Seguchi Masaru, Wada Hiroshi, Sakakura Kenichi, Nakagawa Tom, Ibe Tatsuro, Ikeda Nahoko, Sugawara Yoshitaka, Ako Junya, Momomura Shin-ichi
Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University.
Int Heart J. 2015 May 13;56(3):324-8. doi: 10.1536/ihj.14-328. Epub 2015 Apr 23.
Acute aortic dissection (AAD) is a life-threatening cardiovascular disease with high mortality. Hypertension is a well known risk factor of AAD. There have been previous reports about the association between circadian variation of blood pressure (BP) and cardiovascular events. However, little is known about the association between the onset-time of AAD and circadian variation of BP. The purpose of this study was to clarify the characteristics of circadian variation of BP in AAD and its relation to the onset-time of this disease. This study included type B spontaneous AAD patients who were referred to our institution and treated conservatively between January 2008 and June 2013. Patients with type A AAD, secondary to trauma, and type B AAD which preceded surgical intervention were excluded. Data were retrospectively collected from the hospital medical records. Sixty-eight patients with type B AAD were enrolled. The distribution of the circadian pattern in the study patients was as follows: extreme-dipper, 0% (none); dipper, 20.6% (n = 14); nondipper, 50% (n = 34); riser, 29.4% (n = 20). Non-dipper and riser patterns were more frequently observed compared with other population studies reported previously. Moreover, no patient in the dipper group had night-time onset while 31.5% of the patients in the absence of nocturnal BP fall group (non-dipper and riser) did (P = 0.01). Absence of a nocturnal BP fall was frequently seen in AAD patients. Absence of a nocturnal BP fall may be a risk factor of AAD. Circadian variation of BP may also affect the onset-time of type B AAD.
急性主动脉夹层（AAD）是一种危及生命的心血管疾病，死亡率很高。高血压是AAD众所周知的危险因素。此前已有关于血压（BP）昼夜变化与心血管事件之间关联的报道。然而，关于AAD发病时间与BP昼夜变化之间的关联却知之甚少。本研究的目的是阐明AAD患者BP昼夜变化的特征及其与该病发病时间的关系。本研究纳入了2008年1月至2013年6月期间转诊至我院并接受保守治疗的B型自发性AAD患者。排除A型AAD、继发于创伤的患者以及手术干预前的B型AAD患者。数据从医院病历中回顾性收集。共纳入68例B型AAD患者。研究患者的昼夜模式分布如下：极端杓型，0%（无）；杓型，20.6%（n = 14）；非杓型，50%（n = 34）；上升型，29.4%（n = 20）。与先前报道的其他人群研究相比，可以更频繁地观察到非杓型和上升型模式。此外，杓型组中没有患者在夜间发病，而在无夜间血压下降组（非杓型和上升型）中有31.5%的患者在夜间发病（P = 0.01）。AAD患者中经常出现无夜间血压下降的情况。无夜间血压下降可能是AAD的一个危险因素。BP的昼夜变化也可能影响B型AAD的发病时间。
