Palatini P, Pessina A C, Graniero G R, Canali C, Mormino P, Dorigatti F, Accurso V, Michieletto M, Ferrarese E, Vriz O
Clinica Medica I, Università di Padova.
G Ital Cardiol. 1995 Aug;25(8):977-89.
To evaluate the relationship of coffee use, smoking, physical inactivity, alcohol intake and overweight with casual and ambulatory blood pressure in a large population of borderline to mild hypertensive subjects.
Six hundred and thirty men with a mean (+/- SE) age of 33 +/- 0.4 years (range = 18-45 years) and a mean office blood pressure of 146 +/- 0.4/94 +/- 0.2 mm Hg, participating in the multicentre HARVEST study, were divided into three categories according to: coffee consumption (0 cups, 1-3 cups, > 3 cups/day), number of cigarettes smoked per day (0, 1-10, 11-20), degree of physical activity (no activity, regular training, competitive activity), alcohol intake (no alcohol, < 50 g, > or = 50 g/day) and body mass index (tertiles). All patients underwent non invasive ambulatory blood pressure monitoring with either the A&D TM-2420 model 7 or the Spacelabs 90207 monitor. Moreover, 24-hour urine collection was made for epinephrine and norepinephrine assessment (n = 611).
Twenty-four-hour systolic blood pressure was higher in the coffee drinkers than the nondrinkers (+2.6 mm Hg in the moderate drinkers). Instead, 24-hour diastolic blood pressure was mainly influenced by overweight (3.2 mm Hg difference between the low and high BMI tertiles) and physical inactivity (3.2 mm Hg difference between the sedentary men and the athletes). Generally, the association of the above factors was stronger with ambulatory than with office blood pressure, whereas alcohol intake was only related to office diastolic blood pressure. However, in a multivariate regression analysis alcohol use did not show an independent effect on either office or ambulatory blood pressure. Smoking showed a different effect on office and ambulatory blood pressure. In fact, office blood pressure was higher in the nonsmokers, while 24-hour blood pressure was higher in the smokers. Smoking, coffee and physical inactivity were associated with sympathetic overactivity, as documented by increased urinary catecholamines output.
The results of the present study indicate that overweight and behavioural factors affect 24-hour blood pressure to a larger extent than office blood pressure does. This is likely to be due to their effect on the sympathetic nervous system activity, which would enhance the blood pressure response to daily life stressors.
评估大量临界至轻度高血压受试者中咖啡饮用、吸烟、缺乏运动、饮酒和超重与偶测血压及动态血压之间的关系。
参与多中心HARVEST研究的630名男性，平均（±标准误）年龄为33±0.4岁（范围 = 18 - 45岁），平均诊室血压为146±0.4/94±0.2 mmHg，根据以下因素分为三类：咖啡摄入量（0杯、1 - 3杯、> 3杯/天）、每日吸烟支数（0、1 - 10、11 - 20）、身体活动程度（无活动、规律训练、竞技活动）、酒精摄入量（不饮酒、< 50 g、≥50 g/天）和体重指数（三分位数）。所有患者均使用A&D TM - 2420型号7或Spacelabs 90207监测仪进行无创动态血压监测。此外，收集24小时尿液用于评估肾上腺素和去甲肾上腺素（n = 611）。
咖啡饮用者的24小时收缩压高于不饮用者（中度饮用者高2.6 mmHg）。相反，24小时舒张压主要受超重（低和高BMI三分位数之间相差3.2 mmHg）和缺乏运动（久坐男性与运动员之间相差3.2 mmHg）影响。一般来说，上述因素与动态血压的关联比与诊室血压的关联更强，而酒精摄入量仅与诊室舒张压相关。然而，在多变量回归分析中，饮酒对诊室血压或动态血压均未显示出独立影响。吸烟对诊室血压和动态血压有不同影响。实际上，不吸烟者的诊室血压较高，而吸烟者的24小时血压较高。吸烟、咖啡和缺乏运动与交感神经过度活跃有关，尿儿茶酚胺排出量增加证明了这一点。
本研究结果表明，超重和行为因素对24小时血压的影响程度大于对诊室血压的影响。这可能是由于它们对交感神经系统活动的影响，这会增强血压对日常生活应激源的反应。
