老年高血压病血压昼夜节律与左室肥厚的关系

目的：观察老年高血压病血压昼夜节律与左心室服厚（LVH）的关系。方法：对120例老年高血压患行24小时动态血压监测（ABPM）以观察血压昼夜节律,用超声心动图检测左室重量指数（LVMI）,然后分析二相关关系。结果：血压昼夜节律减弱的70例中LVH有41例,占58．8％,血压昼夜节律消失的50例均有LVH（100％）。血压昼夜节律消失的左室肥厚率显的高于血压昼夜节律减弱的（P＜0．01）。结论：夜间收缩压和舒张压下降率与左室肥厚呈显负相关。     

高血压患者血压变异性与病情关系

目的：本研究观察了85例45岁以上的高血压病患者血压变异性（BPV）及其与病情的关系。结果:(1)血压变异性并不是随着病期无限制的增大,高血压病Ⅱ,Ⅲ期患者的收缩压变异性（SSD）大于I期（P＜0．01）,Ⅲ期并不大于Ⅱ期;（2）舒张压变异性（DSD）各期之间无差别（P＜0．05）;（3）高血压病Ⅲ期的患者,多数昼夜节律性消失,血压形态呈非勺型,均伴随靶器官损害（TOD）。     

偶测血压正常的Ⅱ型糖尿病患者动态血压监测的临床意义

监测36例偶测血压正常的Ⅱ型糖尿病患者的24小时动态血压,38例健康对照组比较,并将糖尿病组分为糖尿病心血管自主神经病变组（16例）及非糖尿病心血管自主神经病组（20例）。结果：与对照组相比,Ⅱ型糖尿病患者的平均24小时、白昼、夜间收缩压明显增高（P＜0．01）,平均24小时、夜间舒张压明显增高（P＜0．05,P＜0．01）,而平均白昼舒张压无明显变化（P＞0．05）;收缩压及舒张压的夜间血压下降百分率均明显降低（P＜0．01,P＜0．05）：糖尿病的心血管自主神经病变组与非心血管自主神经病组相比,夜间收缩压下降百分率明显降低（P＜0．01）,而夜间舒张压下降百分率无明显变化（P＞0．05）。 结论：在Ⅱ型糖尿病患者中,动态血压的监测较偶测血压更易发现夜间血压异常：患者的血压昼夜节律改变是否合并糖尿病自主神经病变有密切关系。     

老年高血压病患者性激素与血管内皮功能的关系

为研究老年高血压病患者性激素,vWF含量和纤溶活性的改变及其相关性,分别采用放射免疫法,酶联免疫吸附法和发色底物法测定了66例（女34例,男32例）I,II期老年高血压病患者和32例（女16例,男16例）老年正常人的雌二醇,睾酮及内皮损伤特异性标志物－von Willebrand因子含量,以及组织型纤溶酶原激活物和纤溶酶原激活物抑制物活性,并进行了相关性分析,结果发现,老年女性高血压病雌二醇水平,组织型纤溶酶原激活物活性明显低于老年女性正常对照组（P＜0．01,P＜0．05）,而von Willebrand因子含量,纤溶酶原激活物抑制物活性明显高于正常对照组（P＜0．05,P＜0．01）,老年男性高血压病组睾酮水平,组织型纤溶酶原激活物活性明显低于老年男性正常对照组（P＜0．05,P＜0．01）,von Willebrand因子含量,纤溶酶原激活物抑制物活性显著高于正常对照组（P＜0．05,P＜0．01）,老年女性高血压病组雌二醇水平与von Willebrand因子含量呈显著负相, 结果提示,老年女性高血压病患者雌二醇水平明显降低,而男性睾酮水平下降,两者都存在明显的内皮损伤,纤溶活性异常,雌二醇可能通过对血管内皮功能的有利影响而对女性高血压起保护作用。     

健康入、糖尿病及高血压患者24小时动态血压比较

155例研究对象，分为正常组，糖尿病组高血压组（轻中度）。采用TM-2421动态血压监测仪监测记录24小时ABP。结果：（1）三组ABP均呈勺型变化，糖尿病和高血压组SBP水平显著高于正常组（P〈0．01．P〈0．05）。高血压组DBP水平显著高于正常组和糖尿病组（P〈0．01，或P〈0．05）。余弦法证实三组ABP变化的显著昼夜节律性，糖尿病和高血压组的夜间血压（SBP、DBP）下降率明显低于正常组（P〈0．01，或P〈0．05）。（2）ABP参数：糖尿病和高血压组ABP均值和负荷明显高于正常组（P〈0．01，或P〈0．05）；ABP变异性三组之间无显著性差异；高血压组ABP曲线下面积显著性高于正常组（P〈0．01），与糖尿病组无显著性差别。结论：高血压和临床正常血压的糖尿病患者均出现ABP部分参数与正常对照组的显著性差异。提示：糖尿病患者在临床明确诊断高血压前已发生血压调节的明显改变。     

老年高血压患者血压昼夜节律特点及药物干预的研究

目的研究老年高血压患者24h动态血压昼夜节律特点以及培哚普利干预的疗效。方法对60例老年高血压患者（观察组）和100例非老年高血压患者（对照组）进行动态血压监测（ABPM）;观察组患者给予口服培哚普利,于服药前后及检测24h动态血压（ABPM）、血脂、血糖、肝肾功能等。结果观察组患者昼夜节律性和全天及昼间舒张压低于对照组（P〈0．05）。夜间收缩压和脉压差均高于对照组（P〈0．001）。观察组口服培哚普利4周后,24h、白昼、和夜间血压均值均比治疗前明显下降（P〈0．01）,夜间血压比白昼血压均值下降明显（P〈0．01）。结论老年高血压患者血压昼夜节律降低、动脉压差增大,白天舒张压降低、夜间收缩压增高、脉压差增大是老年高血压病血压昼夜节律特点。培哚普利能24h缓慢降低老年高血压患者血压尤其夜间收缩压,改善非杓型血压昼夜节律。     

糖尿病患者动态血压改变及与心率变异的关系

选择40例血压正常的2型糖尿病患进行24h动态血压及心电图监测,计算24h全部正常心律R－R间期的标准差（SDNN）,单位为毫秒,并与30例健康比较。结果：糖尿病组白天血压无明显改变,夜间舒张压及平均动脉压较对照组升高（P＜0．01）。且其收缩压、舒张压、平均动脉压的夜间下降百分率较对照组明显降低（均P＜0．01）,正常昼夜节律消失。取平均动脉压夜间下降百分率与SDNN作相关分析,示两显正相关。结论：血压正常的2型糖尿病患已存在血压节律的改变,且此改变与心率变异显相关。     

心率变异、血压昼夜节律和负荷值与高血压病颈动脉粥样硬化的关系探讨

目的 探讨心率变异（HRV）、血压昼夜节律及负荷值与高血压病（EH）颈动脉粥样硬化的关系。方法 用动态心电（DCG）观察HRV，用动态血压（ABPM）观察血压昼夜节律及血压负荷值，用二维实时显像结合彩色双功多普勒超声检查，检测EH患颈动脉粥样硬化病变程度和血流受阻程度。结果 24h的HRV、血压昼夜节律及血压负荷值在EH之A、B 2组与正常对照组（C组）比较，均有统计学显差异，P＜0．01。而A、B2组间无统计学显性差异（P＞0．05）。结论 HRV降低、血压昼夜节律消失及血压负荷值明显增高将使心脑大中血管内膜长期处于高负荷压力下，与EH病期发展和颈动脉扩大及颈动脉粥样硬化斑块的发生率密切相关。     

原发性高血压患者心率变异的昼夜节律变化

目的 评价原发性高血压（EH）的心率变异性（HRV）昼夜节律变化，探讨其临床意义。方法 60例正常人作为对照组，164例高血压病人分为4组：低危组16例，中危组47例，高危组52例和很高危组49例。采用动态心电图（DCC）监测HRV的昼夜节律变化。结果 （1）高血压病 SDNN和SDANN等参数较正常组代，并随危险层次的增高，HRV依次降低，差异有显性（P＜0．05，P＜0．01）。（2）低危组高血压病人HRV昼夜节律变化与正常对照组相似，中危组，高危组和很高危组HRV昼夜节律改变或消失，并依次加重。（3）在伴有和不伴有ST－T异常的高血压病人之间，HRV的差异有显性（P＜0．05）。结论 EH病人HRV减低，昼夜变化节律异常，随分级和危险分层的增高而加重，显减低的HRV和明显的昼夜节律怀可以有助于诊断和预测高血压病人的靶器官损伤及危险性。     

高血压病和脑卒中患者内源性VitC,E的测定及其意义

目的：探讨高血压病和脑卒中患内源性维生素C,E的抗氧化作用。方法：应用紫外分光光度法测定23例高血压病患,30例高血压性脑出血患,25例缺血性脑卒中患和20例正常对照组的血清维生素C,E,超氧化物歧化酶（SOD）和丙二醛（MDA）的含量。结果：与正常对照组相比,高血压病组,维生素C,E,SOD,MDA水平无明显改变：脑出血,脑缺血组急性期;维生素C,E,SOD含量明显降低（P＜0．01）,MDA水平明显升高（P＜0．01）,恢复期,维生素C,E含量恢复正常,SOD含量仍降低（P＜0．05）,MDA仍增高P＜0．05）。结论：在脑卒中急性期患维生素C,E水平明显降低,但随着病情好转逐渐恢复正常,同时伴随SOD,MDA水平改变。     

原发性高血压24小时动态血压分析

目的：分析原发性高血压24小时动态血压变化。方法：应用美国产动态血压监测仪观察40例原发性高血压24小时动态血压并与96例血压正常进行比较。结果：单纯高血压患白天,夜间,平均收缩压,平均舒张压及24小时血压负荷值均比血压正常组高（P＜0．01）,高血压靶器官损害各组收缩压和舒张压又比单纯高压患高（P＜0．01）,结论：24小时动态血压与高血压靶器官损害有关,血压越高,靶器官损害越多,多脏器损害血压最高,脑,肾损害血压次之。     

高血压患者ABPM与器官损害临床观察

高血压患者ＡＢＰＭ与器官损害临床观察戴苏泉段宝祥陈蕴文（南京市第一医院心内科，南京２１０００６）ＡｍｂｕｌａｔｏｒｙＢｌｏｏｄＰｒｅｓｓｕｒｅＭｏｎｉｔｏｒｉｎｇｆｏｒＤｅｔｅｃｔｉｎｇｔｈｅＤａｍａｇｅｏｆＴａｒｇｅｔＯｒｇａｎｓｉｎｔｈｅＨｙｐｅ...     

Use of plasma B-type natriuretic peptide level to identify asymptomatic hypertensive patients with abnormal diurnal blood pressure variation profiles: nondippers, extreme dippers, and risers.

We examined the relationship between plasma B-type natriuretic peptide (BNP) level and diurnal variability pattern of blood pressure (BP). Twenty-four-hour ambulatory BP monitoring was performed in 98 patients with asymptomatic essential hypertension, and the patients were classified into four groups according to their circadian BP variation profiles: dippers (n=29), nondippers (n=36), extreme dippers (n=19), and risers (n=14). Plasma BNP was measured by enzyme immunoassay. Based on the distribution pattern of BNP values, the values were analyzed after logarithmic transformation. Significant differences in plasma BNP levels among the types of circadian BP variations were demonstrated by analysis of variance (p<0.0005). Nondippers and risers showed significantly higher plasma BNP levels (mean [range: -1 SD and +1 SD]: 16.1 [6.3, 41.6] pg/mL and 29.2 [15.9, 53.4] pg/mL, respectively) than dippers (8.4 [3.7, 19.1] pg/mL). The area under the receiver operating characteristics curve for distinguishing patients with abnormal circadian BP variation from those with normal variation was 0.72, indicating that plasma BNP levels were useful for distinguishing between these patients. Specificity of 69% and sensitivity of 72% were obtained with a cut-off value of 10.5 pg/mL (log plasma BNP, 1.02) for distinguishing the abnormal diurnal BP profile group from the normal group. In conclusion, hypertensive patients with abnormal diurnal BP variation patterns (nondippers, extreme dippers, and risers) showed higher plasma BNP levels than those with normal circadian BP variation (dippers). Plasma BNP level is clinically useful for the identification of hypertensive patients who have abnormal circadian BP variability, which increases the risk of cardiovascular events.     

动态血压监测评价高血压患者靶器官损害246例分析

目的探讨动态血压监测对评价高血压患者靶器官损害的价值。方法对246例高血压患者进行24h动态血压监测,其中单纯血压升高118例为原发性高血压组,伴靶器官损害128例为伴靶器官损害组,进行统计学分析。结果(1)伴靶器官损害组24h收缩压、白昼舒张压、夜间舒张压低于原发性高血压组(P<0.01);(2)靶器官损害数目累及3个器官组与累及1个器官组相比,24h平均收缩压、夜间平均舒张压、血压波动的昼夜节律异常和血压负荷参数,差异有统计学意义。结论血压波动的昼夜节律异常、24h平均收缩压、夜间平均舒张压和血压负荷越高,靶器官损害数目越多。     

动脉粥样硬化性肾动脉狭窄患者24小时动态血压特征及靶器官损害相关研究

目的探讨动脉粥样硬化性肾动脉狭窄(ARAS)患者24 h动态血压、昼夜节律变化特征及靶器官损害。方法选择2014年1月~2018年12月在上海交通大学医学院附属瑞金医院高血压科连续住院的ARAS患者121例(ARAS组),另选择同期年龄、性别、体质量指数和高血压病程等匹配的原发性高血压(EH)患者418例(EH组),观察并比较2组诊室及24 h动态血压及靶器官损害的差异。结果与EH组比较,ARAS组诊室收缩压[(155±23)mm Hg(1mm Hg=0.133k Pa)vs(145±22)mm Hg,P<0.01]、诊室脉压[(75±20)mm Hg vs(65±18)mm Hg,P<0.01]、24h收缩压[(143±19)mm Hg vs(130±16)mm Hg,P<0.01]、昼间收缩压[(145±18)mm Hg vs(133±16)mm Hg,P<0.01]、夜间收缩压[(138±21)mm Hg vs(123±18)mm Hg,P<0.01]、夜间舒张压[(75±12)mm Hg vs(73±10)mm Hg,P<0.05]明显升高,差异有统计学意义。与EH组比较,ARAS组杓型血压比例明显降低,反杓型血压比例明显升高(P<0.05)。校正相关因素后,与EH组比较,ARAS组颈动脉内膜中层厚度、左心室质量指数及血浆N末端B型钠尿肽前体水平明显升高,差异有统计学意义(P<0.01)。结论ARAS患者收缩压及夜间血压较高,更多表现为反杓型血压。有独立于血压及肾功能水平更严重的靶器官损害。     

动态血压监测在评价老年高血压靶器官损害中的临床价值

目的探讨动态血压监测在评价老年高血压靶器官损害中的临床价值。方法对206例老年高血压患者进行24小时动态血压监测,根据是否有靶器官损害分为单纯高血压组（A组）,合并心脏损害组（B组）,脑损害组（C组）,肾损害组（D组）,多脏器损害组（E组）,对各组动态血压值、血压昼夜节律、血压变异性及血压负荷值进行分析。结果合并脏器损害组的动态血压值、血压负荷值较单纯高血压组明显增高（P〈0．05或P〈0．01）,在多脏器损害组中收缩压变异性明显增大（P〈0．01）;靶器官损害组的血压昼夜节律异常明显增多（P〈0．01）。结论高血压患者24小时动态血压变化对预测高血压并发症的发生和指导合理治疗有重要意义。     

原发性高血压病患者血压昼夜节律的临床意义探讨

目的 探讨原发性高血压病患者昼夜血压均值波动的节律与临床意义。方法 ９２例原发性高血压病人分成三组,单纯收缩压增高组（ＩＳＨ）３６例,收缩压和舒张压均增高认定为混合组（ＭＤＨ）,共３１例,二组均除外心,脑,肾损害。高血压合并左心室肥大（ＬＶＨ）组２５例。２０例正常个体为对照组,仪器采用美国Ｓｐａｃｅｌａｂｓ ９０２０７无创性携带式血压监测仪,获取２４小时平均收缩压（２４ｈＳＢＰ０和舒张压（２４ｈＤ     

动态血压监测评价老年高血压患者靶器官损害

目的探讨动态血压监测对老年高血压患者靶器官损害的价值.方法对232例已经接受服药治疗并且至少伴有一个靶器官损害的老年高血压患者进行24 h动态血压监测,根据累及靶器官损害数目和并存心脏、脑和肾脏临床状况分为3组,结合临床资料进行统计学分析.结果靶器官损害数目与24 h平均收缩压、夜间平均舒张压、血压波动的昼夜节律异常和血压负荷增高密切相关,靶器官损害累及3个器官与累及1个器官相比差异有统计学意义（P＜0.01）;并存脑血管疾病组夜间平均舒张压增高显著,并存心血管疾病组和肾脏病变组的患者以24 h平均收缩压增高和血压负荷增加显著,并存临床状况的患者,血压波动的昼夜节律异常多见,并存心、脑和肾临床状况组分别与靶器官损害组相比差异有统计学意义（P＜0.01）.结论24 h平均收缩压、夜间平均舒张压和血压负荷越高,靶器官损害数目越多;血压波动的昼夜节律异常多见于并存临床状况的老年高血压患者,应用动态血压监测有助于指导临床治疗.     

Do Obese Individuals With Hypertension Have More Difficult‐to‐Control Blood Pressure and End Organ Damage Than Their Nonobese Counterparts?

The authors assessed whether individuals with elevated body mass index (BMI) and hypertension had more difficult‐to‐control blood pressure (BP) and more evidence of end organ damage using data collected prospectively over 11 years from a secondary care hypertension clinic. A total of 1114 individuals were divided by BMI criteria into normal (n=207), overweight (n=440), and obese (n=467). Mean daytime, nighttime, and 24‐hour systolic BP and diastolic BP were similar in all groups. There was less nocturnal dip in obese compared with overweight groups (P=.025). Individuals with a normal BMI were taking fewer antihypertensive medications than those in the obese group (P=.01). Individuals classified as obese had a higher left ventricular mass index than those with a normal BMI (female, P=.028; male, P<.001); this relationship remained after multivariate linear regression. Obese individuals with hypertension required more medication to achieve similar mean ambulatory BP values, had less nocturnal dip in BP, and had a higher prevalence of left ventricular hypertrophy. As such, obese patients are at potentially increased risk of cardiovascular events.     

No impact of blood pressure variability on microalbuminuria and left ventricular geometry: analysis of daytime variation, diurnal variation and 'white coat' effect

OBJECTIVE: To investigate the influence of blood pressure variability on target organ involvement. METHODS: Using a cross-sectional study of a hypertension clinic at a district general hospital, 420 patients with newly diagnosed untreated essential hypertension referred on a consecutive basis from general practice and 146 normal subjects drawn at random from the Danish National Register underwent a variety of measurements which included: echocardiography with determination of left ventricular mass index and relative wall thickness and early morning urine albumin/creatinine ratio. Mean, standard deviation and coefficient of variation of automated clinic values; daytime, night-time and full 24-h period were extracted from 24-h ambulatory blood pressure (ABP) monitoring. 'White coat' effect and dip were calculated. Hypertensives were classified into subjects with high or low variability, into 'white coat' hypertensives or established hypertensives and into dippers or non-dippers. RESULTS: Standard deviation of daytime blood pressure (BP) was positively associated with target organ damage and BP level, which was not the case when variability was expressed as a coefficient of variation. Patients with high variability exhibited no more significant target organ damage than patients with low variability, but patients with established hypertension had significantly more target organ damage than the 'white coat' hypertensives. The 'white coat' effect as such was not associated with increased target organ involvement. Non-dippers had significantly more cardiac target organ damage than dippers, but the difference disappeared after correction for different 24-h BP level. CONCLUSION: BP variability data obtained by non-invasive ABP monitoring does not seem to improve the information inherent in the BP level.