老年糖尿病伴高血压患者血压昼夜节律变化的探讨

目的：观察老年糖尿病伴高血压患者血压昼夜节律变化。方法：运用24h动态血压监测，并比较68例糖尿病伴高血压患者和42例原发性高血压不伴糖尿病的患者的血压资料。结果：糖尿病伴高血压组夜间收缩压明显高于对照组（P〈0．01）；其血压昼夜差值、节律变化与对照组的差异有显著性（P〈0．05）。结论：昼夜血压差值减小或消失是反映糖尿病伴高血压患者血压调节功能受损的一项指标。     

男性高龄高血压患者腔隙性脑梗死与夜间血压下降幅度的相关性

目的探讨在男性高龄高血压患者中,24h动态血压及夜间血压下降幅度与腔隙性脑梗死(lacunar infarc-tion,LI)的相关性。方法以96例男性高龄高血压患者为对象,均行头颅MRI检查和动态血压监测,并同时收集患者的临床和实验室数据。根据LI的数目,将患者分为无/单发LI组25例和多发LI组71例。结果与无/单发LI组比较,多发LI组患者的夜间平均收缩压明显升高(P=0.01),夜间血压下降幅度明显增大,差异有统计学意义(P=0.00);2组患者的年龄、吸烟史、饮酒史、冠心病史、高血压病程、总蛋白、尿素、肌酐、尿酸、TC、TG、HDL-C、LDL-C、空腹血糖比较,差异无统计学意义(P>0.05);多发LI组患者非杓型血压的发生率显著升高(P=0.01)。结论在高龄高血压患者中,夜间血压异常升高及昼夜节律的异常可能在LI的发展过程中起重要作用。     

首次腔隙性脑梗死患者扩张的血管周围间隙与动态血压变异性分析

目的探讨首次腔隙性脑梗死患者扩张的血管周围间隙(EVRS)与动态血压变异性(BPV)的关系。方法入选符合标准的腔隙性脑梗死患者118例,均行头颅MRI和24h动态血压监测。利用4分半定量评分系统按EVRS是否2分分为2组,基底节平面:重度组44例,轻度组74例;半卵圆中心平面:重度组54例及轻度组64例。患者完成24h动态血压监测,比较各组动态血压相关参数,进行多因素logistic分析。结果在基底节平面,2组年龄、男性、高血压、冠心病、糖尿病、24h收缩压、昼间收缩压、昼间收缩压标准差、昼间收缩压变异系数和夜间舒张压变异系数有显著差异(P0.05);在半卵圆中心平面,2组年龄、高血压、24h收缩压和夜间收缩压标准差有显著差异(P0.05)。多因素logistic回归分析,基底节平面,年龄(OR=1.16,95%CI:1.01~1.22,P=0.02)、昼间收缩压变异系数(OR=1.62,95%CI:1.47~3.68,P=0.03)、夜间舒张压变异系数(OR=1.32,95%CI:1.12~2.43,P=0.04)是发生重度EVRS的独立危险因素。半卵圆中心平面,BPV与EVRS无相关性。结论首次腔隙性脑梗死患者BPV与基底节平面EVRS密切相关,基底节平面EVRS是高血压相关脑损害的独特表现。     

高血压合并脑梗塞患者血压昼夜节律变化的动态观察

将６０例同血压病患者分为脑梗塞组和无脑梗塞组，测定其２４小时动态血压。结果显示，高血压合并脑梗塞组血压昼夜节律消失者２９例，无脑梗塞组１２例，两组比较有显著差异，表明高血压患者中血压昼夜节律消失者易发生脑梗塞。     

中老年原发性高血压患者动态血压临床研究

目的探讨老年原发性高血压患者24h动态血压的波动规律。方法选择我院原发性高血压患者100例，分为老年组50例和中青年组50例，运用无创袖带式动态血压监测仪检测两组患者各项动态血压参数并进行比较分析。结果两组患者的24h平均收缩压（24hSBP）：日间收缩压（dSBP），夜间收缩压（nSBP），收缩压负荷（SBP负荷）差异有显著性意义（P〈0．05），24h平均舒张压（24hDBP），日间舒张压（dDBP），夜间舒张压（nDBP），舒张压负荷（DBP负荷）间差异无显著性意义（P〉0.05），两组患者血压趋势形态间差异有显著性意义（P〈0．05）。两组患者SBP、DBP深杓型、杓型、反杓型比例间差异均有显著性意义（p〈0．05）。结论随着年龄的增长，老年原发性高血压患者以SBP升高为主，血压昼夜节律消失，且较中青年患者更具易变性和不稳定性。     

高血压伴腔隙性脑梗死患者动脉弹性功能与血管性假血友病因子的关系

目的探讨原发性高血压伴腔隙性脑梗死患者动脉弹性功能与血浆中血管性假血友病因子(vWF)的关系。方法选择高血压伴腔隙性脑梗死男性患者60例,根据血压控制情况分为血压控制良好组(30例)和血压控制不良组(30例)。应用美国DP200M动脉仪进行肱动脉弹性测定,在美国ACL3000plus凝血分析仪上采用比浊法测定vWF。结果血压控制良好组血管弹性指标(系统动脉顺应性、系统动脉阻力、肱动脉扩张性、肱动脉阻力)明显好于血压控制不良组(P<0.05)。血压控制不良组vWF明显高于血压控制良好组(163.57±40.50)%vs(131.27±30.99)%,再发脑梗死比率增高(30.00%vs6.67%),且血压控制良好与否和vWF增高、血管弹性指标的改变呈正相关(OR=5.00,95%CI:1.51～16.56;OR=6.91,95%CI:2.16～22.10)。结论高血压伴腔隙性脑梗死患者存在血管弹性功能异常,并与vWF的失衡有关。针对性控制血压及进一步控制vWF的失衡对原发性高血压并腔隙性脑梗死患者有益。     

高龄老年高血压患者动态血压特点

目的探讨80岁以上老年高血压患者治疗中24h动态血压的特点。方法入选高血压患者按年龄分为三组:高龄老年组(≥80岁,n=88)、老年对照组(60～79岁,n=80)及中年对照组(60岁,n=25),回顾性分析三组患者治疗状态下动态血压参数、动态血压昼夜异常发生率及舒张压60mmHg(1mmHg=0.133kPa)的发生率。结果三组患者服药情况差异无统计学意义(P0.05);全天、日间、夜间平均收缩压差别无统计学意义;平均舒张压高龄老年组均低于老年组及中年组(P均0.01);全天、日间、夜间平均脉压差高龄老年组均高于老年组、中年组(P均0.01);高龄老年组24h动态血压昼夜节律异常的发生率明显高于老年组、中年组(P均0.05);舒张压60mmHg的发生率高龄老年组明显高于老年组及中年组(P均0.01)。结论高龄老年高血压患者治疗状态下有舒张压过低及血压昼夜节律异常。     

继发性高血压24小时动态血压研究

目的研究继发性高血压（ＳＨ）２４小时动态血压变化。方法应用美国Ｓｐａｃｅｌａｂｓ９０２０７动态血压监测仪观察了８０例ＳＨ２４小时动态血压并与年龄、性别相配对的８０例高血压病（ＥＨ）患者进行比较。结果ＳＨ患２４小时血压节律与ＥＨ患者不同,ＳＨ患者夜间血压下降不明显,夜间血压明显高于ＥＨ患者（Ｐ＜００１）;ＳＨ患者夜间血压负荷在６０％左右,而ＥＨ患者夜间血压负荷则在１５％左右;ＳＨ患者与ＥＨ患者２４小时血压曲线：白昼（６：００～２２：００）曲线呈重叠、交叉状态,而夜间（２２：００～６：００）曲线呈分离状态,ＥＨ夜间曲线段明显降低。ＳＨ组非杓型明显多于ＥＴ组（Ｐ＜００１）。ＳＨ患者夜间血压／日间血压的比值大于９０％的例数明显多于ＥＨ患者。结论２４小时动态血压监测显示夜间血压下降不明显,夜间血压负荷在５０％以上,呈非杓型,夜间血压／日间血压的比值大于９０％,提示有ＳＨ可能,应作进一步检查。     

高龄老年高血压患者动态血压特点

目的探讨高龄老年高血压患者动态血压特点。方法选择我院心血管内科及老年医学科住院的高血压患者265例,按年龄分为高龄老年组(年龄≥80岁)94例、老年组(60～79岁)90例和60岁组81例,行动态血压监测,分析其血压节律、3个时段(24h、昼间及夜间)血压均值及血压变异性的特点。结果高龄老年组和老年组杓型血压发生率、24h舒张压、昼间舒张压、昼间平均压、夜间舒张压明显低于60岁组,反杓型血压发生率、24h脉压、昼间脉压、夜间收缩压、夜间脉压明显高于60岁组(P0.05,P0.01);高龄老年组杓型血压发生率及24h、昼间、夜间舒张压明显低于老年组[13.83%vs 26.66%,(66.17±7.39)mm Hg(1mm Hg=0.133kPa)vs (70.39±10.96)mm Hg,(66.90±7.55)mm Hg vs (70.88±11.68)mm Hg,(64.10±8.14)mm Hg vs (68.27±11.86)mm Hg,P0.05,P0.01],24h、夜间脉压明显高于老年组(P0.05,P0.01),昼间收缩压变异明显高于老年组和60岁组,24h收缩压变异高于60岁组,差异有统计学意义(P0.01);老年组24h平均压明显低于60岁组(P0.05)。结论高龄老年高血压患者动态血压表现出血压节律异常、脉压增大、血压变异性升高等特点。     

老年高血压患者降压治疗后24小时动态血压与心脑血管事件发生率的分析

目的分析老年高血压患者降压治疗后24h动态血压与心脑血管事件发生的情况,为临床降压治疗提供依据。方法将1074例患者分为两组,高血压组748例,非高血压组326例。采用24h动态血压监测技术监测血压,观察老年高血压患者降压治疗后心脑血管事件发生情况及其他相关指标。结果高血压组降压治疗后24h动态血压水平与非高血压组比较有显著差异(P<0.05),大部分患者血压控制良好,动态24h收缩压、舒张压平均值在正常范围,但均高于非高血压组;心脑血管事件发生率、有高血压家族史、吸烟、糖尿病、既往患有心脑血管病史等人数比率以及体重指数、左心室重量指数均显著高于非高血压组。结论高血压组较非高血压组更易发生心脑血管事件;脉压是其发生心脑血管事件的重要因素;应注意适度降压。     

原发性高血压合并脑微出血患者动态血压特征

目的 对原发性高血压（高血压）患者合并脑微出血的动态血压特征进行探讨.方法 选取80例高血压患者作为研究对象,并将其中有脑微出血的42例患者列为观察组,未合并有脑微出血的38例患者列为对照组.对两组患者的动态血压值进行观察和比较.结果 两组收缩压、舒张压比较,差异无统计学意义（P＞0.05）.两组的随测血压值均比24动态血压监测（ABMP）值高,差异有统计学意义（P＜0.05）.观察组的收缩压夜间下降率、舒张压夜间下降率均低于对照组,差异有统计学意义（P＜0.05）.结论 高血压患者的血压在夜间降低是引发脑微出血相关因素,因此在临床治疗期间,需对血压的动态节律变化加以注意.     

老年高血压患者血压昼夜节律与腔隙性脑梗死、脑白质病变的关系

目的 研究老年高血压患者血压昼夜节律变化与腔隙性脑梗死(LI) 和脑白质病变(WML)的关系。方法 选择2011年4月～2014年2月河北医科大学附属哈励逊国际和平医院门诊及住院年龄≥60岁的高血压病人126例，进行动态血压监测及头颅MRI检查，并同时收集患者的临床和实验室资料。将患者分为杓型组（48例）和非杓型组（78例）。结果 非杓型组24hSBP（136.39±12.45）mmHg、dSBP（138.78±11.67）mmHg、nSBP（133.56±11.7）mmHg明显高于杓型组，非杓型组ASBP%为3.38±1.96，明显低于杓型组11.54±2.41， 两组患者24hSBP、dSBP、nSBP、ASBP%比较差异有统计学意义（P＜0.05）；非杓型组LI46例（58.97%）、WML41例（52.56%），杓型组LI13例（27.08%）、WML11例（22.92%），非杓型组LI、WML的发生率明显高于杓型组，两组比较有统计学差异（P＜0.01）。结论 在老年高血压患者中，非杓型高血压可增加LI和WML的发生率。有效地降低夜间血压，恢复杓型节律有助于减轻靶器官损害。     

Nocturnal blood pressure profiles among normotensive, controlled hypertensive and refractory hypertensive subjects

BACKGROUND:

Nocturnal blood pressure abnormalities are independently associated with an increased risk of death and cardiovascular disease. It is unclear, however, whether they are related to the presence or severity of hypertension.

OBJECTIVES:

To determine and compare the prevalence of sleep pattern disturbances in normotensive (NT) and hypertensive patients.

METHODS:

The present cross-sectional study assessed the nocturnal blood pressure profiles from 24 h ambulatory blood pressure monitoring of refractory hypertensive (RH) (n=26), controlled hypertensive (CH) (n=52) and NT (n=52) subjects who were matched for age, sex and body mass index. Results are expressed as mean ± SD or proportion, as appropriate.

RESULTS:

During sleep, the percentage fall in mean arterial pressure was 15.1±6.1% in the NT group, 11.5±7.0% in the CH group and 7.7±7.7% in the RH group (P<0.0001). The corresponding proportions of nondipping were 25.0%, 42.3% and 61.5%, respectively (P=0.006), and those of nocturnal hypertension were 9.6%, 23.1% and 84.6%, respectively (P<0.0001). All pairwise comparisons of nocturnal blood pressure fall were significant. The proportion of subjects in the RH group who experienced a rise in nocturnal blood pressure (19.2%) was significantly greater than the proportions in the NT and CH groups (P=0.001), as was the proportion of subjects with nocturnal hypertension (P<0.0001). There was less extreme dipping in RH, although the difference was not statistically significant (P=0.08).

CONCLUSIONS:

A significantly higher prevalence of nondipping, nocturnal hypertension and nocturnal blood pressure rising in RH was demonstrated. These sleep disturbances or independently, their cause, may account for the difficulties in attaining blood pressure control.     

Nocturnal blood pressure patterns and cardiovascular outcomes in patients with masked hypertension

Masked hypertension (MHT) is characterized by normal clinic and above normal 24‐hour ambulatory blood pressure (BP) levels. We evaluated clinical characteristics and CV outcomes of different nocturnal patterns of MHT. We analyzed data derived from a large cohort of adult individuals, who consecutively underwent home, clinic, and ambulatory BP monitoring at our Hypertension Unit between January 2007 and December 2016. MHT was defined as clinic BP <140/90 mm Hg and 24‐hour BP ≥ 130/80 mm Hg, and stratified into three groups according to dipping status: (a) dippers, (b) nondippers, and (c) reverse dippers. From an overall sample of 6695 individuals, we selected 2628 (46.2%) adult untreated individuals, among whom 153 (5.0%) had MHT. In this group, 67 (43.8%) were nondippers, 65 (42.5%) dippers, and 21 (13.7%) reverse dippers. No significant differences were found among groups regarding demographics, clinical characteristics, and prevalence of risk factors, excluding older age in reverse dippers compared to other groups (P < 0.001). Systolic BP levels were significantly higher in reverse dippers than in other groups at both 24‐hour (135.6 ± 8.5 vs 130.4 ± 6.0 vs 128.2 ± 6.8 mm Hg, respectively; P < 0.001) and nighttime periods (138.2 ± 9.1 vs 125.0 ± 6.3 vs 114.5 ± 7.7 mm Hg; P < 0.001). Reverse dipping was associated with a significantly higher risk of stroke, even after correction for age, gender, BMI, dyslipidemia, and diabetes (OR 18.660; 95% IC [1.056‐33.813]; P = 0.046). MHT with reverse dipping status was associated with higher burden of BP and relatively high risk of stroke compared to both dipping and nondipping profiles, although a limited number of CV outcomes have been recorded during the follow‐up.     

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。     

Nocturnal hypertension in primary care patients with high office blood pressure: A regional study of the MAPAGE project

Nocturnal hypertension (NH) is an independent cardiovascular risk factor. We aimed to describe the frequency of NH among primary care hypertensive patients and to analyze NH determinants. This observational, cross‐sectional, multicenter study enrolled the patients of 23 general practitioners in Burgundy region, France. We included the first patient of the day with office blood pressure ≥ 140/90 mm Hg, whatever the reason for consultation. All included patients had 24‐hour ambulatory blood pressure monitoring (ABPM). Nocturnal hypertension was considered nighttime mean blood pressure ≥ 120/70 mm Hg, as per current guidelines. Medical, sociodemographic, and deprivation data were collected. Nocturnal hypertensive and non‐hypertensive patients were compared. The determinants of NH were identified using logistic regression models. From July 2015 to November 2018, 447 patients were analyzed. Mean office blood pressure was 158.6/91.5 mm Hg, and 255 patients (57.0%) were taking at least one antihypertensive drug. Among the 409 (91.5%) valid ABPM, 316 (77.3%) showed NH. In multivariate analyses, male sex (odds ratio [OR] = 2.20, 95% confidence interval [CI] 1.29‐3.75), first office diastolic blood pressure >100 mm Hg (OR = 5.71, 95% CI 1.53‐21.40), and current smoking (OR = 5.91, 95% CI 2.11‐16.56) were independent predictors of NH. Obesity was associated with a reduced risk of NH (OR = 0.43, 95% CI 0.25‐0.75). No association was found between deprivation status or sociodemographic factors and NH. To conclude, NH was identified in more than three out of four patients with high office blood pressure. Male smokers with high diastolic blood pressure were most affected by NH. ABPM may improve hypertension management in these patients.     

原发性高血压患者的昼夜血压特点与年龄及性别的研究

目的探讨原发性高血压患者昼夜血压与年龄、性别的关系。方法1 100例原发性高血压患者分为高龄老年组(≥80岁)、老年组(60~79岁)、中老年组(40~59岁)、中青年组(<40岁),分析不同年龄及性别高血压患者的昼夜血压特点。结果夜间血压负荷增高患者的年龄较大(P<0.01)。老年组及高龄老年组的夜间收缩压(SBP)较高,夜间舒张压(DBP)较低(P<0.01)。平均动脉压(MAP)昼夜差值百分比与年龄呈负相关(r=-0.262,P<0.01)。女性患者的夜间DBP较低;夜间血压负荷增高的女性患者夜间SBP较高,夜间DBP较低;非杓型女性患者的夜间SBP、夜间脉压较高(P<0.01)。结论原发性高血压患者的夜间血压、血压昼夜节律与年龄、性别相关。     

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。     

缬沙坦对非勺型高血压患者血压昼夜节律的影响

目的观察缬沙坦对非勺型高血压患者血压昼夜节律的影响。方法选择经24h动态血压监测且诊断为非勺型2级高血压的患者60例为研究对象,将其按电脑数字表法随机均分为治疗组30例：上午7：00和晚上7：00各服缬沙坦80mg;对照组30例：上午7：00服缬沙坦160mg,两组用药8周后复测24h动态血压。比较两组血压昼夜节律的变化。结果两组治疗后24h、白昼、夜间收缩压及舒张压均较治疗前显著下降,差异有统计学意义（P〈0．05）。治疗组的夜间收缩压、舒张压及白昼、夜间血压负荷较对照组显著下降,差异有统计学意义（P〈0．05）。治疗组血压昼夜节律改变有效率明显高于对照组,差异有统计学意义（收缩压：73．33％抵46．67％,P〈0．05;舒张压：76．67％眠43．33％,P〈0．01）。结论应用缬沙坦治疗非勺型高血压,可以很好地控制2级高血压,并改变血压昼夜节律,早晚两次服用,效果更好。