血压正常高值者动态血压负荷及血压变异性与肿瘤坏死因子α的相关性

目的探讨血压正常高值者动态血压负荷及血压变异性与肿瘤坏死因子α(TNF-a)的关系。方法选择理想血压者100例,血压正常高值者105例,高血压患者110例,进行24 h动态血压监测,分别计算三组动态血压负荷及血压变异性,并测定TNF-a水平。结果血压正常高值组TNF-a水平、24 h、白昼及夜间动态血压负荷高于理想血压组,低于高血压组(P<0.01)。血压正常高值组24 h、白昼及夜间血压变异性高于理想血压组,24 h及白昼收缩压变异性、24 h及夜间舒张压变异性低于高血压组(P<0.05)。Pearson相关分析及多元逐步线性回归分析显示,血压正常高值组TNF-α与24 h收缩压负荷、24 h舒张压负荷、24 h收缩压变异性、白昼收缩压负荷、夜间舒张压负荷、夜间收缩压变异性呈正相关(P<0.05),24 h收缩压负荷及变异性、夜间收缩压负荷及变异性是TNF-α的影响因素(P<0.01)。结论血压正常高值者动态血压负荷及血压变异性与TNF-α相关,高血压早期炎症与血压升高有关。     

动态血压监测探讨体重指数与血压的关系

目的:动态血压监测探讨患者体重指数与血压变化情况。方法:选择门诊和病房住院的患者共691例(其中男性417例,女性274例),年龄范围13~90岁,平均年龄为55岁。所有观察对象测量诊室血压、心率、身高、体重和监测24小时动态血压等指标,按照体重指数分为3组,体重指数<24为正常体重组;24≤体重指数<28为超重组;体重指数≥28为肥胖组。结果:肥胖组患者24小时和白天的平均收缩压/舒张压、夜间平均舒张压以及24小时、白天和夜间心率均高于正常体重组,有显著性差异(P<0.05~0.01)。此外,血压负荷也随着体重指数的增加而增加,有显著性差异(P<0.05~0.01)。结论:体重指数与动态血压和血压负荷有较密切的关系;与正常体重组、超重组比较,肥胖组患者的血压最高、心率最快;动态血压提供的数据信息量大,结论更可靠、准确。     

超重/肥胖与动态血压变化的关系

目的:探讨超重/肥胖和动态血压(ABP)变化的相互关系。方法:根据体重指数(BMI)共选择121例肥胖(n=62)、超重(n=39)和正常对照组(n=20)做24h动态血压检测(ABPM),比较3组ABP值的变化。结果:24h、日间和夜间平均收缩压和舒张压水平、日间和夜间血压负荷值在肥胖组>超重组>正常对照组(P<0.01),以夜间收缩压升高更明显;30%超重和56.8%肥胖者血压昼夜节律消失(P<0.01),夜间血压下降率<10%,呈非杓型曲线;BMI、腰围(WC)和ABP各值、负荷值、夜间血压下降率均呈正相关(r=0.32～0.467,P<0.05～<0.01),相关程度夜间高于日间,WC优于BMI。结论:超重、肥胖或腹型肥胖不仅加重血压负荷,还影响昼夜血压节律,这种改变WC高于BMI,且多出现在夜间。     

老年高血压患者动态血压负荷和脉搏波传导速度的相关性研究

目的探讨老年高血压患者24 h动态血压负荷与颈桡动脉脉搏波传导速度(crPWV)的相关性。方法选取60～79岁的老年原发性高血压患者187例,对所有入选对象进行24 h动态血压监测,根据获取的24 h动态血压监测参数分为杓型组90例与非杓型组97例,选择同期体检人群82例为正常对照组。所有受试者行24 h动态血压监测,应用脉搏波速度测定仪测定crPWV,并进行分析。结果杓型组及非杓型组24 h、昼间及夜间收缩压、舒张压负荷均显著高于正常对照组(P<0.01)。非杓型组夜间血压负荷较杓型组升高(P<0.05)。杓型组及非杓型组crPWV均较正常对照组升高(P<0.05)。控制性别、年龄因素后,老年高血压患者24 h收缩压、夜间收缩压负荷、昼间舒张压负荷是crPWV影响的主要因素。结论老年高血压患者动态血压负荷升高,大动脉顺应性降低,其中24 h收缩压、夜间收缩压负荷、昼间舒张压负荷是影响大动脉顺应性的主要危险因素。     

老老年人群动态血压参数与动脉僵硬度的相关性

目的探讨老老年人群动态血压参数与动脉僵硬度的相关性。方法筛选年龄≥80岁的老老年人238例,以血压≥160/95 mm Hg(1 mm Hg=0.133 kPa)为标准,分为高血压组(134例)和对照组(104例),并进行臂-踝脉搏传导速度(baPWV)和24 h动态血压监测。用Pearson分析动态血压各参数与动脉僵硬度的相关性。结果高血压组baPWV高于对照组(P<0.05)。高血压组偶测收缩压,24 h、昼间和夜间收缩压、舒张压、脉压,收缩压负荷及舒张压负荷均高于对照组.夜间收缩压下降率、舒张压下降率低于对照组,差异有统计学意义(P<0.05,P<0.01)。baPWV与偶测血压;24 h收缩压、舒张压、脉压;昼间收缩压、舒张压、脉压、心率;夜间收缩压、舒张压、脉压;收缩压负荷、舒张压负荷呈正相关(P<0.05,P<0.01),而与夜间收缩压下降率呈负相关(P<0.01)。结论高血压是老老年人群动脉僵硬度增加的一个重要因素,动脉僵硬度与动态血压、脉压、心率及血压负荷相关。     

血压正常高值者动脉僵硬度与动态血压参数的关系

目的探讨血压正常高值者动脉僵硬度与动态血压参数的关系。方法选择理想血压者63例,血压正常高值者74例,高血压者67例。监测所有入选者24 h动态血压,应用脉搏波传导速度测定仪测定颈动脉-桡动脉脉搏波传导速度。结果血压正常高值组24 h收缩压、24 h舒张压、白昼收缩压、白昼舒张压、夜间收缩压、24 h脉压、白昼脉压及夜间脉压均高于理想血压组,低于高血压组(P<0.05或P<0.01);血压正常高值组夜间舒张压低于高血压组(P<0.05)。血压正常高值组颈动脉-桡动脉脉搏波传导速度(9.67±1.12 m/s)显著高于血压理想组(8.27±0.99 m/s),低于高血压组(10.55±1.71 m/s;P<0.05或P<0.01)。多元线性回归分析显示,24 h收缩压、24 h脉压、夜间收缩压是颈动脉-桡动脉脉搏波传导速度的影响因素(β值分别为0.385、0.351及0.247,P<0.05)。结论血压正常高值者动脉僵硬度增高,24 h收缩压、24 h脉压、夜间收缩压是影响动脉弹性的主要因素。     

老年原发性高血压患者体质量指数与动态血压参数关系的相关性研究

目的 探讨老年原发性高血压(essential hypertension,EH)患者体质量指数(body mass index,BMI)与24h动态血压(ambulatory blood pressure monitoring,ABPM)参数的关系。方法 选择2013年6月~2014年7月在我院就诊的老年EH患者119例,其中男性68例,女性51例,年龄60~80(68.18±5.88)岁。根据BMI不同水平,分为体质量正常组(正常组)31例:18.5kg/m2≤BMI24.0kg/m2;超重组52例:24.0kg/m2≤BMI28.0kg/m2;肥胖组36例:BMI≥28.0kg/m2。分析BMI对ABPM参数间的影响,并分析其相关性。结果 超重组和肥胖组24h收缩压(24hSBP)、24h舒张压(24hDBP)、日间收缩压(dSBP)、日间舒张压(dDBP)、夜间收缩压(nSBP)、夜间舒张压(nDBP)、nSBP负荷均明显高于正常组(P0.05);肥胖组日间舒张压变化标准差(dDBPSD)、夜间收缩压变化标准差(nSBPSD)和夜间舒张压变化标准差(nDBPSD)均明显高于正常组,差异有统计学意义(P0.05);肥胖组nSBPSD[(12.01±4.24)mm Hg(1 mm Hg=0.133kPa)vs(10.99±4.02)mm Hg,P0.05]、nDBPSD[(9.07±3.49)mm Hg vs(8.09±3.21)mm Hg,P0.05]均明显高于超重组。BMI与24hSBP、24hDBP、dSBP、dDBP、nSBP、nDBP、nSBP负荷和nDBP负荷为老年EH患者BMI的独立危险因素。结论 老年EH患者BMI与ABPM参数之间有显著的关联。     

原发性高血压患者血压变异性与糖尿病的相关性

目的探讨合并2型糖尿病(T2DM)的高血压患者与单纯原发性高血压患者动态血压水平及血压变异性的相关性。方法以800例合并T2DM的原发性高血压患者及800例单纯原发性高血压患者为研究对象,监测研究对象日间、夜间及24 h收缩压及舒张压变异性,并进行对比分析,研究原发性高血压患者血压变异性与糖尿病的相关性。结果高血压合并T2DM组24 h平均收缩压、夜间平均收缩压均明显高于高血压组(均P0.05),高血压合并T2DM组收缩压昼夜差值、舒张压昼夜差值均明显低于高血压组(均P0.05);高血压合并T2DM组24 h收缩压标准差、日间收缩压标准差、日间收缩压变异系数、夜间收缩压标准差、夜间收缩压变异系数、夜间舒张标准差、血压晨峰均明显高于高血压组(均P0.05);经相关分析发现,患者血糖水平与24 h收缩压标准差、24 h收缩压变异系数、日间收缩压标准差、日间收缩压变异系数、日间舒张标准差、日间舒张压变异系数、夜间舒张标准差、血压晨峰呈正相关(均P0.05)。结论原发性高血压合并T2DM患者血压变异性较单纯原发性高血压患者增大,提示糖尿病合并原发性高血压时对患者昼夜血压调节损害较大并可能与血糖水平有关。     

高血压患者颈动脉搏动指数和阻力指数与动态心电血压监测指标的相关性

目的 探讨高血压患者颈动脉搏动指数、阻力指数的变化及其与动态心电血压监测各指标间的相关性。方法 回顾性选取2018年10月—2021年10月间收治的原发性高血压患者210例作为研究对象纳入高血压组,同时选取同期于院内进行体检的健康志愿者300人纳入对照组。测定比较两组研究对象的颈动脉搏动指数、阻力指数、24 h平均收缩压、昼夜平均收缩压、24 h平均舒张压、昼夜平均舒张压,24 h心电ST-T阳性率,并分析动态血压各指标与搏动指数、阻力指数之间的相关性;对高血压组患者按照搏动指数和阻力指数进行三分位分组,比较不同动脉弹性患者动态血压指标的差异。结果 高血压组颈动脉搏动指数、阻力指数、24 h平均血压、昼夜平均收缩压、昼夜平均舒张压、24 h收缩压负荷、24 h舒张压负荷、24 h心电ST-T阳性率高于对照组(均P<0.05)。不同搏动指数亚组患者比较显示,随着患者搏动指数升高,患者的24 h平均血压、昼间收缩压、昼间舒张压、24 h舒张压负荷升高(均P<0.001);不同阻力指数亚组患者比较显示,随着患者阻力指数升高,患者的24 h平均血压、昼间收缩压、夜间收缩压、昼间舒张...     

不同年龄高血压病人血压特点分析

目的:分析不同年龄原发性高血压病人血压特点,为高血压的精准化管理提供指导。方法:回顾性分析2014年5月—2019年4月于天津中医药大学第一附属医院门诊招募的504例原发性高血压病人的临床资料。根据年龄将病人分为青中年组(年龄<60岁)和老年组(年龄≥60岁),进行动态血压监测,分析其24 h、日间、夜间的血压均值,以及血压类型分布、脉压、血压变异性、血压节律特点。结果:(1)老年组病程较长(P<0.05),不吸烟病人较多(P<0.05),服药率更高(P<0.05);青中年组BMI较大(P<0.05),受教育水平较高(P<0.05)。(2)两组动态血压均值均普遍超出诊断标准,尤以夜间血压明显。青中年组舒张压升高的病人数以及舒张压水平均高于老年组(P<0.05);两组动态收缩压水平比较差异无统计学意义(P>0.05)。(3)老年组动态脉压、24 h收缩压标准差(24 hSSD)、日间收缩压标准差(dSSD)大于青中年组(P<0.05),而两组24 h舒张压标准差(24 hDSD)、日间舒张压标准差(dDSD)、夜间收缩压标准差(nSS...     

体检人群脉搏波传导速度与动态血压监测指标的相关性研究

目的:脉搏波传导速度与动态血压监测指标的关系。方法:行动态血压监测的体检者582例,根据血压水平分为正常血压组、血压正常高值组和高血压组,分析脉搏波传导速度与动态血压各指标之间的关系。结果:三组间动态血压各指标显著增高;颈股脉搏波传导速度三组间差异有统计学意义(P<0.05);高血压组颈桡脉搏波传导速度显著高于血压正常组。Pearson相关性分析:颈桡脉搏波传导速度与24 h平均SBP/DBP、白天平均SBP/DBP、夜间平均DBP、白天DBP负荷、夜间DBP负荷均呈正相关。颈股脉搏波传导速度与24 h平均SBP、白天/夜间平均SBP、白天/夜间SBP负荷、白天SBP变化标准差均呈正相关。多元线性回归发现颈股脉搏波传导速度与24 h平均SBP独立相关,颈桡脉搏波传导速度与白天平均DBP独立相关。结论:随血压水平程度升高,脉搏波传导速度明显增快。     

Impact of obesity on 24-hour ambulatory blood pressure and hypertension

The purpose of the present study was to determine the relationship between body mass index (BMI) and parameters derived from 24-hour ambulatory blood pressure monitoring including mean 24-hour daytime and nighttime systolic and diastolic blood pressures, 24-hour daytime and nighttime pulse pressure, mean 24-hour daytime and nighttime heart rate, dipping and nondipping status. 3216 outpatient subjects who visited our hypertension center and were never treated with antihypertensive medication underwent 24-hour blood pressure monitoring. BMI was significantly correlated with clinic systolic and diastolic blood pressures. Significant correlations were also found between BMI and mean 24-hour daytime and nighttime systolic blood pressure, 24-hour daytime and nighttime pulse pressure, and mean 24-hour daytime and nighttime heart rate. In multivariate regression analysis, clinic systolic, diastolic blood pressure, mean 24-hour systolic blood pressure, 24-hour pulse pressure, and high-density lipoprotein were independently correlated with BMI. The incidence of white coat hypertension was higher in overweight and obese patients than in normal weight subjects. Confirmed ambulatory blood pressure hypertension was also found to be higher in overweight and obese individuals compared with normal weight subjects. Our data also highlight the higher incidence of nondipping status in obesity. These findings suggest that obese patients had increased ambulatory blood pressure parameters and altered circadian blood pressure rhythm with increased prevalence of nondipping status.     

Blood pressure load determines left ventricular mass in essential hypertension.

In a series of 35 newly diagnosed, previously untreated patients (mean age 46 years) with mild to moderate essential hypertension, office blood pressure measurements, 24-hour ambulatory blood pressure monitoring, and determination of left ventricular mass index by echocardiography according to the formula of Devereux were performed. We aimed at correlating left ventricular mass index with systolic and diastolic office blood pressure, mean 24-hour systolic and mean 24-hour diastolic blood pressure, systolic and diastolic load. Left ventricular mass index did not correlate with office systolic and office diastolic blood pressure. On the contrary, all correlations with ambulatory blood pressure parameters and left ventricular mass index turned out to be significant (mean 24-hour systolic blood pressure: r = 0.344, P = 0.026; systolic load: r = 0.408, P = 0.020; mean 24-hour diastolic blood pressure: r = 0.490, P = 0.004; diastolic load: r = 0.504, P = 0.003). These results clearly demonstrate that ambulatory blood pressure determinants but not the office blood pressure parameters are well correlated with left ventricular mass index in mild to moderate essential hypertension. Blood pressure load is as important as mean 24-hour blood pressure in this regard.     

Activity-adjusted 24-hour ambulatory blood pressure and cardiac remodeling in children with sleep disordered breathing

Questions remain as to whether pediatric sleep disordered breathing increases the risk for elevated blood pressure and blood pressure-dependent cardiac remodeling. We tested the hypothesis that activity-adjusted morning blood pressure surge, blood pressure load, and diurnal and nocturnal blood pressure are significantly higher in children with sleep disordered breathing than in healthy controls and that these blood pressure parameters relate to left ventricular remodeling. 24-hour ambulatory blood pressure parameters were compared between groups. The associations between blood pressure and left ventricular relative wall thickness and mass were measured. 140 children met the inclusion criteria. In children with apnea hypopnea index <5 per hour, a significant difference from controls was the morning blood surge. Significant increases in blood pressure surge, blood pressure load, and in 24-hour ambulatory blood pressure were evident in those whom the apnea hypopnea index exceeded 5 per hour. Sleep disordered breathing and body mass index had similar effect on blood pressure parameters except for nocturnal diastolic blood pressure, where sleep disordered breathing had a significantly greater effect than body mass index. Diurnal and nocturnal systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure predicted the changes in left ventricular relative wall thickness. Therefore, sleep disordered breathing in children who are otherwise healthy is independently associated with an increase in morning blood pressure surge, blood pressure load, and 24-hour ambulatory blood pressure. The association between left ventricular remodeling and 24-hour blood pressure highlights the role of sleep disordered breathing in increasing cardiovascular morbidity.     

老年高血压患者血压节律变化与靶器官损害的关系

目的 探讨老年高血压患者血压节律变化与靶器官损害的关系. 方法 70例老年高血压患者均行24h动态血压检测、颈动脉超声和超声心动图检查,根据24 h动态血压检测结果分为2组:勺形组40例及非勺形组30例,并对2组颈动脉粥样硬化(CAS)、左室肥厚(LVH)及动态血压各参数进行比较. 结果 CAS及LVH检出率非勺形组均高于勺形组(P＜0.01);2组间24 h平均收缩压(24hSBP)及舒张压(24hDBP)、24 h收缩压和舒张压负荷值(24hSBPL、24hDBPL),差异无统计学意义(P＞0.05).勺形组白天平均收缩压(dSBP)及舒张压(dDBP)、白天收缩压和舒张压负荷值(dSBPL、dDBPL)高于非勺形组(P＜0.05).勺形组夜间平均收缩压(nSBP)及舒张压(nDBP)、夜间收缩压和舒张压负荷值(nSBPL、nDBPL)明显低于非勺形组(P＜0.01). 结论 老年高血压患者血压节律变化的消失与靶器官损害关系密切,高血压患者降压治疗的同时还需纠正紊乱的血压昼夜节律.     

A pressure-time index' for assessing the severity of essential hypertension.

OBJECTIVE: A new derivative of 24 h ambulatory blood pressure monitoring (ABPM) is introduced and its association with left ventricular mass index (LVMI) in essential hypertension is examined. PATIENT: population One hundred and fifty-three previously untreated essential hypertension patients. METHODS: Patients underwent casual blood pressure (BP) readings, 24 h ABPM and left ventricular echocardiographic assessment The following 24 h awake and sleep ABP variables were calculated: mean systolic and diastolic BP, systolic and diastolic BP loads (percentage of systolic readings > 140/120 mmHg (day/ night) and diastolic readings > 90/80 mmHg (day/night)), standard deviation of systolic and diastolic ABP and nocturnal fall of systolic BP, as well as the integrated areas under the ABP curve. The area under the BP curve divided in horizontal slices was accurately modelled by a sigmoid curve. The parameters controlling the shape of the curve and in particular that regarding its 'slope' is hereafter called the 'pressure-time index'. RESULTS: 'Systolic pressure-time index 24 h' (SPTI24) is related to left ventricular mass index (multivariate analysis, P= 0.008). Using either partial correlation coefficients or a multivariate analysis, SPTI24 is related to left ventricular mass index, independently of age, casual blood pressure, mean systolic and diastolic ABP, systolic and diastolic BP loads, BP variability (standard deviation (SD), nocturnal fall of systolic BP) and integrated area under the curve (multivariate analysis, P= 0.004). CONCLUSIONS: In essential hypertension, the SPTI24 is related to LVMI independently of age, casual blood pressure, integrated area under the curve or any other derivative of 24 h ABPM, and might be used to assess the extent of hypertensive load.     

Altered 24-hour blood pressure profiles in children and adolescents with classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency

OBJECTIVE: Children and adolescents with classical congenital adrenal hyperplasia have been shown to be at risk for obesity associated with higher insulin and leptin levels. Because these factors are also known to cause hypertension, the aim of this study was to analyze 24-h blood pressure profiles and their relation to different clinical and laboratory parameters. DESIGN: Fifty-five subjects, aged between 5.3 and 19.0 yr, were enrolled in a prospective, cross-sectional study. All patients had genetically proven 21-hydroxylase deficiency and underwent ambulatory 24-h blood pressure monitoring during a period off school/work. RESULTS (MEDIAN, RANGE): The median body mass index of the cohort was significantly elevated [1.09 sd score (SDS), -2.45 to 3.77]. Daytime and nighttime systolic blood pressures were also significantly elevated (0.67 SDS, -1.5-4.1; 0.63 SDS, -0.91 to 3.3), whereas daytime diastolic blood pressure was significantly lowered (-0.81 SDS, -2.6 to 3.2) and normal during the night (0.11 SDS, -2.0 to 2.0). Overall, there was a normal nocturnal drop of systolic (12.8%, 2.1-22.8) but not diastolic blood pressure (17.2%, 0.90-25.8). The different parameters of systolic and diastolic blood pressures were significantly correlated with body mass index and skinfold thickness (r(s) = 0.271-0.486). There was no correlation with equivalent hydrocortisone and fludrocortisone dosage and laboratory parameters except for serum leptin and insulin. CONCLUSIONS: Our data show altered 24-h blood pressure profiles with elevated systolic levels correlated with the degree of overweight and obesity, whereas normal-weight patients tended to diastolic hypotension.     

缓解期慢性支气管炎对高血压患者血压变异性的影响研究

背景慢性支气管炎与高血压存在共同的危险因素,但目前国内外尚缺乏关于缓解期慢性支气管炎与高血压患者血压变异性关系的研究。目的探讨缓解期慢性支气管炎对高血压患者血压变异性的影响。方法选取2019年7月-2020年2月在宣城市人民医院心血管内科治疗的高血压患者160例为研究对象。根据患者临床诊断是否合并缓解期慢性支气管炎将其分为缓解期慢性支气管炎组24例和非缓解期慢性支气管炎组136例。收集并比较两组一般资料、血液生化指标[同型半胱氨酸、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、总胆固醇、三酰甘油、载脂蛋白A1、载脂蛋白B、脂蛋白(a)、肌酐、尿素氮、尿酸、血清葡萄糖]、24 h动态血压监测参数(白天收缩压平均值、白天舒张压平均值、白天平均血压、白天收缩压负荷、白天舒张压负荷、夜间收缩压平均值、夜间舒张压平均值、夜间平均血压、夜间收缩压负荷、夜间舒张压负荷、全天收缩压平均值、全天收缩压负荷、全天舒张压平均值、全天舒张压负荷、全天平均血压、收缩压下降率、舒张压下降率、全天脉压、24 h收缩压标准差、24 h舒张压标准差、24 h收缩压变异性、24 h舒张压变异性、动态动脉硬化指数)。采用一元线性回归分析和多元线性回归分析探讨高血压患者24 h收缩压变异性和24 h舒张压变异性的影响因素。结果缓解期慢性支气管炎组吸烟、糖尿病史者所占比例和尿素氮、尿酸高于非缓解期慢性支气管炎组(P <0.05)。缓解期慢性支气管炎组全天脉压、24 h收缩压标准差、24 h收缩压变异性大于非缓解期慢性支气管炎组(P <0.05)。一元线性回归分析结果显示,性别(B=-0.029,t=2.040)、糖尿病史(B=0.047,t=4.458)、动态动脉硬化指数(B=0.039,t=2.491)、缓解期慢性支气管炎(B=0.042,t=4.113)可能是高血压患者24 h收缩压变异性的影响因素(P <0.05);性别(B=-0.021,t=2.025)、年龄(B=0.002,t=2.112)、糖尿病史(B=0.024,t=2.393)可能是高血压患者24 h舒张压变异性的影响因素(P <0.05)。多元线性回归分析结果显示,糖尿病史(B=0.030,t=2.731)、缓解期慢性支气管炎(B=0.034,t=2.211)是高血压患者24 h收缩压变异性的影响因素(P <0.05);糖尿病史是高血压患者24 h舒张压变异性的影响因素(B=0.025,t=2.701,P <0.05)。结论缓解期慢性支气管炎是高血压患者24 h收缩压变异性的影响因素,尚未发现其是24 h舒张压变异性的影响因素。