Portaluppi F, Montanari L, Ferlini M, Gilli P
Clinica Medica, University of Ferrara, Italy.
Chronobiol Int. 1990;7(4):321-7.
The extended use of ambulatory monitoring has permitted the identification of many conditions in which the circadian rhythm of blood pressure is altered. The common denominator seems to be an impairment of the autonomic nervous system function. We examined whether the circadian blood pressure rhythm is altered in chronic renal failure (where autonomic dysfunction is usually present) by using a standardized chronobiological inferential statistical method in hospitalized subjects. For this purpose, a group of 30 non-hemodialysis hypertensive patients with chronic renal failure was compared with a second group of 30 patients affected by uncomplicated mild-to-moderate essential hypertension. The two groups were matched by age, sex and circadian mesors of blood pressure. Diet, meal times, sleep, and activity logs were standardized. Blood pressure and heart rate recordings were obtained by using an automatic oscillometric recorder and subsequently analyzed according to the cosinor method. A mean circadian rhythm of blood pressure was documented in both groups, but while the mean acrophases occurred between 2 and 3 p.m. in essential hypertension, in renal failure they were between 11 p.m. and midnight for blood pressure and around 7 p.m. for heart rate. In addition, the mean circadian amplitudes were significantly lower in renal failure, while the mean circadian mesor of heart rate was significantly higher. Our data demonstrate that the circadian rhythms of blood pressure and heart rate are altered also in hypertension due to chronic renal failure.
动态血压监测的广泛应用使得人们能够识别出许多血压昼夜节律发生改变的情况。其共同特征似乎是自主神经系统功能受损。我们采用标准化的时间生物学推断统计方法，对住院患者进行研究，以检验慢性肾衰竭（通常存在自主神经功能障碍）患者的血压昼夜节律是否发生改变。为此，将一组30例慢性肾衰竭非血液透析高血压患者与另一组30例单纯轻至中度原发性高血压患者进行比较。两组在年龄、性别和血压昼夜中值方面相匹配。饮食、用餐时间、睡眠和活动记录均标准化。使用自动示波记录仪记录血压和心率，并随后根据余弦分析法进行分析。两组均记录到血压的平均昼夜节律，但在原发性高血压患者中，平均血压峰值相位出现在下午2点至3点之间，而在肾衰竭患者中，血压峰值相位在晚上11点至午夜之间，心率峰值相位在晚上7点左右。此外，肾衰竭患者的平均昼夜血压波动幅度显著降低，而心率的平均昼夜中值显著升高。我们的数据表明，慢性肾衰竭所致高血压患者的血压和心率昼夜节律也会发生改变。
