Schrader J, Schoel G, Kandt M, Warneke G, Ruschitzka F, Rath W, Scheler F
Abt. für Nephrologie und Rheumatologie, Medizinische Universitätsklinik Göttingen.
Z Kardiol. 1991;80 Suppl 1:21-7.
A typical diurnal variation in blood pressure is observed in patients with essential hypertension. Attenuation or lack of circadian periodicity might be expected in patients with secondary hypertension. Therefore, non invasive ambulatory blood-pressure monitoring was performed in 172 patients with secondary hypertension and in 201 patients with essential hypertension. The following patients with secondary hypertension were investigated: renoparenchymatous nephropathy (n = 29), diabetic nephropathy (n = 24), morbus Conn (n = 6), renal artery stenosis (n = 32), pheochromocytoma (n = 5), hemodialysis patients (n = 30), and patients after kidney transplantation (n = 44). In addition, 36 pregnant women (17 normotensives, 19 hypertensives) were studied. 98.5% of patients with essential hypertension showed a nightly decline in blood pressure of at least 15 mmHg (systolic + diastolic), whereas 70% of patients with secondary hypertension showed either an attenuated circadian rhythm or no circadian rhythm. Patients with pheochromocytoma who had a nighttime increase in blood pressure demonstrated the greatest difference in the essential hypertension collective, followed by patients with diabetic nephropathy and patients after kidney transplantation. After successful treatment of the condition leading to hypertension, circadian periodicity returned in some patients. In summary, these results suggest that the absence of a nighttime decline in blood pressure during 24-h-ambulatory monitoring is an indication of secondary hypertension, which should be further investigated. As a practical consequence, antihypertensive drugs should also be applied in an evening dose in secondary hypertensives. Noninvasive ambulatory blood-pressure monitoring is recommended for treatment control, especially in patients who need an efficient blood-pressure control.
原发性高血压患者存在典型的血压昼夜波动。继发性高血压患者可能出现昼夜节律减弱或消失。因此，对172例继发性高血压患者和201例原发性高血压患者进行了无创动态血压监测。对以下继发性高血压患者进行了研究：肾实质肾病（n = 29）、糖尿病肾病（n = 24）、Conn综合征（n = 6）、肾动脉狭窄（n = 32）、嗜铬细胞瘤（n = 5）、血液透析患者（n = 30）以及肾移植术后患者（n = 44）。此外，还研究了36例孕妇（17例血压正常者，19例高血压患者）。98.5%的原发性高血压患者夜间血压至少下降15 mmHg（收缩压 + 舒张压），而70%的继发性高血压患者昼夜节律减弱或无昼夜节律。嗜铬细胞瘤患者夜间血压升高，与原发性高血压患者群体差异最大，其次是糖尿病肾病患者和肾移植术后患者。导致高血压的疾病成功治疗后，部分患者的昼夜节律恢复。总之，这些结果表明，24小时动态血压监测中夜间血压无下降是继发性高血压的一个指征，应进一步调查。实际应用中，继发性高血压患者也应在晚上服用降压药。建议进行无创动态血压监测以控制治疗，尤其是对需要有效控制血压的患者。
