Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.
Hypertens Res. 2013 Jun;36(6):478-84. doi: 10.1038/hr.2013.19. Epub 2013 Mar 21.
In Asian populations, a high prevalence of stroke, high salt intake and high salt sensitivity, the effects of which are partly augmented by epidemic obesity, are associated with hypertension. These factors are closely associated with resistant hypertension, especially with the disrupted circadian rhythm of blood pressure (BP), that is, non-dipper and riser patterns. An ambulatory BP profile-based strategy combined with medication and devices (renal denervation and baroreceptor activation therapy) would help to achieve 'perfect 24-h BP control', consisting of strict reduction of the 24-h BP level, restoring disrupted circadian BP rhythms and reducing excess BP variability. Such BP control would protect high-risk patients with resistant hypertension against systemic hemodynamic atherothrombotic syndrome (which involves systemic atherothrombotic vascular diseases and target-organ damage, advanced by the composite risks of pulsatile hemodynamic stress from central pressure and blood flow and by thrombometabolic risk factors). Information technology-based home sleep BP pressure monitoring may be useful for assessing the risk during sleep in high-risk patients with resistant hypertension and sleep apnea syndrome.
在亚洲人群中，与高血压相关的因素包括高发的中风、高盐摄入和高盐敏感性，这些因素部分受肥胖流行的影响。这些因素与难治性高血压密切相关，尤其是与血压昼夜节律紊乱（即非杓型和晨峰型）有关。基于动态血压监测的策略结合药物和器械（肾去神经和压力感受器激活治疗）治疗有助于实现“完美的 24 小时血压控制”，包括严格降低 24 小时血压水平、恢复紊乱的昼夜血压节律和降低血压变异性。这种血压控制可以保护难治性高血压的高危患者免受全身血流动力学动脉粥样血栓形成综合征（涉及全身动脉粥样血栓形成血管疾病和靶器官损伤，由中心压力和血流的脉动血流动力学应激以及血栓代谢危险因素构成的复合风险所推动）的影响。基于信息技术的家庭睡眠血压监测可能有助于评估难治性高血压和睡眠呼吸暂停综合征高危患者睡眠期间的风险。
