Nielsen F S, Hansen H P, Jacobsen P, Rossing P, Smidt U M, Christensen N J, Pevet P, Vivien-Roels B, Parving H H
Steno Diabetes Center, Gentofte, Denmark.
Diabet Med. 1999 Jul;16(7):555-62. doi: 10.1046/j.1464-5491.1999.00127.x.
To elucidate the putative factors involved in the blunted nocturnal blood pressure reduction in hypertensive Type 2 diabetic patients with diabetic nephropathy.
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.
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.
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.
阐明2型糖尿病肾病高血压患者夜间血压降低减弱的潜在相关因素。
对31例2型糖尿病肾病高血压患者（24例男性，年龄60（45 - 73）岁）的细胞外液容量、从组织间隙到血浆容量的液体转移（血细胞比容）、交感神经活动（血浆去甲肾上腺素和肾上腺素）以及体内“生物钟”（血清褪黑素）进行了研究。除细胞外液容量外，所有变量均在患者于21:30至23:00躺在床上清醒时（基线）以及23:00至07:00睡眠期间重复测量。以夜间血压降低中位数（8.4%）为指导，将患者分为两组；第1组夜间血压降低最高，第2组夜间血压降低最低。
第1组血细胞比容从基线到睡眠期平均（95%置信区间（CI））下降1.7（0.3 - 3.1）%，而第2组上升0.5（-1.0 - 1.9）%，平均差异（95%CI）为 - 2.1（-4.0至 - 0.2）%（P = 0.029）。去甲肾上腺素从基线到睡眠期，第1组平均（95%CI）下降13.3（0.0 - 25.0）%，而第2组上升7.7（-9.7 - 28.4）%，平均差异（95%CI）为 - 19.6（-35 - 0.0）%（P = 0.049）。夜间血压变化与去甲肾上腺素（r = 0.51，P = 0.004）和血细胞比容（r = 0.42，P = 0.018）的夜间变化均相关。两组肾上腺素均保持恒定。两组的细胞外液容量和血浆褪黑素水平相当。
睡眠期间持续的肾上腺素能活动与2型糖尿病肾病高血压患者夜间血压降低减弱有关，可能是通过缺乏外周血管舒张介导的，而细胞外液容量分布和褪黑素分泌的变化没有影响。
