Mancia G, Frattola A, Parati G, Santucciu C, Ulian L
Cattedra di Medicina Interna, Ospedale San Gerardo, Monza, Università di Milano, Italy.
J Cardiovasc Pharmacol. 1994;24 Suppl A:S6-11.
Several studies have now shown that hypertension-induced end-organ damage is more closely related to 24-h average blood pressure than to clinic measurements. Furthermore, the degree of variability of blood pressure during a 24-h period bears a relation to organ damage that is independent of average blood pressure value. The measurement of blood pressure variability is a complex task, however, because data from automatic ambulatory blood pressure monitoring should be interpreted with caution, especially if the interval between blood pressure measurements is more than 15 min, and different types of blood pressure variability (e.g., short-term and long-term) can make calculation of variability by standard deviation of 24-h blood pressure values difficult, which further complicates measurement procedures and interpretation. Evidence is growing to suggest that blood pressure variability in hypertension is clinically significant. We have recently shown that over a 7.5-year period, end-organ damage is independently related to the initial blood pressure variability. Although information on the effect of antihypertensive treatment on 24-h blood pressure variability is limited, the available data suggest more of an effect on 24-h average blood pressure levels than on 24-h blood pressure changes. Further studies should investigate treatment effects on different types of blood pressure variability and the impact of treatment on patient protection and prognosis.
现在有几项研究表明，高血压引起的靶器官损害与24小时平均血压的关系比与诊所测量值的关系更为密切。此外，24小时内血压的变异性程度与器官损害有关，且这种关系独立于平均血压值。然而，血压变异性的测量是一项复杂的任务，因为自动动态血压监测的数据应谨慎解读，尤其是当血压测量间隔超过15分钟时，并且不同类型的血压变异性（例如，短期和长期）会使通过24小时血压值的标准差计算变异性变得困难，这进一步使测量程序和解读复杂化。越来越多的证据表明高血压中的血压变异性具有临床意义。我们最近表明，在7.5年的时间里，靶器官损害与初始血压变异性独立相关。尽管关于降压治疗对24小时血压变异性影响的信息有限，但现有数据表明，降压治疗对24小时平均血压水平的影响比对24小时血压变化的影响更大。进一步的研究应调查治疗对不同类型血压变异性的影响以及治疗对患者保护和预后的影响。
