Division of Cardiovascular Medicine, Department of Internal Medicine, School of Medicine, Center for Community and General Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
Hypertension. 2012 Oct;60(4):921-8. doi: 10.1161/HYPERTENSIONAHA.112.198101. Epub 2012 Aug 14.
In ambulatory blood pressure (BP) monitoring, nighttime BP has a superior ability to predict hypertensive target organ damage than awake BP. We evaluated whether nighttime BP, assessed by a home BP monitor, was associated with hypertensive target organ damage. We measured clinic BP, out-of-clinic BP including nighttime home BP, and the urinary albumin:creatinine ratio (UACR) in 854 patients who had cardiovascular risk factors. Nighttime home BP was measured at 2:00, 3:00, and 4:00 am, in addition to clinic, awake ambulatory, nighttime ambulatory, and awake home BP. Nighttime home systolic BP (SBP) was slightly higher than nighttime ambulatory SBP (difference, 2.6 mm Hg; P<0.001). Clinic (r=0.186), awake ambulatory (r=0.173), nighttime ambulatory (r=0.194), awake home (r=0.298), and nighttime home (r=0.311) SBPs were all associated with log-transformed UACR (all P<0.001). The correlation coefficient for the relationship between nighttime home SBP and log-transformed UACR was significantly greater than that for the relationship between nighttime ambulatory SBP and log-transformed UACR (P<0.001). The goodness of fit of the association between SBP and UACR was improved by adding nighttime home SBP to the other SBPs (P<0.001). Nighttime home diastolic BP also improved the goodness-of-fit of the association between diastolic BP and UACR (P=0.001). Similar findings were observed for the left ventricular mass index in the subgroup (N=594). In conclusion, nighttime home BP is slightly different from (but comparable to) nighttime ambulatory BP. The addition of nighttime home BP to other BP measures improves the association of BP with hypertensive target organ damage.
在动态血压监测中，夜间血压预测高血压靶器官损害的能力优于清醒时血压。我们评估了家庭血压监测评估的夜间血压是否与高血压靶器官损害有关。我们测量了 854 名有心血管危险因素的患者的诊所血压、包括夜间家庭血压的非诊所血压以及尿白蛋白/肌酐比值（UACR）。除了诊所、清醒动态、夜间动态和清醒家庭血压外，还在凌晨 2:00、3:00 和 4:00 测量夜间家庭血压。夜间家庭收缩压（SBP）略高于夜间动态 SBP（差值为 2.6mmHg；P<0.001）。诊所（r=0.186）、清醒动态（r=0.173）、夜间动态（r=0.194）、清醒家庭（r=0.298）和夜间家庭（r=0.311）SBP 均与对数变换的 UACR 相关（均 P<0.001）。夜间家庭 SBP 与对数变换的 UACR 之间的相关系数明显大于夜间动态 SBP 与对数变换的 UACR 之间的相关系数（P<0.001）。将夜间家庭 SBP 加入其他 SBP 可改善 SBP 与 UACR 之间的关联拟合度（P<0.001）。夜间家庭舒张压也改善了舒张压与 UACR 之间关联的拟合度（P=0.001）。在亚组（N=594）中也观察到了类似的左心室质量指数的发现。总之，夜间家庭血压与夜间动态血压略有不同（但可比较）。将夜间家庭血压加入其他血压测量值可改善血压与高血压靶器官损害之间的关联。
