Stergiou George S, Mastorantonakis Stylianos E, Roussias Leonidas G
Hypertension Center, Third University Department of Medicine, Sotiria Hospital, Athens, Greece.
Hypertens Res. 2008 Oct;31(10):1859-64. doi: 10.1291/hypres.31.1859.
The surge in blood pressure (BP) upon rising after waking in the morning has been associated with increased risk of target organ damage and cardiovascular events. The reproducibility of this phenomenon within the same 24-h period was tested in subjects with a siesta during ambulatory BP monitoring by assessing the morning surge (MS) vs. the evening surge (ES) after siesta. Ambulatory BP recordings with reported siesta from hypertensive subjects were analyzed. MS and ES were assessed using four different definitions. The intraindividual reproducibility was assessed using the standard deviation of differences between MS and ES, the concordance correlation coefficient, the coefficient of variation and the agreement between MS and ES in detecting "surgers" among hypertensive subjects (top quartile of the BP surge distribution). A total of 562 ambulatory recordings were analyzed (476 subjects, mean age 54.9+/-13.2 [SD] years, treated 47%). Average MS (16.3/14.4 mmHg, systolic/diastolic) was higher than ES (13.3/12.1 mmHg, p<0.001) due to higher post-rising BP in the morning (p<0.01). The intraindividual reproducibility was rather poor, with no clear differences among different definitions. However, there was about 70% agreement between MS and ES in the detection of "surgers" (systolic and diastolic, kappa statistic 0.18). These data suggest that, although the intraindividual reproducibility of the BP surge within the same 24-h period is rather poor, about 70% of the "morning surgers" were also "evening surgers." Thus, the BP surge might be an inherent pathophysiological characteristic of the BP behavior of an individual and deserves further investigation.
早晨醒来后起身时血压（BP）的急剧上升与靶器官损害和心血管事件风险增加有关。通过评估午睡后的早晨血压骤升（MS）与傍晚血压骤升（ES），在动态血压监测期间对有午睡习惯的受试者在同一24小时内该现象的可重复性进行了测试。分析了高血压患者报告有午睡习惯的动态血压记录。使用四种不同定义评估MS和ES。使用MS和ES之间差异的标准差、一致性相关系数、变异系数以及MS和ES在检测高血压患者（血压骤升分布的上四分位数）中的“骤升者”之间的一致性来评估个体内可重复性。共分析了562份动态记录（476名受试者，平均年龄54.9±13.2[标准差]岁，47%接受治疗）。由于早晨起身后的血压较高（p<0.01），平均MS（收缩压/舒张压为16.3/14.4 mmHg）高于ES（13.3/12.1 mmHg，p<0.001）。个体内可重复性相当差，不同定义之间无明显差异。然而，在检测“骤升者”方面，MS和ES之间约有70%的一致性（收缩压和舒张压，kappa统计量为0.18）。这些数据表明，尽管在同一24小时内血压骤升的个体内可重复性相当差，但约70%的“早晨骤升者”也是“傍晚骤升者”。因此，血压骤升可能是个体血压行为的一种内在病理生理特征，值得进一步研究。
