Habas Elmukhtar, Akbar Raza A, Alfitori Gamal, Farfar Khalifa L, Habas Eshrak, Errayes Nada, Habas Aml, Al Adab Aisha, Rayani Amnna, Geryo Nagat, Elzouki Abdel-Naser Y
Internal Medicine, Hamad General Hospital, Doha, QAT.
Internal Medicine, Alwakra General Hospital, Doha, QAT.
Cureus. 2023 Jul 30;15(7):e42681. doi: 10.7759/cureus.42681. eCollection 2023 Jul.
Blood pressure (BP) variations depend on various internal, environmental, and behavioral factors. BP fluctuations occur both in normotensive and hypertensive people. Although it fluctuates over the 24-hr day and night, the morning BP increases after waking up and declines throughout sleep. It is typical for BP to decrease by 10% to 20%, while sleeping, known as dipping BP. However, if there is no decrease in nighttime mean systolic BP or a drop of less than 10 mmHg, it is called nondipping BP. Conversely, reverse dipping BP means an increase in mean systolic BP instead of a drop during the night. Reverse dipping is observed in hypertension (HTN), diabetes mellitus (DM), chronic kidney disease (CKD), and obstructive sleep apnea (OSA) syndrome. The introduction of ambulatory BP monitoring (ABPM) led to the emergence of identifying normal and elevated BP patterns. Non-dipping BP increases the risk of cardiovascular system (CVS) complications such as left ventricular hypertrophy, proteinuria, glomerular filtration rate (GFR) reduction, and CKD progression. A loss or blunting of the normal BP profile is recognized as a deleterious variant, and restoring abnormal BP patterns has been reported to significantly impact end-organ damage, morbidity, and mortality. In this non-systematic clinically-oriented, comprehensive review, we aim to update the BP variables and the pathophysiology of nondipping BP and point out the areas which need more investigation from a nephrology perspective because the nondipping BP increases the risk of proteinuria, GFR reduction, and CKD progression. A literature search of PubMed, Google, EMBASE, and Google Scholar was conducted. Checks of selected papers and relevant reviews complemented the electronic search. With improved BP measurement methods, the physiology of BP profile variations is readily detectable during the day and night. A nondipping BP profile is a distinct BP pattern that may have significant end-organ damage effects and therapeutic importance for nephrologists. The pathophysiology of the nondipping BP variant must be clarified to prevent complications, and further investigations are required. Furthermore, there is debate about the best BP index to utilize: systolic BP, diastolic BP, mean arterial pressure, or a mixture of all. All these areas are important and need new research projects.
血压（BP）变化取决于各种内部、环境和行为因素。血压波动在血压正常者和高血压患者中均会出现。尽管血压在24小时的昼夜周期中波动，但早晨醒来后血压会升高，而在整个睡眠过程中血压会下降。睡眠期间血压典型地会下降10%至20%，这被称为勺型血压。然而，如果夜间平均收缩压没有下降或下降幅度小于10 mmHg，则称为非勺型血压。相反，反勺型血压是指夜间平均收缩压升高而非下降。高血压（HTN）、糖尿病（DM）、慢性肾脏病（CKD）和阻塞性睡眠呼吸暂停（OSA）综合征患者中可观察到反勺型血压。动态血压监测（ABPM）的引入使得识别正常和升高的血压模式成为可能。非勺型血压会增加心血管系统（CVS）并发症的风险，如左心室肥厚、蛋白尿、肾小球滤过率（GFR）降低以及CKD进展。正常血压模式的丧失或减弱被认为是一种有害变异，据报道恢复异常血压模式会对终末器官损伤、发病率和死亡率产生显著影响。在这篇非系统性的、以临床为导向的综合性综述中，我们旨在更新血压变量和非勺型血压的病理生理学，并从肾脏病学角度指出需要更多研究的领域，因为非勺型血压会增加蛋白尿、GFR降低和CKD进展的风险。我们对PubMed、谷歌、EMBASE和谷歌学术进行了文献检索。对所选论文和相关综述的检查补充了电子检索。随着血压测量方法的改进，血压模式变化的生理学在白天和夜间都很容易检测到。非勺型血压模式是一种独特的血压模式，可能对终末器官有显著损害作用，对肾脏病学家具有治疗重要性。必须阐明非勺型血压变异的病理生理学以预防并发症，还需要进一步研究。此外，关于最佳血压指标的使用存在争议：收缩压、舒张压、平均动脉压，还是所有指标的综合。所有这些领域都很重要，需要新的研究项目。
