Cuspidi Cesare, Meani Stefano, Valerio Cristiana, Catini Eleonora, Fusi Veronica, Sala Carla, Zanchetti Alberto
Istituto di Medicina Cardiovascolare, Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Ospedale Maggiore, IRCCS, Milano and Istituto Auxologico Italiano IRCCS, Università degli Studi di Milano, Milano, Italy.
Blood Press Monit. 2005 Aug;10(4):175-80. doi: 10.1097/01.mbp.0000170921.55412.02.
The relationship between metabolic syndrome components, as defined by the Adult Treatment Panel III report, and ambulatory blood pressure in hypertensive patients has not been investigated to date.
To explore the relation between metabolic syndrome components ambulatory blood pressure levels and blood pressure day/night variations in a large population of never-treated essential hypertensive patients.
This investigation included 519 patients with uncomplicated grade 1 and 2 hypertension (mean age 45+11 years) who were attending a hypertension hospital outpatient clinic. They underwent the following procedures: (1) repeated clinic blood pressure measurements; (2) blood sampling for routine chemistry examinations; and (3) ambulatory blood pressure monitoring over two 24-h periods within 4 weeks. Because, by selection, all participants fulfilled one of the Adult Treatment Panel III criteria, the additional four criteria, abdominal obesity, hypertriglyceridemia, low HDL cholesterol and high blood fasting glucose, were specifically searched for. Patients were stratified according to the absence (group I) or the presence of one (group II), two (group III), three or four (group IV) components of the metabolic syndrome. Nocturnal dipping was defined as a night-time reduction in average systolic and diastolic blood pressure >10% compared to average daytime values. Each participant was classified according to the consistency of the dipping or nondipping status in the first and second ambulatory blood pressure measurement periods as follows: reproducible dipper (DD: decrease in blood pressure >10% in both ambulatory blood pressure measurement periods), reproducible nondipper (ND-ND: decrease in blood pressure <10% in both ambulatory blood pressure measurement periods) and variable dipper (VD: i.e dipper in one and nondipper in the other ambulatory blood pressure measurement period).
In the whole population mean clinic and 48-h ambulatory blood pressures were 146/96 and 136/87 mmHg, respectively. In all, 197 patients (38%) had no metabolic syndrome components other than high blood pressure, 171 (33%) had one, 109 (21%) had two and 42 (8%) had three or four components. The four groups did not differ in age, clinic blood pressure, average 48-h, daytime, night-time systolic and diastolic blood pressure, and percentages of nocturnal fall in systolic and diastolic blood pressure. Furthermore, the distribution of three different ambulatory blood pressure patterns (DD, ND-ND and VD) was similar in the four groups: I=54.6%, 23.0%, 22.4%; II=51.1%, 21.7%, 27.2%; III=51.9%, 23.6%, 24.5%; and IV=52.7%, 27.2%, 25.1%, respectively.
Our findings indicate that no significant relationship exists between the extent of metabolic alterations and ambulatory blood pressure levels or circadian variations in blood pressure in uncomplicated essential hypertensive patients.
成人治疗小组第三次报告所定义的代谢综合征各组分与高血压患者动态血压之间的关系迄今尚未得到研究。
在大量未经治疗的原发性高血压患者中探讨代谢综合征各组分、动态血压水平以及血压昼夜变化之间的关系。
本研究纳入了519例单纯性1级和2级高血压患者（平均年龄45±11岁），这些患者均在一家高血压医院门诊就诊。他们接受了以下检查：（1）多次测量诊室血压；（2）采集血样进行常规生化检查；（3）在4周内分两个24小时时段进行动态血压监测。由于通过筛选所有参与者均符合成人治疗小组第三次报告的一项标准，则专门检查了另外四项标准，即腹型肥胖、高甘油三酯血症、低高密度脂蛋白胆固醇和空腹血糖升高。根据是否存在代谢综合征的一个组分（第二组）、两个组分（第三组）、三个或四个组分（第四组），将患者分为无代谢综合征组分（第一组）。夜间血压下降定义为夜间平均收缩压和舒张压较白天平均值下降>10%。根据第一次和第二次动态血压测量时段内血压下降或非下降状态的一致性，将每位参与者分类如下：重复性杓型血压者（DD：两个动态血压测量时段血压均下降>10%）、重复性非杓型血压者（ND-ND：两个动态血压测量时段血压均下降<10%）和变异性杓型血压者（VD：即一个动态血压测量时段为杓型血压而另一个为非杓型血压）。
在整个人群中，平均诊室血压和48小时动态血压分别为146/96 mmHg和136/87 mmHg。共有197例患者（38%）除高血压外无代谢综合征组分，171例（33%）有一个组分，109例（21%）有两个组分，42例（8%）有三个或四个组分。四组患者在年龄、诊室血压、平均48小时、白天、夜间收缩压和舒张压以及收缩压和舒张压夜间下降百分比方面无差异。此外，三种不同动态血压模式（DD、ND-ND和VD）在四组中的分布相似：第一组分别为54.6%、23.0%、22.4%；第二组分别为51.1%、21.7%、27.2%；第三组分别为51.9%、23.6%、24.5%；第四组分别为52.7%、27.2%、25.1%。
我们的研究结果表明，在单纯性原发性高血压患者中，代谢改变程度与动态血压水平或血压昼夜变化之间不存在显著关系。
