Department of Internal Medicine D, The Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Am J Hypertens. 2012 Feb;25(2):159-64. doi: 10.1038/ajh.2011.191. Epub 2011 Oct 20.
The circadian pattern of blood pressure (BP) has yet to be defined among individuals with orthostatic hypotension (OH). The objective of this study was to evaluate whether OH is associated with nocturnal change in systolic BP.
In a prospective study, we evaluated patients who were referred for 24-h ambulatory blood pressure monitoring (ABPM). All subjects underwent orthostatic BP testing before recording their respective 24-h ABPM.
The study includes 185 subjects, 114 males, mean age 58 ± 18 years (range 19-89). Participants were classified, based on pattern of systolic BP changes at night, as dippers (greater than 10% decrease; n = 74), nondippers (0-10% decrease; n = 77), and reverse-dippers (increase; n = 34). Nineteen patients (10.3%) had OH. Almost all participants with OH (95%) had an abnormal diurnal BP pattern, and most of them (58%) were reverse-dippers, whereas only 56% of the participants without OH had an abnormal diurnal BP variation, and only 14% were reverse-dippers (P < 0.001). Systolic BP decreased with upright posture by 12 and 2 mm Hg in the reverse-dippers and the nondippers, respectively, and increased by 2 mm Hg in the dippers (P < 0.001). Postural changes in systolic BP were inversely related to the changes between day and night BP readings(r = -0.43; P < 0.01). In a multivariate linear regression analysis, orthostatic BP change, use of ≥2 antihypertensive drugs and female sex were related to nocturnal BP changes.
The decrease in BP during upright posture may be a marker of nondipping or reverse-dipping pattern of diurnal BP.
直立性低血压（OH）患者的血压（BP）昼夜节律模式尚未确定。本研究的目的是评估 OH 是否与夜间收缩压的变化有关。
在一项前瞻性研究中，我们评估了因 24 小时动态血压监测（ABPM）而转介的患者。所有患者在记录各自的 24 小时 ABPM 之前均进行了直立位 BP 测试。
该研究共纳入 185 例患者，男性 114 例，平均年龄 58 ± 18 岁（19-89 岁）。根据夜间收缩压变化模式，参与者分为杓型（下降> 10%；n = 74）、非杓型（下降 0-10%；n = 77）和反杓型（升高；n = 34）。19 例（10.3%）患者有 OH。几乎所有 OH 患者（95%）的日间 BP 模式异常，其中大多数（58%）为反杓型，而无 OH 患者中仅有 56%的日间 BP 变化异常，仅有 14%为反杓型（P < 0.001）。反杓型和非杓型患者的直立位收缩压分别下降 12 和 2 mmHg，而杓型患者收缩压增加 2 mmHg（P < 0.001）。收缩压的体位变化与日间和夜间 BP 读数之间的变化呈负相关（r = -0.43；P < 0.01）。在多元线性回归分析中，直立位 BP 变化、使用≥2 种降压药和女性与夜间 BP 变化有关。
直立位时 BP 下降可能是非杓型或反杓型日间 BP 模式的标志。
