Izzedine Hassane, Launay-Vacher Vincent, Deray Gilbert
Nephrology Department, Pitie-Salpetriere Hospital, 47-83, Blvd de l'Hopital, 75013, Paris, France.
Int J Cardiol. 2006 Mar 8;107(3):343-9. doi: 10.1016/j.ijcard.2005.03.046.
Blood pressure (BP) varies according to cycles characterized by a reduction during sleep and an increase on awakening. The nighttime decrease is absent or blunted in some patients (termed "non-dippers"). Cross-sectional and prospective data have shown that non-dippers have more target organ damage than have dippers in normotensive and hypertensive subjects. We reviewed the English language literature regarding this association. A non-fortuitous association seems to exist between non-dipper status and cardiovascular risk such as stroke and cardiac events. Among diabetic patients, this phenomenon has been described to occur more often in individuals with autonomic neuropathy and with different degrees of diabetic nephropathy. In normoalbuminuric normotensive type I diabetic patients without any degree of autonomic dysfunction, according to traditional cardiovascular tests, diastolic BP (dBP) night/day ratio is associated with an increased glomerular filtration rate and an increased extracellular volume. The disruption of the circadian rhythm of sympathovagal activity in non-dipper patients was associated with higher levels in systolic BP (sBP) and dBP and with a reduced decline in sBP and dBP levels during the night. Therefore, the prognostic implications of the non-dipper status may be important since the overall 24-h blood pressure load is elevated in these individuals. These data suggest that patients in whom blood pressure decreases during the night incur less damage to their brain, kidneys, heart, and blood vessels than people with elevated nocturnal BP.
血压（BP）会根据特定周期发生变化，其特点是睡眠期间血压降低，醒来时血压升高。在一些患者中（称为“非勺型血压者”），夜间血压下降不明显或不存在。横断面研究和前瞻性研究数据表明，在血压正常和高血压的受试者中，非勺型血压者比勺型血压者有更多的靶器官损害。我们回顾了关于这种关联的英文文献。非勺型血压状态与中风和心脏事件等心血管风险之间似乎存在必然联系。在糖尿病患者中，这种现象在患有自主神经病变和不同程度糖尿病肾病的个体中更为常见。在没有任何自主神经功能障碍程度的正常白蛋白尿血压正常的I型糖尿病患者中，根据传统心血管测试，舒张压（dBP）的夜间/日间比值与肾小球滤过率增加和细胞外液量增加有关。非勺型血压患者交感神经-迷走神经活动昼夜节律的破坏与收缩压（sBP）和dBP水平升高以及夜间sBP和dBP水平下降减少有关。因此，非勺型血压状态的预后意义可能很重要，因为这些个体的24小时总体血压负荷升高。这些数据表明，夜间血压下降的患者对其大脑、肾脏、心脏和血管造成的损害比夜间血压升高的人要小。
