Manner Ingjerd W, Waldum-Grevbo Bård, Witczak Birgit Nomeland, Bækken Morten, Øktedalen Olav, Os Ingrid, Schwartz Thomas, Sjaastad Ivar
a Department of Nephrology , Oslo University Hospital , Oslo , Norway.
b Institute for Experimental Medical Research , Oslo University Hospital and University of Oslo , Oslo , Norway.
Blood Press. 2017 Dec;26(6):332-340. doi: 10.1080/08037051.2017.1346459. Epub 2017 Jul 4.
Non-dipping nocturnal blood pressure (BP) pattern has been reported prevalent among HIV-infected patients and is associated with adverse cardiovascular outcomes. The aims of this observational study were to identify predictors of nocturnal BP decline, and to explore whether diurnal BP profile is associated with alterations in cardiac structure and function.
A total of 108 treated HIV-infected patients with suppressed viremia underwent ambulatory BP measurement, 51 of these patients also underwent echocardiography.
Non-dipping nocturnal BP pattern was present in 51% of the patients. Decreased nocturnal decline in systolic BP (SBP) correlated with lower CD4 count (r = 0.21, p = 0.032) and lower CD4/CD8 ratio (r = 0.26, p = 0.008). In multivariate linear regression analyses, lower BMI (p = 0.015) and CD4/CD8 ratio <0.4 (p = 0.010) remained independent predictors of nocturnal decline in SBP. Nocturnal decline in SBP correlated with impaired diastolic function, e' (r = 0.28, p = 0.049) as did nadir CD4 count (r = 0.38, p = 0.006). In multivariate linear regression analyses, nadir CD4 count <100 cells/μL (p = 0.037) and age (p < 0.001) remained independent predictors of e'.
Compromised immune status may contribute to attenuated diurnal BP profile as well as impaired diastolic function in well-treated HIV infection.
据报道，非勺型夜间血压模式在HIV感染患者中普遍存在，且与不良心血管结局相关。本观察性研究的目的是确定夜间血压下降的预测因素，并探讨日间血压分布是否与心脏结构和功能的改变有关。
共有108例接受治疗且病毒血症得到抑制的HIV感染患者进行了动态血压测量，其中51例患者还接受了超声心动图检查。
51%的患者存在非勺型夜间血压模式。收缩压（SBP）夜间下降减少与较低的CD4细胞计数（r = 0.21，p = 0.032）和较低的CD4/CD8比值（r = 0.26，p = 0.008）相关。在多变量线性回归分析中，较低的体重指数（BMI）（p = 0.015）和CD4/CD8比值<0.4（p = 0.010）仍然是SBP夜间下降的独立预测因素。SBP夜间下降与舒张功能受损、e'（r = 0.28，p = 0.049）以及最低CD4细胞计数（r = 0.38，p = 0.006）相关。在多变量线性回归分析中，最低CD4细胞计数<100个细胞/μL（p = 0.037）和年龄（p < 0.001）仍然是e'的独立预测因素。
在接受良好治疗的HIV感染中，免疫状态受损可能导致日间血压分布减弱以及舒张功能受损。
