Henskens Léon H, Kroon Abraham A, van Oostenbrugge Robert J, Haest Rutger J, Lodder Jan, de Leeuw Peter W
Department of Internal Medicine, Division of General Internal Medicine, Subdivision Vascular Medicine, University Hospital Maastricht, Maastricht, The Netherlands.
J Hypertens. 2008 Apr;26(4):691-8. doi: 10.1097/HJH.0b013e3282f4225f.
We assessed how different definitions of the awake and asleep periods and use of various blood pressure (BP) indices affect the extent of the nocturnal BP dip, the prevalence of dippers and nondippers, their respective reproducibilities and the relation of nondipping with target-organ damage.
We performed 24-h ambulatory BP monitoring twice and determined the left ventricular mass index and urinary albumin excretion as indices of target-organ damage in 150 hypertensive patients (off-medication). Awake and asleep periods were assessed using fixed and diary time methods, covering all readings available (wide) or excluding morning and evening transition hours (narrow). Nondipping (BP dip < 10%) was established for systolic BP and diastolic BP, their combinations (and/or), and mean arterial pressure.
The different awake-asleep definitions caused significant variation in both the extent of the BP dip and the number of dippers and nondippers in comparison with the wide diary definition (i.e. use of actual awake and sleep periods). The prevalences of dippers and nondippers also varied significantly with the BP index. Reproducibility analyses of the BP dip and the dipping status yielded repeatability coefficients (expressed as percentages of nearly maximal variation) between 42.39 and 48.71%, and kappa values between 0.323 and 0.459, respectively. Some classifications, but not all, discriminated significantly between consistent dippers and nondippers in terms of left ventricular mass index or urinary albumin excretion.
Use of different definitions of awake-asleep and BP indices affects significantly the classification of nocturnal BP dipping and its relation with hypertensive target-organ damage.
我们评估了清醒期和睡眠期的不同定义以及各种血压（BP）指标的使用如何影响夜间血压下降幅度、杓型和非杓型血压的患病率、它们各自的可重复性以及非杓型血压与靶器官损害的关系。
我们对150名高血压患者（未服药）进行了两次24小时动态血压监测，并测定了左心室质量指数和尿白蛋白排泄量作为靶器官损害指标。使用固定时间法和日记时间法评估清醒期和睡眠期，涵盖所有可用读数（宽范围）或排除早晚过渡时段（窄范围）。根据收缩压、舒张压、它们的组合（和/或）以及平均动脉压确定非杓型血压（血压下降<10%）。
与宽范围日记定义（即使用实际清醒期和睡眠期）相比，不同的清醒-睡眠定义导致血压下降幅度以及杓型和非杓型血压的数量有显著差异。杓型和非杓型血压的患病率也因血压指标而异。血压下降幅度和血压下降状态的可重复性分析得出重复性系数（表示为几乎最大变化的百分比）在42.39%至48.71%之间，kappa值分别在0.323至0.459之间。在左心室质量指数或尿白蛋白排泄量方面，一些分类（但不是全部）在一致的杓型和非杓型血压之间有显著区分。
使用不同的清醒-睡眠定义和血压指标会显著影响夜间血压下降的分类及其与高血压靶器官损害的关系。
