两种钙离子拮抗剂治疗老年非杓型高血压临床对比研究

目的：探讨硝苯地平和氨氯地平治疗老年非杓型高血压临床疗效及安全性差异。方法研究对象整群选取该院2013年3月—2015年6月收治老年非杓型高血压患者共170例,以随机数字表法分为A组(85例)和B组(85例),分别采用氨氯地平与硝苯地平治疗;比较两组患者诊室血压控制率,血压昼夜节律异常改善率及不良反应发生率等。结果 A组患者诊室血压控制率分别为81.54%(53/85),84.62%(55/85);两组患者血压控制率比较差异无统计学意义(P>0.05);A组和B组患者血压昼夜节律异常改善率分别为31.76%(27/85),54.12%(46/85);B组患者血压昼夜节律异常改善率显著高于A组(P﹤0.05);A组患者中发生头晕3例,头痛2例,面色潮红8例,不良反应发生率为15.29%;B组患者中发生头晕4例,头痛4例,面色潮红7例,不良反应发生率为17.65%;两组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论硝苯地平和氨氯地平治疗老年非杓型高血压均可有效控制血压水平,并未导致严重不良反应发生;但硝苯地平应用在促进血压昼夜节律恢复方面效果优于氨氯地平。     

红细胞分布宽度和中性粒细胞淋巴细胞比值对非杓型血压的预测价值

目的探讨非杓型血压的临床特点和相关因素,以提高非杓型血压的知晓率。方法选择住院部原发性高血压或其他心脏疾病并发原发性高血压的患者105例,按昼夜血压波动情况分为杓型血压组及非杓型血压组。分别两组收集临床资料,并行血常规、血生化等辅助检查的结果。结果 105例患者中,杓型血压患者37例（35.2%）,非杓型血压患者68例（64.8%）。且非杓型血压患者红细胞分布宽度（RDW）、血小板计数、中性粒细胞淋巴细胞比值（NLR）及血小板淋巴细胞比值（PLR）均较杓型血压患者显著升高（P〈0.05）。Logistic回归分析和ROC曲线结果提示,当RDW≥14.1%及NLR≥1.9与非杓型血压的预测显著相关（P〈0.01）。结论住院高血压病患者中非杓型血压的发生率较高,RDW≥14.1%及NLR≥1.9是非杓型高血压发生的独立预测因子。     

The effects of nocturnal dipping on cardiovascular outcomes and proteinuria in essential hypertensive patients

Individuals who do not have a 10% to 20% reduction in blood pressure (BP) during the night are known as ‘nondippers’. Non-dipping patterns in hypertensive patients have been shown to be associated with an excess of target organ damage and other adverse outcomes. The present study was designed to investigate the relationship between nocturnal BP pattern, defined on the basis of the ambulatory blood pressure monitoring (ABPM) recording, and cardiac and renal target organ damage in a population of at least one year treated essential hypertensive subjects. The present analysis involved 123 patients with treated essential hypertension attending the outpatient clinic of our centre. Each patient was subjected to the following procedures: blood sampling for routine blood chemistry, spot urine for proteinuria, 24-hour periods of ABPM, and echocardiography. In the ABPM period, a dipping pattern was observed in 65 of the 123 patients, and a non-dipping pattern in 58 patients. Body mass index was higher in the non-dippers (26 ± 4 versus 28 ± 4, p<0.05). The proteinuria in spot urine was significantly higher in the non-dippers (10 ± 6 versus 24 ± 48, p<0.03). Left ventricular mass, interventricular septum thickness, posterior wall thickness and left ventricular systolic diameter were significantly higher in the non-dippers compared to the dippers. Left ventricular diastolic function was similar in non-dipper cases, except E-wave deceleration time. In treated essential hypertensives the blunted or absent nocturnal fall in blood pressure can be a strong predictor of cardiac and renal events. Hypertensive patients should be evaluated by ambulatory blood pressure monitoring. To prevent patients at risk for morbidity and mortality casualities as a result of hypertension, patients should be evaluated by ambulatory blood pressure monitoring. This method can be utilized for exacting future follow-ups with the patient.     

高血压类型与微量白蛋白尿的相关分析

目的探讨高血压患者脉压与尿微量白蛋白(microalbuminuria)排泄量的关系。方法选取243例原发性高血压患者,按照高血压类型分为杓型(198例)和非杓型(45)两组。比较两组间性别、年龄、总胆固醇、甘油三酯、高密度脂蛋白胆固醇和低密度脂蛋白胆固醇水平、体重指数、蛋白尿的发生率及24h尿蛋白排泄量。结果非杓型高血压组尿蛋白阳性率为41.3%、24h尿白蛋白排泄量为(234.6±41.4)mg,均明显高于杓型高血压组23%,(146±35)mg。收缩压、脉压与24h尿蛋白量呈正相关,其相关系数r分别为0.478(p<0.05)、0.637(p<0.05);尤其在非杓型高血压中,脉压与24h尿蛋白量排泄量相关系数r=0.81(p<0.05)远高于杓型(r=0.58,p<0.05)。结论非杓型高血压较杓型高血压引起的肾损害害明显早于和严重于杓型高血压;抗高血压治疗亦应注意合理地控制夜间血压。     

Is there an association between non-dipping blood pressure and measures of glucose variability in type 1 diabetes?

Aim

To assess the relationship between glucose variability (GV) and non-dipping of blood pressure (BP) as a marker of cardiovascular autonomic neuropathy (CAN) among patients with type 1 diabetes (T1D).

Ambulatory pulse pressure, decreased nocturnal blood pressure reduction and progression of nephropathy in type 2 diabetic patients

Aims/hypothesis  We followed type 2 diabetic patients over a long period to evaluate the predictive value of ambulatory pulse pressure (PP) and decreased nocturnal BP reduction (non-dipping) for nephropathy progression. Methods  Type 2 diabetic patients (n = 112) were followed for an average of 9.5 (range 0.5–14.5) years. At baseline, all patients underwent 24 h ambulatory BP measurement. Urinary albumin excretion rate was evaluated by three urinary albumin:creatinine ratio measurements at baseline and follow-up. Results  At baseline, patients who subsequently progressed to a more advanced nephropathy stage (n = 35) had reduced diastolic night/day BP variation and higher 24 h systolic BP and PP values; they also had more advanced nephropathy and were more likely to smoke than those with no progression of nephropathy (n = 77). In a Cox regression analysis, independent predictors of nephropathy progression were 24 h PP (p < 0.01), diastolic night:day BP ratio (p = 0.02) and smoking (p = 0.02). The adjusted hazards ratio (95% CI) for each mmHg increment in 24 h PP was 1.04 (1.01–1.07), whereas the adjusted hazards ratio (95% CI) for each 1% increase in diastolic night:day BP ratio was 1.06 (1.01–1.11). Only one of 33 patients (3.0%) with both a diastolic night:day BP ratio and a 24 h PP below the median progressed, whereas 17 of 32 patients (53.1%) with both a diastolic night:day BP ratio and a 24 h PP equal to or above the median progressed to a more advanced nephropathy stage (p < 0.001). Conclusions/interpretation  Ambulatory PP, impaired nocturnal BP decline and smoking are strong, independent predictors of nephropathy progression in type 2 diabetic patients.     

Ambulatory blood pressure monitoring profiles in a cross-sectional analysis of a large database of normotensive and true or suspected hypertensive patients

Objective

To assess ambulatory blood pressure monitoring (ABPM) circadian patterns and their determinants in a large sample of normotensive and hypertensive patients.