亚低温治疗对重型颅脑损伤患者电解质的影响

目的　探讨亚低温治疗对重型颅脑损伤患者电解质的影响。方法　收集 4 2例重型颅脑损伤 (GCS≤ 8分 )患者 ,平均年龄 4 1 7岁。亚低温组于伤后 12h内实施亚低温治疗 ( 32～ 34℃ ) ,时程 3～ 5d ;对照组入院后给予常规治疗。于降温前和降温 2 4、4 8、72h及复温后各时段查血电解质 ,并搜集相应时段的 2 4h尿查电解质 ,进行统计学分析。结果　降温前和复温后两组血清及尿K 、Mg2 差异无显著性 ( P >0 0 5 )。而在降温 2 4、4 8、72h时段 ,亚低温组血清K 、Mg2 水平明显低于对照组 ;亚低温组尿量及尿K 、Mg2 水平明显高于对照组 (P <0 0 5 )。两组血Na 水平在各时段无显著差异 (P >0 0 5 )。结论　亚低温治疗重型颅脑损伤时 ,可能导致低血K 、Mg2 。亚低温治疗过程中应及时给予补充和纠正电解质的损失。     

两种灌洗液对前列腺增生电切手术患者术后电解质及血浆渗透压的影响

目的:比较以无菌蒸馏水和5%甘露醇作为灌洗液对前列腺电切手术患者术后电解质和血浆渗透压的影响. 方法:将60例患者随机分为蒸馏水灌洗组(A组)和5%甘露醇灌洗组(B组),分别于手术前及手术后2h、4h、8h、24h各采取血样本,测试血钾(K )、钠(Na )、氯(Cl-)、空腹血糖(FPG)和血浆渗透压(Posm)的变化. 结果:与A组比较,术前B组各指标无显著变化(P>0.05).术后2h、4h、8h,B组血浆K 浓度较A组低,Na 、Cl-血浆浓度及Posm较A组高(P<0.05).术后24h两组各指标比较无显著性差异(P>0.05).两组FPG比较无显著性差异(P>0.05). 结论:与蒸馏水灌洗比较,以5%甘露醇作为灌洗液对术后电解质和血浆渗透压的影响较小.     

托拉塞米对心脏瓣膜置换术后患者在ICU中的疗效观察

目的观察静脉给予托拉塞米对风湿性心脏病瓣膜置换术后患者在ICU中的临床疗效。方法以60例使用呋塞米利尿的患者为对照,观察52例风湿性心脏病瓣膜置换术后第3天的患者静脉给予首剂托拉塞米注射液后药物作用时间、血液电解质的变化;同时保持每天入量,静脉补钾、钠量相当,记录不同时段尿量,并测定尿液中钾、钠量。观察患者的症状、心率、呼吸、心电图和血流动力学变化及不良反应。结果两组患者在ICU治疗中均未出现恶心等消化道不良反应,给药前后血压、呼吸、心率、心电图和血流动力学均未出现显著改变。托拉塞米首剂静脉给药较呋塞米首剂给药作用时间明显延长(P<0.01)。当首剂给药后、尿量达到500 mL时,托拉塞米组血液电解质波动范围明显较小(P<0.01,P<0.05)。给药后0～4 h托拉塞米组尿量高于呋塞米组,尿钾、钠低于呋塞米组(P<0.05);0～12 h托拉塞米组尿量明显高于呋塞米组,尿钾、钠显著低于呋塞米组(P<0.01);0～24 h、48～72 h两组比较差异无统计学意义。结论对于风心病瓣膜置换术后早期在ICU中的患者,托拉塞米利尿作用及对机体内环境的稳定性明显优于呋塞米。     

肾移植术后多尿期尿中电解质的变化规律及输液护理

目的观察肾移植患者术后24h内尿中电解质的变化规律,分析术后电解质改变的影响因素。方法随机选取40例肾移植患者,术后均给予EG溶液补液,分别测定术后1h,5h,9h,13h,17h,21h尿中的电解质浓度。结果尿中钠离子、氯化物浓度与正常人相似,钾离子和钙离子浓度低于正常人。尿中钠、氯化物、钙离子随时间推移浓度逐渐下降,尿钾浓度相对恒定。结论尿中钠、钾、钙离子的改变可能与术前使用速尿及术后渗透性利尿有关,而氯化物的变化可能与钠离子的协同转运有关。术后多尿期的存在致大量电解质丢失,应及时补充。     

急性颈髓损伤病人的水钠代谢变化及尿PGE2变化

目的研究急性完全性颈髓损伤病人继发的水钠代谢紊乱及尿中前列腺素PGE2排出量的相应变化,探讨颈髓损伤病人继发水钠代谢紊乱的发生机制.方法完全性颈髓损伤(CSCI)病人28例,对照18例.检测血压、心率、血电解质、尿量、液体入量以及尿电解质排出量的变化,放免检测尿前列腺素PGE2的变化.结果 CSCI组血Na+值低于对照组(P＜0.01),92.9%可出现低钠血症.CSCI组尿量(P＜0.01)及24 h尿Na+排出量(P＜0.05)均高于对照组;血压、心率均低于对照组(P＜0.01);24 h尿PGE2排出总量高于对照组(P＜0.01).结论颈髓损伤后交感神经系统抑制,血压降低,肾血流量减少,肾皮质缺血缺氧,继而刺激肾脏前列腺素合成增多,产生利钠利尿作用,可能是颈髓损伤继发低钠血症的发生机制之一.     

血管迷走性晕厥儿童24h尿电解质含量变化

目的 探讨血管迷走性晕厥儿童24 h尿电解质含量变化,对临床补盐补液治疗提供依据.方法 2004-06～2007-04在中南大学湘雅二医院晕厥专科门诊就诊或住院的不明原因晕厥或先兆晕厥儿童79例(晕厥组),男31例,女48例,平均年龄(11.18±2.47)岁.匹配健康儿童11例为对照(对照组).研究对象留取24 h尿,测量尿量后,采用日本HITACHI公司7600-020全自动生化分析仪检测24 h尿电解质(钾、钠、氯、钙、磷、镁)含量.结果 ①晕厥组24 h尿量较对照组减少(P>0.05),24 h尿电解质含量变化不明显(P>0.05),每毫升尿钠和尿钙增加(P<0.01或P<0.05).②晕厥儿童HUTT阳性组24 h尿钠、尿钾较HUTT阴性组明显增加(P<0.05),每毫升尿钠增加(P<0.05).③晕厥儿童24 h尿电解质含量和每毫升尿电解质含量在血管抑制型与心脏抑制型 混合型组、男女性别、<12岁组与≥12岁组、晕厥频次<4次组和晕厥频次≥4次组之间比较差异无统计学意义(P>0.05).结论 24 h尿钠含量增加与VVS发病关系密切,临床治疗VVS要强调健康教育,重视补盐补液方案.     

24小时尿钠排泄与难治性高血压患者血压达标状态的相关性:单中心横断面研究

  目的  分析24 h尿钠排泄与难治性高血压(resistant hypertension,RH)患者诊室血压及家庭自测血压(home blood pressure monitoring,HBPM)达标状态的关系。  方法  通过北京协和医院心内科门诊RH数据库,收集2017年10月至2018年3月间在北京协和医院心内科门诊就诊的RH患者临床资料,进行横断面调查。检测患者24 h尿钠,记录患者同期诊室血压、HBPM水平及临床用药情况,以所有患者24 h尿钠水平四分位数为分界点,将研究对象分为低尿钠、低-中尿钠、中-高尿钠及高尿钠4组。采用多因素Logistic回归,分析影响RH血压达标状态的危险因素。  结果  共202例RH患者入选本研究,男性107例,女性95例,平均年龄(59.87±16.30)岁。24 h尿钠平均水平为(198.92±96.59)mmol,年轻患者及体质量指数高者尿钠水平更高(P均＜0.001)。随尿钠升高,降压药物的服用种类显著增多(P=0.001),早晨及上午的HBPM达标率低(P=0.040, 0.032)。多因素Logistic回归分析显示,24 h尿钠水平与诊室血压(OR=2.356, 95% CI:1.004~5.533, P=0.049),HBPM早晨血压(OR=2.408, 95% CI:1.026~5.650, P=0.030)及HBPM上午血压(OR=2.299, 95% CI:1.031~5.129, P=0.033)达标状态独立相关,而与下午及夜间HBPM血压达标状态无显著相关(P均＞0.05)。  结论  24 h尿钠是RH患者诊室血压及HBPM早晨及上午血压达标的独立相关因素,限制钠盐摄入对减少RH患者血压波动、促进血压达标有重要作用。     

达格列净对2型糖尿病患者血、尿电解质的影响

目的 观察单用二甲双胍血糖控制不佳（糖化血红蛋白,HbA1c＞7.5%）的2型糖尿病（T2DM）患者,应用达格列净后对血电解质（血钠、血钾、血钙）、尿电解质（24小时尿钠、24小时尿钾、24小时尿钙）、尿渗透浓度及其他代谢指标的影响,评估用药后的安全性。方法 选取在2017年9月至2019年4月期间,于沧州市人民医院本部院区内分泌门诊及住院部就诊的103例T2DM患者,按照随机抽样法分成对照组（55例）和试验组（48例）。对照组给予二甲双胍治疗,试验组给予二甲双胍联合达格列净治疗。观察用药24周后患者血电解质、尿电解质、尿渗透浓度及其他代谢指标较基线和对照组的变化以及评估用药的安全性。结果 治疗24周后,试验组的尿电解质、尿渗透浓度水平较基线及对照组均有所升高,差异有统计学意义(P＜0.05);试验组的血糖参数、总胆固醇（TC）、甘油三酯（TG）、24小时尿蛋白、体重指数（BMI）、体重水平较基线及对照组降低,差异存在统计学意义(P＜0.05);血电解质、尿pH、低密度脂蛋白胆固醇（LDL C）、高密度脂蛋白胆固醇（HDL C）、估算的肾小球滤过率（eGFR）水平较基线及对照组无明显变化,差异无统计学意义(P＞0.05)。结论 在单用二甲双胍控制不佳的T2DM患者中联合应用达格列净治疗,可有降低血糖、改善血脂、减轻体重、减少尿蛋白等多重获益,虽然会引起尿电解质增多及尿渗透浓度升高,但血电解质水平无明显改变,无严重不良事件发生,使用上更安全。     

尿钾排泄量减少与高血压正常高值期患者发生高血压的关系研究

目的探究尿钾排泄量与高血压前期患者发生高血压的关系。方法本研究选取于2011年1至7月在社区体检时检出的高血压前期患者200例为观察组,同时选取血压正常的志愿者200例进行对照。从早6点开始,于次日6点结束收集入组人员24 h尿液,进行尿钾排泄量测定,同时测量人员血压,数据统计后进行分析,比较两组人员尿钾排泄量的差异及尿钾排泄量与血压的相关关系,随访3年,记录发生高血压的例数,同时测量尿钾排泄量,比较患高血压与未患高血压人群尿钾排泄量的差异。结果观察组患者24 h尿钾排泄量为(29.01±7.30)mmol/L,对照组为(36.40±10.04)mmol/L,两组比较,差异具有统计学意义(P<0.05);对24 h尿钾排泄量与血压的相关关系进行分析,结果提示24 h尿钾排泄量与血压存在负相关(r=-0.79,P<0.05);3年内,高血压前期人群中有74例发展为高血压,24 h尿钾水平为(25.37±5.23)mmol/L,未发展为高血压的126例,24 h尿钾水平为(30.05±7.44)mmol/L,两组比较,差异具有统计学意义(P<0.05)。结论尿钾排泄量与高血压前期患者血压存在负相关,即患者血压越高,尿钾排泄量越低,临床上可以通过尿钾排泄量的测定来及早预防高血压的发生。     

血压负荷与老年高血压病并靶器官损害

目的 :采用动态血压 (ABPM)监测方法研究老年原发性高血压 (EH)患者的血压负荷变化与靶器官受损的关系。方法 :对 86例老年 (EH)患者进行 2 4h动态血压监测 ,根据检测结果随机分为杓型组或非杓型组 ,并分析血压负荷与高血压所致的靶器官损害 (心房纤颤、室性心律失常 ,充血性心力衰竭、脑血管意外 )进行比较。结果 :2 4h动态平均收缩压 (SBP)和平均舒张压(DBP)与上述各项事件有明显差异 (P <0 .0 1) ,脑血管意外发生与夜间平均SBP、DBP有显著差异 (P <0 .0 1)。而动态血压中有杓型变化与无杓型变化者比较 ,其心脑血管并发症的发病率明显降低 ,血压负荷值 >35 %是心脑血管疾病发生的信号。结论 :血压昼夜节律、2 4h总体SBP水平及SBP、DBP负荷值是导致老年高血压并心脑在管疾病发生率高的主要原因     

Antihypertensive effect of oral potassium aspartate supplementation in mild to moderate arterial hypertension.

BACKGROUND: Previous studies showed that potassium chloride (48-120 mmol/day) supplementation reduced arterial blood pressure (BP) in hypertensive patients. OBJECTIVES: Our aim was to evaluate the effect of a lower dose of potassium aspartate salt on BP in individuals with essential arterial hypertension. METHODS: One hundred and four patients (65 males, age 53 +/- 12 years) with mild to moderate essential hypertension (systolic/diastolic BP 154.2/96.2 +/- 10.8/5.4 mmHg) were allocated in two comparable groups of 52 to receive or not 30 mmol/day per os of potassium aspartate supplementation for four weeks. Office and 24-h BP, as well as serum and urinary electrolytes, were measured at baseline and at the follow-up visit after four weeks. RESULTS: Office and 24-h BP did not change in the control group, while these values were significantly reduced in the potassium supplementation group. Changes in office (systolic BP: 154.4 +/- 8.2 vs. 142.2 +/- 7.6 mmHg; diastolic BP: 95.0 +/- 5.6 vs. 87.2 +/- 4.3 mmHg, P < 0.001 for both) and 24-h BP (systolic BP: 142.7 +/- 8.2 vs. 134.8 +/- 6.3 mmHg; diastolic BP: 90.8 +/- 4.4 vs. 84.6 +/- 3.8 mmHg, P < 0.001 for both) following potassium supplementation were highly significant. The changes in day time and night time BP were similar. The treated group showed significantly increased potassium serum level and 24-h urinary excretion of potassium (P < 0.01 in both cases) after four weeks, while the untreated group showed no significant changes of the same parameters. Urinary Na/K ratio decreased significantly with potassium supplementation (P < 0.001). In the treated group changes in office (r = 0.58, P < 0.001) and 24-h SBP (r = 0.51, P < 0.001), but not in DBP (r = 0.29 and r = 0.25, n.s.), correlated positively with the urinary Na/K ratio at baseline. CONCLUSIONS: A relatively low supplementation of 30 mmol/day of potassium as aspartate lowered office and 24-h ambulatory BP in subjects with mild to moderate essential hypertension. The antihypertensive effect was sustained throughout the day, and was greater in the patients with high basal urinary Na/K ratio.     

Decrease in oxidative stress through supplementation of vitamins C and E is associated with a reduction in blood pressure in patients with essential hypertension

Oxidative stress has been associated with mechanisms of EH (essential hypertension). The aim of the present study was to test the hypothesis that the antioxidant properties of vitamins C and E are associated with a decrease in BP (blood pressure) in patients with EH. A randomized double-blind placebo-controlled clinical trial was conducted in 110 men with grade 1 EH (35-60 years of age without obesity, dyslipidaemia and diabetes mellitus, non-smokers, not undergoing vigorous physical exercise, without the use of any medication and/or high consumption of fruit and vegetables). Participants were randomly assigned to receive either vitamins C+E [vitamin C (1 g/day) plus vitamin E (400 international units/day)] or placebo for 8 weeks. Measurements included 24 h ambulatory BP and blood analysis of oxidative-stress-related parameters in erythrocytes (GSH/GSSH ratio, antioxidant enzymes and malondialdehyde) and plasma [FRAP (ferric reducing ability of plasma)], and levels of 8-isoprostane, vitamins C and E were measured at baseline and after treatment. Following administration of vitamins C+E, patients with EH had significantly lower systolic BP, diastolic BP and mean arterial BP and higher erythrocyte and serum antioxidant capacity compared with either placebo-treated patients with EH or the patients with EH at baseline prior to treatment. BP correlated positively with plasma 8-isoprostane levels and negatively with plasma FRAP levels in the vitamins C+E- and placebo-treated groups. In conclusion, the present study supports the view that oxidative stress is involved in the pathogenesis of EH, and that enhancement of antioxidant status by supplementation with vitamins C and E in patients with EH is associated with lower BP. This suggests intervention with antioxidants as an adjunct therapy for hypertension.     

Possibilities of achieving target blood pressure in patients with essential hypertension in relation to renal functional status and age

AIM: To study renal functional changes in patients with essential hypertension (EH) and normal blood creatinine levels during antihypertensive therapy with currently available drugs to achieve blood pressure lower than 140/90 mm Hg. MATERIALS AND METHODS: Renal functional changes were studied in 114 patients with EH and normal blood creatinine levels during antihypertensive therapy aimed at achieving blood pressure lower than 140/90 mm Hg. Glomerular filtration rate (GFR) was calculated by the Cockcroft-Gault formula and blood creatinine levels were measured before and 6, 12, 24, 52 weeks of treatment. RESULTS: Renal dysfunction was detected in 43.9% of the patients as GFR < 80 ml/min in 35.1% and hyperfiltration (GFR > 140 ml/min) in 8.8%. The patients with baseline decreased GFR were older, had a longer history of EH, and lower body-mass index than those with hyperfiltration (p < 0.05). There was a considerable renal functional improvement in patients with baseline decreased GFR and achieved BP < 140/90 mm Hg. Target BP could be achieved only in 20% of the patients with hyperfiltration. Antihypertensive therapy caused reduced hyperfiltration in these patients. In patients aged over 60 years who had a baseline GFR < 80 ml/min, achievement of target BP also promoted renal functional improvement. CONCLUSION: Most patients with EH and normal blood creatinine levels have renal dysfunction. Normalization of BP substantially improves renal functional parameters irrespective of age.     

Baroreceptor regulation of arterial pressure in elderly patients with systolic and essential hypertension

AIM: To study efficiency of baroreceptor regulation of circulation with reference to vegetative regulation of the heart (VRH) and 24-h rhythms of blood pressure (BP) in elderly patients with systolic hypertension (SH) and essential hypertension (EH). MATERIAL AND METHODS: Synchronous 24-h monitoring of BP, ECG with evaluation of VRH by the system Cardio Tens 01 (Meditech, Hungary), examination of BP baroreceptor regulation from carotid areas with the method "cervical Camera" and in performing active orthostatic test were conducted in 50 elderly patients with mild and moderate SH and EH. RESULTS: Weakening of BP baroresponse was more noticeable in SH patients than in EH patients though the cardiochronotropic component of baroreflex in EH was stronger. Stimulation of the carotid baroreflex by elevated BP is accompanied by different weakening of adrenergic efferentation depending on AH form. The results of testing baroreflex by BP reduction in the group of SH patients point to the absence of efficient reactions of systemic circulation. In EH, circulation reacts extra actively. The condition of the cardiovascular system in SH is characterized by marked amplitude hypertension and asynchronous 24-h rhythm of vegetative impacts on the myocardium in the presence of subnormal afferentation of carotid receptors. CONCLUSION: The baroreflex control of the cardiovascular system in various forms of AH differs from that of normotensive subjects. The baroreflex and parameters of 24-h profile of AP and VRH are correlated.     

慢性阻塞性肺疾病急性加重期患者体液离子含量的变化

目的：了解慢性阻塞性肺疾病（COPD）患者体液离子含量的变化。方法：选择46例合并肺心病的COPD急性加重期患者，测定其血清、红细胞、白细胞及24h尿K、Na、Ca、Mg离子含量。结果：患者自细胞Ca增高，红细胞Ca、Mg、K及白细胞Mg、血清Mg、Na均显著降低。红细胞Mg与白细胞Mg显著正相关。该组患者尿Ca增多占54％，尿K、Na、Mg减低者分别占92％，65％及32％。结论：COPD患者存在K、Mg缺失，用红细胞Mg评价机体的Mg状态更具有实用性。     

Co-renitek treatment of patients with moderate and severe forms of hypertensive disease

AIM: To evaluate efficacy and tolerance of a compound drug co-renitec combining an ACE inhibitor enalapril maleate and diuretic hydrochlorothiazide co-renitec taken for 16 weeks in essential hypertension (EH). MATERIAL AND METHODS: 28 patients with EH (16 males and 12 females aged 47-74 years) of mean duration 13.1 +/- 1.6 years. Blood pressure (BP) was monitored for 24 hours with the device SL 90207 (SpaceLabs Medical, USA). Microalbuminuria (MAU) was estimated with the use of immunoturbodimetric test. RESULTS: By 24-hour monitoring, co-renitec reduced day BP by 14.9/8.9 +/- 3/2 mm Hg, nocturnal BP lowered by 18.6/11.4 +/- 3/2 mmHg, pulse pressure also fell. Coefficient T/P was 53.5% for systolic BP (SBP) and 59.6% for diastolic BP (DBP). The target SBP was reached in 77% patients, target DBP--in 69%. Co-renitec significantly decreased MAU, albumines excretion normalized in 46% patients. CONCLUSION: Co-renitec lowers both day and nocturnal blood pressure, improves 24-h rhythm of BP, has a positive effect on the kidneys. This allows its recommendation as a first-line drug in patients with moderate and severe EH.     

Clinical efficiency and tolerance of hydrogen sulfide balneotherapy in hypertensive patients living in arid zone

AIM: To examine clinical efficiency and safety of moderate hydrogen sulfide (HS) baths in the treatment of hypertensive patients living in arid zones. MATERIAL AND METHODS: Sixty patients with stable essential hypertension (EH) of stage I-II according to WHO classification living in arid climate took sparing HS baths. Efficiency of the baths was assessed by changes in blood pressure (BP), 24-h monitoring of BP. RESULTS: It is shown that systolic and diastolic BP after HS balneotherapy fell significantly both in daytime and at night. The 24-h profile of BP improved, heart rate decreased by 4.3%, physiological fluctuations of BP and BP variability were not damaged. CONCLUSION: Moderate HS baths are recommended for wider use in a hot climate of the arid zone as an effective and safe method of balneotherapy which can be adjuvant to basic medication of EH.     

高血压合并脑卒中24 h动态血压的变化

目的；研究高血压并脑卒中患者24h动态血压变化特征。方法 应用美国Spacelabs90217动态血压监测仪观察了90例高血压并脑卒中患者24h动态血压，并与年龄、性别相配对的90例原发性高血压（EH）患者进行比较；比较了脑卒中患者中35例脑出血患者和55例脑梗死患者的24h动态血压。结果：高血压并脑卒中患者24h动态血压均值高于EH患者；24h血压曲线：波峰血压值相近，夜间波谷两值差别较大。两组昼夜节律有极显著差异（P〈0．01）。脑卒中组中脑出血组24h动态血压均值高于脑梗死组。结论：血压增高，昼夜节律消失有发生脑卒中可能，应加紧防治。     

Sodium-lithium countertransport and the Gly460-->Trp alpha-adducin polymorphism in essential hypertension

A polymorphism of the alpha-subunit of adducin, Gly460-->Trp, may affect membrane ion transport and be associated with human EH (essential hypertension). The alpha-adducin Gly460-->Trp polymorphism was determined in 242 NC (normal controls) and 73 patients with EH and was related to the membrane ion transport marker in EH, erythrocyte Na/LiCT (sodium-lithium countertransport), in a subgroup of these subjects. The Km for external sodium was lower in patients with EH than NC. The Km of the Trp allele was lower than with the Gly/Gly genotype [NC, 105+/-6 compared with 88+/-5 mmol Na/l respectively (P=0.05); patients with EH, 76+/-5 compared with 64+/-4 mmol Na/l respectively (P=0.06)]. The Km was lower in patients with EH than NC for any adducin genotype. Thiol alkylation with NEM (N-ethylmaleimide) caused a decrease in Km in NC, but not in patients with EH. With a Trp allele, NEM lowered Km less in NC (-20 compared with -35) and increased it in patients with EH (+24 compared with +3; P=0.007 for genotype effect). Thiol alkylation with NEM caused an increase in Vmax in patients with EH but not in NC. With a Trp allele, NEM increased Vmax substantially in patients with EH (+0.12 compared with +0.03) but did not cause a decrease in NC (+0.02 compared with -0.06; P=0.007 for genotype effect). In conclusion, the Gly460-->Trp polymorphism of alpha-adducin modifies the kinetics of Na/LiCT. The effect of this genotype is different in patients with EH compared with NC and it does not explain the abnormal kinetics in patients with EH. The Trp allele was not associated with disease in the population studied. Several cytoskeletal proteins may interact with adducin in the overall phenotype of EH.     

Prognostic value of the degree of night decrease of systolic pressure in patients with mild and moderate forms of hypertension (7-9-year prospective study)

AIM: To study a relationship between a carcadian blood pressure (BP) rhythm and cardiovascular events (CE) during 7-9 year follow-up in males with mild to moderate essential hypertension (EH). MATERIAL AND METHODS: 50 males (mean age 48.6 +/- 0.7 years) with mild to moderate EH were prospectively followed up for 7-9 years (8.4 +/- 0.1 years). We analysed 24-h BP recordings and protocol of echocardiography performed during the first hospitalization. The patients were divided into three groups: group 1 (n = 18) with normal (10-20%) nocturnal fall of systolic BP (NF SBP) and normal left ventricular mass index (LVMI < 125 g/m2); group 2 (n = 16) with insufficient (< 10%) NF SBP and normal LVMI; group 3 (n = 16) with LVMI > 125 g/m2. In these groups we assessed the prevalence of CE: myocardial infarction (MI), stroke (S), sudden death (SD), new cases of angina pectoris (AP), transient cerebral ischemic attack (TIA). RESULTS: No significant differences were found between the groups by mean age, body mass index, duration of arterial hypertension, mean 24-h and awake systolic and diastolic BP while significant differences were by nighttime BP profile parameters. During the follow-up 16 CE in 12 patients were documented (3 fatal and 13 nonfatal). In group 1 CE were observed in 1 patient (twice MI), in group 2-7 cases of CE (1 S, 1 TCIA, 2 MI, 2 AP) in 6 patients, in group 3-7 cases (2 MI, 3 TIA, 2 AP) in 5 patients, 3 of them were fatal. CONCLUSION: Insufficient nocturnal fall of SBP (< 10%) is an adverse prognostic factor for cardiovascular morbidity in mild to moderate essential male hypertensives.