Circadian variation of blood pressure in patients with diabetic nephropathy

Summary The association between diurnal blood pressure variation and diabetic nephropathy was assessed in four groups of Type 1 (insulin-dependent) diabetic patients who underwent 24-h ambulatory blood pressure monitoring using an oscillometrie technique. Patients with nephropathy, who had never been treated for hypertension (group D₃,n = 13), were individually matched for age, sex and diabetes duration to a group of microalbuminuric patients (D₂,n = 26), to normoalbuminuric patients (D₁,n = 26) and to healthy control subjects (C,n = 26). Group D3 was also compared to patients with advanced nephropathy receiving treatment for hypertension, mainly a combination of angiotensin converting enzyme inhibitors, metoprolol and diuretics (D₄,n = 11). In group D₃ 24-h diastolic blood pressure (85 ± 8 mm Hg) was comparable to the results obtained in D₄ (85 ± 8 mm Hg) but significantly higher than in D₂ (78 ± 7 mm Hg), D₁ (73 ± 7 mm Hg) and C (73 ± 7 mm Hg,p < 0.05, Tukey's test). The night/day ratio of diastolic blood pressure was higher in D₃ (86 ± 5 %) and D₂ (85 ± 7%) than in C (80 ± 7 %,p < 0.02). This ratio was also elevated in group D₄ (94 ± 8%) compared to D₃ (p < 0.05) corresponding to a marked smoothing of the diurnal blood pressure curve. The 24-h heart rate (beats per min) was significantly elevated in D₃ (84 ± 8) and D₂ (80 ± 10) compared with C (73 ± 11,p < 0.05 Tukey's test), suggesting the presence of parasympathetic neuropathy In conclusion the normal circadian variation of blood pressure was moderately disturbed in a group of microalbuminuric patients and patients with less advanced overt nephropathy. Patients with advanced diabetic nephropathy receiving antihypertensive therapy showed a marked reduction of nocturnal blood pressure fall, which can only be identified by the application of ambulatory blood pressure measurements to verify the 24-h effectiveness of blood pressure control.     

24‐h ambulatory blood pressure variability and hypertensive nephropathy in Han Chinese hypertensive patients

Blood pressure (BP) is characterized by spontaneous oscillation over time, which is described as BP variability (BPV). The current study aimed to investigate whether short‐term BPV was correlated with hypertensive nephropathy in Han Chinese individuals with hypertension. A single‐center prospective cohort study of 300 Han Chinese participants with hypertension was conducted in Taiwan. Five different BPV parameters were derived from ambulatory BP monitoring (ABPM), including standard deviation (SD), weighted SD (wSD), coefficient of variation (CoV), successive variation (SV), and average real variability (ARV). Renal event was defined as > 50% reduction in baseline estimated glomerular filtration rate (eGFR). The average age of the participants was 63.5 years. The baseline eGFR was 84.5 mL/min/1.73 m². The participants were divided into two groups according to the wSD of systolic BP (SBP). Survival was assessed via a Kaplan‐Meier analysis. During the 4.2‐year follow‐up, the participants with the highest SBP wSD tertile had a greater number of renal events (6.0%) than their counterparts (0.5%) (log‐rank test, p = .007). The Cox proportional hazard regression model was used to assess the independent effects of BPV, and results showed that 24‐h SBP (HR = 1.105; 95% CI = 1.020–1.197, p = .015) and 24‐h DBP (HR = 1.162; 95% CI = 1.004–1.344, p = .044) were independently associated with renal events. However, BPV parameters were only associated with renal events univariately, but not after adjusting for baseline characteristics, 24‐h mean BP, and office BP. Therefore, the risk of hypertensive nephropathy was independently associated with 24‐h mean BP, but not with ambulatory BPV, in Han Chinese participants with hypertension.     

超声造影联合动态血压评价原发性高血压患者的价值分析

目的：探讨超声造影联合动态血压评价原发性高血压患者的价值。方法：2013年2月到2015年12月选择在我院诊治的单纯原发性高血压患者(对照组,n=125)与原发性高血压肾病患者(高血压肾病组,n=125)作为研究对象,两组都进行动态血压监测和超声造影检测,同时进行相关性分析。结果：高血压肾病组的24 h SBP、24 h DBP和24 h PP值均明显高于对照组,对比差异有统计学意义(P<0.05)。高血压肾病组的达峰时间明显多于对照组(P<0.05),而两组的峰值强度、曲线下面积、曲线尖度对比差异无统计学意义(P>0.05)。Spearman相关分析显示在高血压肾病患者中,24 h SBP、24 h DBP和24 h PP均与超声造影的达峰时间存在显著正相关(r=0.293,0.413,0.433, P<0.05);多因素Logistic 逐步回归分析显示24 h SBP、24 h DBP、达峰时间对高血压肾病有独立的预测价值(P<0.05)。结论：超声造影联合动态血压评价原发性高血压肾病具有良好的相关性,可为高血压肾病早期诊断及防治提供了新思路,具有很好的应用价值。     

Increased sympathetic activity during sleep and nocturnal hypertension in Type 2 diabetic patients with diabetic nephropathy.

AIMS: To elucidate the putative factors involved in the blunted nocturnal blood pressure reduction in hypertensive Type 2 diabetic patients with diabetic nephropathy. METHODS: Extracellular fluid volume and fluid shift from interstitial to plasma volume (haematocrit), sympathetic nervous activity (plasma noradrenaline and adrenaline) and the internal 'body clock' (serum melatonin) were investigated in 31 hypertensive Type 2 diabetes mellitus (DM) patients with diabetic nephropathy (24 males, age 60 (45-73) years). All variables, except extracellular volume, were measured repeatedly with the patients lying awake in bed from 21:30 to 23:00 h (baseline) and during sleep from 23:00 to 07:00 h. Using the median nocturnal blood pressure reduction (8.4%) as a guide, the patients were divided into groups; group 1 with the highest and group 2 with the lowest nocturnal blood pressure reduction. RESULTS: Haematocrit decreased from baseline to the sleep period in group 1 by a mean (95% confidence interval (CI)) of 1.7 (0.3-3.1)%, but it increased by 0.5 (-1.0-1.9)% in group 2, mean difference (95% CI), -2.1 (-4.0 to -0.2)% (P = 0.029). Noradrenaline decreased from baseline to the sleep period, mean (95% CI), by 13.3 (0.0-25.0)% in group 1 but rose by 7.7 (-9.7-28.4)% in group 2, mean difference (95% CI), -19.6 (-35-0.0)% (P = 0.049). The nocturnal blood pressure change correlated to the nocturnal change in both noradrenaline (r = 0.51, P = 0.004) and haematocrit (r = 0.42, P = 0.018). Adrenaline remained constant in both groups. Extracellular fluid volume and plasma melatonin levels were comparable in the two groups. CONCLUSION: Sustained adrenergic activity during sleep is associated with blunted nocturnal blood pressure reduction in hypertensive Type 2DM patients with diabetic nephropathy, probably mediated through a lack of peripheral vasodilatation whereas changes in extracellular fluid volume distribution and melatonin secretion have no impact.     

Increased secretion of TGF-beta1 by peripheral blood mononuclear cells from patients with Type 1 diabetes mellitus with diabetic nephropathy.

AIMS: To study transforming growth factor (TGF)-beta1 secretion by peripheral blood mononuclear cells (PBMC) from Type 1 diabetic patients with and without nephropathy. METHODS: Thirty normoalbuminuric Type 1 diabetic patients (urinary albumin excretion rate (AER) < 20 microg/min), 12 microalbuminuric (AER 20-200 microg/min), 10 nephropathic (AER > 200 microg/min), and 13 non-diabetic individuals were recruited. TGF-beta1 secretion by PBMC was measured by enzyme immunoassay (EIA) after 48 h culture with and without phytohaemagglutinin (PHA) (5 microg/ml). RESULTS: After 48 h culture, the highest TGF-beta1 levels secreted by unstimulated PBMC were found in patients with nephropathy (median 6.2 (range 0.9-20.0) ng/ml) when compared to patients with normal albumin excretion (4.1 (0.2-11.3) ng/ml), microalbuminuria (1.8 (0.2-6.4) ng/ml) and healthy controls (1.0 (0.2-7.0) ng/ml); P = 0.02 for the three diabetic groups and P = 0.006 for all groups. At 48 h, the PHA-stimulated TGF-beta1 levels were 12.4 (2.9-30.0) ng/ml in nephropathic, 7.3 (0.5-21.2) ng/ml in normoalbuminuric, and 5.5 (0.5-27.6) ng/ml in microalbuminuric patients (P = 0.05). A correlation was observed between TGF-beta1 and diastolic blood pressure in the subgroup of patients with incipient and overt nephropathy (r = 0.45, P = 0.04). CONCLUSIONS: Type 1 diabetic patients with overt nephropathy show increased TGF-beta1 secretion by PBMC. Diastolic blood pressure levels correlated with TGF-beta1 secretion in diabetic patients with nephropathy. Increased TGF-beta1 secretion by PBMC may be associated with renal and vascular disease in Type 1 diabetes mellitus.     

Endothelial dysfunction, ambulatory pulse pressure and albuminuria are associated in Type 2 diabetic subjects.

AIM: Elevated pulse pressure (PP) is associated with microvascular complications in Type 2 diabetic patients. In non-diabetic subjects, elevated PP has been associated with endothelial dysfunction. The relation between endothelial dysfunction and PP in diabetic subjects has not previously been examined. We examined the relation between PP, markers of endothelial activation and albuminuria in Type 2 diabetic patients. METHODS: In 46 Type 2 diabetic patients and 19 non-diabetic subjects, we performed 24-h ambulatory blood pressure (AMBP) monitoring. Urinary albumin excretion rate was measured as three urinary albumin/creatinine ratios. Von Willebrand factor (vWF), fibrinogen, E-selectin and soluble intercellular adhesion molecule 1 (ICAM-1) were measured in plasma. RESULTS: Thirty-four patients had normoalbuminuria (group N) and 12 had micro- or macroalbuminuria (group A). PP levels increased in a stepwise manner from the control group (group C) to group N and group A; night PP 43 +/- 5, 48 +/- 10 and 59 +/- 12 mmHg (groups C, N and A, respectively, P < 0.001). Likewise, plasma levels of vWF, fibrinogen, E-selectin and ICAM-1 increased from group C to group A; e.g. ICAM-1 [median (interquartile range)] 191 (160-217), 213 (189-262) and 316 (260-417) ng/ml, groups C, N and A, respectively, P < 0.001). In diabetic patients, night PP and plasma levels of E-selectin and ICAM-1 correlated (r = 0.38, P < 0.01 and r = 0.37, P = 0.01, night PP with E-selectin and ICAM-1, respectively). CONCLUSION: Increased PP is associated with endothelial activation and albuminuria in Type 2 diabetic patients. Thus, endothelial dysfunction may represent a pathophysiological link between an elevated PP and microvascular complications in these subjects. Prospective studies are needed to further elucidate these associations.     

高血压合并颈动脉粥样硬化患者动态血压特征分析

目的研究高血压合并颈动脉粥样硬化患者的动态血压特征和临床意义。方法选择高血压患者111例,行动态血压监测。所有患者行颈动脉超声检查,根据结果将患者分为斑块组66例和无斑块组45例,斑块组又根据斑块数量分为单一斑块组24例和多发斑块组42例。比较各组动态血压情况。结果斑块组较无斑块组患者24 h、昼间和夜间平均收缩压、舒张压和动脉压均显著增高(P<0.05),且斑块组非杓型血压发生率较无斑块组也显著增高(63.6%vs 44.4%,P<0.05);多发斑块组较单一斑块组患者24 h、昼间和夜间平均收缩压、舒张压和动脉压均显著增高(P<0.05),且多发斑块组非杓型血压发生率较单一斑块组显著增高(76.2%vs 41.7%,P<0.05)。结论持续血压升高是产生颈动脉粥样硬化的重要影响因素,且颈动脉斑块更易引发血压昼夜节律调节紊乱。     

高龄老年高血压患者动态血压和动态心电图特点及临床分析

目的分析高血压患者的24h动态血压、心电图的特点，并结合临床分析，为临床高龄老年高血压防治提供可参考依据。方法共入选老年高血压患者214例，按年龄分为两组，A组：高龄老年组（≥80岁）96例；B组：低龄老年组（60～79岁）118例。采用24h动态血压和24h动态心电图同步监测技术，记录血压和心电图变化，同时采集多次住院病历，观察高血压患者治疗过程中血压控制情况，心律失常以及靶器官损害发生情况。结果高龄老年组的大部分患者血压控制良好。24h动态血压水平两组之间仍有明显差异，高龄老年组心律失常、心脑血管事件次数、糖尿病、体重指数、左心室重量指数等均显著高于低龄老年组。结论与低龄老年组相比，80岁以上的高龄老年高血压患者肾损害明显，其24h动态血压水平与动态心电图改变及肾损害之间密切相关。     

高血压伴腔隙性脑梗死患者夜间动态血压的变化

目的 探讨动态血压监测(ABPM)在防治脑梗死中的作用。方法 采用无创性携带式动态血压检测仪,对50例高血压伴有腔隙性脑梗死的患及33例不伴有脑梗死的高血压患(对照组)进行动态血压检测,并观察其随测血压。结果 腔隙性脑梗死组夜间(10pm～6am)平均收缩压与舒张压显低于对照组,夜间、白昼的收缩压与舒张压比值与对照组比较,差异有显性意义。结论 伴有腔隙性脑梗死的高血压患机体调节血压昼夜节律变化的机制紊乱,较无腔隙性脑梗死的高血压患严重;夜间平均收缩压与舒张压过低可能是部分高血压患发生腔隙性脑梗死的重要因素之一。     

Effects of smoking on blood pressure and proteinuria in patients with diabetic nephropathy

Objectives. To investigate the effects of smoking on blood pressure and proteinuria in hypertensive diabetic patients with nephropathy.
Design. Controlled, randomized, cross-over study.
Setting. Tertiary care centre, University Hospital of Düsseldorf, Germany.
Subjects. A total of 25 subjects were recruited, each of whom smoked at least 20 cigarettes a day: 10 normotensive healthy volunteers and 15 hypertensive type 1 (insulin-dependent) diabetic outpatients with diabetic retinopathy and persistent micro- or macroalbuminuria; 10 diabetic patients had normal autonomic function test, whilst five patients showed signs of autonomic neuropathy.
Interventions. Controlled smoking or nonsmoking over a period of 8 h on separate days.
Main outcome measures. Blood pressure was measured every 10 min with an automatic device and urine samples were collected every 3 h.
Results. Systolic blood pressure increased during smoking in controls (mean) (11.5 mmHg, P= 0.0001) and in diabetic patients without autonomic neuropathy (7.9 mmHg; P=0.018 ), but not in patients with autonomic neuropathy (-2.4 mmHg; P =0.792). Diastolic blood pressure increased during smoking in controls (6.2 mmHg; P= 0.019) but not in diabetic patients (2.5 mmHg; P =0.204. 0.2 mmHg; P= 0.956). During smoking, median proteinuria and albuminuria increased in diabetic patients without autonomic neuropathy (8.1 mg mmol^-1 creatinine, P=0.002; and 2.6 mg mmol creatinine, P= 0.084). No significant changes in albuminuria or proteinuria occurred in the other two groups.
Conclusions. Smoking increases blood pressure values in healthy subjects and in hypertensive patients with diabetic nephropathy and without autonomic neuropathy. This effect of smoking may be partly responsible for the faster progression of diabetic nephropathy in smoking diabetic patients.     

老年高血压患者动态血压负荷和脉搏波传导速度的相关性研究

目的探讨老年高血压患者24 h动态血压负荷与颈桡动脉脉搏波传导速度(crPWV)的相关性。方法选取60～79岁的老年原发性高血压患者187例,对所有入选对象进行24 h动态血压监测,根据获取的24 h动态血压监测参数分为杓型组90例与非杓型组97例,选择同期体检人群82例为正常对照组。所有受试者行24 h动态血压监测,应用脉搏波速度测定仪测定crPWV,并进行分析。结果杓型组及非杓型组24 h、昼间及夜间收缩压、舒张压负荷均显著高于正常对照组(P<0.01)。非杓型组夜间血压负荷较杓型组升高(P<0.05)。杓型组及非杓型组crPWV均较正常对照组升高(P<0.05)。控制性别、年龄因素后,老年高血压患者24 h收缩压、夜间收缩压负荷、昼间舒张压负荷是crPWV影响的主要因素。结论老年高血压患者动态血压负荷升高,大动脉顺应性降低,其中24 h收缩压、夜间收缩压负荷、昼间舒张压负荷是影响大动脉顺应性的主要危险因素。     

Sex difference in sympathetic nervous system activity and blood pressure in hypertensive patients

Increased sympathetic nervous system (SNS) activity leads to increased risk of cardiovascular morbidity and mortality. This study investigated whether there were sex differences in SNS activity among Chinese patients with hypertension. Ethnic Chinese non‐diabetic hypertensive patients aged 20–50 years were enrolled in Taiwan. A total of 970 hypertensive patients (41.0 ± 7.2 years) completed the study, 664 men and 306 women. They received comprehensive evaluations including office blood pressure (BP) measurement, 24‐h ambulatory BP monitoring, and 24‐h urine sampling assayed for catecholamine excretion. Compared to women, men were younger, had higher body mass index (BMI), office systolic BP (SBP), office diastolic BP (DBP), 24‐h ambulatory BP, and 24‐h urine catecholamine excretion. In men, 24‐h urine total catecholamine levels were correlated with 24‐h SBP (r = 0.103, p = .008) and 24‐h DBP (r = 0.083, p = .033). In women, however, there was no correlation between 24‐h urine total catecholamine levels and 24‐h ambulatory BP. Multivariate linear regression indicated that being male (β = 1.65, 95% confidence interval [CI] 0.01–3.29, p = .048) and 24‐h urine total catecholamine (β = 5.03, 95% CI 0.62–9.44, p = .025) were both independently associated with 24‐h SBP; being male was independently associated with 24‐h DBP (β = 3.55, 95% CI 2.26–4.85, p < .001). In conclusion, Chinese men with hypertension had higher SNS activity than women, and SNS activity was independently associated with 24‐h ambulatory BP in men rather than in women. These findings suggest that different hypertensive treatment strategies should be considered according to patient sex.     

Day and night variation in ambulatory blood pressure in type 1 diabetes mellitus with nephropathy and autonomic neuropathy

Abstract. The objective was to study ambulatory blood pressure and heart rate variability between day and night in patients with type 1 (insulin-dependent) diabetes mellitus with different degrees of diabetic nephropathy, and to evaluate the influence of autonomic neuropathy and type of antihypertensive treatment. Twenty type 1 diabetic patients with diabetic nephropathy and antihypertensive treatment were studied with 24-h ambulatory blood pressure monitoring using an oscillometric method. They were compared with eight insulin-treated diabetic patients with short duration of diabetes (1–5 years) and with 10 apparently healthy subjects. The degree of autonomic neuropathy was evaluated by measuring the RR-interval during deep breathing and uprising. The 24-h blood pressure was generally higher in patients with diabetic nephropathy compared to those other two groups. These patients also had a lower ratio between day and night in diastolic blood pressure compared to the control subjects (1.15 ± 0.12 vs. 1.25 ± 0.76, P < 0.05) and heart rate compared to the diabetic patients without nephropathy, as well as the control subjects (1.15 ± 0.08 vs. 1.26 ± 0.09 vs. 1.27 ± 0.08, P < 0.01, respectively). All patients with diabetic nephropathy had clinical signs of autonomic neuropathy as judged by RR-interval measurements during deep breathing and uprising.     

Pulse pressure and mortality in hypertensive type 2 diabetic patients. A cohort study

HYPOTHESIS: Hypertension is a well-known cardiovascular risk factor in type 2 diabetic patients. It has been suggested that pulse pressure (PP) could be an independent cardiovascular risk factor in the general population, particularly in the elderly. An association between office PP and cardiovascular mortality has been previously reported in diabetic patients, while the relationship between ambulatory measurements of PP and all-cause mortality has not been assessed so far. AIM: To assess the relationship between ambulatory PP and all-cause mortality in diabetic patients with hypertension. METHODS: A cohort study was performed on a consecutive series of 435 diabetic outpatients. All patients underwent office blood pressure measurement (OBP) and 24-h ambulatory blood pressure monitoring (ABPM). Mortality was assessed through queries at the Registry Offices of the city of residence for each patient. Mean follow-up was 3.8 +/- 1.2 years. RESULTS: Fifty-eight patients (13.3%) died during the follow-up. Mortality was significantly (p < 0.05) higher in patients in the highest quartile and lower in patients in the lowest quartile, when compared to the intermediate quartiles, both for office and ABPM-PP. In a multivariate analysis, after adjustment for numerous variables (including current hypoglycaemic, antihypertensive statin and aspirin treatment), mortality was increased by 3.1 and 5.3% for each incremental mmHg of office PP (p < 0.05) and ABPM-PP (p < 0.001) respectively. CONCLUSIONS: High PP, assessed through office measurement or ABPM, was associated with increased mortality in hypertensive type 2 diabetic patients. In our sample, PP assessed with ABPM is a better predictor of mortality than office PP.     

血压昼夜节律与老年高血压患者血管僵硬度相关性临床研究

目的 探讨老年原发性高血压住院患者血压昼夜节律与血管僵硬度的潜在关系。方法 本研究纳入了2022年1月至2023年6月在解放军总医院住院的老年原发性高血压患者440例,所有患者均接受了动态血压监测（ABPM）和肱-踝动脉脉搏波传导速度（baPWV）检查。收集患者一般临床资料、用药史、生化检测指标及动态血压监测数据,将患者分为baPWV正常组（<1400cm/s）、baPWV低危组（1400-1800cm/s）和baPWV高危组（>1800cm/s）。使用logistic回归分析动脉僵硬度升高的影响因素,ROC曲线评价预测效力,构建血管老化风险预测模型。结果 440名老年高血压人群中,平均年龄68.6?6.4岁,其中男性235例（53.4%）。高危组患者年龄和收缩压明显高于正常组和低危组（P<0.01）。趋势卡方检验结果提示血管僵硬度增高的患者反勺型血压模式比例明显增加（χ2=17.626,r=0.168,P<0.01）。多因素logistic回归分析显示baPWV升高的独立危险因素包括年龄、体质量指数（body mass index,BMI）、空腹血糖、24h平均收缩压、白天平均收缩压、夜间平均收缩压及反勺型血压模式（P<0.05）。纳入上述七项指标后,ROC曲线下面积为0.804。结论 反勺型血压模式与老年患者血管僵硬度增高直接相关。动态血压监测评估昼夜节律可有助于预测老年高血压患者的血管衰老。     

焦虑抑郁状态对老年高血压患者动态血压影响的研究

目的探讨老年高血压伴发抑郁焦虑情绪患者的24h动态血压变化规律。方法选择老年高血压患者120例,进行抑郁自评量表和焦虑自评量表的心理问卷调查及汉密尔顿抑郁量表和汉密尔顿焦虑量表的评定,根据评分结果分为抑郁焦虑组75例和无抑郁焦虑组45例,对所有研究对象进行24h动态血压监测,并对结果进行比较分析。结果抑郁焦虑组24h收缩压、昼间收缩压、夜间收缩压明显高于无抑郁焦虑组[(136.0±14.6)mm Hg(1mm Hg=0.133kPa)vs(126.0±13.4)mm Hg,(139.0±15.2)mm Hg vs(130.0±13.6)mm Hg,(132.0±13.6)mm Hg vs(123.0±12.5)mm Hg,P<0.01]。抑郁焦虑组24h收缩压标准差、昼间收缩压标准差及24h收缩压加权标准差显著高于无抑郁焦虑组[(14.78±1.62)mm Hg vs(14.07±1.80)mm Hg,(13.25±2.94)mm Hg vs(12.28±3.05)mm Hg,(14.07±1.37)mm Hg vs(10.81±1.91)mm Hg,P<0.05,P<0.01]。结论有抑郁焦虑情绪的老年高血压患者血压变异性显著高于无抑郁焦虑高血压患者。     

Prevalence and clinical correlates of ambulatory blood pressure phenotypes in a Saudi hypertensive population

International Guidelines recommend ambulatory blood pressure monitoring (ABPM) for the management of hypertension. ABPM phenotypes predict outcomes independent of office blood pressure (BP). The authors explored the prevalence and clinical correlates of ABPM phenotypes and relationship with office BP in Saudi patients (n = 428, mean age 53.5 ± 14.6, 55% male) referred to a Specialist Hypertension clinic in Riyadh, Saudi Arabia. ABPM phenotypes included sustained normotension (27%), masked hypertension, MHT(32%), sustained hypertension, SHT(52%), and white coat hypertension(2.6%). MHT was more prevalent using asleep than 24‐hours (26.4% vs 12.9%, P < .01) or awake BP (26.4% vs 8.5%, P < .001) and observed in 85% of pre‐hypertensive patients. Isolated nocturnal hypertension was more prevalent in MHT vs SHT (70% vs 30%, P < .001). Office BP overestimated control rates compared with ABPM (48% vs 12.9%, P < .001). Our study shows that one in three Saudi patients will be managed inappropriately if office BP alone was relied upon for management of hypertension.     

老年高血压患者血压昼夜节律控制情况及影响因素分析

目的观察治疗中的老年高血压患者血压昼夜节律的控制情况,并分析其影响因素。方法连续收集10年来曾在我科住院的老年高血压患者共638例。根据动态血压监测结果将血压昼夜节律分为杓型、非杓型、反杓型及超杓型,并通过非条件Logistic回归分析血压昼夜节律的影响因素。结果入选病例中,正常血压节律者占23.57%(151/638),异常血压节律者占76.43%(487/638);其中非杓型占48.43%,反杓型占26.49%,超杓型占1.41%。非条件Logistic回归结果提示,年龄≥80岁是异常血压节律的危险因素,而服用利尿剂则降低血压异常节律的危险(P<0.05)。性别、靶器官损害、糖尿病及其他降压药物对血压节律均无影响(P>0.05)。结论在老年高血压患者中应重视血压节律的监测。对异常血压昼夜节律的患者,选用利尿剂可能是较好的治疗措施之一。     

Left atrial size in 164 hypertensive patients: an echocardiographic and ambulatory blood pressure study

BACKGROUND: Left atrial enlargement (LAE) is associated with an increased risk of death and cardiovascular (CV) hospitalization. Whether or not LAE reflects early structural change from hypertension is unclear. HYPOTHESIS: The aim of this study was to evaluate the relationship between LA size, 24-h blood pressure measurements, age, body mass index (BMI), and left ventricular mass index (LVMI) in hypertensive patients. METHODS: We studied 164 outpatients (age range 30-76 years, 73 men and 91 women) with mild to moderate hypertension. Physical examination, electrocardiogram, noninvasive blood pressure monitoring (ABPM), Doppler echocardiogram were performed. Left ventricular mass index and LA dimensions were calculated. The sample was divided by age (< 60 and > or = 60 years). RESULTS: Left ventricular hypertrophy (LVH) was present in 45% of patients aged < 60 years and in 70% of patients aged > or = 60 years (p = 0.002). Left atrial enlargement (> 4 cm) was present in 35% of elderly and in 24% of young patients (p = 0.31), and in 36% of patients with and 21% of patients without LVH (p = 0.0057). There was no significant difference in the younger patients with and without LVH. The incidence of obesity was low (31%) in the whole sample. The percentage of overweight in the elderly patients with LVH and higher LA size was equally low. Multivariate analysis showed age (p = 0.044) and LVMI (p = 0.002) as the only significant predictors of LA enlargement. CONCLUSION: Since LAE is associated with a high risk of death and CV hospitalization, we emphasize the importance of development and use of drugs that inhibit LVH.     

Effects of different statin types and dosages on systolic/diastolic blood pressure: Retrospective analysis of 24‐hour ambulatory blood pressure database

We previously demonstrated lower diastolic blood pressure (BP) levels under statin therapy in adult individuals who consecutively underwent 24‐hour ambulatory BP monitoring and compared their levels to untreated outpatients. Here we evaluated systolic/diastolic BP levels according to different statin types and dosages. 987 patients (47.5% female, age 66.0 ± 10.1 years, BMI 27.7 ± 4.6 kg/m², clinic BP 146.9 ± 19.4/86.1 ± 12.1 mm Hg, 24‐hour BP 129.2 ± 14.4/74.9 ± 9.2 mm Hg) were stratified into 4 groups: 291 (29.5%) on simvastatin 10‐80 mg/d, 341 (34.5%) on atorvastatin 10‐80 mg/d, 187 (18.9%) on rosuvastatin 5‐40 mg/d, and 168 (17.0%) on other statins. There were no significant BP differences among patients treated by various statin types and dosages, except in lower clinic (P = .007) and daytime (P = .013) diastolic BP in patients treated with simvastatin and atorvastatin compared to other statins. Favorable effects of statins on systolic/diastolic BP levels seem to be independent of types or dosages, thus suggesting a potential class effect of these drugs.