Matteucci Elena, Giampietro Ottavio
Department of Internal Medicine, University of Pisa, Italy.
Curr Diabetes Rev. 2012 Sep;8(5):355-61. doi: 10.2174/157339912802083496.
Circadian misalignment has been implicated in the development of diabetes mellitus and cardiovascular disease. Circadian rhythms of blood pressure (BP) and heart rate (HR) have long been known and the mechanisms controlling them have been actively investigated in physiology and disease. In this respect, the introduction of 24-hour ambulatory blood pressure monitoring (ABPM) has enabled a more accurate assessment of circadian BP patterns in order to solve diagnostic uncertainty or to establish dipper status. However, attention has been mainly focused on measures of extent (midline estimating statistic of rhythm, MESOR, and amplitude) rather than timing (acrophase) of changes within a cycle. The review summarises 1) evidence for altered characteristics of BP rhythm (in particular, phase shifts along the time axis) in animal and human diabetes mellitus, 2) the mechanisms that have been supposed to underlie the observed changes in cardiovascular function before diabetes onset and during progression of the disease, and 3) the adverse consequences that may result from an altered circadian BP rhythm.
昼夜节律失调与糖尿病和心血管疾病的发生有关。血压（BP）和心率（HR）的昼夜节律早已为人所知，并且在生理学和疾病领域中，人们一直在积极研究控制它们的机制。在这方面，24小时动态血压监测（ABPM）的引入能够更准确地评估昼夜血压模式，以解决诊断不确定性或确定杓型状态。然而，注意力主要集中在变化程度的测量指标（节律中线估计统计量，MESOR，以及振幅）上，而非一个周期内变化的时间（峰相位）。本综述总结了：1）动物和人类糖尿病患者血压节律特征改变（特别是沿时间轴的相移）的证据；2）在糖尿病发病前和疾病进展过程中，被认为是心血管功能观察到的变化背后的机制；3）昼夜血压节律改变可能导致的不良后果。
