Regression of left ventricular mass in hypertensive patients treated with perindopril/indapamide as a first-line combination: the REASON echocardiography study

BACKGROUND: Increase in left ventricular mass (LVM) may be linked to morbidity and mortality in hypertensive patients. Arterial stiffness, systolic blood pressure (BP), and pulse pressure (PP) seem to be the main determinants of LVM. The perindopril/indapamide combination normalizes systolic BP, PP, and arterial function to a greater extent than atenolol. The aim of this study was to compare the effects of perindopril (2 mg)/indapamide (0.625 mg) first-line combination with atenolol (50 mg) on LVM reduction in hypertensive patients. METHODS: Two hundred fourteen patients with essential hypertension participating in the PREterax in Regression of Arterial Stiffness in a ContrOlled Double-BliNd (REASON), randomized, double-blind, parallel-group study, underwent M-mode two-dimensional-guided echocardiography. RESULTS: Perindopril/indapamide and atenolol were both effective at brachial BP reduction during the 12-month period. The systolic BP reduction was significantly greater with perindopril/indapamide than with atenolol (-21.2 v -15.3 mm Hg), whereas the reduction in diastolic BP was similar between treatment groups (-12.1 v -11.3 mm Hg). Reduction in LVM was higher with perindopril/indapamide than with atenolol. The between-group difference was significant for LVM (-13.6 v -4.3 g, P = .027), LVM/body surface area (LVMI1, P = .032), and LVM/body height2.7 (LVMI2, P = .013). The 124 patients with LV hypertrophy at baseline showed greatest LVM regression (LVM: -22.5 v -8.9 g, P = .009; LVMI1, P = .031; LVMI2, P = .028). The reduction in LVM adjusted for brachial systolic BP and heart rate was still significantly greater with perindopril/indapamide than with atenolol. CONCLUSIONS: Treatment, based on a first-line perindopril/indapamide combination in hypertensive patients, was more effective than atenolol on regression of echocardiographic indices of LVM and LV hypertrophy.     

Twenty-four-hour blood pressure monitoring and effects of indapamide

Twenty-four-hour blood pressure (BP) monitoring with a noninvasive device (Kontron) has been used to assess the effect of a single dose of indapamide in a group of patients with essential hypertension. Originally 23 patients were selected. Three patients withdrew from the study because of refusal to go through the second 24-hour recording. Eight of the remaining patients had to be excluded for technical reasons, which left 12 patients available for analysis. All patients received a single dose of indapamide, 2.5 mg/day. Before treatment began, a 24-hour BP control was performed, and a second one a month later (37 +/- 8 days). The age of the patients was 46 +/- 10 years. Diurnal BP (8 am to 10 pm) and heart rate were, respectively, 148 +/- 15/101 +/- 6 mmHg and 79 +/- 9 beats/min; night BP (10 pm to 8 am) was 131 +/- 15/88 +/- 7 mmHg and heart rate 71 +/- 10 beats/min. After therapy, diurnal BP was 131 +/- 15/92 +/- 7 mmHg (-15 +/- 7/-8 +/- 4: p less than 0.0001/p less than 0.0001); heart rate 82 +/- 8 beats/min (difference not significant); night BP was 115 +/- 13/80 +/- 8 mmHg (-16 +/- 11/-8 +/- 7: p less than 0.0001/p less than 0.0001) and heart rate 70 +/- 9 beats/min (difference not significant). Twenty-four-hour systolic work values were 106 +/- 15 at the beginning of the trial and 96 +/- 14 (-9.7 +/- 14; p less than 0.05) after 1 month of indapamide treatment. Variability did not change with treatment.(ABSTRACT TRUNCATED AT 250 WORDS)     

Twenty-four-hour ambulatory blood pressure monitoring in atrial fibrillation

BACKGROUND: Due to large beat-to-beat blood pressure variation the use of 24-h ambulatory blood pressure monitoring in patients with atrial fibrillation has been questioned. METHODS: Repeatability and variability of 24-h ambulatory blood pressure (Accutraccer II or Diasys Integra), and daily blood pressure variation was examined in 42 patients aged 51-81 (median 73.5) years admitted for elective electrocardioversion of atrial fibrillation. RESULTS: Before cardioversion 24-h ambulatory systolic blood pressure was slightly lower and nocturnal blood pressure reduction was larger in the group of patients who achieved sinus rhythm than in the group who maintained atrial fibrillation (11.5/10.5 versus 4.1/4.7 mmHg; P < 0.05). No statistically significant change was observed in ambulatory blood pressure after cardioversion in any of the two groups. Blood pressure variability (SD/mean) was 10-14% both in patients with and without conversion to sinus rhythm. Coefficient of repeatability (2 SD of difference) was 13.6 mmHg (16.6%) for diastolic blood pressure and 30.2 mmHg (24.7%) for systolic blood pressure in patients with normalized heart rhythm and 17.0 and 29.0 mmHg (21.5 and 22.4%) in patients with maintained atrial fibrillation, respectively. CONCLUSION: Ambulatory blood pressure monitoring provides data with similar variability and repeatability in patients with atrial fibrillation as in subjects with normal cardiac rhythm. Twenty-four-hour ambulatory blood pressure measurement is applicable in atrial fibrillation in the same way as during sinus rhythm.     

Selective reduction of cardiac mass and central blood pressure on low-dose combination perindopril/indapamide in hypertensive subjects

OBJECTIVE: In hypertension, blockade of the renin-angiotensin system reduces left ventricular mass (LVM) independently of brachial systolic (S), diastolic (D), and mean (M) blood pressure (BP). From central to peripheral arteries, MBP and DBP are practically unchanged, whereas SBP and pulse pressure (PP) increase significantly. The objective was to determine whether changes in LVM under drug treatment was preferentially associated with changes in central or brachial SBP and PP. DESIGN: A substudy of 146 subjects was selected from 469 hypertensive patients submitted to a double-blind randomized trial comparing the combination of perindopril (2 mg; Per) and indapamide (0.625 mg; Ind) with atenolol (50 mg, one tablet per day). MAIN OUTCOME MEASURES: Before and after 1 year of treatment: LVM (echocardiography) in 146 subjects and, in 52 of them, central (carotid) BP and timing of wave reflections (tonometry). RESULTS: LVM changes were significantly associated with antihypertensive treatment, with lower LVM with Per/Ind than with atenolol. Changes in SBP and PP, but not in MBP and DBP, were more significantly associated with Per/Ind than with atenolol, with more pronounced effects using central than brachial measurements, and a longer delay in central return of wave reflections under Per/Ind. In the sampling of 52 patients with tonometry, the change in LVM between the two drug regimens was significantly linked to central, but not brachial, PP change. CONCLUSIONS: This observational study shows a lower LVM under Per/Ind than under atenolol. The greater change in LVM on Per/Ind was linked to central and not brachial blood pressure.     

Usefulness of ambulatory blood pressure monitoring in hypertensive patients

Treated or untreated hypertensive patients may have very different blood pressure levels when measured by the doctor in his surgery and when measured by ambulatory monitoring during their usual everyday activities. It is now possible to record blood pressure non-invasively with a portable blood pressure measuring device, the Remler M2000. Using this device, we observed that less than half of the patients referred by their medical practitioner for hypertension had abnormally high blood pressures during their everyday activities. We also noted that the ambulatory blood pressure profile of a given hypertensive patient cannot be predicted from the blood pressure recorded by his or her doctor. Consequently, we concluded that ambulatory blood pressure recordings would appear to be essential for the detection of patients with high blood pressure readings at the doctor's surgery and during everyday activities. These patients probably include the only group which really needs appropriate antihypertensive therapy.     

Twenty-four-hour ambulatory blood pressure monitoring in the evaluation of antihypertensive drugs: methodological aspects

Ambulatory blood pressure monitoring (ABPM) provides reproducible measurements over 24 h, avoiding the alerting reaction. However, the reproducibility of mean hourly ambulatory values is poorer by far than the whole day average. In phases II and III clinical triams ABPM seems to evaluate the time-course of the antihypertensive effect and helps to determine the trough: peak ratio. The potential advantage of the method could be an increase in statistical power of the trial, with regard to the number of patients to include, according to the study design. ABPM led to the identification of 'white-coat' hypertension with elevated clinic blood pressure measurements and persistently normal ABPM over time. No epidemiological evidence to include patients in trials according to ABPM criteria has been provided to date, but a subsequent stratification on the initial ABPM data has to be performed. Although an insignificant effect on the 24 h mean blood pressure values in short-term trials, the use of placebo seems to be necessary to supply reference blood pressure values for dosing and trough: peak ratio determination. Whether ABPM is able to decrease the number of patients to include remains debated. It has been noted that an increasing number of readings could lead to a decrease in SD and that a decrease in the number of patients required can be expected both in parallel and in cross-over design trials. However, it has been reported that the advantage of the higher reproducibility of ABPM could be lost in parallel design trials and that analysis of the antihypertensive effect of the drug throughout the 24 h could then require more patients. In order to conduct multicentre trials using ABPM, a consensus among investigators is needed for the presentation and analysis of the results. We have to overcome these difficulties in order to avoid a 'centre effect' and to allow for the expected increase in power of the trial. In such a trial the comparability of parallel groups could be jeopardized by a misadherence to the ABPM protocol. How can ABPM modify the doctor-patient relationship?. A pedagogical approach seems necessary, namely to inform the patients concerning technical and medical prerequisites of the method, in order to conform to the 'guidelines'. ABPM might constitute a new determinant of compliance with treatment; but its influence, beneficial or not, remains to be assessed. Compliance evaluation could be combined with ABPM, in order to provide a better evaluation of the antihypertensive effect of the drugs.     

Role of ambulatory blood pressure monitoring in hypertensive patients having controlled office blood pressure

Background and objectivesAmbulatory blood pressure (BP) monitoring has become useful in the diagnosis and management of hypertensive individuals. In this study we tried to know the role of office and ambulatory BP in treated hypertensive patients.Methods and patientsProspective cohort of 561 treated hypertensive patients were enrolled in the study. Hypertension definitions were according to JNC 8 classification. Office BP and ambulatory BP monitoring was done according to defined protocol.ResultsFrom a subgroup of 158 treated hypertensive patients, 91(16.2%) patients were having white coat hypertension (p value 0.00 by Pearson chi square test). In a subset of 403 patients who were having controlled BP on the day of enrolment as well as on the day of attaching ambulatory BP monitor; 98 (17.4%) patients were having masked uncontrolled hypertension (MUCH). In addition there was very significant percentage of non-dippers and reverse dippers. In our study we found that office BP has a moderate to low specificity and sensitivity and low negative predictive value for overall control in treated hypertensive patients.ConclusionAmbulatory BP monitoring should be included in the management protocol of treated hypertensive patients, for the optimal BP control.     

Sleep disturbance during ambulatory blood pressure monitoring of hypertensive patients

BACKGROUND: Hypertensive patients who fail to exhibit a normal fall in blood pressure at night may have a greater risk of target-organ damage. Sleep, with associated cessation of physical activity, is the principal determinant of nocturnal blood pressure 'dip'. OBJECTIVE: To ascertain whether hypertensive patients, who experience the discomfort of higher cuff-inflation pressures during ambulatory blood pressure monitoring, experience more interference with sleep, manifested by greater nocturnal physical activity. DESIGN: A retrospective case- control study. METHODS: Subjects were selected from a database of 475 patients who had undergone simultaneous 24 h ambulatory blood pressure monitoring and monitoring of physical activity with a wrist-mounted piezoelectric accelerometer. Sixty-one hypertensives (average daytime systolic blood pressure >/= 150 mmHg) were age matched to 61 subjects with average daytime systolic blood pressures 相似文献   

Assessment of blood pressure control in hypertensive stroke survivors: an ambulatory blood pressure monitoring study

BACKGROUND: We compared the sensitivity of office blood pressure and ambulatory blood pressure monitoring recordings in evaluating the effectiveness of antihypertensive treatment and identified factors related to inadequate blood pressure control among hypertensive stroke survivors. METHODS: Office blood pressure and ambulatory blood pressure monitoring measurements were performed at 120+/-30 days after ictus in 187 first-ever consecutive hypertensive stroke survivors who were receiving blood pressure-lowering medications according to international guidelines. Handicap was assessed by the modified Rankin Scale. Blood pressure was regarded as controlled if office and daytime ambulatory systolic and diastolic blood pressure values were <140/90 and <135/85 mmHg, respectively. Patients were subclassified according to the degree of their nocturnal systolic blood pressure fall [(mean daytime values-mean night-time values)100/mean daytime values] as dippers (>or=10%), nondippers (>or=0% and <10%) and reverse dippers (<0%). RESULTS: Effective blood pressure control was documented in significantly (P<0.001) fewer patients using ambulatory blood pressure monitoring (32.1%) than those using office recordings (43.3%), whereas in 16% of the study population a masked lack of per-treatment blood pressure control (elevated ambulatory blood pressure in the presence of normal office blood pressure levels) was identified. The distribution of dipping patterns differed significantly (P=0.01) between controlled hypertensive individuals (normal office and ambulatory measurements) and patients with isolated ambulatory hypertension (dippers: 31.3 vs. 10.0%; nondippers:56.9 vs. 53.3%; reverse dippers: 11.8 vs. 36.7%). Logistic regression analysis revealed diabetes mellitus and functional independency (modified Rankin Scale score<2) as independent predictors of inadequate blood pressure control. CONCLUSION: Ambulatory blood pressure monitoring detects a substantial number of treated hypertensive stroke survivors with a masked lack of per-treatment blood pressure control, who present a higher prevalence of abnormal circadian blood pressure patterns (reverse dipping). Diabetes mellitus and poststroke functional independency are the main factors contributing to inadequate blood pressure control.     

动态血压监测对老年高血压病人预后的评价

目的：确定动态血压是否比诊室血压能更好地预测经治老年高血压患靶器官的损害。方法：根据24小时收缩压（SBP）的水平将69例病人分为3组（＜130mmHg、130－139mmHg,≥140mmHg)进行回顾性分析。结果：I组患的靶器官损害发生率明显低于后两组。结论：24小时SBP＞130mmHg和／或PP≥60mmHg可作为老年高血压患危险分层的指标。     

Twenty-four-hour ambulatory blood pressure in shift workers

Blood pressure and heart rate of 15 male shift workers were measured every 15 minutes for 24 hours during three work shifts: morning, 4:00 AM to noon; afternoon, noon to 8:00 PM; and night, 8:00 PM to 4:00 AM. For each shift, 24-hour systolic and diastolic blood pressure showed a large "trough" (the low pressure span) and a continuous range of elevated pressure (the high pressure span). Fourier series were used to model the 24-hour blood pressure profiles. A careful examination of the residuals (measured minus predicted pressures) showed that four harmonics were necessary to describe the data accurately. The model enabled localization in each blood pressure profile of the high and low pressure spans that did not coincide with the subject's work and rest periods. The time and slope of blood pressure entering and leaving these spans could also be individually determined. Mean blood pressure during the high pressure span was the same for the three shifts, but mean blood pressure during the low pressure span was lower when the subject worked in the afternoon. During that shift, the systolic blood pressure slopes entering and leaving the low pressure span were steeper than during the two other shifts. The high pressure span was longest during the night shift and shortest during the afternoon shift. Therefore, a change in the working time profoundly perturbed the 24-hour blood pressure profile.(ABSTRACT TRUNCATED AT 250 WORDS)     

Improvement in blood pressure, arterial stiffness and wave reflections with a very-low-dose perindopril/indapamide combination in hypertensive patient: a comparison with atenolol

International guidelines recommend that antihypertensive drug therapy should normalize not only diastolic (DBP) but also systolic blood pressure (SBP). Therapeutic trials based on cardiovascular mortality have recently shown that SBP reduction requires normalization of both large artery stiffness and wave reflections. The aim of the present study was to compare the antihypertensive effects of the very-low-dose combination indapamide (0.625 mg) and perindopril (2 mg) (Per/Ind) with the beta-blocking agent atenolol (50 mg) to determine whether Per/Ind decreases SBP and pulse pressure (PP) more than does atenolol and, if so, whether this decrease is predominantly due to reduction of aortic pulse wave velocity (PWV) (automatic measurements) and reduction of wave reflections (pulse wave analysis, applanation tonometry). In a double-blind randomized study, 471 patients with essential hypertension were followed for 12 months. For the same DBP reduction, Per/Ind decreased brachial SBP (-6.02 mm Hg; 95% confidence interval, -8.90 to -3.14) and PP (-5.57; 95% confidence interval, -7.70 to -3.44) significantly more than did atenolol. This difference was significantly more pronounced for the carotid artery than for the brachial artery. Whereas the 2 antihypertensive agents decreased PWV to a similar degree, only Per/Ind significantly attenuated carotid wave reflections, resulting in a selective decrease in SBP and PP. The very-low-dose combination Per/Ind normalizes SBP, PP, and arterial function to a significantly larger extent than does atenolol, a hemodynamic profile that is known to improve survival in hypertensive populations with high cardiovascular risk.     

Mechanism(s) of selective systolic blood pressure reduction after a low-dose combination of perindopril/indapamide in hypertensive subjects: comparison with atenolol

OBJECTIVES: The goal of this study was to determine if a low-dose combination of the angiotensin-converting enzyme inhibitor perindopril (Per) and the diuretic indapamide (Ind) reduces central (thoracic aorta, carotid artery) as well as brachial systolic blood pressure (SBP) more than the beta-blocker atenolol and to determine the hemodynamic factors influencing independently brachial and central SBP: pulse wave velocity (PWV) and pattern of wave reflections. BACKGROUND: In high cardiovascular risk populations, angiotensin blockade improves survival without affecting brachial SBP and diastolic blood pressure (DBP). Whether central SBP, which is physiologically lower than brachial SBP, is significantly reduced has never been investigated. METHODS: This study was a double-blind randomized trial for one year in patients with essential hypertension. RESULTS: For a similar DBP reduction, Per/Ind decreased SBP significantly more than atenolol, with a more pronounced reduction for central than for brachial SBP. After one year, the difference between brachial and central SBP was maintained by Per/Ind (8.28 +/- 1.53 mm Hg) and significantly attenuated by atenolol (0.29 +/- 1.61 mm Hg). Under atenolol, the principal factor modulating SBP reduction was mean blood pressure. Under Per/Ind, this parameter played a minor role, and the central SBP reduction implied a major role for disturbed PWV and wave reflections. CONCLUSIONS: Under Per/Ind, but not atenolol, normalization of brachial SBP is achieved with a significantly greater reduction of central SBP. This hemodynamic profile reflects changes of wave reflections issued from distal arterial and arteriolar territory, where Per/Ind, but not atenolol, is known to improve vessel wall structure.     

Spironolactone and altizide used in combination with enalapril: Twenty-four-hour ambulatory recording of blood pressure

The addition of enalapril or acebutolol to a regimen of altizide + spironolactone in patients with moderate hypotension was investigated in a multicenter study of S3 patients. The patients underwent semiambulatory 24-hour blood pressure monitoring, especially to observe hypotensive episodes. In the 25 patients uncontrolled with altizide + spironolactone alone, enalapril and acebutolol were about equally effective in reducing blood pressure. The incidence of hypotension was low and comparable for both treatment groups, provided that the initial dose of angiotensin-converting enzyme inhibitor was low (5 mg).     

Automated ambulatory blood pressure monitoring: a study in age-matched normotensive and hypertensive men

Noninvasive automated techniques have been used in this study in 29 ambulatory normotensive and hypertensive men to monitor blood pressure during a full 24-hour period. The two groups of men were carefully matched for age. The data were analyzed with respect to possible differences in the circadian pattern of blood pressure, in the variability of blood pressure, and differences in the prevalence of abnormal blood pressures between the two groups. The circadian pattern of blood pressure in hypertensive patients was displayed parallel to that in normotensive control subjects but at a significantly higher level. The difference between daytime and nighttime systolic blood pressure was greater in normotensive than in hypertensive men. However, variability of blood pressure was not different between the two subgroups. Hypertensive men showed on average a greater incidence of abnormal blood pressures than normotensive subjects. However, nine of the normotensive control subjects showed more than 25% of abnormal readings of systolic or diastolic blood pressures during a 24-hour recording period. In contrast, fewer than 25% of abnormal blood pressure readings were found in nine of the hypertensive patients. The data reported here may help to better define the use of ambulatory blood pressure monitoring techniques in the diagnosis of hypertension.     

Detecting sodium-sensitivity in hypertensive patients: information from 24-hour ambulatory blood pressure monitoring

Sodium sensitivity is an important cardiovascular risk factor for which a diagnosis requires a time-consuming protocol, the implementation of which is often challenging for patients and physicians. Our aim was to assess the reliability of an easier approach based on data from 24-hour ambulatory blood pressure monitoring performed in hypertensive subjects during daily-life conditions and habitual diet. We enrolled 46 mild to moderate hypertensive subjects who underwent 24-hour ambulatory blood pressure monitoring during usual sodium intake. Patients were divided into 3 classes of sodium sensitivity risk on the basis of ambulatory blood pressure monitoring data: low risk if dippers and a 24-hour heart rate ≤ 70 bpm; high risk if nondippers and a 24-hour heart rate of > 70 bpm; intermediate risk with the remaining combinations (dippers with heart rate > 70 bpm or nondippers with heart rate ≤ 70 bpm). Then patients underwent a traditional sodium sensitivity test for the dichotomous classification as sodium sensitive or sodium resistant and for evaluating the sodium sensitivity index. Prevalence of sodium-sensitive patients and mean value of sodium sensitivity index were calculated in the 3 risk classes. The sodium sensitivity index markedly and significantly increased from the low-risk to the high-risk class, being equal to 19.9 ± 14.4, 37.8 ± 8.3, and 68.3 ± 17.0 mm Hg/(mol/day) in the low-risk, intermediate-risk, and high-risk classes, respectively (M ± SEM). Also, the prevalence of sodium-sensitive patients increased significantly from the low-risk class (25%) to the intermediate-risk (40%) and high-risk (70%) classes. Thus, performance of 24-hour ambulatory blood pressure monitoring in daily-life conditions and habitual diet may give useful information on the sodium sensitivity condition of hypertensive subjects in an easier manner than with the traditional sodium sensitivity test approach.     

Is ambulatory blood pressure monitoring reliable in hypertensive patients with atrial fibrillation?]

Atrial fibrillation (AF) is commonly seen in patients (pts) with systemic hypertension. They are usually excluded from ambulatory blood pressure monitoring (ABPM) because its accuracy is unknown. The aim of our study was to determine if ABPM can be used to assess 24 hour BP in pts with AF. We included hypertensive pts with chronic (> 6 months) AF, controlled heart rate (60-100 c.p.m), under therapy and also hypertensive pts in sinus rhythm (control group--CG). They were submitted to 24 hour ABPM (Spacelabs 90207). Manual BP with a standard mercury sphygmomanometer was taken during 3 visits (office BP) and on the day of ambulatory monitoring. Simultaneous measurements with a T-Tube were also performed. Thirty pts with chronic AF (63% males), mean age 73 +/- 8 years (52-85) and 18 pts in sinus rhythm (CG) were studied. The age, gender, office BP, ambulatory BP and proportion of successful measurements was similar in the 2 groups. In CG systolic and diastolic office BP did not differ from day ambulatory BP (148 +/- 14/84 +/- 7 vs 138 +/- 18/76 +/- 11 mmHg) and the same was seen in pts in AF (table). In this group, only the systolic BP taken immediately before the ambulatory device was put on, was significantly different from day ambulatory BP (148 +/- 21 vs 137 +/- 19 mmHg, p = 0.04). The proportion of successful measurements in AF group was 94 +/- 8 (65-98) with 93% > 80%. In 64 simultaneous measurements the differences were 6 +/- 5 and 5 +/- 5 mmHg for systolic and diastolic BP. Casual and ambulatory heart rate was also similar in the two groups (76 +/- 7/76 +/- 12--AF group; 78 +/- 10/78 +/- 8--control group). In conclusion, this study demonstrates that ABPM can be used to assess BP in patients with atrial fibrillation. There was a high percentage of successful recordings (93%). As in patients in sinus rhythm, there was no significantly difference in mean office blood pressure and daytime ambulatory blood pressure.     

肾血管性与原发性高血压患者24h动态血压的比较

目的 比较肾血管性高血压(RVH)与原发性高血压(EH)患者24 h动态血压的差别.方法 应用动态血压监测仪观察51例RVH患者的24 h动态血压,并与年龄、性别与之相匹配的51例EH患者的24 h动态血压进行比较.结果 RVH组24 h、白天及夜间动态收缩压、舒张压及脉压均值都比EH组有不同程度的升高(P<0.05),尤以夜间收缩压升高明显;血压负荷增加明显,24 h收缩压、舒张压负荷分别达到58.96%和35.98%,而EH组血压负荷均在20.00%左右,两组比较差异有统计学意义(P<0.05).EH组夜间血压下降率为10.36%,血压曲线呈勺型(60.8%的患者夜间血压下降率>10%);而RVH组夜间血压下降率为5.39%,血压曲线呈非勺型(仅有27.50%的患者夜间血压下降率>10%).结论 RVH患者动态血压均值、脉压和血压负荷明显增加,昼夜节律减弱.

Abstract：

Objective To compare 24 h ambulatory blood pressure changes between patients with renovascular hypertension and essential hypertension.Methods The 24 h ambulatory blood pressure of patients with age and gender matched renovascular hypertension (RVH, n=51) was compared with that of patients with essential hypertension (EH, n=51).Results The 24 h, daytime and nighttime systolic blood pressures(SBP),diastolic blood pressures(DBP) and pulse pressures (PP) in RVH were significantly higher than in EH (all P<0.05), especially the nocturnal SBP (P<0.05). The SBP and DBP loads in RVH were 58.96% and 35.98% respectively, while blood pressure loads were around 20.00% in EH (P<0.05). In patients with RVH, The nocturnal blood pressure fall was 5.39%, and only 27.50% patients were dippers, while the nocturnal blood pressure fall was 10.36% and 60.8% patients were dippers in EH.Conclusion RVH patients have higher dynamic BP, PP, BP loads and blunted diurnal rhythm compared to those with EH.     

动态血压监测评价吲哒帕胺新型缓释片的降压作用

目的　评价吲哒帕胺 (商品名纳催离 ,法国施维雅药厂生产 ) 1 5mg缓释片的长效降压效果及安全性。方法　 3个中心收治的 10 8例轻、中度高血压病患者 [男 5 9例 ,女 4 9例 ,平均年龄 (5 1± 11)岁 ]服安慰剂 2周后及服吲哒帕胺 1 5mg缓释片 8周后 ,分别于早晨 8:0 0来医院佩带 2 4h动态血压监测仪 ,进行连续 30h动态血压测定 ,计算谷峰比值 (T/P)及每小时平均血压 ,同时在服吲哒帕胺1 5mg缓释片的第 2、4、8周在诊所测坐位血压。药物安全性主要观察血钾及血尿酸。结果　 10 8例轻、中度高血压患者服药后通过诊所测坐位血压评价 ,降压总有效率为 6 7 6 % ;2 4h动态血压监测结果按全部患者计算或有效病例计算 ,T/P比值结果相近。全组计算收缩压 (SBP)与舒张压 (DBP)的T/P比值分别为 0 80和 0 79。服缓释片与服安慰剂后第 2 5～ 30h动态血压监测发现 ,血压分别为 (134± 12 ) /(89± 9)mmHg (1mmHg =0 133kPa)及 (14 2± 12 ) / (92± 7)mmHg(P <0 0 1)。对 2 4h动态血压最大降压幅度≥ 2 0 / 10mmHg的 33例有反应者 ,分析其最大降压时间 ,93%在 8～ 19h,其中 14～ 17h为最高峰。服药后出现轻度低血钾 8例 (7 4 % ) ,仅 1例血钾 <3 0mmol/L(2 94mmol/L) ;血尿酸轻度升高者 18例(16 7% )。结论　吲哒