Elliott W J
Department of Preventive Medicine, Rush Medical College of Rush University and Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA.
Am J Hypertens. 1999 Feb;12(2 Pt 2):43S-49S. doi: 10.1016/s0895-7061(98)00279-9.
In most people, blood pressure (BP) displays a characteristic diurnal pattern, with a decline during sleep and a sharp increase around the time of awakening. The early morning surge in BP is synchronous with an increase in the risk of catastrophic cardiovascular events, including acute myocardial infarction, sudden cardiac death, and stroke. Although most clinical investigations have centered on modulating or even preventing the morning surge, emerging data suggest that it may be important to avoid nocturnal hypotension, especially in elderly patients and in those with established atherosclerotic disease. Considerable evidence has been accumulated to suggest that excessive lowering of BP at night (whether naturally or through the use of antihypertensive medications) can result in untoward ischemic phenomena, including silent cerebral damage (Binswanger's disease) or ophthalmologic symptoms (eg, anterior ischemic optic neuropathy). Controlled-onset extended-release verapamil, through its unique delivery system, tends to diminish the morning BP surge, whereas it preserves a normal nocturnal BP decline; its effect on preventing early morning cardiovascular catastrophes (while preserving relatively normal nocturnal BP) is currently being tested in a large, international clinical trial.
在大多数人身上，血压呈现出一种典型的昼夜模式，睡眠期间血压下降，醒来前后血压急剧上升。清晨血压激增与灾难性心血管事件风险增加同步，这些事件包括急性心肌梗死、心源性猝死和中风。尽管大多数临床研究都集中在调节甚至预防清晨血压激增，但新出现的数据表明，避免夜间低血压可能很重要，尤其是在老年患者和已患动脉粥样硬化疾病的患者中。已有大量证据表明，夜间血压过度降低（无论是自然降低还是通过使用抗高血压药物）会导致不良缺血现象，包括无症状脑损伤（宾斯旺格病）或眼科症状（如前部缺血性视神经病变）。控释维拉帕米通过其独特的给药系统，往往会减少清晨血压激增，同时保持夜间血压正常下降；其预防清晨心血管灾难（同时保持相对正常的夜间血压）的效果目前正在一项大型国际临床试验中进行测试。
