Imai Y, Abe K, Sasaki S, Minami N, Nihei M, Munakata M, Murakami O, Matsue K, Sekino H, Miura Y
Department of Medicine, Tohoku University School of Medicine, Sendai, Japan.
Hypertension. 1988 Jul;12(1):11-9. doi: 10.1161/01.hyp.12.1.11.
The circadian blood pressure rhythm was compared in patients with Cushing's syndrome, essential hypertension, and primary aldosteronism. In patients with essential hypertension or primary aldosteronism, a clear nocturnal fall in systolic and diastolic blood pressure and heart rate was observed. This fall was seen in untreated subjects as well as in patients receiving combined treatment with a calcium antagonist, diuretic, converting enzyme inhibitor, alpha-blocker and beta-blocker, or sympatholytic drug. In these groups, there was a positive correlation between heart rate and systolic or diastolic blood pressure. On the other hand, in patients with Cushing's syndrome, there was no nocturnal fall in blood pressure but in some patients a rise was observed. In all patients there was a nocturnal fall in heart rate. Thus, there was no significant correlation between heart rate and blood pressure in these patients. Exogenous glucocorticoid eliminated the normal nocturnal fall of blood pressure in patients with chronic glomerulonephritis or systemic lupus erythematosus. These results suggest that the changed circadian blood pressure pattern in patients with Cushing's syndrome is not due to antihypertensive treatment or to the mineralocorticoid excess accompanying this disease, but it is attributable to excess glucocorticoid or the associated disturbance in the adrenocorticotropic hormone-glucocorticoid system (or both). This conclusion also implies that the normal circadian rhythm of blood pressure may be regulated at least in part by the adrenocorticotropic hormone-glucocorticoid system.
对库欣综合征、原发性高血压和原发性醛固酮增多症患者的昼夜血压节律进行了比较。在原发性高血压或原发性醛固酮增多症患者中，观察到收缩压、舒张压和心率在夜间有明显下降。这种下降在未经治疗的受试者以及接受钙拮抗剂、利尿剂、转换酶抑制剂、α受体阻滞剂、β受体阻滞剂或抗交感神经药物联合治疗的患者中均可见到。在这些组中，心率与收缩压或舒张压之间存在正相关。另一方面，在库欣综合征患者中，血压夜间无下降，但在一些患者中观察到血压升高。所有患者的心率在夜间均有下降。因此，这些患者的心率与血压之间无显著相关性。外源性糖皮质激素消除了慢性肾小球肾炎或系统性红斑狼疮患者正常的夜间血压下降。这些结果表明，库欣综合征患者昼夜血压模式的改变并非由于降压治疗或该疾病伴随的盐皮质激素过多，而是归因于糖皮质激素过多或促肾上腺皮质激素 - 糖皮质激素系统的相关紊乱（或两者兼有）。这一结论还意味着正常的昼夜血压节律可能至少部分受促肾上腺皮质激素 - 糖皮质激素系统调节。
