Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China.
Department of Cardiology, The Liaoyu Hospital of Dalian, Dalian, China.
Clin Exp Hypertens. 2023 Dec 31;45(1):2229535. doi: 10.1080/10641963.2023.2229535.
This study aimed to explore whether circadian rhythm of blood pressure is associated with brachial-ankle pulse wave velocity (baPWV) and brachial artery flow-mediated dilation (FMD) in patients with essential hypertension.
This cross-sectional study included 4,217 patients with essential hypertension who completed 24-hour ambulatory blood pressure monitoring, baPWV, and FMD. BaPWV and FMD were measured to evaluate arterial stiffness and endothelial dysfunction. Participants were divided into dipper, non-dipper, and reverse dipping groups according to the nocturnal systolic blood pressure dipping percentage.
In this study, baPWV was highest in the reverse dipping groups, followed by non-dipper and dipper groups (1667.11 ± 327.90 vs. 1613.88 ± 325.11 vs. 1577.45 ± 306.15 cm/s, < .001) and FMD gradually increased (4.41 ± 2.87 vs. 4.70 ± 2.84 vs. 4.92 ± 2.79%, = .001). baPWV and FMD were significantly associated with declining nocturnal systolic blood pressure (SBP). Interestingly, FMD (β = 0.042, = .014) was only positively associated with a drop in nocturnal SBP decline in patients <65 years of age. Whereas baPWV was consistently negatively associated with nocturnal SBP decline regardless of age (β = -0.065, < .001, age <65 years; β = -0.149, = .002, age ≥ 65). Receiver operating characteristics (ROC) curves analysis showed areas under the curve (AUC) of baPWV/FMD for predicting circadian rhythm of blood pressure are 0.562/0.554 with a sensitivity of 51.7%/53.9% and specificity of 56.4%/53.4.
Impairment of baPWV and FMD were correlated with abnormal circadian rhythm of blood pressure in essential hypertension, suggesting a decrease in nighttime SBP may associate with endothelial function and arterial stiffness.
本研究旨在探讨原发性高血压患者的血压昼夜节律是否与肱踝脉搏波速度（baPWV）和肱动脉血流介导的舒张功能（FMD）相关。
这是一项横断面研究，共纳入 4217 例原发性高血压患者，完成了 24 小时动态血压监测、baPWV 和 FMD 检测。baPWV 和 FMD 用于评估动脉僵硬度和内皮功能。根据夜间收缩压下降百分比，将参与者分为杓型、非杓型和反杓型组。
在本研究中，反杓型组的 baPWV 最高，其次是非杓型组和杓型组（1667.11 ± 327.90 vs. 1613.88 ± 325.11 vs. 1577.45 ± 306.15 cm/s， < .001），FMD 逐渐升高（4.41 ± 2.87 vs. 4.70 ± 2.84 vs. 4.92 ± 2.79%， = .001）。baPWV 和 FMD 与夜间收缩压（SBP）下降显著相关。有趣的是，在年龄<65 岁的患者中，FMD（β=0.042， = .014）仅与夜间 SBP 下降呈正相关。而 baPWV 与夜间 SBP 下降呈负相关，与年龄无关（β=−0.065， < .001，年龄<65 岁；β=−0.149， = .002，年龄≥65 岁）。受试者工作特征（ROC）曲线分析显示，baPWV/FMD 预测血压昼夜节律的曲线下面积（AUC）分别为 0.562/0.554，敏感性分别为 51.7%/53.9%，特异性分别为 56.4%/53.4%。
原发性高血压患者的 baPWV 和 FMD 损害与血压昼夜节律异常相关，提示夜间 SBP 下降可能与内皮功能和动脉僵硬度有关。
