高血压病时间治疗学的探讨

目的探讨不同时间服用降压药对高血压治疗有效性和平稳性的影响。方法将90例2级以上原发性高血压病人分为3组。A组早晨顿服氨氯地平和厄贝沙坦组。B组早晨服厄贝沙坦,晚上服氨氯地平组。C组早晨服用氨氯地平,晚上服厄贝沙坦组,病人均于服药前及服药两周后进行动态血压监测。结果服药2周后各组夜间时段及24h平均收缩压明显下降。组间比较A组B组、A组C组(P0.01),B组和C组间差异无统计学意义(P0.05);各组夜间时段及24h平均动脉压明显下降,组间比较A组B组、A组C组(P0.01),B组和C组间差异无统计学意义(P0.05);各组夜间时段舒张压明显下降,组间比较A组B组、A组C组(P0.01),B组和C组间差异无统计学意义(P0.05)。结论联合用药的降压效果显著,早晚分次服药较早晨顿服两种药物更有效控制夜间血压,早晚分次服药使夜间及24h血压下降更平稳。     

盐酸贝那普利联合硝苯地平控释片不同给药时间的降压疗效观察

目的探讨盐酸贝那普利联合硝苯地平控释片不同时间给药时降压疗效的差别。方法采用随机、单盲、平行对照设计,将120例2级原发性高血压患者按随机数分为三组,分别为早晨服用盐酸贝那普利和硝苯地平控释片组(A组41例,男21例,女20例);早晨服用盐酸贝那普利晚上服用硝苯地平控释片组(B组39例,男20例,女19例);早晨服用硝苯地平控释片晚上服用盐酸贝那普利组(C组40例,男22例,女18例)。三组患者均于服药前及服药后15天进行动态血压监测,并计算平滑指数等指标。结果服药15天后,三组治疗前后比较,血压均明显下降,差异有统计学意义(P<0.01),三组间24hSBP、24hDBP、24hMABP、dSBP、dDBP、dMABP、nDBP两两比较均无统计学意义;A、B组nSBP、nMABP比较无统计学意义;A组与C组间nSBP、nDBP比较差异有统计学意义(P<0.01);B组与C组间nSBP、nDBP比较差异有统计学意义(P<0.01);A组、B组与C组间nMABP比较差异有统计学意义(P<0.01)。C组夜间收缩压、舒张压及平均动脉压平滑指数与A、B两组比较差异均有统计学意义(P<0.05),但A、B两组比较差异无统计学意义(P>0.05)。结论晚间应用ACEI类药物较早晨顿服两种药物及晨服ACEI类药物能更有效控制夜间血压,且使夜间及24h血压下降更平稳。     

不同给药方法对原发性高血压患者血压平滑指数的影响

目的探讨不同给药方法对原发性高血压治疗平滑指数的影响。方法将120例2级以上原发性高血压患者随机分为A、B、C组各40例,A组每天早7∶00服用坎地沙坦酯和苯磺酸氨氯地平;B组每天早7∶00服用坎地沙坦酯,晚7∶00服用苯磺酸氨氯地平;C组每天早7∶00服用苯磺酸氨氯地平,晚7∶00服用坎地沙坦酯。服药2周后进行动态血压监测并计算相应平滑指数。结果 A组夜间平均收缩压(nSBP)、24 h平均收缩压(24 hSBP)、夜间平均动脉压(nMABP)、24 h平均动脉压(24hMABP)、夜间平均舒张压(nDBP)平滑指数均小于B组(P均<0.01)和C组(P均<0.05);B组与C组比较差异无统计学意义。结论早晚两次服用降压药物,能够有效控制24h血压及夜间血压,从而使降压更平稳。     

老年高血压患者联合使用缬沙坦和非洛地平降压治疗的时间治疗学研究

目的探讨在降压药物种类和数量相同的情况下,通过改变缬沙坦的服药时间对老年高血压患者血压周期性变化的影响。方法拟选择住院的非杓形老年高血压患者167例。随机、单盲的方法将入选患者随机分为2组,服用缬沙坦80 mg和非洛地平5 mg,1/日,1次1片。A组(n=82)服药时间选择在早7时,即两种降压药物均于清晨服用;而B组(n=85)服用缬沙坦的时间为晚7时,即非洛地平于清晨服用,缬沙坦夜间服用。治疗随访8周后复查24小时动态血压监测(ABPM)。结果 15例患者因失访或未能按要求服药而被退出,A组共74例、B组共78例患者完成治疗。B组患者夜间平均收缩压、舒张压及24 h平均收缩压、舒张压的降低程度均显著高于A组(P0.01及P0.05);夜间血压下降率的增加显著高于A组(P0.01),非杓形血压的比例下降程度亦显著高于A组(P0.01)。结论对于血压周期性形态为非杓形患者,将缬沙坦放在夜间服用可改善患者的夜间血压下降率,有助于纠正患者的血压节律。     

不同服药方法对非杓型高血压患者降压疗效的影响

目的:探讨不同服药方法对非杓型高血压患者降压疗效的影响。方法:60例2级和3级非杓型高血压患者随机分为顿服组30例、分服组30例,顿服组每天7:00服用非洛地平缓释片5mg和厄贝沙坦150mg;分服组每天7:00服用非洛地平缓释片5mg或厄贝沙坦150mg,晚7:00服用厄贝沙坦150mg或非洛地平缓释片5mg。患者均于服药前及服药后4周,采用动态血压监测系统进行血压监测。结果:服药4周后分服组24h平均收缩压下降值、24h平均舒张压下降值和24h平均动脉压下降值大于顿服组(均P0.05);分服组夜间平均收缩压下降值、平均舒张压下降值和平均动脉压下降值显著大于顿服组(均P0.01);分服组24h平均收缩压平滑指数、24h动脉压平滑指数显著高于顿服组(均P0.05);分服组夜间平均收缩压平滑指数、平均舒张压平滑指数和平均动脉压平滑指数显著高于顿服组(均P0.01)。治疗后分服组有18例昼夜节律由非杓型改变为杓型,显著多于顿服组的4例(P0.01)。结论:长效降压制剂联合治疗2级和3级非杓型高血压,早晚分次给药与早晨顿服相比,降压效果更好、降压更加平稳,更有利于血压的昼夜节律由非杓型恢复为正常的杓型。     

坎地沙坦不同给药时间对非杓型高血压患者血压水平及血压昼夜节律的影响

目的研究坎地沙坦不同给药时间对非杓型高血压患者血压昼夜节律与血压水平的影响。方法将156例非杓型高血压患者随机分为:A组和B组,两组患者均给予口服坎地沙坦治疗,每天4mg。但A组患者早晨7:30服药,B组晚间7:30服药,治疗8周。治疗前后检测并比较两组患者24小时动态血压值及血压的昼夜节律变化。结果两组患者治疗前后24小时平均收缩压、白昼平均收缩压、夜间平均收缩压、24小时平均舒张压、白昼平均舒张压和夜间平均舒张压均显著下降(P0.05),且B组24h平均收缩压和夜间平均收缩压比A组下降更为显著,差异具有统计学意义(P0.05)。治疗后两组血压昼夜节律均得到改善,B组夜间血压降低有效率显著高于A组,差异有统计学意义(P0.05)。结论晚夜服用坎地沙坦对非杓型高血压患者降压效果及血压昼夜节律调节作用更好。     

缬沙坦联合氨氯地平或氢氯噻嗪对老年高血压患者血压变异性的影响

目的 观察比较缬沙坦分别联合氨氯地平或氢氯噻嗪对老年高血压患者血压及其变异性的影响.方法 选取138例老年高血压患者,随机分为两组,A组70例给予口服缬沙坦80 mg联合氨氯地平5mg qd;B组68例给予口服缬沙坦80 mg联合氢氯噻嗪12.5 mg qd.分别在治疗前、治疗8w时进行24 h动态血压监测,观察24 h、白天与夜间收缩压变异性(systolic blood pressure variability,SBPV)和舒张压变异性(diastolic blood pressure variability,DBPV);24h、白天与夜间平均收缩压(systolic blood pressure,SBP)和平均舒张压(diastolic blood pressure,DBP).结果 与治疗前比较治疗后第8周A组与B组24 h、白天、夜间SBP、DBP、SBPV均下降(P＜0.05),A组下降幅度均大于B组(P＜0.05).A组治疗8w后,DBPV均有下降(分别地,P＜0.05),而B组无变化,组间比较差异有统计学意义(P＜0.05).结论 缬沙坦联合氨氯地平或氢氯噻嗪治疗均能有效控制老年高血压患者的血压,但缬沙坦联合氨氯地平具有更佳的血压达标率和更低的血压变异性.     

不同时间服用坎地沙坦对老年高血压患者动态血压的影响

目的探讨在降压药物种类和数量相同的情况下,通过改变坎地沙坦的服药时间对老年高血压患者血压节律的影响。方法将157例经非洛地平和氢氯噻嗪治疗4周后复查24h动态血压监测(ABPM)证实血压仍控制不理想的老年高血压患者随机分为2组:A组于早晨加用坎地沙坦,B组于夜间睡前加用坎地沙坦;治疗随访8周后复查ABPM。结果两组治疗后,24h平均收缩压和舒张压降低。B组患者夜间平均收缩压和舒张压以及24h平均收缩压和舒张压的降低幅度显著高于A组(均P0.01);夜间收缩压下降率的变化幅度[(3.2±7.1)%比(-2.5±6.4)%]、夜间舒张压下降率的变化幅度[(5.9±7.2)%比(-0.5±6.8)%]高于A组(均P0.05)。B组非杓型血压比例下降38.8%,而A组增加7.2%(P0.01)。结论夜间服用坎地沙坦可更有效地降低老年高血压患者的夜间及24h血压。     

老年原发性高血压患者早期肾功能损害的相关因素分析

目的 观察老年原发性高血压患者的24 h动态血压与尿中微量白蛋白(mAIb)的关系,探讨早期肾功能 损害的相关因素.方法 选择原发性高血压患者140例.测量24 h动态血压各参数、高敏C反应蛋白(hs-CRP)、血脂及尿mAIb后,根据24 h平均脉压分为A、B两组.A组68例,24 h平均脉压40～60 mm Hg(1 mm Hg=0.133kPa);B组72例,24 h平均脉压≥60 mm Hg.对两组动态血压、hs-CRP、血脂、病程进行比较,并进行相关性分 析.结果 两组患者24 h平均收缩压,昼问平均脉压、夜间平均脉压、尿mAIb、hs-CRP、LDL-C比较有统计学差异(P<0.05),且两组尿mAIb与24 h平均收缩压,昼间平均脉压、夜间平均脉压、hs-CRP、LDL-C呈显著正相关.经病程校正后,尿mAIb与24 h平均收缩压、昼间平均脉压、夜间平均脉压、hs-CRP仍存在相关性(P<0.05), 与其他变量无相关性.结论 24 h平均收缩压、24 h平均脉压可作为高血压患者早期肾损害的预测指标.     

高血压等多因素对左心室重量指数的影响

目的探究左心室重量指数(LVMI)改变的影响因素。方法高血压门诊就诊的400例患者进行无创动态血压监测(ABPM),并检测空腹静脉血糖、血脂,行心脏彩超检查。根据LVMI水平分为阳性组(n=85)和阴性组(n=315),将组间有显著差异的指标进行回归分析。其中155例服药患者根据其服药类别分为:A组[n=51,血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体拮抗剂(ARB)]; B组(n=15,β受体阻滞剂); C组(n=76,钙通道阻滞剂); D组:(n=13,利尿剂),分析不同药物分组间各指标的差异,并分析不同药物对LVMI的影响。结果与LVMI阴性组比较,LVMI阳性组的体重指数(BMI)、腰围、高血压病程、收缩压、24 h平均收缩压、24 h平均舒张压、白昼收缩压、白昼舒张压、夜间收缩压、夜间舒张压、清晨收缩压、清晨舒张压、白昼收缩压负荷值、白昼舒张压负荷值、夜间收缩压负荷值、夜间舒张压负荷值、收缩压昼夜节律、夜间舒张压变异性、24 h平均心率的水平均显著升高(P0. 05),且高血压、糖尿病的患病率增加; Logistic回归分析提示高血压、糖尿病、高血压病程、24 h平均收缩压、白昼收缩压、收缩压昼夜节律、夜间舒张压变异性和24 h平均心率均为LVMI改变的危险因素。服用ACEI或ARB或钙通道阻滞剂患者的LVMI水平及阳性率均较服用利尿剂或β受体阻滞剂者低,ACEI或ARB或钙通道阻滞剂为LVMI的保护因素。结论高血压、糖尿病是LVMI增加的危险因素,同时高血压病程、收缩压昼夜节律、夜间收缩压负荷、夜间舒张压变异性、24 h平均心率等多重因素亦对LVMI增加具有重要意义,ACEI或ARB或钙通道阻滞剂对原发性高血压患者LVMI改变起保护作用。     

缬沙坦联合苯磺酸氨氯地平对女性高血压患者血压谷峰比值与平滑指数的影响

目的探讨在女性高血压患者中联用缬沙坦与苯磺酸氨氯地平对于控制血压谷峰比值及平滑指数的作用。方法对我院63例女性高血压患者进行随机分组,将单用苯磺酸氨氯地平、单用缬沙坦和联用两者治疗者各纳入A组、B组和C组,分析并评估3组病例的临床治疗情况。结果与治疗前相比,三组患者的24hSBP、24hDBP、dSBP、dDBP、nSBP和nDBP水平均显著下降（均为P〈0.05）。且除24hDBP之外,C组治疗后其余指标均要较A组和B组改善更明显（P〈0.05）。C组治疗后的血压谷峰比值与平滑指数均要较A组和B组高（P〈0.05）。结论为女性高血压患者提供缬沙坦与苯磺酸氨氯地平治疗有确切效果,对于控制患者血压谷峰比值、平滑指数有重要意义。     

The antihypertensive efficacy and safety of a chronotherapeutic formulation of propranolol in patients with hypertension

This study evaluated the antihypertensive efficacy and tolerability of a chronotherapeutic formulation of propranolol designed for nighttime dosing (propranolol controlled release [CR]). A total of 434 patients with mild-to-moderate hypertension were randomized to placebo or to one of four doses of propranolol CR (80, 120, 160, or 640 mg/d). At baseline, the mean morning blood pressures were similar in each treatment group and averaged 152/101 mm Hg. After 8 weeks of treatment, morning diastolic blood pressure, the primary efficacy measurement, was significantly reduced from baseline in placebo (-6.98 mm Hg) and all propranolol groups (p<0.001). The decreases ranged from 10.1 mm Hg in the 80-mg/d group to 11.0 mm Hg in the 120-mg/d group and were significantly larger than placebo in the 120-, 160-, and 640-mg/d groups (p<0.05). Blood pressure measured in the evening (trough) demonstrated similar antihypertensive efficacy. Heart rate and rate-pressure product were reduced in a dose-related manner by propranolol CR. The formulation was well tolerated with only fatigue and dizziness being reported more frequently than in the placebo group. Propranolol CR is an effective antihypertensive formulation that may reduce blood pressure during the morning period of maximum cardiovascular risk.     

Pharmacist-based antihypertensive medication review and assignment of morning versus evening dosing of once-daily antihypertensive medications: A pilot study to assess feasibility and efficacy in chronic kidney disease patients

Evening dosing of antihypertensive medications lowers nighttime blood pressure, and in one large randomized trial, it reduced the risk for cardiovascular outcomes. However, the feasibility of nighttime dosing in routine clinical practice is unknown. The purpose of this pilot study was to evaluate the effect of a brief pharmacist intervention to assign patients to take antihypertensive medications at specific times of the day. In this pilot, randomized controlled trial, 79 patients with moderate to severe chronic kidney disease (CKD) taking one or more antihypertensive medications once daily were randomized to take one once-daily antihypertensive either in the morning or in the evening. A total of 79 patients were randomized (39 to morning dosing, 40 to evening dosing). Average (SD) age was 56.5 (14) years, 68% were male, and average (SD) estimated glomerular filtration rate (eGFR) was 36.6 (8.9) mL/min/1.73m². Adherence, defined as taking the once-daily medication at the time indicated six or seven times in the last 7 days and not taking it at any other time during the day, was 91% in the morning arm and 95% in the evening arm (p = 0.57). This pilot demonstrates the feasibility and efficacy of a pharmacist–physician collaborative to assign once-daily antihypertensive medications to either morning or evening dosing.     

Repeated ambulatory monitoring reveals an evening rise in blood pressure in a Japanese population

Recent studies have revealed 2 peaks in the onset of cardiovascular events, 1 in the morning and another in the evening. We evaluated whether blood pressure (BP) also rises in the morning/evening and identified the determinants of evening BP rise using 24‐hour ambulatory BP monitoring for 7 consecutive days. We identified 2 BP peaks, 1 in the morning (0‐3 hours after waking) and 1 in the evening (9‐12 hours after waking). Subjects were subclassified according to the extent of evening BP rise: those in the top quartile (≥6.45 mm Hg, n = 34; ER group) vs all others. After adjustment for age, sex, and 24‐hour systolic BP, evening BP rise was associated with the use of antihypertensive medications [odds ratio (OR), 3.57; 95% confidence interval (CI), 1.46‐8.74; P = .01] and estimated glomerular filtration rate (OR, 0.96; 95% CI, 0.93‐0.99; P = .04), confirming its association with antihypertensive medication use and renal dysfunction.     

Prediction of stroke by home "morning" versus "evening" blood pressure values: the Ohasama study

Predictive power of self-measured blood pressure at home (home BP) for cardiovascular disease risk has been reported to be higher than casual-screening BP. However, the differential prognostic significance of home BP in the morning (morning BP) and in the evening (evening BP), respectively, has not been elucidated. In the Ohasama study, 1766 subjects (>or=40 years) were followed up for an average of 11 years. The predictive power for stroke incidence of evening BP was compared with that of morning BP as continuous variables. The Cox regression model demonstrated that evening BP and morning BP predicted future stroke risk equally. Subjects were also assigned to 1 of 4 categories based on home BP. In this analysis, stroke risk in morning hypertension ([HT] morning BP >or=135/85 mm Hg and evening BP <135/85 mm Hg; relative hazard (RH): 2.66; 95% CI:1.64 to 4.33) and that in sustained HT(morning BP and evening BP >or=135/85 mm Hg; RH: 2.38; 95% CI: 1.65 to 3.45) was significantly higher than that in normotension (morning BP and evening BP <135/85 mm Hg). The risk in morning HT was more remarkable in subjects taking antihypertensive medication (RH: 3.55; 95% CI: 1.70 to 7.38). Although the risk in evening HT (morning BP <135/85 mm Hg and evening BP >or=135/85 mm Hg) was higher than that in normotension, the differences were not significant. In conclusion, morning BP and evening BP provide equally useful information for stroke risk, whereas morning HT, which indicates HT specifically observed in the morning, might be a good predictor of stroke, particularly among individuals using anti-HT medication.     

氨氯地平及达爽对高血压患者血压昼夜变化规律的影响

目的 观察高血压患者血压昼夜变化节律,并按照时间治疗学的原则,探讨氨氯地平(络活喜)及达爽在不同给药时间对高血压患者血压昼夜规律的影响.方法 130例2级或3级高血压患者来源于2008年5月-2009年11月在哈尔滨市第一医院心内科门诊及住院治疗的病人.在监测24 h动态血压后,根据动态血压昼夜变化节律将病人分为杓型和非杓型.杓型(n=34)血压者晨起(6:00)一次性给予达爽5mg、络活喜5mg;非杓型血压者均衡性别、年龄因素后分为3组,Ⅰ组(n=30)晨起(6:00)给予达爽5mg、络活喜5mg;Ⅱ组(n=32)晨起(6:00)给予达爽5 mg,晚间(18:00)给予络活喜5 mg;Ⅲ组(n=34)晨起(6:00)给予络活喜5 mg,晚间(18:00)给予达爽5 mg.4周后,复查24 h动态血压(1 Pa=13.3 mmHg),分析治疗前后24 h平均收缩压(24hSBP)、24 h平均舒张压(24 hDBP);白天、夜间平均收缩压(dSBP,nSBP);白天、夜间平均舒张压(dDBP,nDBP).结果 ①杓型血压者晨起一次给药,24 hSBP、24 hDBP和dSBP、dDBP分别由(154.3±5.6)、(95.4±3.1)mmHg和(158.7±6.5)、(99.6±3.7)mmHg下降至(137.2±3.9)、(82.5±2.7)mmHg和(139.7±3.8)、(85.2±3.5)mmHg(t值分别为2.124、2.356,2.278、2.449,P均<0.05).②非杓型Ⅰ、Ⅱ、Ⅲ组高血压患者治疗后24 hSBP[(139.6±4.1)、(134.5±4.6)、(133.4±3.5)mmHg]和24 hDBP[(83.5±4.2)、(80.8±5.6)、(81.6±4.7)mmHg]与治疗前[(154.4±6.1)、(156.7±6.7)、(156.6±5.2)mmHg和(95.8±2.8)、(94.9±3.8)、(95.7±3.2)mmHg]比较明显下降(t值分别为2.038、2.040、2.135,2.142、2.213、2.216,P均<0.05);治疗后dSBP[(138.9±5.4)、(136.7±4.1)、(137.4±6.4)mmHg]和dDBP[(85.8±5.3)、(83.6±5.1)、(83.9±5.2)mmHg]与治疗前[(158.6±3.5)、(158.4±5.6)、(159.5±4.3)mmHg和(98.4±3.7)、(99.6±3.7)、(83.9±5.2)mmHg]比较明显下降(t值分别为2.021、2.252、2.261,2.217、2.167、2.076,P均<0.05);治疗后nSBP[(133.7±4.6)、(129.8±5.7)、(127.6±2.8)mmHg]和nDBP[(87.8±2.9)、(78.5±6.4)、(77.8±4.8)mmHg]与治疗前[(146.7±6.9)、(149.8±3.9)、(150.2±4.1)mmHg和(93.7±4.2)、(95.7±4.3)、(93.4±3.3)mmHg]比较明显下降(t值分别为1.798、2.032、2.014,1.864、2.157、2.166,P均<0.05).治疗后nSBP、nDBP,Ⅰ、Ⅱ、Ⅲ组组间比较差异有统计学意义(F值分别为2.32、2.17,P均<0.05);其中Ⅱ组和Ⅲ组效果优于Ⅰ组(q值分别为3.17、4.03,3.32、4.19,P均<0.05),但Ⅱ组和Ⅲ组间效果相似(P>0.05).结论 高血压患者应重视血压节律的检测,杓型血压者晨起一次给药即可有效控制血压;非杓型者早晚分次给药较晨起顿服两种药物更能有效控制患者的夜间血压,达到有效平稳降压.     

Lack of adequate blood pressure control in the morning and evening periods in medicated hypertensive patients considered to be controlled in the office.

BACKGROUND AND AIM: In hypertensive patients tight blood pressure (BP) control during the critical morning and evening periods may be relevant for preventing cardiovascular events, which most frequently occur at these times of the day. METHODS: In a prospective study we evaluated 24h ambulatory BP (ABP) values (24h, daytime, nighttime, morning period between 6-10 am and evening period between 6-10 pm), in 103 hypertensive patients (HTs), aged between 18-79 years, considered to be controlled in the office in the previous two months (office BP < 140/90 mmHg, 2 x 3 readings, before taking medication), who were being treated with antihypertensive drugs taken once daily in the morning. Based on ABP data, HTs were considered to have good BP control if daytime BP values were < 135/85 mmHg, < 133.1/85.4 mmHg during the morning period, and < 138.1/89.3 mmHg during the evening period. Otherwise control of ABP was considered poor. These limits correspond to the upper 95% confidence limits of BP calculated for each period in a normotensive control population of 210 subjects age-matched to the HTs. RESULTS: Of the 103 HTs, 39 were under monotherapy and the remaining 64 on combination regimens (34 with two drugs, 29 with three and one with four). Based on ABP data of the 103 HTs, poor ABP control was observed in 36 (35%) in the morning period, in 24 (23%) in the evening period and in 29 (28%) for daytime BP values. ABP values during both the morning and evening periods correlated significantly with daytime values (r = 0.72 and r = 0.89 respectively, p < 0.01) but not with office values. CONCLUSIONS: A significant proportion of treated HTs who are considered to be controlled in the office present abnormally high ABP levels, particularly in the critical early morning period, but also during the evening and throughout the daytime period.     

醛固酮合成酶基因CYP11B2(-344T/C)多态性对北京汉族人群高血压患者缬沙坦降压疗效的影响

目的探讨醛固酮合成酶基因CYP11B2(-344T/C)多态性与北京汉族人原发性高血压的关系及对缬沙坦降压疗效的影响。方法采用多聚酶链式反应结合限制性内切酶片段长度多态性分析方法检测1999年8月至2003年10月首都医科大学宣武医院345例原发性高血压(EH)患者和156名健康人(NE)醛固酮合成酶基因CYP11B2(-344T/C)多态性。并测定各组人群的诊室血压、24h血压以及各项生化指标。其中98例高血压患者给予缬沙坦80mg,每日1次,用药4周,测定用药前后的血压指标。结果EH组CC CT基因型频率显著高于NE组;EH组C等位基因频率显著高于NE组(P<0.01)。CC CT基因型用药后的收缩压下降值、舒张压下降值、平均动脉压下降值及24h收缩压下降值、24h舒张压下降值、24h平均动脉压下降值均显著大于TT基因型(P<0.05)。结论醛固酮合成酶基因CYP11B2(-344T/C)多态性与北京汉族人原发性高血压明显相关,并且可能是缬沙坦降压疗效的有效预测因子。     

Prevalence of Masked Hypertension in Subjects Treated with Antihypertensive Drugs as Assessed by Morning versus Evening Home Blood Pressure Measurements: The J-HOME Study

To investigate the relationship between morning and evening home blood pressure (BP) measurements to make a diagnosis of masked hypertension, we collected information on the characteristics of 3,303 essential hypertensive outpatients receiving antihypertensive medication in Japan using a physician, self-administered questionnaire. All patients were asked to measure their home BP once every morning and once every evening for two weeks. Morning and evening home BP values of each patient were defined as the average of all morning and all evening home BP values, respectively. The mean BP values of all study subjects were 142.8/80.6 mmHg for office BP, 139.8/81.8 mmHg for morning home BP, 133.7/76.9 mmHg for evening home BP, and 136.8/79.3 mmHg for the average of the morning and evening home BPs. Masked hypertension was defined as an office BP < 140/90 mmHg and a home BP ≥ 135/85 mmHg. The prevalence of masked hypertension diagnosed using morning home BP (23.1%) was higher than that diagnosed by evening home BP (14.7%); the prevalence was 19.0% when diagnosed using the average of the morning and evening home BPs. Among the 1,386 patients with a normal office BP, the diagnosis of masked hypertension based on morning and evening home BP values differed in 28.8% of patients for systolic BP and 20.9% for diastolic BP (kappa coefficient = 0.43). The present study showed that the prevalence of masked hypertension was underestimated when the diagnosis of masked hypertension was made on the basis of evening home BP.     

Prevalence of Masked Hypertension in Subjects Treated with Antihypertensive Drugs as Assessed by Morning versus Evening Home Blood Pressure Measurements: the J-HOME study

To investigate the relationship between morning and evening home blood pressure (BP) measurements to make a diagnosis of masked hypertension, we collected information on the characteristics of 3,303 essential hypertensive outpatients receiving antihypertensive medication in Japan using a physician, self-administered questionnaire. All patients were asked to measure their home BP once every morning and once every evening for two weeks. Morning and evening home BP values of each patient were defined as the average of all morning and all evening home BP values, respectively. The mean BP values of all study subjects were 142.8/80.6 mmHg for office BP, 139.8/81.8 mmHg for morning home BP, 133.7/76.9 mmHg for evening home BP, and 136.8/79.3 mmHg for the average of the morning and evening home BPs. Masked hypertension was defined as an office BP < 140/90 mmHg and a home BP > or = 135/85 mmHg. The prevalence of masked hypertension diagnosed using morning home BP (23.1%) was higher than that diagnosed by evening home BP (14.7%); the prevalence was 19.0% when diagnosed using the average of the morning and evening home BPs. Among the 1,386 patients with a normal office BP, the diagnosis of masked hypertension based on morning and evening home BP values differed in 28.8% of patients for systolic BP and 20.9% for diastolic BP (kappa coefficient = 0.43). The present study showed that the prevalence of masked hypertension was underestimated when the diagnosis of masked hypertension was made on the basis of evening home BP.