±1.01 7.04±3.24 6.69±1.84 0.828 糖化血红蛋白(x±s，%) 6.50±1.31 6.06±1.91 6.19±0.73 7.06±1.92 5.79±1.73 0.145 总胆固醇(x±s，mmol/L) 4.37±1.01 4.22±1.29 4.16±0.78 4.35±1.08 4.62±0.89 0.424 LDL-C(x±s，mmol/L) 2.44±0.88 2.21±1.05 2.41±0.91 2.37±0.88 2.59±0.71 0.527 eGFR[x±s，ml/(min·1.73 m2)] 80.69±23.30 75.68±24.76 75.00±25.05 83.71±19.52 87.18±25.69 0.183 平均用药数量(x±s) 3.62±0.72 3.26±0.56 3.61±0.70 3.78±0.73 3.84±0.77 ＜0.01 24 h尿钠(x±s，mmol) 198.9±96.6 92.34±22.79 157.15±16.39 212.32±15.16 333.91±72.61 ＜0.01 P值为4组间整体比较的统计学分析结果；BMI：体质量指数; LDL-C:低密度脂蛋白胆固醇；eGFR:估计肾小球滤过率 
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表 2 影响难治性高血压患者诊室及家庭自测血压达标状态的多因素Logistic回归分析
影响因素 诊室血压达标 家庭自测血压达标 OR(95% CI) P值 早晨 上午 下午 睡前 OR(95% CI) P值 OR(95% CI) P值 OR(95% CI) P值 OR(95% CI) P值 BMI 2.473(1.020~5.996) 0.045 1.040(0.460~2.334) 0.925 0.876(0.307~2.498) 0.805 1.174(0.415~3.319) 0.762 1.590(0.548~4.616) 0.394 eGFR 1.560(0.805~3.020) 0.187 0.217(0.054~0.880) 0.032 0.248(0.055~1.113) 0.069 1.614(0.638~4.083) 0.321 1.841(0.736~4.603) 0.192 24 h尿钠 2.356(1.004~5.533) 0.049 2.408(1.026~5.650) 0.030 2.299(1.031~5.129) 0.033 1.485(0.471~4.681) 0.500 1.610(0.427~6.069) 0.481 24 h尿钾 0.996(0.589~1.686) 0.989 1.231(0.783~1.936) 0.368 1.430(0.785~2.605) 0.243 0.908(0.491~1.679) 0.758 0.697(0.210~2.315) 0.556 应用螺内酯 0.447(0.144~1.384) 0.163 0.991(0.316~3.113) 0.988 0.787(0.231~2.687) 0.703 0.489(0.130~1.847) 0.292 0.285(0.066~1.239) 0.094 ≥4种抗高血压药物 0.327(0.110~0.972) 0.044 0.415(0.121~1.422) 0.162 0.873(0.268~2.844) 0.822 0.661(0.175~2.489) 0.540 0.211(0.047~0.943) 0.042 诊室血压以＜140/90 mm Hg为达标，家庭自测血压以＜135/85 mm Hg为达标; BMI、eGFR：同表 1
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