Cuspidi C, Meani S, Fusi V, Valerio C, Catini E, Magrini F, Zanchetti A
Istituto di Medicina Cardiovascolare, Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Ospedale Maggiore, IRCCS, Milano, Italy.
J Hum Hypertens. 2005 Jun;19(6):471-7. doi: 10.1038/sj.jhh.1001850.
Isolated ambulatory hypertension is a condition characterized by elevated ambulatory but normal clinic blood pressure (BP), and has been reported to be associated with increased cardiovascular risk in untreated subjects. However, little is known about the relationship between this condition and intermediate end points such as target organ damage (TOD) in treated hypertensives. We investigated the impact of isolated ambulatory hypertension on left ventricular hypertrophy (LVH) and microalbuminuria (MA) in a selected sample of treated nondiabetic hypertensives with effective and prolonged clinic BP control (BP<140/90 mmHg). Clinic BP measurements, routine diagnostic procedures, echocardiography and 24-h urine collection for MA, were undertaken in 80 patients (mean age 53+/-8 years) with essential hypertension attending our hospital outpatient centre at baseline and after an average follow-up of 30 months. At follow-up evaluation BP status was assessed by self-measurement of BP and ambulatory BP monitoring (ABPM). At the follow-up visit, 51 out of 80 patients (63.7%) reached a BP control according to ABP (average daytime BP<132/85 mmHg) criteria (group I) whereas the remaining 29 did not (group II); home BP was controlled (BP<135/85 mmHg) in all members of group I and in 86% of group II. In the overall study population, mean Sokolow voltage, LV mass index (LVMI) and urinary albumin excretion (UAE) decreased compared to baseline from 24.1+/-5.0 to 18.9+/-5.1 mm (P<0.05), 115.6+/-24.1 to 97.7+/-21.6 g/m(2) (P<0.01), 11.8+/-23.7 to 5.8+/-14.9 mg/24 h (P<0.05), respectively. The prevalence of ECG LVH, altered LV patterns and MA fell from 7.5 to 2.5% (P=NS), from 45 to 25 (P<0.01) and from 13.7 to 5.1% (P<0.05), respectively. However, when data were analysed separately for the two groups a significant decrease of echo LVH and MA was found only in patients with controlled ABP. LVMI and MA decreased from 117.1+/-23.1 to 95.9+/-22.1 g/m(2) (P<0.01) and 12.8+/-24.7 to 4.1+/-5.7 mg/24 h (P<0.05) in group I, and from 114.1+/-24.8 to 102.3+/-20.3 (P=NS) and 11.9+/-22.1 to 6.3+/-18.1 mg/24 h (P=NS) in group II. In conclusion, in the present study isolated ambulatory hypertension in treated patients is associated with a lack of regression in cardiac and extracardiac TOD, suggesting that a tight BP control throughout the 24 h plays a key role in lowering hypertension-induced structural and functional alterations at cardiac and renal level.
孤立性动态高血压是一种以动态血压升高但诊室血压正常为特征的病症，据报道，在未经治疗的患者中，其与心血管风险增加有关。然而，对于这种病症与治疗的高血压患者的诸如靶器官损害（TOD）等中间终点之间的关系，人们知之甚少。我们在一组经过治疗且临床血压得到有效且长期控制（血压<140/90 mmHg）的非糖尿病高血压患者样本中，研究了孤立性动态高血压对左心室肥厚（LVH）和微量白蛋白尿（MA）的影响。对80例原发性高血压患者（平均年龄53±8岁）进行了研究，这些患者在基线时以及平均随访30个月后，在我院门诊中心接受了诊室血压测量、常规诊断程序、超声心动图检查以及24小时尿微量白蛋白收集。在随访评估时，通过自我测量血压和动态血压监测（ABPM）来评估血压状况。在随访时，80例患者中有51例（63.7%）根据ABP（平均日间血压<132/85 mmHg）标准达到了血压控制（I组），而其余29例未达到（II组）；I组所有成员以及II组86%的成员家庭血压得到控制（血压<135/85 mmHg）。在整个研究人群中，与基线相比，平均索科洛夫电压、左心室质量指数（LVMI）和尿白蛋白排泄量（UAE）分别从24.1±5.0降至18.9±5.1 mm（P<0.05）、从115.6±24.1降至97.7±21.6 g/m²（P<0.01）、从11.8±23.7降至5.8±14.9 mg/24 h（P<0.05）。心电图LVH、左心室形态改变和MA的患病率分别从7.5%降至2.5%（P=无统计学意义）、从45降至25（P<0.01）以及从13.7%降至5.1%（P<0.05）。然而，当对两组数据分别进行分析时，仅在ABP得到控制的患者中发现回声LVH和MA有显著下降。I组LVMI和MA分别从117.1±23.1降至95.9±22.1 g/m²（P<0.01）以及从12.8±24.7降至4.1±5.7 mg/24 h（P<0.05），II组则分别从114.1±24.8降至102.3±20.3（P=无统计学意义）以及从11.9±22.1降至6.3±18.1 mg/24 h（P=无统计学意义）。总之，在本研究中，治疗患者中的孤立性动态高血压与心脏和心外TOD的消退不足有关，这表明24小时全程严格的血压控制在降低高血压引起的心脏和肾脏水平的结构和功能改变方面起着关键作用。
