原发性高血压患者血压变异性分析

目的探讨原发性高血压病(EH)血压变异性(BPV)变化的临床意义。方法对204例EH者(A组)和92例正常人(B组)进行24h动态血压监测(ABPM),以测得的各时间段血压标准差(SD)作为BPV指标。结果与B组比较,EH者长时BPV明显增大(P<0.05)。两组白天BPV大于夜间,收缩压变异大于舒张压变异。结论EH者BPV明显高于正常人。     

血压变异性研究进展

近年来,系列临床试验及流行病学研究结果证实,高血压病对心脑血管系统的危害不仅是平均血压增加的结果,血压变异性(BPV)与平均血压水平一样影响高血压患者靶器官的损害及总体预后。随着动态血压监测技术(ABPM)的成熟及广泛应用,用其评估BPV的研究日益增多。但我国目前对高血压病的诊治,侧重于治疗后血压绝对值变化的评     

老年高血压病人血压变异性分析

目的：探讨老年高血压病患血压变异性与靶器官损害及年龄的关系。方法：对478例老年高血压病人及229例非高血压进行了24小时动态血压监测，以测得的血压标准差作为血压变异性指标。结果：高血压病患的24小时血压变异性大于非高血压（P＜0．05），高血压病人中靶器官损害的24小时血压变异性大于无损害的（P＜0．05）；各年龄组间的血压变异性无明显差别。结论：老年高血压病人24小时血压变异性增加，靶器官损害的24小时变异性更高。     

中青年原发性高血压患者晨峰血压与血压变异性的关系

目的探讨中青年原发性高血压患者晨峰血压与血压变异性的关系。方法收集2011年11月至2015年1月在北京大学人民医院高血压病房住院,既往未治疗或已停止降压药物治疗4周以上,且同时完善了24 h动态血压监测和动态心电图监测的160例中青年原发性高血压患者,分析其24 h动态血压和动态心电图监测结果。根据晨峰血压水平是否超过28.67 mmHg(所有患者晨峰血压水平的最高四分位水平)分为晨峰血压增高组(44例)和非晨峰血压增高组(116例)进行组间比较。结果与非晨峰血压增高组相比,晨峰血压增高组患者24 h收缩压变异性、24 h舒张压变异性、夜间收缩压变异性、夜间舒张压变异性均增大,这4个血压变异性指标与晨峰血压之间的相关系数分别为0.325、0.315、0.316和0.286(均为P0.001);应用Logistic逐步回归分析校正了24 h收缩压水平、日间收缩压水平和血压节律等影响晨峰血压的因素后,除夜间舒张压变异性与晨峰血压的相关性消失外,24 h收缩压变异性、24 h舒张压变异性、夜间收缩压变异性与晨峰血压的相关性仍显著存在,OR值分别为2.43(1.06~5.59)、2.23(1.16~4.30)、1.32(1.06~1.64)。结论对于中青年原发性高血压患者,昼夜血压下降程度、24 h血压变异性和夜间血压变异性均与晨峰血压明显相关。与舒张压变异性相比,收缩压变异性与晨峰血压的相关性更强。24 h收缩压水平、日间收缩压水平和晨峰心率水平也在一定程度上影响着晨峰血压。     

高血压患者血压变异性与冠脉病变的相关性

早期发现和干预血管病变,评估危险因素,对于心血管疾病的上游防治具有重要意义[1-3].24 h动态血压监测(ABPM),不仅可以提供24 h的平均血压,而且还可以了解这段时间内血压的变化情况.一定时间内血压波动的程度即为血压变异性(BPV).通常用动态血压标准差(SD)与变异系数(CV)动态血压标准差与平均值的比值(SD/mean)来表示血压随着时间的推移所发生的变异性[4].本实验探讨动态BPV与冠心病关系,为临床预防冠心病的发展提供理论依据.     

老年高血压病人血压变异性分析

目的　　探讨老年原发性高血压患者血压变异性与靶器官损害及年龄的关系。方法　对 478例老年高血压病人及 2 2 9例健康查体者 (非高血压者 )进行了 2 4h动态血压监测 ,以测得的血压标准差作为血压变异性指标。结果　原发性高血压患者的 2 4h血压变异性大于非高血压者 ;高血压病人靶器官损害者的 2 4h血压变异性大于无损害者 ;各年龄组间的血压变异性无明显差别。结论　老年高血压病人 2 4h血压变异性增加 ,靶器官损害者的 2 4h血压变异性高 ,未发现血压变异性与年龄相关     

高血压患者血压昼夜模式与心率变异性的相关性分析

目的探讨正常血压人群以及高血压人群中不同血压昼夜模式与心率变异性(HRV)的相关性分析。方法共入选2009年1月至2010年8月中山大学附属第一医院门诊及病房患者406例,其中高血压病例286例,根据动态血压监测结果分为杓型组、非杓型组和反杓型组,并设对照组120例。全部病例均在监测动态血压的同时记录动态心电图,并分析心率变异性的时域指标。结果非杓型组和反杓型组的SDNN、SDANN、SDNN index、RMSSD、pNN50和Triangular Index值均比杓型组和对照组降低(P<0.05),其中,反杓型组的上述指标明显降低。结论不同血压昼夜模式的高血压病患者HRV指标有明显差别,血压昼夜模式消失的高血压病患者自主神经功能受损更加严重。     

高血压患者动态血压变异性与心室重构的相关性

目的 观察高血压患者动态血压变异性(BPV)与心室重构的关系.方法 入选2008-03-2010-08初诊为高血压的患者120例,行24 h动态血压监测(ABPM),根据24 h收缩压BPV的总变异系数(CV)分为两组:高CV组(CV＞12.16%)和低CV组(CV≤12.16%),各组60例.另入选50例同期年龄性别...     

高血压病患者血压变异性与靶器官损害的相关性研究

目的为评价高血压病患者血压变异性与靶器官损害程度的关系。方法对１５例正常人及４３例高血压病患者按临床分期进行了２４小时无创性动态血压监测。结果高血压病Ⅲ期组２４小时、日间及夜间的收缩压、舒张压的血压变异系数（ＣＶ）均显著大于Ⅱ期组和Ｉ期组（Ｐ＜０．０５）,Ⅱ期组的２４小时、日间的收缩压、舒张压和夜间的舒张压的血压变异系数亦显著大于１期组（Ｐ＜０．０５）;血压变异度（ＳＤ）Ⅲ期组２４小时、日间及夜间的收缩压、舒张压和Ⅱ期组２４小时收缩压、日间收缩压明显高于Ｉ期组（Ｐ＜０．０５）。高血压病Ⅲ期、Ⅱ期组的血压变异系数明显大于对照组（Ｐ＜０．０５）;血压变异度Ⅲ期组以及Ⅱ期组的２４小时收缩压、日间收缩压和夜间收缩压、舒张压显著大于对照组（Ｐ＜０．０５）,高血压病Ｉ期组的血压变异系数及血压变异度与对照组相比,无显著差异。结论随着靶器官损害加重,血压变异性亦增大,血压变异系数不受降压药物治疗的影响,应用动态血压监测高血压病患者的血压变异系数对评价靶器官的损害程度有一定价值。     

动态血压变异性与高血压左心室肥厚的关系探讨

24小时动态血压监测 (2 4ｈＡＢＰＭ)广泛应用于临床 ,为高血压病及其合并症的诊断和治疗开辟新的途径。高血压左心室肥厚 (ＬＶＨ)不仅与血压水平有关 ,而且还可能与血压变异性相关。血压变异性表示血压波动程度。血压变异性与高血压ＬＶＨ之间的关系目前还不十分清楚 ,研究结     

血压变异性与高血压靶器官损害的关系

目的探讨血压变异性与高血压靶器官损害的关系。方法选择６０例高血压病人进行２４ｈ动态血压监测和静息及应激状况下短时血压监测，以各时间段血压的标准差作为血压变异性指标，并测定左心室重量指数（ＬＶＭＩ）和２４ｈ尿微量蛋白（ＭＡＵ）。结果与正常对照组比较，高血压患者长时血压变异增大，静息及心算时的短时血压变异也增大；ＬＶＭＩ，ＭＡＵ与长时血压变异显著相关，但与各状态下短时血压变异不相关。结论提示血压变异性增大是高血压患者的一个重要的临床特征，长时血压变异可能与某些靶器官（心、肾）损害有关     

Perioperative Blood Pressure Variability in the Treated Hypertensive Patients

Perioperative blood pressure (BP) management is important to prevent cardiovascular complication, especially for hypertensive patients. In the present study, we investigated perioperative BP variability and contributing factors in hypertensive patients. Subjects were 28 treated hypertensive patients who underwent total or subtotal gastrectomy. Ambulatory BP monitoring was carried out before and after (16 days in average) the surgery. Angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and diuretics were withdrawn on the previous day, while other drugs were administered until the day of surgery. BP, body weight, blood chemistry, as well as the use of intravenous vasopressor or vasodepressor agents during the perioperative period were investigated. The 24-hour BP before surgery was 124 ± 19/70 ± 12 mm Hg, and the number of antihypertensive drugs was 1.8. In 22 patients, intravenous vasopressor agents were used during surgery, while another patient received intravenous vasodepressor agents after surgery. The 24-hour BP significantly decreased after surgery (?8.2 ± 14.7/?2.6 ± 7.3 mm Hg). Body weight, serum Na, and hematocrit also decreased. There were nine patients whose 24-hour systolic BP decreased by more than 10 mm Hg and for two patients more than 20 mm Hg. The decrease in BP correlated with the change in serum Na. Forty-three percent of the patients who took ACE inhibitors/ARBs showed BP reduction greater than 10 mm Hg, while 25% of the patients without these drugs showed such BP reduction. Our findings suggest that 24-hour BP decreases after gastrectomy. Patients taking ACE inhibitors or ARBs may need careful monitoring to prevent excessive BP fall.     

伴及不伴OSA高血压患者的血压变异性和OSA相关性研究

目的研究伴或不伴睡眠呼吸暂停(obstructive sleep apnea,OSA)高血压患者的血压变异性和OSA的相关性。方法纳入阴虚阳亢型轻中度高血压患者90例,对患者行便携式睡眠仪监测、24h动态血压(ABPM)监测。观察患者血压的均值、变异性,及昼夜节律和OSA的关系;采用多元逐步回归法分析OSA和血压的关系。结果与不伴OSA的高血压患者相比,伴OSA患者的血压变异性和非杓型血压发生率明显增高,夜间血压下降率明显降低(P<0.05);其中夜间平均收缩压、24h收缩压血压标准差与睡眠呼吸暂停低通气指数(apnea hypopnea index,AHI)呈正相关,夜间收缩压下降率和AHI呈负相关(P<0.05)。结论伴OSA患者的血压变异性增高,昼夜节律紊乱。     

Ambulatory Blood Pressure Variability Is Increased in Diabetic Hypertensives

The purpose of this study was to examine the possible difference in the 24-hr BP profile—including short-term BP variability, assessed as the standard deviation—between diabetic and non-diabetic hypertensives. We measured 24-hr ambulatory BP in 11 diabetic hypertensives (diabetic HT) and 10 non-diabetic hypertensives (non-diabetic HT) who were hospitalized for the educational program in our hospital and were under stable salt intake. Renal function and sleep apnea were also estimated. There were no significant differences in 24-hr systolic BP (141 mmHg vs. 135 mmHg, ns), daytime systolic BP (143 mmHg vs. 138 mmHg, ns), and nighttime systolic BP (135 mmHg vs. 130 mmHg, ns) between diabetic HT and non-diabetic HT. The values of 24‐hr HR (69.7 beats/min vs. 65.2 beats/min, ns) and 24-hr HR variability (9.9 beats/min vs. 10.1 beats/min, ns) were also similar between the groups. Interestingly, diabetic HT had a significantly greater 24-hr systolic and diastolic BP variability than non-diabetic HT (18.2 mmHg vs. 14.5 mmHg, p < 0.05; 11.5 mmHg vs. 9.6 mmHg, p < 0.05, respectively). The values for creatinine clearance, urinary protein excretion, and apnea-hypopnea index were similar between the groups. Bivariate linear regression analysis demonstrated that fasting blood glucose was the primary determinant of 24-hr diastolic BP variability (r = 0.661, p < 0.01). Multiple stepwise regression analysis revealed that fasting blood glucose was a significant and independent contributor to 24-hr systolic BP variability (r = 0.501, p < 0.05). Taken together, these results demonstrate that BP variability is increased in diabetic hypertensives. Furthermore, it is possible that an elevation of fasting blood glucose may contribute to the enhanced BP variability in hypertensives.     

Ⅱ型糖尿病病人的动态血压与胰岛素的关系

目的了解Ⅱ型糖尿病（ＮＩＤＤＭ）病人的动态血压与血中胰岛素的关系。方法对７２例ＮＩＤＤＭ病人行２４ｈ动态血压监测，根据监测结果，分为ＮＩＤＤＭ合并高血压组３６人，未合并高血压组３６人。所有病人行空腹血糖、胰岛素及血脂等检查，并经ｔ检验和多元回归分析。结果ＮＩＤＤＭ合并高血压组较未合并高血压组的空腹血胰岛素浓度显著增高（Ｐ＜０．００１），而且胰岛素浓度分别与２４ｈ平均收缩压和舒张压呈独立的相关性（Ｐ＜０．００１）。结论ＮＩＤＤＭ病人合并高血压较未合并高血压有更高的胰岛素血症，且在ＮＩＤＤＭ病人中高胰岛素血症是高血压的独立的危险因子。     

动态血压评价福辛普利治疗老年收缩期高血压的临床疗效

目的评价福辛普利治疗老年收缩期高血压（ＩＳＨ）的临床疗效及其安全性。方法５６例轻、中度高血压患者服用福辛普利５～２０ｍｇ，１／ｄ，疗程６周，采用随测血压（ＣＢＰ）和２４ｈ动态血压监测（ＡＢＰＭ）。结果总有效率为９１．１％。谷峰比率：收缩压（ＳＢＰ）为７３．５％，舒张压（ＤＢＰ）为５２．８％。治疗后，２４ｈ平均ＳＢＰ（２４ｈＳ）、最低ＳＢＰ（ＭｉｎＳ）、最高ＳＢＰ（ＭａｘＳ）、白昼平均ＳＢＰ（ｄＳ）、夜间平均ＳＢＰ（ｎＳ）和血压负荷值（Ｓ＞１４０）均呈显著性下降（Ｐ＜０．０１）；２４ｈ平均ＤＢＰ（２４ｈＤ）、最高ＤＢＰ（ＭａｘＤ）和夜间平均ＤＢＰ（ｎＤ）亦有明显下降（Ｐ＜０．０５）。不良反应的发生率为２３．３％。结论福辛普利是治疗ＩＳＨ的安全、有效、耐受良好的药物     

原发性高血压患者短时收缩压变异性观察

目的：研究原发性高血压（EH）短时收缩压变异性（SBPV）的变化,推测SSBPV在EH上的病生理机制。方法：用无袖带式动态血压仪检测31例性别和年龄匹配的EH虱的SSBPV,并与正常组（n=32)比较,。按静坐、站立、心算、握力、踏车依次进行,第组监测10分钟,每2次心跳采样1次,有效血压记录不少于300点。结果：（1）EH组与对照组在踏车时的SSBPV较高其余的状态差异均显著（P＜0．01）。（2）对照组中SSBPV依次为握力＞站立＞心算＞静坐,且各状态间差异显著（P＜0．05）,尤其在站立与静坐间（P＜0．01）。（3）EH组心算与握力时的SBPV较同组静坐明差异显著（P＜0．05）。（4）EH组静坐、站立、心算时的SSBPV较正常组明显升高（P＜0．01）。但握力、踏车时与正常组无差异（P＞0．05）。结论：无论EH患者抑或正常人,脑力劳动与等长、等张运动是SSBPV增强的重要因素,体位改变对SSBPV的意义尚不能肯定。SSBPV既与收缩压显著升高有关,也可独立于收缩压之外,EH较正常人于静坐、站立、心算时SSBPV明显升高,但握力、踏车时差异不显著。SSBPV增大是EH一个重要特征,主要由于动脉压力反射敏感性减退及阻力小动脉结构重型所致血管收缩反应性增强,其可能参与靶器官损害。     

高血压患者血浆一氧化氮含量与动态血压的关系

目的探讨原发性高血压患者血浆一氧化氮含量变化及其与２４小时动态血压值的相关性。方法５８例原发性高血压患者，平均年龄６０．２±１１．７岁，男性３０例，女性２８例，用比色法测定血浆硝酸根含量，并用２４小时动态血压仪测量动态血压。结果高血压患者血浆硝酸根含量（１．２１±０．４３ｎｍｏｌ／ｍｌ）明显低于正常人（１．４６±０．２３ｎｍｏｌ／ｍｌ），并与疾病的严重程度相平行，相关分析显示血浆硝酸根含量与２４小时动态血压值呈负相关。结论一氧化氮在高血压病的发生、发展中起着重要的作用     

Insulin Resistance and Blood Pressure Circadian Variation in an Obese Hypertensive Population

Insulin resistance (IR) is related to arterial hypertension and target organ damage. Hypertensive individuals exhibiting a diminished nocturnal blood pressure (BP) reduction (non-dippers) have an increased incidence of cardiovascular events. The association, however, of IR with BP circadian variation has not been evaluated so far. Therefore, this study examined 226 (116 male and 110 female) overweight and obese subjects (BMI > 27kg/m²) with newly diagnosed essential hypertension who underwent clinical and laboratory evaluation, including an oral glucose tolerance test and ambulatory BP measurement (ABPM). IR was estimated using the homeostasis model assessment (HOMA-IR). The population was grouped according to HOMA-IR values > 2.75 (insulin resistance type) or < 2.75 (insulin sensitive type). Results. No significant differences were observed between dippers (n = 137) and non-dippers (n = 89) with respect to age, gender, BMI, serum cholesterol, triglycerides, LDL-C, and HDL-C levels, nor smoking habits. The proportion of IR subjects among dippers (59.1%) and non-dippers (56.7%) was similar (p = 0.833). Moreover, no significant association was found when the HOMA-IR was examined as a continuous component (p = 0.96). Conclusions. Insulin resistance is not associated with nocturnal blood pressure reduction in obese hypertensives. This may be explained by the notion that insulin secretion does not follow a circadian mode of variation.     

Ambulatory Versus Casual Blood Pressure in the Diagnosis of Hypertensive Patients

Recent advances in medical technology have enabled the development of fully automatic portable noninvasive blood pressure recorders which can reliably monitor changes of blood pressure over periods of 24 hour or more. The commercial availability of such recorders raises the question of their relevance to the practical management of hypertensive patients.

The rationale for the use of Ambulatory Blood Pressure monitoring (ABPM) is the enormous variability of blood pressure. This has been amply demonstrated with both invasive and noninvasive ABPM, and is not a matter of dispute (1,2). Since the adverse effects of blood pressure on the circulation are thought to depend either on the average level of pressure over time or possibly also on the peak levels of pressure, there is a sound theoretical reason for thinking that multiple measurementspage missing 258-258