Palatini P, Penzo M, Racioppa A, Zugno E, Guzzardi G, Anaclerio M, Pessina A C
First Medical Clinic, University of Padua, Italy.
Arch Intern Med. 1992 Sep;152(9):1855-60.
The purpose of this study was to assess whether hypertensive target organ damage is related to average nighttime blood pressure (BP) and to BP variability.
Sixty-seven normotensive subjects and 171 borderline, 309 mild, 140 moderate, and 41 severe hypertensive patients were studied with noninvasive ambulatory BP monitoring. Each subject was assigned a target organ damage score of 0 to 5 on the basis of funduscopic changes and degree of left ventricular hypertrophy calculated from electrocardiogram and chest roentgenogram.
When the 728 subjects were subdivided into five classes of increasing daytime BP, in each class a significantly higher degree of target organ damage was present in the subjects with higher nighttime diastolic BP. A similar, although nonsignificant, trend was observed in the subjects with higher nighttime systolic BP. In particular, higher nighttime BP levels were accompanied by a more severe degree of left ventricular hypertrophy. As for variability, subjects with higher daytime systolic BP SD, but not with higher daytime diastolic SD, displayed a more severe degree of target organ damage; this was accounted for by a higher degree of retinal abnormalities. The association between target organ damage and systolic BP SD was present both in men and women, while that with nighttime BP was present only in men. No relationship was found between degree of cardiovascular complications and peaks of pressure.
These results suggest that a reduced day-night BP difference and an increased daytime BP variability, evaluated as the SD, are associated with a higher degree of hypertensive cardiovascular complications. Whether this BP profile is the cause or the consequence of target organ damage remains to be established.
本研究旨在评估高血压靶器官损害是否与平均夜间血压（BP）及血压变异性相关。
对67名血压正常者以及171名临界高血压、309名轻度高血压、140名中度高血压和41名重度高血压患者进行无创动态血压监测研究。根据眼底变化以及由心电图和胸部X线片计算得出的左心室肥厚程度，为每位受试者赋予0至5分的靶器官损害评分。
当将728名受试者按照日间血压升高的程度分为五类时，在每一类中，夜间舒张压较高的受试者靶器官损害程度明显更高。在夜间收缩压较高的受试者中也观察到了类似趋势，尽管不显著。特别是，夜间血压水平较高伴随着更严重的左心室肥厚程度。至于变异性，日间收缩压标准差较高的受试者（而非日间舒张压标准差较高的受试者）显示出更严重的靶器官损害程度；这是由更高程度的视网膜异常所致。靶器官损害与收缩压标准差之间的关联在男性和女性中均存在，而与夜间血压的关联仅在男性中存在。未发现心血管并发症程度与血压峰值之间存在关联。
这些结果表明，昼夜血压差值减小以及以标准差评估的日间血压变异性增加与高血压心血管并发症程度较高相关。这种血压模式是靶器官损害的原因还是结果仍有待确定。
