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高血压药物降低睡眠血压的程度与服药时间有关:系统评价和已发表人体试验的荟萃分析。

Extent of asleep blood pressure reduction by hypertension medications is ingestion-time dependent: Systematic review and meta-analysis of published human trials.

机构信息

Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo, Vigo, 36310, Spain; Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, 78712-0238, USA.

Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo, Vigo, 36310, Spain.

出版信息

Sleep Med Rev. 2021 Oct;59:101454. doi: 10.1016/j.smrv.2021.101454. Epub 2021 Jan 23.

Abstract

Combined evidence of published prospective outcome trials and meta-analyses substantiate elevated asleep blood pressure (BP) and blunted sleep-time relative BP decline (non-dipping), regardless of wake-time office BP and awake or 24 h BP means, are jointly the most highly significant independent prognostic markers of cardiovascular disease (CVD) risk and worthy therapeutic targets for prevention. Nonetheless, current guidelines continue to recommend the diagnosis of hypertension, when based on ambulatory BP monitoring (ABPM), rely, solely, on either the 24 h or "daytime" BP means. They also fail to recommend the time to treat patients. We conducted a systematic review of published human trials regarding ingestion-time differences in the effects of hypertension medications on asleep BP and sleep-time relative BP decline. Some 62 such trials published between 1992 and 2020, totaling 6120 hypertensive persons, evaluated 21 different single and 8 dual-fixed combination therapies. The vast (82.3%) majority of the trials substantiate the bedtime/evening vs. upon-waking/morning treatment schedule produces statistically significant better clinical benefits, including enhanced reduction of asleep systolic BP by an average 5.17 mmHg (95%CI [4.04, 6.31], P < 0.001 between treatment-time groups) without inducing sleep-time hypotension, reduced prevalence of the high CVD risk non-dipper 24 h BP pattern, improved kidney function, and reduced cardiac pathology. Furthermore, systematic and comprehensive review of the ABPM-based literature published the past 29 years reveals no single study that reported significantly better benefits of the most recommended, yet unjustified by medical evidence, morning hypertension treatment-time scheme.

摘要

已发表的前瞻性结局试验和荟萃分析的综合证据证实,无论清醒时诊室血压和清醒或 24 小时血压平均值如何,睡眠时血压升高(BP)和睡眠时相对 BP 下降(非杓型)是心血管疾病(CVD)风险的最重要的独立预后标志物,并值得作为预防的治疗靶点。尽管如此,目前的指南仍然建议根据动态血压监测(ABPM)诊断高血压,仅依靠 24 小时或“白天”血压平均值。它们也没有建议治疗患者的时间。我们对已发表的关于高血压药物对睡眠时血压和睡眠时相对 BP 下降影响的摄入时间差异的人类试验进行了系统评价。1992 年至 2020 年期间发表的约 62 项此类试验,共有 6120 名高血压患者,评估了 21 种不同的单药和 8 种双联固定复方制剂。绝大多数(82.3%)试验证实,与晨起/清晨治疗方案相比,睡前/晚间治疗方案可产生统计学上显著更好的临床获益,包括平均降低睡眠时收缩压 5.17mmHg(95%CI[4.04, 6.31],P<0.001 ),而不引起睡眠时低血压,降低 CVD 风险高的非杓型 24 小时血压模式的发生率,改善肾功能,减少心脏病理。此外,对过去 29 年发表的基于 ABPM 的文献进行系统和全面的回顾,没有一项研究报告称最推荐的晨起高血压治疗时间方案具有显著更好的获益,尽管该方案缺乏医学证据支持。

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