动态血压监测与高血压病预后的关系

目的 :探讨动态血压 (ABP)及偶测血压 (CBP)与高血压预后的关系。方法 :2 2 0例原发性高血压患者入选时分别测量基础状态下ABP及CBP、并根据白昼舒张压水平分为高、中、低 3个亚组 (HL、ML、LL) ,然后长期随访观察与高血压病相关的心脑血管“事件”。结果 :平均随访 38个月 ,发生各类“事件”者 2 6例 ,单因素分析表明 :“事件”组各项ABP参数明显高于“非事件”组 (P <0 0 5～ 0 0 1) ,而 2组CBP间无显著差异 (P >0 0 5 )。LL、ML、HL 3个亚组中“事件”发生率分别为 2例 10 0人年、3 4例 10 0人年及 6 3例 10 0人年。多因素分析显示 :SBP节律、夜间SBP水平及总胆固醇 (CT)水平为高血压患者“事件”发生的独立危险因素 ,分别为RR =3 0 8、RR =1.2 6、RR =1.4 9(P <0 0 5～ 0 0 1)。结论 :ABP在判断高血压预后方面较CBP更具有临床意义 ,较高的ABP水平提示不良的预后 ,SBP节律、夜间SBP水平是预测高血压患者心脑血管“事件”及肾脏受损的独立危险因素     

Arterial distensibility and ambulatory blood pressure monitoring in essential hypertension

Arterial distensibility estimated by carotid femoral pulse wave velocity was evaluated in 22 patients with sustained essential hypertension, together with 3 different methods of blood pressure (BP) measurement: mercury sphygmomanometer, semiautomatic BP recording using the Dinamap apparatus and 24-hour ambulatory BP monitoring using a Spacelabs monitor. Although pulse wave velocity did not correlate with BP measured by mercury sphygmomanometer, it strongly and positively correlated with BP measurements using the other 2 procedures. The best correlation was observed with ambulatory BP with respect to systolic BP only (r = 0.685, p less than 0.001). Since cardiovascular morbidity and mortality in hypertensive patients is mainly related to lesions of the large arteries, the determination of pulse wave velocity together with ambulatory BP measurements is proposed for the evaluation of cardiovascular risk.     

Verapamil and 24-hour ambulatory blood pressure monitoring in essential hypertension

The antihypertensive effects of oral regular and slow-release verapamil, a calcium-channel blocking agent, were evaluated in 22 patients with mild to moderate hypertension (sitting diastolic blood pressure [DBP] 95 to 112 mm Hg). The dose required to control blood pressure varied from 80 to 120 mg, 3 times a day. All patients received regular verapamil for a further 3 to 4 months, when systolic blood pressure (SBP) and DBP had risen from the end of the open-label phase. During a double-blind phase patients were randomly assigned to continue the same dose of regular verapamil, 3 times a day, or an equivalent daily dose of sustained-release verapamil (240 to 360 mg once a day). Seven of the 11 patients on regular and 3 of the 11 on sustained-release verapamil were also taking diuretics. This antihypertensive program was continued for at least 4 weeks. During the efficacy period, 24-hour ambulatory blood pressure monitoring was carried out. Mean 24-hour SBP and DBP were 133 +/- 20 and 89 +/- 13 mm Hg, respectively, on regular and 131 +/- 22 and 87 +/- 12 mm Hg, respectively, on sustained-release verapamil. There were no statistically significant differences noted between the 2 groups. Mean SBP and DBP varied similarly during awake and sleep hours with both formulations of verapamil. With regular verapamil, SBP was 139 +/- 18 and 124 +/- 20 mm Hg and DBP 92 +/- 11 and 84 +/- 13 mm Hg during awake and sleep hours, respectively; with sustained release, SBP was 138 +/- 21 and 122 +/- 22 mm Hg and DBP 92 +/- 10 and 80 +/- 10 mm Hg during awake and sleep hours, respectively. Heart rate fell during the entry period and continued during the entire study period. No other adverse effects were noted during the double-blind phase. In summary, verapamil is an effective antihypertensive medication and can be administered once a day as a sustained-release preparation; it is most useful in patients in whom adrenergic blocking drugs are indicated.     

老年高血压病及脑卒中患者动态血压分析的探讨

目的　探讨老年高血压病及脑卒中患者动态血压的特点。方法　对 30 7例高血压病患者进行动态血压监测 ,并根据年龄分为 :A组 (对照组n =16 1) ,年龄 <6 0岁 ;B组 (观察组n =14 6 ) ,年龄≥ 6 0岁。两组中又根据是否合并脑卒中 ,进一步分为 4个亚组A1 、B1 组 (无脑卒中 ) ,A2 、B2 组 (脑卒中 )。结果　B组老年高血压患者无论有无脑卒中 ,其血压昼夜节律性明显低于A组 (P <0 .0 5 )。B组脉压 [B1 组昼脉压 5 2 .9mmHg(1mmHg =0 .133kPa) ,夜脉压4 9.4mmHg;B2 组昼脉压 5 3.2mmHg ,夜脉压 5 3mmHg]较A组脉压 (A1 组昼脉压 4 3.6mmHg ,夜脉压 4 0 .3mmHg ;A2组昼脉压 4 7.2mmHg ,夜脉压 4 4mmHg)明显增大 (P <0 .0 5 )。B2 组夜间收缩压 (12 8.1mmHg)明显高于其余 3组 (A1组 117.4mmHg、A2 组 12 1.1mmHg、B1 组 12 0 .7mmHg ,P <0 .0 5 )。结论　血压昼夜节律降低、动态脉压增大及夜间收缩压增高是老年高血压患者动态血压的特点     

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。     

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。     

The placebo effect in ambulatory blood pressure monitoring

The reduction of clinic blood pressure by placebo tablets in clinical trials of antihypertensive drugs is well established and health authorities require a placebo arm in these trials in order to know how much of the total reduction of blood pressure is attributable to the drug. Most authors now favor the hypothesis that, in contrast to clinic blood pressure measurements, ambulatory blood pressure monitoring (ABPM) is not subject to a placebo effect. Scientific evidence so far shows that ABPM recordings are affected by a negligible and clinically irrelevant placebo effect in short-term trials. Nevertheless, the results of the SYST-EUR study suggest that placebo treatment induces a reduction of blood pressure in old patients with isolated systolic hypertension even when blood pressure is measured by 24 h ABPM, and raise the question of whether a placebo arm is required in clinical trials when ABPM is used to measure changes in blood pressure. In this article, the evidence supporting and contradicting the hypothesis that placebo exerts an effect on ABPM and the possible explanations for the discrepancy are reviewed. My position is that clinical trials on antihypertensive drugs using ABPM should be designed with the same standards as those using clinic blood pressure measurements; that is, randomized, double-blind, placebo-controlled studies. This should be an absolute requirement in long-term trials. Short-term trials lasting no more than 12 weeks, particularly those focused on examining average changes in 24 h diastolic blood pressure, may be designed without a placebo arm.     

Assessment of patients with office hypertension by 24-hour noninvasive ambulatory blood pressure monitoring

To assess the discrepancy between casual (office) and home blood pressure readings in patients performing home blood pressure monitoring, we analyzed office, home, and 24-hour ambulatory blood pressure and heart rates in 19 patients in a prospective four-week study. After the month of study, the average difference between mean office and manual home blood pressures in this office hypertensive group was 30 +/- 17/20 +/- 6 mm Hg. The blood pressures taken in the office were substantially greater than the 24-hour average blood pressures and ambulatory blood pressures during work or while at home (awake). An analysis of the automatic monitor readings while in the doctor's office and at 15-minute intervals after leaving the office showed a progressive reduction in blood pressure and heart rate during the first hour after leaving the office. A mean 24-hour blood pressure of less than 130/80 mm Hg was found in 13 (68%) patients. These data suggest that patients with office hypertension are usually normotensive but may have a persistent and recurrent pressor response in a medical care setting. Ambulatory blood pressure monitoring provides confirmation of not only the office-home disparity, but also suggests that stress other than office visits fails to elicit a hypertensive response.     

Reproducibility of ambulatory blood pressure measurements in essential hypertension

BACKGROUND: Data on the reproducibility of serial measurements of ambulatory blood pressure in hypertensive patients are lacking. The purpose of this study was to examine (1) the reproducibility of four consecutive ambulatory blood pressure measurements, and (2) the reproducibility of nocturnal falls in blood pressure in hypertensive patients. METHODS: Twenty patients with mild to moderate essential hypertension underwent four separate ambulatory blood pressure monitorings, on the same day of the week, at 30-day intervals. Antihypertensive therapy was discontinued for 2 weeks before each recording. Comparing the mean values of blood pressure over 24h, as well as diurnal, nocturnal and hourly periods, among the four recordings determined the reproducibility of blood pressure measurements. A day/night difference in mean systolic and in mean diastolic blood pressure defined the nocturnal fall in blood pressure. RESULTS: No significant differences were observed in either hourly, 24-h, diurnal or nocturnal systolic blood pressure, diastolic blood pressure and heart rate, or in the nocturnal fall in systolic and diastolic blood pressure among the four recordings. CONCLUSIONS: Hourly systolic blood pressure, diastolic blood pressure, heart rate, and nocturnal fall in blood pressure were reproducible in four ambulatory blood pressure monitorings recorded over 4 months. These findings suggest that ambulatory blood pressure monitoring is a reliable tool to monitor blood pressure changes.     

Self monitoring versus ambulatory blood pressure monitoring]

Blood pressure is a variable parameter for which the isolated determination cannot be considered as a characteristic of the subject. Therefore, the clinical measurement of blood pressure constitutes the method of reference but presents limits and causes of errors which pose a problem for its validity in evaluating the average blood pressure level in certain patients. In order to overcome the limits of occasional measurement, different methods of blood pressure measurement have been proposed. Among these methods, self monitoring of blood pressure by the patient and 24 hour ambulatory blood pressure monitoring (ABPM) are the most used. Each of these methods presents advantages and disadvantages, indications and limits of use. The information obtained by each of them is of a different nature: these methods are not substitutes but are complementary. Self monitoring and ABPM seem to evaluate the pressure load better than clinical monitoring and are better correlated to the organic effects of hypertension and thus the cardiovascular morbidity and mortality, ABPM in particular. However, it remains to be clarified whether the use of these methods in the evaluation of cardiovascular risk and the therapeutic management of the hypertensive can improve the long term cardiovascular prognosis.     

氯沙坦的降压疗效及其对血压谷/峰比值的影响

目的:以动态血压观察氯沙坦片对原发性高血压病患者的疗效及其对血压谷峰比值的影响。方法:60例原发性高血压病患者被随机均分为氯沙坦片组和苯那普利片组(各30例),分别给予氯沙坦片50～100mg和苯那普利片10～20mg,晨服,1次/日,疗程16周。结果:治疗后两组病人的血压均有明显下降,氯沙坦片组,收缩压(SBP)由治疗前的168.2±16.3 mmHg降至138.3±17.2mmHg,舒张压(DBP)由治疗前的99.8±8.1mmHg降至治疗后的85.3±6.4mmHg,SBP、DBP谷/峰比值分别为0.73和0.68;苯那普利组;SBP由治疗前的169.4±16.7mmHg降至139.3±16mmHg,DBP由治疗前的98.7±9.2mmHg降至治疗后的84.6±6.3mmHg,SBP、DBP谷/峰比值分别为0.67、0.63,与治疗前比较,P均<0.01,但组间比较差异不显著(P>0.05)。氯沙坦组无明显副作用,苯那普利组有6例出现咳嗽,2例咳嗽较剧烈,退出观察。结论:氯沙坦片能安全、有效、平稳地降低高血压病人的血压,其疗效与苯那普利疗效相似,但副作用明显少于后者,是高血压治疗的理想用药。     

Effects of lisinopril vs hydralazine on left ventricular hypertrophy and ambulatory blood pressure monitoring in essential hypertension

In order to compare the long-term effects on ambulatory bloodpressure and left ventricular hypertrophy of hydralazine andlisinopril we studied 30 patients, all , nales, still hypertensive(diastolic blood pressure 95 mmHg) despite combined beta-blockerldiuretictherapy and with echocardiographic evidence of left ventricularhypertrophy (left ventricular mass index 131 g. m^–1)They were randomized to receive hydralazine slow release 50mg twice daily or lisinopril 20mg once daily in addition toprevious therapy (atenolol 50 mglchlorthalidone 125 mg) for6 months. Casual blood pressure, non-invasive ambulatory bloodpressure monitoring (ABPM), M-mode echocardiogram, plasma reninactivity and plasma catecholamines were evaluated before therandomization and after 6 months of treatment. Both drugs significantlyreduced casual as well as daytime systolic and diastolic bloodpressure, without statistical differrences between the two treatments.Lisinopril was sign more effective than hydralazine in reducingnight-time systolic and diastolic blood pressure. Plasma norepinephrinewas significantly reduced by lisinopril and increased by hydralazine.Left ventricular mass was significantly reduced by lisinoprilbut not by hydralazine. The results of linear regression andmultiple regression analysis suggested that the lisinopril-induceddecrease in both day- and night-time blood pressure might accountfor the regression of left ventricular hypertrophy, whereasthe lack of left ventricular hypertrophy regression during hydralazinetreatment could be due mainly to the reflex sympathetic activationinduced by the drug.     

动态血压监测在原发性高血压早期肾损害诊断中的临床研究

目的探讨动态血压均值、动态脉压及昼夜节律变化与微量蛋白尿的关系,为动态血压监测(ABPM)应用于早期诊断和评价高血压性肾损害提供科学依据。方法选择2003年6月至2004年10月昆明市第一人民医院心内科住院的原发性高血压患者125例,测量动态血压各参数:24h平均收缩压(24hSBP)、24h平均舒张压(24hDBP)、24h平均脉压(24hPP)等及尿微量白蛋白(mAlb)、尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)。(1)根据动态血压测量的结果将受试者按24hPP≤40mm Hg(1mm Hg=0.133kPa)、41~55mm Hg、56~70mm Hg、>70mm Hg分为A、B、C、D组,比较各组的尿mAlb、NAG检测值及其阳性率,行24hSBP、24hDBP、24hPP与尿mAlb、NAG的相关回归分析。(2)根据血压昼夜节律变化,将上述受试者分为"杓型"组和"非杓型"组,比较两组尿mAlb、NAG检测值及其阳性率。结果(1)A组与B组之间,尿mAlb、NAG及微量蛋白尿阳性率差异无显著性意义(P>0.05),B组、C组与D组随24hPP的增高,尿mAlb、NAG及微量蛋白尿阳性率依次明显增高,各组间差异有显著性意义(P<0.05)。(2)24hPP与尿mAlb、NAG呈正相关(r=0.79、0.78,P<0.05),24hSBP与尿mAlb、NAG呈正相关(r=0.78、0.76,P<0.05),24hDBP与mAlb、NAG呈负相关(r=-0.64、-0.65,P<0.05);建立多元回归方程得出高血压早期肾损害时对应的24hSBP、24hDBP及24hPP值分别为150mm Hg、91mm Hg、58mm Hg。(3)"非杓型"组尿mAlb、NAG及微量蛋白尿阳性率明显高于"杓型"组,两组间差异有显著性意义(P<0.05)。结论动态血压均值、动态脉压及昼夜节律变化可为原发性高血压患者早期肾损害的检测评价指标,24hSBP高于150mm Hg、24hPP高于58mm Hg,24hDBP过度下降的患者易出现高血压性肾损害,夜间血压下降率<10%的患者为原发性高血压性肾损害的高危患者。     

高血压病患者运动血压与动态血压关系的研究

目的　探讨高血压病患者运动血压与动态血压的关系。方法　分别以活动平板运动试验中最大运动量时收缩压 (peakSBP)和舒张压 (peakDBP)过度升高和反应正常分组 ,以运动后收缩压(recSBP)和舒张压 (recDBP)恢复慢和恢复正常分组 ,对比分析 30 3例 1、2级高血压病患者的动态血压变化。结果　peakSBP、peakDBP过度升高组动态血压各检测值均显著高于反应正常组 (P <0 0 5或0 0 1) ;recSBP恢复慢组的夜间平均收缩压、舒张压显著高于恢复正常组 (P <0 0 1) ;recDBP恢复慢组白昼舒张压负荷显著高于恢复正常组 (P <0 0 1)。多元逐步回归分析显示 ,对peakSBP、peakDBP、recSBP最具影响的共同参数为夜间平均舒张压。结论　高血压病患者运动试验中 74 2 6 %～ 81 85 %存在运动中血压过度升高和运动后收缩压恢复慢并与动态血压检测值有显著统计意义。     

Sustained-released verapamil and ambulatory recording of blood pressure in mild to moderate essential hypertension]

An open study in 25 patients evaluated the efficacy and safety of Isoptine S.R., in some cases associated with Aldactazine in mild to moderate essential hypertension. After a placebo period of 2 weeks, the patients received sustained release verapamil (240 mg/24 hours) in a single morning dose for 6 months. An increase in the dosage (360 mg/24 hours in two subdoses) could be made during the first month of treatment if the diastolic blood pressure remained greater than or equal to 95 mmHg. If the diastolic blood pressure persisted at these levels at the second monthly assessment, a tablet of Aldactazine was associated. The blood pressure was evaluated by means of conventional clinical determinations and 24-hour ambulatory recordings carried out at the time of inclusion and then after 3 and 6 months of treatment. From the first month of treatment, the casual blood pressure determinations in the supine and standing position fell highly significantly (p less than 0.0001), resulting in a mean reduction of 22.3 mmHg in the systolic blood pressure (-12.6%) and of 17.4 mmHg in the diastolic blood pressure (-17%). The ambulatory recordings of blood pressure also showed a significant reduction in the mean systolic blood pressure over 24 hours (p less than 0.05 at the 3rd month of treatment), in the mean diastolic blood pressure over 24 hours (p less than 0.01) and the mean pressure (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparison of felodipine extended release and conventional tablets in essential hypertension using ambulatory blood pressure monitoring

Two formulations of felodipine, conventional and extended release (ER) tablets, were compared in a double-blind, crossover study of patients whose blood pressure was not being controlled using metoprolol 100 mg once daily. Nineteen patients with a supine diastolic blood pressure greater than or equal to 95 mmHg after 4 weeks of taking metoprolol and placebo were randomly assigned to felodipine conventional (5 mg twice a day) or ER (10 mg once daily) for 4 weeks. A 2-week washout period was then followed by 4 weeks of treatment with the alternative formulation. Metoprolol once daily was taken concomitantly throughout the study. Clinic blood pressure was measured at 0 h (i.e. 12 h after the last dose of conventional, and 24 h after the last ER felodipine dose), and then 2 and 5 h after the following dose had been taken. Ambulatory blood pressure and the heart rate were monitored over 24 h using an Accutracker (Suntech Medical Instruments, Raleigh, North Carolina, USA). During the final treatment, both felodipine formulations caused similar substantial falls in supine blood pressure compared with pressures prior to randomized treatment. The falls in clinic blood pressures (systolic/diastolic) were similar with the conventional and ER formulations at all time points, i.e. 0 h (21/13; 19/11 mmHg), 2 h (39/18; 36/18 mmHg) and 5 h (30/12; 35/11 mmHg) after the morning dose was taken. Both formulations also produced similar falls in blood pressures over 24 h and during the daytime (21/12; 20/12 mmHg).(ABSTRACT TRUNCATED AT 250 WORDS)     

Metabolic syndrome score and ambulatory blood pressure in untreated essential hypertension

BACKGROUND: The relationship between metabolic syndrome components, as defined by the Adult Treatment Panel III report, and ambulatory blood pressure in hypertensive patients has not been investigated to date. OBJECTIVE: To explore the relation between metabolic syndrome components ambulatory blood pressure levels and blood pressure day/night variations in a large population of never-treated essential hypertensive patients. METHODS: This investigation included 519 patients with uncomplicated grade 1 and 2 hypertension (mean age 45+11 years) who were attending a hypertension hospital outpatient clinic. They underwent the following procedures: (1) repeated clinic blood pressure measurements; (2) blood sampling for routine chemistry examinations; and (3) ambulatory blood pressure monitoring over two 24-h periods within 4 weeks. Because, by selection, all participants fulfilled one of the Adult Treatment Panel III criteria, the additional four criteria, abdominal obesity, hypertriglyceridemia, low HDL cholesterol and high blood fasting glucose, were specifically searched for. Patients were stratified according to the absence (group I) or the presence of one (group II), two (group III), three or four (group IV) components of the metabolic syndrome. Nocturnal dipping was defined as a night-time reduction in average systolic and diastolic blood pressure >10% compared to average daytime values. Each participant was classified according to the consistency of the dipping or nondipping status in the first and second ambulatory blood pressure measurement periods as follows: reproducible dipper (DD: decrease in blood pressure >10% in both ambulatory blood pressure measurement periods), reproducible nondipper (ND-ND: decrease in blood pressure <10% in both ambulatory blood pressure measurement periods) and variable dipper (VD: i.e dipper in one and nondipper in the other ambulatory blood pressure measurement period). RESULTS: In the whole population mean clinic and 48-h ambulatory blood pressures were 146/96 and 136/87 mmHg, respectively. In all, 197 patients (38%) had no metabolic syndrome components other than high blood pressure, 171 (33%) had one, 109 (21%) had two and 42 (8%) had three or four components. The four groups did not differ in age, clinic blood pressure, average 48-h, daytime, night-time systolic and diastolic blood pressure, and percentages of nocturnal fall in systolic and diastolic blood pressure. Furthermore, the distribution of three different ambulatory blood pressure patterns (DD, ND-ND and VD) was similar in the four groups: I=54.6%, 23.0%, 22.4%; II=51.1%, 21.7%, 27.2%; III=51.9%, 23.6%, 24.5%; and IV=52.7%, 27.2%, 25.1%, respectively. CONCLUSIONS: Our findings indicate that no significant relationship exists between the extent of metabolic alterations and ambulatory blood pressure levels or circadian variations in blood pressure in uncomplicated essential hypertensive patients.     

24小时动态血压监测在原发性高血压伴靶器官损伤中的诊断价值

目的探讨24小时动态血压监测(ABPM)在原发性高血压伴靶器官(心、脑、肾)损伤诊断方面的敏感性。方法50例原发性高血 压患者均行24小时监测,同时做心脏超声、心电图、经颅多普勒检查及验尿常规、血尿素氮、肌酐。结果合并靶器官损伤者夜间血压均值 及血压负荷值增高,血压变异性增大,呈非勺型昼夜模式。结论ABPM可作为原发性高血压伴靶器官损伤的检查手段之一。