Zweiker R, Eber B, Schumacher M, Toplak H, Klein W
Division of Cardiology, University of Graz, Austria.
Acta Med Austriaca. 1994;21(3):86-9.
About 1 third of all patients with essential hypertension reveal an impaired circadian pattern of blood pressure. This phenomenon called "non-dipping" (i.e. a lack of the normal nocturnal fall in blood pressure) is related to a higher incidence of end-organ damage such as left ventricular hypertrophy. It is the purpose of this study to evaluate, whether or not non-dipping of blood pressure may worsen the prognosis of hypertensive subjects. 116 consecutive hypertensives underwent an ambulatory blood pressure monitoring (ABPM) using the Spacelabs 2000 device. 2 groups were established: Group I (n = 87) were "dippers", group II (n = 29) "non-dippers" showing a diminished or even lack of nocturnal fall in blood pressure. No difference was seen concerning sex, mean 24-hour systolic blood pressure, systolic and diastolic causal blood pressure and heart rate. However, a significant difference in age and mean 24-hour diastolic blood pressure could be observed. In a follow-up investigation after approximately 31 months all patients and/or their physicians were contacted concerning cardiovascular events during the time since the ABPM was performed. In Group I only 1 transient ischemic attack occurred, but in group II 4 patients showed major cardiovascular events: 3 deaths occurred (2 of which caused by myocardial infarction, 1 by apoplexy), while 1 suffered from a transient ischemic attack (p < 0.001). Thus, in essential hypertension non-dipping of blood pressure is associated with an increased occurrence of cardiovascular events, and, therefore, the circadian blood pressure profile should be carefully monitored.
约三分之一的原发性高血压患者呈现血压昼夜节律受损。这种被称为“非勺型”的现象（即夜间血压缺乏正常下降）与诸如左心室肥厚等靶器官损害的较高发生率相关。本研究的目的是评估血压非勺型是否会使高血压患者的预后恶化。116例连续性高血压患者使用太空实验室2000设备进行了动态血压监测（ABPM）。分为两组：第一组（n = 87）为“勺型者”，第二组（n = 29）为“非勺型者”，其夜间血压下降减弱甚至缺乏。在性别、平均24小时收缩压、收缩压和舒张压的因果血压以及心率方面未见差异。然而，在年龄和平均24小时舒张压方面可观察到显著差异。在大约31个月后的随访调查中，就自进行ABPM以来这段时间内的心血管事件与所有患者和/或他们的医生进行了联系。第一组仅发生了1次短暂性脑缺血发作，但第二组有4例患者出现了重大心血管事件：3例死亡（其中2例由心肌梗死引起，1例由中风引起），1例患有短暂性脑缺血发作（p < 0.001）。因此，在原发性高血压中，血压非勺型与心血管事件的发生率增加相关，因此，应仔细监测血压昼夜节律。
