Tsioufis Costas, Antoniadis Dimitris, Stefanadis Christodoulos, Tzioumis Kostas, Pitsavos Christos, Kallikazaros Ioannis, Psarros Themis, Lalos Spyros, Michaelides Andreas, Toutouzas Poulos
Department of Cardiology, University of Athens, Hippokration Hospital, Greece.
Am J Hypertens. 2002 Jul;15(7 Pt 1):600-4. doi: 10.1016/s0895-7061(02)02954-0.
Recently a growing amount of interest has been focused on new risk factors for cardiovascular disease, such as insulin, leptin, homocysteine, and urinary albumin excretion (UAE). Furthermore, the absence of a nocturnal blood pressure (BP) decrease is emerging as an index for future target organ damage. In the present study we aimed to determine the relationship between these risk factors and circadian BP variations in essential hypertensive subjects. One hundred six patients, aged 54+/-7 years, with stage I-II untreated hypertension were classified as dippers and nondippers according to the diurnal variation of >10% between mean daytime and nighttime systolic BP (SBP) and diastolic BP (DBP) in 24-h noninvasive ambulatory BP monitoring. Venous blood samples were drawn for determination of insulin, leptin, and homocysteine plasma levels, whereas UAE was evaluated in three consecutive 24-h urine samples. Nondippers compared to dippers had significantly greater hemodynamic load and higher UAE (by 17 mg/24 h, P < .05). The two groups did not differ regarding serum insulin, plasma leptin, and homocysteine levels. In the entire population, leptin was positively correlated with age, body mass index, 24-h DBP, fasting serum insulin, and plasma homocysteine levels, whereas homocysteine levels were significantly related to 24-h SBP and DBP values. Multiple linear regression analyses revealed that only UAE was significantly related with nocturnal SBP and DBP decrease (P < .05 for both). These findings suggest that the increased UAE observed in nondipper hypertensive subjects possibly represents a useful indicator-for future target organ damage.
最近，越来越多的关注集中在心血管疾病的新风险因素上，如胰岛素、瘦素、同型半胱氨酸和尿白蛋白排泄量（UAE）。此外，夜间血压（BP）无下降正逐渐成为未来靶器官损害的一个指标。在本研究中，我们旨在确定这些风险因素与原发性高血压患者昼夜血压变化之间的关系。106例年龄为54±7岁、未经治疗的I-II期高血压患者，根据24小时无创动态血压监测中白天平均收缩压（SBP）和舒张压（DBP）与夜间的差值>10%的昼夜变化，分为杓型和非杓型。采集静脉血样以测定胰岛素、瘦素和同型半胱氨酸的血浆水平，而UAE则在连续三份24小时尿样中进行评估。与杓型患者相比，非杓型患者具有明显更高的血流动力学负荷和更高的UAE（高17mg/24小时，P<.05）。两组在血清胰岛素、血浆瘦素和同型半胱氨酸水平方面无差异。在整个人群中，瘦素与年龄、体重指数、24小时DBP、空腹血清胰岛素和血浆同型半胱氨酸水平呈正相关，而同型半胱氨酸水平与24小时SBP和DBP值显著相关。多元线性回归分析显示，只有UAE与夜间SBP和DBP下降显著相关（两者均P<.05）。这些发现表明，在非杓型高血压患者中观察到的UAE升高可能是未来靶器官损害的一个有用指标。
