清晨血压及血压晨峰的临床诊断价值

目的：探讨清晨血压在疾病诊断中的临床价值。方法对我院动态血压室近三个月的24 h 动态血压数据进行统计,分析心脑血管病患者的24 h 动态血压,对其清晨时段的血压状况进行研究。结果308例普通高血压患者中有202例清晨时段血压控制不佳,心脑血管病患者中有70％～80％清晨血压控制不佳。结论清晨血压升高在高血压患者中的发生率较高、危险性大,与心脑血管事件密切相关。清晨血压对隐匿性高血压的诊断具有临床意义。     

Meal-induced blood pressure fall in patients with isolated morning hypertension

Abstract

We aimed to determine a possible association between isolated morning hypertension (IMH) and meal-induced blood pressure (BP) fall in adult treated hypertensive patients who underwent home BP measurements. A total of 230 patients were included, median age 73.6, 65.2% women. After adjusting for age, sex, number of antihypertensive drugs, office and home BP levels, the association between IMH and meal-induced BP fall was statistically significant. In conclusion, meal-induced BP fall and IMH detected through home blood pressure monitoring (HBPM) are independently associated in hypertensive patients. The therapeutic implications of such observation need to be clarified in large-scale prospective studies.     

老年人清晨血压与全天血压相关性探讨

目的：探讨老年人清晨血压与全天血压之间的关系。方法根据动态血压监测结果,从我院2015年9至10月接受动态血压监测的体检老年人中选取全天血压均值升高的高血压患者和全天血压均值正常者各44例,分别为高血压组（A 组）和正常对照组（B 组）。比较两组的清晨血压与全天血压均值,并分析清晨收缩压／舒张压均值与全天血压收缩压／舒张压均值之间是否存在相关性。结果A 组的清晨和全天血压均值都高于 B 组。两组的清晨收缩压／舒张压均值与全天收缩压／舒张压均值之间呈正相关关系,且差异有统计学意义（P ＜0．001）。结论老年人清晨血压能在一定程度上反映全天血压水平,建议在老年人中积极推行清晨血压管理。     

Prognostic value of morning surge of blood pressure in middle‐aged treated hypertensive patients

We investigated the prognostic value of morning surge (MS) of blood pressure (BP) in middle‐aged treated hypertensive patients. The occurrence of a composite end point (coronary events, stroke, and heart failure requiring hospitalization) was evaluated in 1073 middle‐aged treated hypertensive patients (mean age 49 years). Patients with preawakening MS of BP above the 90th percentile (27/20.5 mm Hg for systolic/diastolic BP) were defined as having high MS of BP. During the follow‐up (mean 10.9 years), 131 cardiovascular events occurred. After adjustment for various covariates, including known risk markers and ambulatory BP parameters, patients with high MS of systolic BP (hazard ratio 1.81, 95% confidence interval 1.10‐2.96) and those with high MS of diastolic BP (hazard ratio 1.98, 95% confidence interval 1.19‐3.28) were at higher cardiovascular risk than those with normal MS. In middle‐aged treated hypertensive patients, high MS of systolic and diastolic BP is independently associated with increased cardiovascular risk.     

Usefulness of morning home blood pressure measurements in patients with type 2 diabetes mellitus: results of a 10-year,prospective, longitudinal study

Abstract

Previous cross-sectional studies and 6-year longitudinal study have demonstrated that home blood pressure (HBP) measurements upon awakening have a stronger predictive power for death, micro- and macrovascular complications than clinic blood pressure (CBP) measurements in patients with type 2 diabetes (T2DM). This study investigated which of these measurements offers stronger predictive power for outcomes over 10 years. At baseline, 400 Japanese patients with T2DM were classified as having hypertension (HT) or normotension (NT) based on HBP and CBP. The mean survey duration was 95 months. Primary and secondary end-points were death and new or worsened micro- and macrovascular complications, respectively. Differences in outcomes for each end-point between HT and NT patients were analyzed using Kaplan–Meier survival curves and log-rank testing. Associated risk factors were assessed using Cox proportional hazards analysis. Based on HBP, death and micro- and macrovascular complications were significantly higher in patients with HT than with NT at baseline and end-point. Based on CBP, there were no significant differences in incidence of death, micro- or macrovascular complications between patients with HT and NT at baseline and end-point, although a significant difference in incidence of death was observed between the HT and NT groups at end-point. However, the significance was significantly lower in CBP than in HBP. One risk factor associated with micro- and macrovascular complications in patients with HBP was therapy for HT. This 10-year longitudinal study of patients with T2DM demonstrated that elevated HBP upon awakening is predictive of death, and micro- and macrovascular complications.     

Discrepancies in the diagnosis of hypertension in adolescents according to available office and home high blood pressure criteria

This study aimed at comparing the prevalence of abnormal blood pressure (BP) phenotypes among 241 adolescents referred for hypertension (15.4 ± 1.4 years, 62% males, 40% obese) according to mostly used or available criteria for hypertension [AAP or ESH criteria for high office BP (OBP); Arsakeion or Goiânia schools’ criteria for high home BP monitoring (HBPM)]. High OBP prevalence was greater when defined by AAP compared with ESH criteria (43.5% vs. 24.5%; p < .001), while high HBPM prevalence was similar between Arsakeion and Goiânia criteria (33.5% and 37.5%; p = .34). Fifty‐five percent of the sample fulfilled at least one criterion for high BP, but only 31% of this subsample accomplished all four criteria. Regardless of the HBPM criteria, AAP thresholds were associated with lower prevalence of normotension and masked hypertension and greater prevalence of white‐coat and sustained hypertension than ESH thresholds. These findings support the need to standardize the definition of hypertension among adolescents.     

Comparison between unattended automated office blood pressure and conventional office blood pressure under the environment of health checkup among Japanese general population

Unattended automated office blood pressure (AOBP) measurement has been endorsed as the preferred in‐office measurement modality in recent Canadian and American clinical practice guidelines. However, the difference between AOBP and conventional office blood pressure (CBP) under the environment of a health checkup remains unclear. We aimed to identify the clinical significance of AOBP as compared to CBP under the environment of a health checkup. There were 491 participants (333 females, mean age of 62.5 years) who were at least 20 years old, including 179 participants who were previously diagnosed with hypertension. Mean AOBPs were 131.8 ± 20.9/76.6 ± 11.7 mm Hg, and CBPs were 135.6 ± 21.6/77.3 ± 11.5 mm Hg. There was a difference of 3.9 mm Hg in systolic blood pressure (SBP) and 0.8 mm Hg in diastolic BP between AOBP and CBP. In all participants, SBP and pulse pressure, as well as the white coat effect (WCE), increased with age. The cutoff value used was 140/90 mm Hg for CBP and 135/85 mm Hg for AOBP, and the prevalence of WCE and masked hypertension effect (MHE) was 12.4% and 14.1%, respectively. Even in a health checkup environment of the general population, there was a difference between the AOBP and CBP, and the WCE was observed more strongly in the elderly with a history of hypertension, suggesting that a combination of AOBP with CBP may be useful in detecting WCE and MHE in all clinical scenarios including health checkups, and help solve the “hypertension paradox” not only in Japan but in all over the world.     

老年原发性高血压患者晨峰现象与左心室肥厚

目的: 探讨老年原发性高血压晨峰现象与左心室肥厚的关系。方法: 老年原发性高血压患者107例根据24 h动态血压监测分为有晨峰现象（MBPS）组（40例）和无晨峰现象（NMBPS）组（67例）,检查空腹血脂、血糖和肌酐,并计算体质量指数（BMI）和左室质量指数（LVMI）。结果: MBPS组的24 h动态血压监测收缩压高于NMBPS组（P<0.05）。MBPS组的LVMI显著高于NMBPS组［（132±28）g/m2 vs.(113±28)g/m2,P<0.01］。结论: 老年原发性高血压有晨峰现象者更易发生左心室肥厚。     

High morning blood pressure surge is associated with oxidative stress and paraoxonase 1 activity in newly diagnosed hypertensive patients

Background: Both oxidative stress and morning surge (MS) of blood pressure (BP) were found to be closely related with cardiovascular and cerebrovascular diseases. We investigated the association between MS of BP and oxidative stress in newly diagnosed hypertensive patients. Methods: We prospectively included 237 newly diagnosed hypertensive patients in the present study (mean age: 51.6 ± 11.7 years). The patients were classified according to the extent of the sleep-through surge as follows: the top decile of sleep-through surge (>47.2 mmHg, n = 27; EMShigh group), versus all others (n = 210, EMSlow group). Total antioxidant capacity (TAC) and total oxidant status (TOS) levels were determined by using an automated measurement method. The oxidative stress index (OSI) was calculated as the ratio of TOS to TAC. Serum paraoxonase 1 (PON-1) activity was measured spectrophotometrically. Results: Patients in EMShigh group were found to have higher hs-CRP, TOS, and OSI values and lower TAC and PON-1 values (p < 0.01, for all). MS of BP was associated with hs-CRP, PON-1, TOS, TAC, and OSI levels in bivariate analysis. Multivariate linear regression analysis showed that MS of BP was significantly associated with PON-1(β = ?0.206, p < 0.001), OSI (β = 0.602, p < 0.001) and hs-CRP (β = 0.210, p < 0.001). Conclusion: Present study shows that OSI is increased and antioxidant PON-1 activity is decreased in patients with enhanced MS of BP. There is a close association between high MS of BP and oxidative stress markers in newly diagnosed hypertensive patients.     

Reliability of morning,before‐dinner,and at‐bedtime home blood pressure measurements in patients with hypertension

The authors evaluated differences in the reliability of home blood pressure measurements taken in the morning, before dinner, and at bedtime. Forty‐eight patients with hypertension (age range, 50–89 years; mean age, 76.4 years) measured their home blood pressure using a validated automatic information/communication technology‐based device for 14 consecutive days. Those days were divided into the first seven days (1–7) and the following 8 to 14 days (days 8–14) and compared systolic blood pressure (SBP) reliability in the two periods for each measurement time point. In Bland‐Altman analyses, morning SBP showed the least standard error of measurement (3.0 mm Hg). There were fixed biases in morning and before‐dinner SBP with average limits of agreement of 3.9 and 6.4 mm Hg, respectively. For at‐bedtime SBP, a random error was detected and the minimal detectable change was 13.8 mm Hg. The percentage of near‐maximal variation of morning SBP was the smallest at 18.1%. Morning SBP therefore provided the most reliable home blood pressure value in the day.     

代谢综合征各组分与原发性高血压患者血压晨峰发生的相关性

目的:探讨代谢综合征(MS)各组分与原发性高血压（EH）患者血压晨峰（MBPS）发生的相关性。方法: 回顾性分析了在山东省章丘市农村入选的EH患者322例,根据患者是否并发有MS将患者分为并发MS组（n=126）和单纯EH组（n=196）,所有患者监测24h动态血压,比较两组患者血压晨峰发生情况。结果: 并发MS组患者24hSBP、白天(d)SBP、夜间(n)SBP、24 h脉压(PP)、dPP、nPP、MBPS值均显著高于单纯EH组,差异有统计学意义（P<0.05或P<0.01）。并发MS组患者MBPS发生率为60.3%显著高于单纯EH组,差异有统计学意义（P<0.01）。Pearson相关分析显示,MBPS与年龄、空腹血糖(FPG)、总胆固醇(TC)、三酰甘油、低密度脂蛋白胆固醇、SBP、PP、体质量指数及腰围呈正相关,相关系数分别为0.38,0.44,0.48,0.26,0.35,0.38,0.34,0.21和0.43,P<0.05或P<0.01。多元线性逐步回归分析显示,TC、年龄、FPG、SBP及腰围是影响EH并发MS患者出现MBPS的主要危险因素（P<0.05或P<0.01）。结论: MS与MBPS的发生密切相关,其组分FPG、SBP及腰围是影响MBPS发生的主要危险因素。     

Trend of office and home blood pressure control in treated hypertensive patients: changes in antihypertensive medication and salt intake

Blood pressure (BP) control in hypertensives has improved in recent years; however, it remains insufficient. We investigated the trend of BP control status in hypertensive patients with antihypertensive medication and salt intake. Two hundred and eight treated hypertensive patients were prospectively followed between 2007 and 2012. During this period, average clinic BP significantly decreased from 137?±?12/80?±?9 to 133?±?11/76?±?8?mmHg, and the achievement rate of BP control defined as <140/90?mmHg increased from 58% to 71% (p?p?p?相似文献   

血压昼夜节律及晨峰血压对老年认知功能的影响

目的 探讨血压昼夜节律对高龄高血压患者认知功能的影响。方法 入选2013年6月至2014年8月期间在北京友谊医院老年心内科住院的96例高龄高血压患者（年龄≥80岁）,根据简易精神状态量表（MMSE）评分,将其分为轻度认知功能障碍组（MCI组,35例）和认知功能正常组（对照组,61例）。比较两组患者的一般情况、合并症,以及动态血压监测指标。结果 MCI组患者与对照组的24h平均收缩压（24h SBP）分别为（131.14±12.61）和（131.00±13.17）mmHg、24h平均舒张压（24h DBP）分别为（65.74±7.35）和（64.08±8.39）mmHg,两组比较差异均无统计学意义（P＞0.05）。两组昼间平均收缩压（dSBP）、昼间平均舒张压（dDBP）、夜间平均收缩压（nSBP）、夜间平均舒张压（nDBP）比较,差异也无统计学意义（P＞0.05）。但MCI组晨峰血压与对照组比较明显升高[（8.69±12.64） vs （4.08±12.78）mmHg,P＜0.05]。结论 清晨血压升高与高龄高血压患者认知功能受损有关。     

Antihypertensive medication use and blood pressure control among treated older adults

The association of different antihypertensive regimens with blood pressure (BP) control is not well‐described among community‐dwelling older adults with low comorbidity. We examined antihypertensive use and BP control in 10 062 treated hypertensives from Australia and the United States (US) using baseline data from the ASPirin in Reducing Events in the Elderly (ASPREE) trial. Renin‐angiotensin system (RAS) drugs were the most prevalently used antihypertensive in both countries (Australia: 81.7% of all regimens; US: 62.9% of all regimens; P < .001). Diuretics were the next most commonly used antihypertensive in both countries, but were more often included in regimens of US participants (48.9%, vs 33.3% of regimens in Australia; P < .001). Among all antihypertensive classes and possible combinations, monotherapy with a RAS drug was the most common regimen in both countries, but with higher prevalence in Australian than US participants (35.9% vs 20.9%; P < .001). For both monotherapy and combination users, BP control rates across age, ethnicity, and sex were consistently lower in Australian than US participants. After adjustment for age, sex, ethnicity, and BMI, significantly lower BP control rates remained in Australian compared to US participants for the most commonly used classes and regimens (RAS blocker monotherapy: BP control = 45.5% vs 54.2%; P = .002; diuretic monotherapy: BP control = 45.2% vs 64.5%; P = .001; and RAS blocker/diuretic combo: BP control = 50.2% vs 65.6%; P = .001). Our findings highlight variation in antihypertensive use in older adults treated for hypertension, with implications for BP control. Differences in BP control that were observed may be influenced, in part, by reasons other than choice of specific regimens.     

老年原发性高血压患者血压晨峰现象对靶器官影响的临床研究

目的研究老年原发性高血压患者血压晨峰现象，明确其对主要靶器官结构及功能的潜在损害。方法采用24h动态血压监测仪分析88例老年高血压患者的血压，确认晨峰组与非晨峰组，均常规检查血脂、空腹血糖、测定尿微量白蛋白（UALB），计算体质量指数（BMI）、左心室质量指数（LVMI）、心电图计算QT离散度（QTcd）。结果晨峰组的24h白昼、夜间平均收缩压均显著高于非晨峰组动态血压监测水平，晨峰组的LVMI、QTcd和UALB指标均高于非晨峰组（P〈0．05）；2组BMI、血脂、血糖差异无统计学意义（P〉0．05）。结论血压晨峰使靶器官损害增加，因此遏制原发性高血压患者的晨峰反应对降压达标和减缓靶器官受累程度具有重要意义。     

Comparison among research,home, and office blood pressure measurements for pregnant women: The TMM BirThree Cohort Study

Blood pressure (BP) measurements of pregnant women have been collected in offices and at home for previous research. However, it remains uncertain whether there is difference between research BP, defined as BP measured for the purpose of epidemiological research and BP measured at home or in an office. Therefore, the present study aimed to compare research BP with home and unstandardized office BP. Research, home, and office BP were measured among pregnant women who participated in the Tohoku Medical Megabank Project Birth and Three‐Generation Cohort Study (TMM BirThree Cohort Study). Research BP was measured twice at our research center while the participant was seated and after resting for 1‐2 minutes. Research, home, and office BP were compared and agreement among the values was assessed. Differences among research, home, and office BP values and possible factors affecting differences were analyzed. Among 656 pregnant women, the mean (± standard deviations) research systolic (S), diastolic (D) BP, home SBP, home DBP office SBP, and office DBP were 103.8 ± 8.5, 61.8 ± 7.3, 104.4 ± 9.2, 61.2 ± 6.8, 110.5 ± 10.8, and 63.8 ± 8.7mmHg, respectively. Research SBP value was lower than home value (P = .0072; difference between mean research and home BP: −0.61 ± 7.8 mmHg). Research SBP and DBP values were lower than office values (P < .0001 for both SBP and DBP; means ± standard deviations of differences between research and office BP: 6.7 ± 10.1 and 2.0 ± 8.5 mmHg for SBP and DBP, respectively). In conclusion, when research BP is measured under conditions controlled, research BP can give close values to home BP for pregnant women.     

清晨高血压伴2型糖尿病对靶器官的影响

目的:探讨清晨高血压(MBPS)伴2型糖尿病(T2DM)对靶器官的影响.方法:600例原发性高血压(EH)患者,其中伴T2DM者188例,不伴T2DM者412例;依据有无MBPS和T2DM分为:MBPS伴T2DM组(A组,72例)、MBPS不伴T2DM组(B组,120例)、T2DM非MBPS组(C组,116例)、非MBPS不伴T2DM组(D组,292例).检测24 h动态血压、臂踝脉搏波传导速度(baPWV)、颈动脉内膜中层厚度(IMT)、左室质量指数(LVMI)、超敏C反应蛋白(hsCRP)、尿微量白蛋白(UAM).结果:伴T2DM的EH患者MBPS发生率为38.30%,明显高于不伴T2DM的EH患者(29.13%),P<0.05.A组hsCRP[(5.70±1.07)mg/L]、baPWV[(2 129±115)cm/s]、LVMI[(141.0±13.1)g/m2]、IMT[(1.11±0.07)mm]、UAM[(38.04±15.61)mg/L]均显著高于其他各组(P＜0.05).B组和C组hsCRP、baPWV、IMT、LVMI、UAM也显著高于D组(均P<0.05).结论:EH伴T2DM患者的MBPS发生率明显增加; MBPS或T2DM都会加重EH患者的动脉粥样硬化,导致hsCRP、baPWV、IMT、LVMI、UAM明显增加,当两者并存时,对靶器官的损害更加明显.     

厄贝沙坦联合维生素D对老年高血压患者晨峰血压及动脉僵硬度的影响

目的 探讨厄贝沙坦联合维生素D对老年高血压患者晨峰血压及动脉僵硬度的影响.方法 选择我院2020年1月至6月期间收治的老年高血压病患者80例,随机分为对照组(40例)和观察组(40例).对照组口服厄贝沙坦片治疗,观察组在此基础上肌注维生素D3治疗.比较两组治疗前后24h平均收缩压(24h SBP)、平均舒张压(24h ...     

血压正常高值者血压晨峰与冷加压试验的相关性

目的:探讨血压正常高值者血压晨峰现象与冷加压试验后血压变化的相关性。方法:将258例受试者按血压水平分为理想血压组、血压正常高值组和高血压病组。所有受试者均进行24小时动态血压监测及冷加压试验。结果:血压正常高值者清晨血压上长幅度为（27±9）mmHg,冷加压后0 s及60 s SBP增加幅度分别为(14±6)mmHg及(9±5)mmHg,晨峰及冷加压试验阳性发生率分别为45%及26%,低于高血压病组,但明显高于理想血压组（P<0.05）。血压晨峰、吸烟史、年龄及高密度脂蛋白胆固醇是影响0 s SBP增加幅度的主要因素;血压晨峰、年龄及空腹血糖是影响60 s SBP增加幅度的主要因素。结论:血压正常高值者清晨血压上升明显,冷加压后血压显著上升,冷加压后血压增幅与血压晨峰相关。     

Comparative effects of valsartan plus either cilnidipine or hydrochlorothiazide on home morning blood pressure surge evaluated by information and communication technology–based nocturnal home blood pressure monitoring

The authors tested the hypothesis that a valsartan/cilnidipine combination would suppress the home morning blood pressure (BP) surge (HMBPS) more effectively than a valsartan/hydrochlorothiazide combination in patients with morning hypertension, defined as systolic BP (SBP) ≥135 mm Hg or diastolic BP ≥85 mm Hg assessed by a self‐measuring information and communication technology–based home BP monitoring device more than three times before either combination''s administration. This was an 8‐week prospective, multicenter, randomized, open‐label clinical trial. The HMBPS, which is a new index, was defined as the mean morning SBP minus the mean nocturnal SBP, both measured on the same day. The authors randomly allocated 129 patients to the valsartan/cilnidipine (63 patients; mean 68.4 years) or valsartan/hydrochlorothiazide (66 patients; mean 67.3 years) combination groups, and the baseline HMBPS values were 17.4 mm Hg vs 16.9 mm Hg, respectively (P = .820). At the end of the treatment period, the changes in nocturnal SBP and morning SBP from baseline were significant in both the valsartan/cilnidipine and valsartan/hydrochlorothiazide groups (P < .001): −5.0 vs −10.0 mm Hg (P = .035) and −10.7 vs −13.6 mm Hg (P = .142), respectively. HMBPS was significantly decreased from baseline in both groups (P < .001), but there was no significant difference between the two groups: 14.4 mm Hg vs 14.0 mm Hg, respectively (P = .892). Valsartan/cilnidipine could not significantly suppress HMBPS compared with valsartan/hydrochlorothiazide. Large‐scale randomized controlled studies are needed to assess how reducing HMBPS will affect future cardiovascular outcomes. The information and communication technology–based home BP monitoring device may become an alternative to ambulatory BP monitoring, which has been a gold standard to measure nocturnal BP and the morning BP surge.