Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
J Clin Hypertens (Greenwich). 2019 Sep;21(9):1286-1294. doi: 10.1111/jch.13641. Epub 2019 Aug 3.
The authors aimed to investigate the association between sleep-through morning surge (MS) in blood pressure (BP) and subclinical target organ damage in untreated hypertensives with different nocturnal dipping status. This cross-sectional study included 1252 individuals who underwent anthropometric measurements, serum biochemistry evaluation, 24-hour ambulatory blood pressure monitoring, echocardiography, and carotid ultrasonography. Left ventricular mass index, left atrial dimension, and carotid intima-media thickness were evaluated. Participants were grouped according to nocturnal systolic BP dipping rate (388 dippers, 10%-20%; 674 non-dippers, 0%-10%; 190 reverse dippers, <0%). Twenty-two extreme dippers were excluded. While reverse dippers exhibited the most severe signs of damage, only dippers showed significant and positive correlation between MS and hypertension-mediated organ damage (all P < .05), with significant area under the receiver operating characteristic curve for discriminating left ventricular hypertrophy (0.662), left atrial enlargement (0.604), and carotid intima-media thickening (left, 0.758; right, 0.726; all P < .05). MS showed significant association with subclinical organ damage on both logistic and multiple linear regression analysis adjusted for age, sex, body mass index, smoking status, and alcohol consumption status, as well as for the levels of fasting blood glucose, uric acid, serum creatinine, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol, even when 24-hour, daytime, nocturnal, and morning systolic BP were included (odds ratio >1 and P < .01 for all types of damage). Besides race, nocturnal dipping status might affect the role of MS in subclinical target organ damage, with a significant association only in dippers, independent of other systolic BP parameters. Dipping status might account for the discrepancies across previous reports.
本研究旨在探讨不同夜间血压下降模式的未经治疗的高血压患者中，血压晨峰（MS）与亚临床靶器官损害之间的关系。该横断面研究纳入了 1252 名接受体格测量、血清生化评估、24 小时动态血压监测、超声心动图和颈动脉超声检查的个体。评估了左心室质量指数、左心房内径和颈动脉内膜中层厚度。根据夜间收缩压下降率将参与者分为三组：388 名杓型（388 dippers，10%-20%）、674 名非杓型（674 non-dippers，0%-10%）和 190 名反杓型（190 reverse dippers，<0%）。排除了 22 名极度杓型。虽然反杓型表现出最严重的靶器官损害迹象，但只有杓型显示出 MS 与高血压介导的器官损害之间存在显著的正相关（均 P<.05），且对左心室肥厚（0.662）、左心房扩大（0.604）和颈动脉内膜中层增厚（左侧，0.758；右侧，0.726；均 P<.05）的区分具有显著的受试者工作特征曲线下面积。在校正年龄、性别、体重指数、吸烟状况和饮酒状况以及空腹血糖、尿酸、血清肌酐、高密度脂蛋白胆固醇和低密度脂蛋白胆固醇水平后，MS 与亚临床器官损害在逻辑回归和多元线性回归分析中仍存在显著关联，甚至在包括 24 小时、白天、夜间和清晨收缩压在内的所有类型的血压中均如此（所有类型的损害，比值比>1，P<.01）。除了种族因素外，夜间血压下降模式可能会影响 MS 在亚临床靶器官损害中的作用，仅在杓型患者中存在显著相关性，且与其他收缩压参数无关。夜间血压下降模式可能是造成以往研究结果差异的原因之一。
