Carmona J, Amado P, Vasconcelos N, Santos I, Almeida L, Teles J, Nazaré J
Serviço de Cardiologia do Hospital Egas Moniz, Lisboa, Portugal.
Rev Port Cardiol. 2001 Feb;20(2):135-50; discussion 153-4.
Nocturnal Hypertension (NH) is an independent risk factor for cardiovascular morbidity and mortality (M-M). However, an inappropriate decrease in diastolic BP during the night significantly increases morbidity. There are no prospective studies on the long-term consequences on M-M in treated NH. We accordingly studied M-M in 107 consecutive patients with treated NH, assessed by ambulatory blood pressure monitoring (ABPM), during a four-year follow-up.
From the initial 107 patients six died (5 from brain or cardiovascular causes). In 65 patients it was possible to repeat the ABPM during the follow-up period. They were hypertensive patients class I-II (JNC IV) 62 +/- 10 years old, 56 were male and were observed before and after starting treatment on a four-year follow-up period. We considered age, sex, body mass index, previous cerebral and cardiovascular accidents, type and number of drugs administered, smoking habits, plasma cholesterol, glycemia, and causal and ambulatory blood pressure monitoring (ABPM) (24 hr, 6 am-10 am, 10 pm-6 am and pulse pressure) before and after follow-up, dipper status and the period of follow-up.
The patients whom died were older and had a significantly higher systolic blood pressure compared to the survivors. We considered two groups: with (A - n = 18) or without (B - n = 47) cerebral and cardiac morbidity. The A group had more previous cerebral and cardiovascular accidents (p = 0.05), a more intensive treatment (p = 0.02), and a greater fall in diastolic blood pressure (DBP) during the night in both absolute and percentage numbers, after treatment, than the B group. However, after regression analysis, the only independent risk marker differentiating between the two groups was the percentage fall in the DBP after treatment (dipper phenomenon) (p = 0.01).
In 65 treated hypertensive (NH) patients assessed by ABPM before and after treatment (four-year follow-up) we identified a group with cerebral and cardiovascular morbidity. These patients, in contrast with another group with no morbidity, had more previous cerebral and cardiovascular accidents, they were more intensively treated, and they had a greater fall in diastolic blood pressure after therapy (absolute and percentage values). However, after regression analysis the diastolic nocturnal blood pressure dipper phenomenon after treatment was the only risk marker associated with morbidity. In such cases it is possible that treatment guided by ABPM can decrease morbidity.
夜间高血压（NH）是心血管疾病发病和死亡（M-M）的独立危险因素。然而，夜间舒张压不适当下降会显著增加发病率。目前尚无关于经治疗的NH患者M-M长期后果的前瞻性研究。因此，我们对107例经动态血压监测（ABPM）评估的连续经治疗的NH患者进行了为期四年的随访，以研究M-M情况。
最初的107例患者中有6例死亡（5例因脑部或心血管疾病）。65例患者在随访期间能够重复进行ABPM。他们为I-II级（美国国家联合委员会IV级）高血压患者，年龄62±10岁，56例为男性，在开始治疗前后进行了为期四年的随访观察。我们考虑了年龄、性别、体重指数、既往脑卒中和心血管意外、所用药物的类型和数量、吸烟习惯、血浆胆固醇、血糖，以及随访前后的偶测血压和动态血压监测（ABPM）（24小时、上午6点至10点、晚上10点至上午6点）及脉压、杓型状态和随访时间。
死亡患者年龄较大且收缩压显著高于存活者。我们将患者分为两组：有（A组 - n = 18）或无（B组 - n = 47）脑卒中和心脏疾病。A组既往有更多的脑卒中和心血管意外（p = 0.05），治疗更积极（p = 0.02），且治疗后夜间舒张压（DBP）的绝对下降值和下降百分比均大于B组。然而，经过回归分析，区分两组的唯一独立风险标志物是治疗后DBP的下降百分比（杓型现象）（p = 0.01）。
在65例经治疗的高血压（NH）患者中，在治疗前后（四年随访）通过ABPM评估，我们识别出一组有脑卒中和心血管疾病的患者。与另一组无疾病的患者相比，这些患者既往有更多的脑卒中和心血管意外，接受了更积极的治疗，且治疗后舒张压下降幅度更大（绝对值和百分比值）。然而，经过回归分析，治疗后夜间舒张压杓型现象是与疾病相关的唯一风险标志物。在这种情况下，以ABPM为指导的治疗可能会降低发病率。
