Amano K, Sakamoto T, Sugimoto T
Second Department of Internal Medicine, Faculty of Medicine, University of Tokyo.
J Cardiol. 1990;20(1):111-22.
Blood pressure (BP) recordings were obtained every 30 min using a noninvasive ambulatory BP recorder during 24 hours in 93 subjects with hypertension. Recordings were analyzed in four different situations: (1) annual check up at the health service center, (2) at work, (3) at home, and (4) during sleep. Subjects with BP higher than 160/95 mmHg in any of the three situations were defined as established hypertensive (n = 36); Subjects with 140-159/90-94 mmHg, as the borderline hypertensive (n = 32); and subjects with BP lower than 139/89 mmHg, as the normotensive (n = 25). Four successive systolic and diastolic BP values were averaged and served as 24-hour BP patterns. Systolic BP over 140 mmHg, diastolic BP over 90 mmHg and mean BP over 107 mmHg were defined as a s-hyperbaric index (s-HBI), d-HBI and m-HBI, respectively. The normotensive group showed a marked decrease of BP after recordings explained by the "white coat phenomenon". The 24-hour recordings in all the three groups showed the highest BP at work and the lowest during sleep. The situational BP changes were generally similar, but the established hypertensive group showed larger BP differences between work and home (SBP 8.8 +/- 9.0 mmHg, 7.8 +/- 8.3 mmHg). For differentiating the three groups, the hyperbaric index was better than the 24-hour average BP. The average home BP showed a good correlation with the 24-hour average BP [SBP: r = 0.94 (p less than 0.01), DBP: r = 0.85 (p less than 0.01)]. Especially, BPs recorded before sleep predicted well the 24-hour average BP. An average of multiple BP measurements before sleep is thought to represent a 24-hour average BP more closely than a conventionally used single recording at home or after awakening.
在93名高血压患者中，使用无创动态血压记录仪在24小时内每隔30分钟记录一次血压（BP）。记录在四种不同情况下进行分析：（1）在健康服务中心进行年度体检时；（2）工作时；（3）在家时；（4）睡眠期间。在这三种情况中任何一种情况下血压高于160/95 mmHg的受试者被定义为确诊高血压患者（n = 36）；血压在140 - 159/90 - 94 mmHg之间的受试者为临界高血压患者（n = 32）；血压低于139/89 mmHg的受试者为血压正常者（n = 25）。连续四个收缩压和舒张压值取平均值作为24小时血压模式。收缩压超过140 mmHg、舒张压超过90 mmHg和平均血压超过107 mmHg分别被定义为收缩期高血压指数（s - HBI）、舒张期高血压指数（d - HBI）和平均高血压指数（m - HBI）。血压正常组在记录后血压出现明显下降，这可以用“白大衣现象”来解释。所有三组的24小时记录显示工作时血压最高，睡眠期间血压最低。不同情况下的血压变化总体相似，但确诊高血压组在工作和在家时的血压差异更大（收缩压8.8±9.0 mmHg，7.8±8.3 mmHg）。为区分这三组，高血压指数比24小时平均血压更好。家庭平均血压与24小时平均血压具有良好的相关性[收缩压：r = 0.94（p < 0.01），舒张压：r = 0.85（p < 0.01）]。特别是，睡眠前记录的血压能很好地预测24小时平均血压。与传统在家中或醒来后使用的单次记录相比，睡眠前多次血压测量的平均值被认为更能准确代表24小时平均血压。
