Morgan Trefor Owen
Department of Physiology, University of Melbourne, Victoria 3010, Australia.
Expert Rev Cardiovasc Ther. 2010 Jun;8(6):803-9. doi: 10.1586/erc.10.60.
Blood pressure (BP) varies throughout the day owing to interactions between the sympathetic nervous and the renin-angiotensin systems. When awake BP is controlled by sympathetic nervous system activity but during sleep the renin-angiotensin system becomes more important. The lower BP during sleep is a more powerful predictor of outcome than the awake BP. Certain individuals do not have the fall in BP with sleep and this worsens the outcome. Inadequate handling of sodium by the kidney is an important factor preventing this BP fall. The different drug classes have varying effects on BP during 24 h. Drugs that act independently of the two controlling systems have a similar effect at day and night. Drugs that act on the sympathetic nervous system have a greater effect during the day and little effect during sleep unless the sympathetic system is still active. Drugs that act via the renin-angiotensin system have a greater effect during sleep. Controlling BP during sleep may improve outcome.
由于交感神经系统和肾素-血管紧张素系统之间的相互作用，血压在一天中会有所变化。清醒时，血压由交感神经系统活动控制，但在睡眠期间，肾素-血管紧张素系统变得更为重要。睡眠期间较低的血压比清醒时的血压更能有力地预测预后。某些个体睡眠时血压不会下降，这会使预后恶化。肾脏对钠处理不当是阻止血压下降的一个重要因素。不同类别的药物在24小时内对血压有不同影响。独立于这两个控制系统起作用的药物在白天和晚上有相似的效果。作用于交感神经系统的药物在白天有更大的作用，而在睡眠期间作用很小，除非交感神经系统仍然活跃。通过肾素-血管紧张素系统起作用的药物在睡眠期间有更大的作用。控制睡眠期间的血压可能会改善预后。
