Cuspidi Cesare, Giudici Valentina, Negri Francesca, Sala Carla
Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milano, Italy.
Expert Rev Cardiovasc Ther. 2010 Jun;8(6):781-92. doi: 10.1586/erc.10.29.
The classification of hypertensive subjects according to circadian blood pressure (BP) variations (i.e., dipping vs nondipping) is a useful means for reliable individual risk stratification and effective therapeutic decision-making. Increasing evidence, although not univocal, suggests that a reduced nocturnal BP fall relates to an excess of cardiovascular complications. The association between nondipping status with left ventricular hypertrophy (LVH) and its therapeutic implications are still debated; in this article we examined the studies published in the last decade on this controversial issue. The studies identified by a PubMed search were eligible for the analysis if they fulfilled the following criteria: full articles in English, published from 1 January 2000 to 31 December 2009, and inclusion of adult or elderly subjects. According to these criteria, 26 studies encompassing 3877 participants have been selected. A total of 17 studies for a total of 2497 subjects were positive for a link between nondipping and LVH, whereas the remaining nine studies were negative. Notably, three studies that accurately defined the nondipping status on the basis of two consistent ambulatory blood pressure monitoring sessions over a short time interval showed a significant association of this pattern with LVH; this suggests that a persisting nondipping pattern is associated with a more pronounced cardiac involvement. Preliminary data support the view that nondipping may be reverted to dipping by chronotherapy and by diuretics in salt-sensitive patients. Whether restoring the normal nocturnal BP dip in hypertensives with LVH regresses cardiac damage at present remains an untested hypothesis.
根据昼夜血压（BP）变化（即勺型与非勺型）对高血压患者进行分类，是可靠的个体风险分层和有效治疗决策的有用方法。越来越多的证据表明，夜间血压下降幅度减小与心血管并发症增多有关，尽管这些证据并不一致。非勺型状态与左心室肥厚（LVH）之间的关联及其治疗意义仍存在争议；在本文中，我们研究了过去十年中发表的关于这个有争议问题的研究。通过PubMed搜索确定的研究，如果符合以下标准，则有资格进行分析：英文全文，发表于2000年1月1日至2009年12月31日，且纳入成人或老年受试者。根据这些标准，共选择了26项研究，涵盖3877名参与者。总共17项研究（涉及2497名受试者）表明非勺型与LVH之间存在关联，而其余9项研究则为阴性。值得注意的是，三项基于短时间间隔内两次一致的动态血压监测准确界定非勺型状态的研究表明，这种模式与LVH存在显著关联；这表明持续的非勺型模式与更明显的心脏受累有关。初步数据支持这样的观点，即通过时间治疗法以及对盐敏感患者使用利尿剂，非勺型可能会转变为勺型。目前，恢复LVH高血压患者正常的夜间血压勺型是否能使心脏损伤消退仍是一个未经检验的假设。
