Department of Clinical Therapeutics, Alexandra Hospital, Athens University School of Medicine, Athens, Greece.
J Hypertens. 2010 Jan;28(1):51-8. doi: 10.1097/HJH.0b013e328331b6c8.
The extent of target organ damage has been associated with both central hemodynamics and arterial stiffening, and the time rate of blood pressure (BP) changes in essential hypertension. However, the relative significance of these parameters has not been examined.
We recruited 232 consecutive uncomplicated newly diagnosed hypertensive patients and 241 normotensive individuals. Twenty-four-hour ambulatory BP monitoring was performed in all individuals. The time rate of SBP variation was computed as the first derivative of the SBP values against time. Aortic central SBP and central DBP, central pulse pressure, central augmentation index and central augmentation pressure were assessed noninvasively by pulse wave analysis. Common carotid artery intima-media thickness was measured by high-resolution ultrasonography.
Median 24-h time rate of BP changes was 0.571 +/- 0.114 mmHg/min. Traditional risk factors, office SBP, several ambulatory BP monitoring parameters (24-h SBP, 24-h pulse pressure, 24-h heart rate and BP dipping), 24-h time rate of BP changes, time rate of BP changes at different time intervals, and central SBP, central pulse pressure, central augmentation index and central augmentation pressure significantly correlated with intima-media thickness. Age, sex, BMI, 24-h time rate of BP changes, time rate of BP changes measured at 0100-0600 h and 24-h heart rate remained significant associates of intima-media thickness after adjustment for confounding factors. By multivariate stepwise linear regression, 24-h time rate of BP changes and time rate of BP changes at 0100-0600 h had incremental value over traditional risk factors, other ambulatory BP monitoring parameters and central hemodynamics.
These findings indicate that time rate of BP variation is superior to central hemodynamics as an associate of carotid intima-media thickness in hypertensive and normotensive individuals.
靶器官损伤的程度与中心血液动力学和动脉僵硬度以及原发性高血压的血压（BP）变化时间率有关。然而，这些参数的相对重要性尚未得到检验。
我们招募了 232 例连续的未经治疗的新诊断的高血压患者和 241 名血压正常的个体。所有个体均进行了 24 小时动态血压监测。SBP 变化的时间率计算为 SBP 值随时间的一阶导数。通过脉搏波分析无创地评估主动脉中心 SBP 和中心 DBP、中心脉压、中心增强指数和中心增强压。通过高分辨率超声测量颈总动脉内膜中层厚度。
中位 24 小时 BP 变化时间率为 0.571 +/- 0.114 mmHg/min。传统危险因素、诊室 SBP、几种动态血压监测参数（24 小时 SBP、24 小时脉压、24 小时心率和 BP 下降）、24 小时 BP 变化时间率、不同时间间隔的 BP 变化时间率以及中心 SBP、中心脉压、中心增强指数和中心增强压与内膜中层厚度显著相关。年龄、性别、BMI、24 小时 BP 变化时间率、0100-0600 小时的 BP 变化时间率和 24 小时心率在调整混杂因素后仍然是内膜中层厚度的显著相关因素。通过多元逐步线性回归，24 小时 BP 变化时间率和 0100-0600 小时的 BP 变化时间率在传统危险因素、其他动态血压监测参数和中心血液动力学方面具有增量价值。
这些发现表明，BP 变化时间率优于中心血液动力学，是高血压和血压正常个体颈动脉内膜中层厚度的相关因素。
