1周血压变化的规律

目的探讨也门亚丁人人体血压1周动态节律(周节律)的存在及其在临床中的作用.方法对29例健康人和高血压病患者进行1周动态血压监测(ABPM);另外对58例高血压合并急性脑卒中患者的发病时间进行统计.结果健康人和高血压病患者血压的1周波动多呈双峰双谷型,模式为周六为第1个高峰,周二或周三血压为第2个高峰,周五为最低值.高血压病患者周节律更为明显.血压1周节律性波动与急性脑卒中患者发病时间基本一致.结论也门亚丁人人体动态血压存在周节律,急性脑卒中患者1周发病时间规律与血压周节律密切相关,血压高峰日的发现对预防也门亚丁人的高血压及其并发症具有重要意义.     

1周血压变化的规律

目的探讨也门亚丁人人体血压1周动态节律(周节律)的存在及其在临床中的作用。方法对29例健康人和高血压病患者进行1周动态血压监测(ABPM);另外对58例高血压合并急性脑卒中患者的发病时间进行统计。结果健康人和高血压病患者血压的1周波动多呈双峰双谷型,模式为周六为第1个高峰,周二或周三血压为第2个高峰,周五为最低值。高血压病患者周节律更为明显。血压1周节律性波动与急性脑卒中患者发病时间基本一致。结论也门亚丁人人体动态血压存在周节律,急性脑卒中患者1周发病时间规律与血压周节律密切相关,血压高峰日的发现对预防也门亚丁人的高血压及其并发症具有重要意义。     

动态血压和偶测血压监测对原发性高血压病的应用价值

对６０例原发性高血压病患者和３４例健康人进行２４ｈ动态血压监测，并与偶测血压比较。结果显示：高血压病患者的偶测血压值均高于动态血压均值（Ｐ〈０．０１），而健康人无显著差异（Ｐ〉０．０５）。高血压病患者与健康人２４ｈ血压节律均呈两峰一谷及昼高夜低的特点，但高血压病患者的第一峰更为突出。认为动态血压较偶测血压对高血压病的诊断更为准确，对临床选择最佳用药时机指导价值亦更大。     

急性脑卒中患者血压特点的分析

目的研究急性脑卒中患者血压影响因素及动态血压特点。方法82例发病在7天内的急性脑卒中患者。记录患者住院诊室血压及24 h动态血压。血压≥140/90 mm Hg(1 mm Hg=0.133 kPa)为诊室血压升高;24 h动态血压平均值≥130/80 mm Hg、日间平均值≥135/85 mm Hg、夜间平均值≥125/75 mm Hg为动态血压升高。结果既往高血压病史对急性脑卒中患者诊室血压升高有影响(P<0.05)。有高血压病史者平均诊室血压(146.02±18.89)/(86.36±11.52)mm Hg,无高血压病史者平均诊室血压(136.22±14.63)/(82.61±11.86)mm Hg,二者收缩压水平差异有显著性意义(P<0.05)。急性脑卒中患者动态血压表现为夜间血压负荷增加,24 h平均血压于发病后4~5天明显升高,6~7天降低。诊室血压升高与诊室血压正常比较,血压形态均以非杓形和反杓形为主,2组差异无显著性意义(P>0.05)。结论急性脑卒中诊室血压升高与高血压病史有关,急性脑卒中随发病时间延长,血压呈下降趋势。     

高血压病患者血压昼夜节律改变与高血压肾损害的关系

目的：探讨高血压病患者血压昼节律改变与高血压肾损害的关系。方法：对62例原发性高血压病患者进行24h动态血压监测，根据检测结果将62例高血压病患者分成杓型组与非杓型组，并测定两组患者的血、尿β2－微球蛋白（β2－MG）、尿微量白蛋白（mAIb)及血尿素氮（BUN）、血肌酐（Cr)。比较杓型组与非杓型组血压增值、血压昼节律变化及血、尿β2－MG、尿mAIb、血BUN、Cr。结果：血压昼节律改变者血，尿β2－MG、尿mAIb、血BUN、Cr均较正常昼节律者增加（P＜0．01）。结论：血压昼节律改革呈非杓型者其肾损害较杓型者严重。     

高血压病脑出血的动态血压监测分析

对４０例高血压病脑出血及２０例Ｉ期高血压病患者进行了动态血压（ＡＢＰＭ）监测，结果显示，脑出血组夜间平均收缩压及舒张压，夜间血压下降率〈１０％者垃明显高于对照组，且血压昼夜波动节律基本消失，提示夜间平均血压过高及血压昼夜节律基本消失对高血压病脑出血具有早期预报价值。     

动态血压监测氨氯地平治疗高血压病疗效观察

<正> 随着对高血压患者24h动态血压监测(Ambulatory Blood Pressure Monitoring,简称ABPM研究的深入,发现过高的血压负荷和异常的昼夜血压节律有发生脑卒中的较大危险,并有高的心血管发病率.氨氯地平治疗高血压病的疗效和安全性已得到证实,但国内鲜有报道其对24h动态血压的影响.为此,利用ABPM,观察氨氯地平(Amlodipine,辉瑞制药有限公司生产,简称ALD)对25例轻中度高血压病患者24h动态血压及血压节律的影响,以进一步评价ALD降压情况.     

昼夜节律消失高血压患者左室肥厚的相关研究

24h动态血压监测（ABPM）可了解血压昼夜变化节律，ABPM能够较完整地反映人体血压状况。通过对患者的24h动态血压观察，了解血压昼夜变化程度，探讨血压昼夜节律消失的高血压患者左室肥厚与动态血压各参数的相关关系。     

如何使血压平稳

一、血压是如何波动　目前 2 4ｈ动态血压监测已从临床研究普及到对高血压患者的诊断与评价治疗效果。对轻中度原发性高血压患者进行 2 4ｈ动态血压监测 ,发现 2个血压高峰和 2个低谷 ,即早起6～ 8点为第一个血压高峰 ;8点后开始下降 ,到中午12点至下午 2点为第一个低谷 ;然后血压开始上升 ,到下午 5～ 8点为第二个高峰 ,也是全天最高血压时间 ;此后血压下降 ,到凌晨 1～ 2点为全天最低点 ,也就是第二个低谷 ,最后血压逐渐上升 ,再进入次日的第一个高峰。医学上根据血压波动曲线又可分为以下几种类型 :1 少数患者以早起第一个高峰为突出 ;2 …     

高血压患者24小时动态血压分析

对１００例高血压患者进行２４ｈ动态血压监测，结果２４ｈ动态血压波动规律呈双峰双谷状，第一高峰在上午７～１１时左右，第二高峰在下午１６～２１时左右，且收缩压第二高峰值明显高于第一高峰值，２４ｈ动态血压均值昼夜为１３９／８３ｍｍＨｇ，日间为１４０／８６ｍｍＨｇ，夜间为１３６／８０ｍｍＨｇ。血压负荷收缩压为４８％，舒张压为３２％。     

Repeated office blood pressure controls reduce the prevalence of white-coat hypertension and detect a group of white-coat normotensive patients

BACKGROUND: The aim of this study was to evaluate whether repeated office blood pressure controls may change the prevalence of white-coat hypertension among hypertensive patients. METHODS: We studied 221 newly diagnosed, never-treated hypertensive patients, all men, aged 31-60 years. On the first visit, they underwent sitting blood pressure measurements (two readings were taken by mercury sphygmomanometer and averaged) and non-invasive 24 h ambulatory blood pressure monitoring (ABPM) every 15 min. Thereafter, each patient made four further visits over an 8-week period. On each visit, three sitting readings were taken and averaged. On the last visit, ABPM was performed again. Subjects who had hypertension in the clinic but whose daytime ambulatory blood pressure was less than 134/90 mmHg were considered to have white-coat hypertension. RESULTS: On the first visit, all patients were, by definition, clinically hypertensive and ABPM detected a prevalence of white-coat hypertension of 25.8%. On the following visits, the prevalence of clinical hypertensive patients progressively declined; on the last visit, the 82.3% of all patients resulted yet clinical hypertensive: on ambulatory blood pressure 71.9% were sustained hypertensives, whereas 10.4 had white-coat hypertension. Of the patients originally labelled as hypertensive, 17.7% proved to be clinically normotensive: 13.6% had also daytime ambulatory blood pressure in the normal range, whereas 4.1% showed elevated blood pressure during daytime ABPM (white-coat normotensives). CONCLUSION: These data suggest that repeated office blood pressure controls in newly diagnosed hypertensives reduce the number of office hypertensive patients, reduce the number of white-coat hypertensive patients and detect a small group of white-coat normotensive patients.     

非杓型血压的临床特点及相关因素分析

目的:研究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和治疗率。方法:选择原发性高血压或其他心脏疾病并发原发性高血压,并排除严重并发疾病的患者。收集临床资料,并行血生化、心电图、心超等辅助检查。所有患者进行24小时动态血压监测,将夜间平均血压与白天比较,无下降者,为反杓型血压组,下降超过10%,为杓型血压组,下降不超过10%,为非杓型血压组,并分析其临床特点。结果:共55例入选,所有患者均为高血压Ⅱ级或Ⅲ级,杓型血压者19例(35%),非杓型者22例(40%),反杓型者14例(25%),广义非杓型血压共36例(占65%)。不同血压节律组间比较,年龄、冠心病史、脑卒中史、血浆尿素氮及夜间收缩压、舒张压差异有显著性。Logistic回归提示冠心病史、脑卒中史、血浆尿素氮增高为血压昼夜节律异常的影响因素。结论:住院高血压病患者中非杓型血压的发生率较高,冠心病、脑卒中、血浆尿素氮增高的患者是非杓型血压的相关因素。     

Isolated ambulatory hypertension is common in outpatients referred to a hypertension centre

The present investigation was aimed at determining the prevalence and the blood pressure (BP) profile of isolated ambulatory hypertension, defined as an elevated ambulatory BP with normal office blood pressure, in a series of 1488 consecutive outpatients referred for routine clinical evaluation of suspected or established arterial hypertension. All patients underwent both office BP (OBP) measurement by a physician and 24-h ambulatory blood pressure monitoring (ABPM). Using OBP values (cutoff for diagnosis of hypertension >/=140/90 mmHg) and daytime ABPM (cutoff for diagnosis of hypertension >/=135/85 mmHg), patients were classified into eight subgroups. In the whole series we found that, independent of treatment status, the prevalence of isolated ambulatory hypertension exceeded 10%. More importantly, 45.3% of individuals who presented with normal OBP values, showed elevated BP at ABPM. Night-time BP, 24-h pulse pressure, and BP variability were significantly higher in isolated ambulatory hypertensives than in normotensive or in white-coat hypertensive individuals. Therefore, isolated ambulatory hypertension is characterized by a blood pressure profile that is similar to that observed in sustained hypertension. These findings suggest that isolated ambulatory hypertension is very common and probably the indications for ABPM should be more extensive in outpatients referred to hypertensive centre.     

糖耐量低减患者动态血压的改变

为观察糖耐量低减（ＩＧＴ）患者动态血压（ＡＢＰＭ）的改变，对血压正常和血压增高的ＩＧＴ患者各２０例进行２４小时ＡＢＰＭ监测及各项生化指标检查，并设有糖耐量正常组和糖尿病组进行对照研究。结果ＩＧＴ患者２４小时ＡＢＰＭ的变化与糖耐量正常者相似，但具有夜间血压增高和昼夜血压差值减小的趋势。血压昼夜节律异常的ＩＧＴ患者ＡＢＰＭ的改变为夜间血压升高。表明ＩＧＴ患者已开始出现早期的血压改变。     

Ambulatory blood pressure monitoring of chronically dialyzed pediatric patients.

BACKGROUND: Background Ambulatory blood pressure monitoring (ABPM) has been shown to be more representative of blood pressure levels in adult patients than are casual measurements of blood pressure. OBJECTIVE: To evaluate, by means of ABPM, the behavior of blood pressure in children with chronic renal failure submitted to continuous ambulatory peritoneal dialysis and compare the results with casual blood pressure monitoring measurements. DESIGN: Evaluation of blood pressures in chronically dialyzed pediatric patients by ABPM. METHODS: Ten pediatric patients, treated by continuous ambulatory peritoneal dialysis were evaluated by ABPM using the oscillometric SpaceLabs 90207 monitor, every 10 min during the day and every 15 min during the night, for 24h. RESULTS: Six of 10 patients were found normotensive by office measurement of blood pressure; four of 10 patients were found hypertensive by casual measurements of blood pressure. With ABPM we obtained a mean success rate of 92.5%, confirmed hypertension in all the patients classified hypertensive in terms of office readings and reclassified six of six patients from normotensive to hypertensive. The mean systolic and diastolic physiologic falls in blood pressure at night were respectively by 10 and 15%. At the time of the ABPM study end-organ damage was present in two patients judged to be normotensive in terms of office blood pressures. CONCLUSION: Casual recordings of blood pressure are not representative of average blood pressure in dialyzed pediatric patients. ABPM seems to be a useful diagnostic aid for assessing treatment of hypertension in children with end-stage renal disease.     

妊娠高血压综合征动态血压监测及其意义

目的探讨妊娠高血压综合征动态血压监测的特征变化。方法用动态血压仪测定３２例妊娠高血压患者的血压，并和２０例正常妊娠和２０例正常相当年龄的健康妇女作对照。结果正常孕妇ＡＢＰＭ各参数均高于同龄健康妇女；妊娠高血压ＡＢＰＭ各参数均高于正常孕妇。妊娠高血压蛋白尿阳性者的昼夜血压比值及血压负荷数均较无蛋白尿者明显增高，且与病情严重度相关。结论正常中、晚期妊娠的收缩压有增高趋势，舒张压升高对妊娠高血压更具特征性。ＡＢＰＭ测定所出现的血压昼夜节律变化和血压负荷增高和病情的严重度相关。     

高血压并发心脑靶器官损害的动态血压特征

目的探讨高血压有心脑合并症时的昼夜血压变化的规律。方法６８例高血压患者中１６例有左室肥厚，１６例有左室肥厚伴脑血管意外，１２例有脑血管意外；２４例未发现有心脑并发症作为对照。全部患者作动态血压测定。结果有并发症的三组患者以收缩压和舒张压共同升高，夜间下降率＜１０％，血压昼夜波动成为非杓型为特点。心室肥厚组日间血压和对照组无明显差异，而脑血管意外组具有清晨血压升高的特点。结论血压的昼夜波动变化与高血压患者合并症的发生有密切关系。     

Ambulatory Blood Pressure Monitoring in the Prediction and Prevention of Coronary Heart Disease

We reviewed studies of ambulatory blood pressure monitoring (ABPM) in patients with symptomatic coronary heart disease (CHD) or asymptomatic coronary lesions and in patients at high coronary risk, such as in the presence of hypertension. We identified ten cross-sectional and seven prospective studies in patients with CHD or coronary lesions. These studies showed that patients with CHD or coronary lesions often had nocturnal non-dipping or increased blood pressure variability, and might have increased risk of coronary events, due to either uncontrolled hypertension or treatment-induced hypotension identified by ABPM. We identified ten observational studies in hypertensive patients and normotensive subjects and five therapeutic trials in hypertension. These observational studies demonstrated that one or more ambulatory blood pressure components might provide predictive value for coronary events above and beyond clinic blood pressure. The therapeutic trials were less conclusive, but suggestive of additional value for the prevention of coronary events.     

非洛地平缓释片对原发性高血压患者动态血压的影响及与细胞内胞浆游离钙浓度的关系

目的 观察非洛地平对高血压患者动态血压的影响及与细胞内胞浆游离钙浓度的关系。方法 检测28例原发性高血压患者及相应对照组之血压及淋巴细胞胞浆游离钙浓度及非洛地平缓释片治疗四周后血压及淋巴细胞胞浆游离钙浓度的变化,并观察其治疗前后24h动态血压的变化。结果 原发性高血压患者淋巴细胞胞浆游离钙浓度显著高于对照组,非洛地平缓释片治疗后淋巴细胞胞浆游离钙浓度和血压显著下降(P<0.01),淋巴细胞胞浆游离钙浓度的下降幅度与收缩压及舒张压下降幅度呈正相关(r=O.866,P<0.001及r=0.734,P<0.001)。治疗后24h平均收缩压、24h平均舒张压、日间平均收缩压、日间平均舒张压、夜间平均收缩压、夜间平均舒张压、日间收缩压负荷、日间舒张压负荷、夜间收缩压负荷、夜间舒张压负荷均较治疗前明显降低(P<0.05-P<0.01)。结论非洛地平是平稳有效的抗高血压药物,其降压作用可能是通过降低细胞内胞浆游离钙浓度而发挥作用。