Ravogli A, Arzilli F, Omboni S, Giovannetti R, Mutti E, Salvetti A, Mancia G
Centro di Fisiologia Clinica e Ipertensione, Istituto Scientifico Ospedale S. Luca, Milano, Italy.
J Hypertens. 1996 Jan;14(1):53-6.
To investigate whether nocturnal blood pressure fall is blunted in renovascular hypertension and can therefore be used as a diagnostic criterion for this condition.
In 14 renovascular hypertensive patients (age 43.8+/-2.1 years, mean+/-SEM, clinic blood pressure 173.6+/-3.7 mmHg systolic and 109.0+/-2.0 mmHg diastolic) and in 14 age- and blood pressure-matched essential hypertensive controls 24 h ambulatory blood pressure was measured after washout from drug treatment, during angiotensin converting enzyme inhibitor treatment and, in renovascular hypertension, also after percutaneous transluminal renal angioplasty.
The 24 h average systolic and diastolic blood pressures were 146.4+/-5.7 and 97.5+/-3.6 mmHg in renovascular and 144.3+/-1.2 and 98.0+/-2.2 mmHg in essential hypertensive patients. The angiotensin converting enzyme inhibitor treatment reduced 24 h average systolic and diastolic blood pressures by 8.5% and 9.7% in the renovascular and by 8.3% and 10.8% in the essential hypertensive group. Greater systolic and diastolic blood pressure reductions (-18.2% and -18.1%) were observed in renovascular hypertensive patients after percutaneous transluminal renal angioplasty. Blood pressure fell by about 10% during the night and the fall was similar in renovascular and in essential hypertensive patients. In the former group, nocturnal hypotension was similar after washout, during angiotensin converting enzyme inhibitor treatment and after percutaneous transluminal renal angioplasty. Similar results were obtained for nocturnal bradycardia.
Nocturnal blood pressure fall is equally manifest in renovascular and essential hypertension. The removal of the renal artery stenosis and blood pressure normalization do not enhance this phenomenon. Nocturnal hypotension seems therefore to be unaffected by renovascular hypertension.
研究肾血管性高血压患者夜间血压下降是否减弱，以及能否将其作为该疾病的诊断标准。
选取14例肾血管性高血压患者（年龄43.8±2.1岁，均值±标准误，诊室收缩压173.6±3.7 mmHg，舒张压109.0±2.0 mmHg）和14例年龄及血压匹配的原发性高血压对照者，在药物洗脱期、血管紧张素转换酶抑制剂治疗期间，以及肾血管性高血压患者经皮腔内肾血管成形术后，测量24小时动态血压。
肾血管性高血压患者24小时平均收缩压和舒张压分别为146.4±5.7 mmHg和97.5±3.6 mmHg，原发性高血压患者分别为144.3±1.2 mmHg和98.0±2.2 mmHg。血管紧张素转换酶抑制剂治疗使肾血管性高血压患者24小时平均收缩压和舒张压分别降低8.5%和9.7%，原发性高血压组分别降低8.3%和10.8%。肾血管性高血压患者经皮腔内肾血管成形术后，收缩压和舒张压下降幅度更大（分别为-18.2%和-18.）。夜间血压下降约10%，肾血管性高血压患者和原发性高血压患者的下降幅度相似。在前一组中，洗脱期、血管紧张素转换酶抑制剂治疗期间及经皮腔内肾血管成形术后夜间低血压情况相似。夜间心动过缓也得到类似结果。
肾血管性高血压和原发性高血压患者夜间血压下降同样明显。肾动脉狭窄解除和血压正常化并未增强这一现象。因此，夜间低血压似乎不受肾血管性高血压影响。
