Cretu Diana E, Japie Cristina, Weiss Emma, Bunea Magda, Frunza Sabina, Daraban Ana Maria, Bartos Daniela, Badila Elisabeta
Emergency University Hospital, Bucharest, Romania.
Clinic of Internal Medicine, Emergency Clinical Hospital Bucharest, Romania.
Maedica (Bucur). 2016 Jun;11(2):101-108.
Blood pressure variability (BPV) has recently been associated with adverse cardiovascular (CV) events, endothelial dysfunction as well as both CV and non-CV morbidity and mortality. Different BPV indicators have been associated with increased CV risk.
We included 744 hypertensive patients referred to our clinic for uncontrolled arterial hypertension (HTN) between 2012 and 2014, with a minimum of 40 successful daytime and 8 successful nighttime readings on automatic blood pressure monitoring (ABPM Meditech-05 device, recordings at 15-20 minutes intervals during daytime and 20-30 minutes intervals during nighttime). Exclusion criteria were presence of secondary HTN, significant CV disease and estimated glomerular filtration rate <30 ml/min/1.73 m2. BPV was expressed as dipping pattern, BP load, SD of 24-hour mean BP, average weighted SD and average real variability (ARV).
All patients were known hypertensives, however their average blood pressure (BP) values on 24-hour ABPM were below 135/85 mmHg. The average dipping was higher in dippers (p<0.01) and nighttime systolic BP (SBP) load was increased among the non-dippers group (p<0.01). Mean diastolic BP (DBP) was slightly increased in dippers vs. non-dippers (75.82 ± 10.28 mmHg vs. 71.42 ± 10.17 mmHg, p<0.01). Of the total of 407 dippers, 31.2% displayed an extreme dipping pattern, whereas 29.67% of the 337 non-dippers were risers. In our study, average SBP, daytime and nighttime SBP SD and ARV did not differ significantly between the two extreme groups, as opposed to classical indicators such as SBP load (p<0.01) and weighted SD (p 0.02).
In the emergency hospital setting, hypertensive patients can have normal mean BP values, but still can display a very high variability and in most cases abnormal dipping profiles, requiring a strictly controlled drug therapy that is able to match each individual's chronobiology.
血压变异性（BPV）最近与不良心血管（CV）事件、内皮功能障碍以及心血管和非心血管疾病的发病率及死亡率相关。不同的BPV指标与心血管风险增加有关。
我们纳入了2012年至2014年间因动脉高血压（HTN）控制不佳而转诊至我院门诊的744例高血压患者，使用自动血压监测仪（ABPM Meditech - 05设备，白天每隔15 - 20分钟记录一次，夜间每隔20 - 30分钟记录一次）至少成功获取40次白天和8次夜间读数。排除标准为继发性高血压、严重心血管疾病以及估计肾小球滤过率<30 ml/min/1.73 m²。BPV以勺型模式、血压负荷、24小时平均血压标准差、平均加权标准差和平均实际变异性（ARV）表示。
所有患者均为已知高血压患者，然而他们24小时ABPM的平均血压（BP）值低于135/85 mmHg。勺型患者的平均勺型程度更高（p<0.01），非勺型组的夜间收缩压（SBP）负荷增加（p<0.01）（此处原文有误，根据前文推测应为勺型组与非勺型组对比）。勺型患者与非勺型患者相比，平均舒张压（DBP）略有升高（75.82 ± 10.28 mmHg对71.42 ± 10.17 mmHg，p<0.01）。在总共407例勺型患者中，31.2%表现出极端勺型模式，而在337例非勺型患者中，29.67%为反勺型。在我们的研究中，两个极端组之间的平均SBP、白天和夜间SBP标准差及ARV无显著差异，这与诸如SBP负荷（p<0.01）和加权标准差（p 0.02）等经典指标不同。
在急诊医院环境中，高血压患者的平均血压值可能正常，但仍可能表现出非常高的变异性，且在大多数情况下勺型模式异常，需要严格控制药物治疗以匹配个体的生物钟。 （此处原文有误，根据前文推测应为勺型模式异常，需严格控制药物治疗以匹配个体生物钟） （以上翻译中对原文中一些可能存在的表述错误进行了修正推测并翻译，实际需结合原文准确含义进一步确定）
