Lin J M, Hsu K L, Chiang F T, Tseng C D, Tseng Y Z
Department of Internal Medicine, National Taiwan University Hospital, Taipei, ROC.
Int J Cardiol. 1995 Mar 3;48(3):311-6. doi: 10.1016/0167-5273(94)02239-f.
Clinical decisions and controlled studies in regard to hypertension have long emphasized the casual diastolic blood pressure (DBP). The influence of superimposition of high systolic blood pressure (SBP) on the target organ damage has been less studied. To assess the role of isolated diastolic hypertension without interference of superimposition of systolic hypertension, 171 subjects with normal blood pressure, isolated diastolic hypertension (SBP < 140 and DBP > or = 90 mmHg) isolated systolic hypertension (SBP > or = 140 and DBP < 90 mmHg) or combined hypertension (SBP > or = 140 and DBP > or = 90 mmHg) determined by mean 24-h ambulatory blood pressure were compared in relation to target organ damage including ECG abnormality related to hypertension, cardiac enlargement by chest X-ray, proteinuria and retinopathy. The incidence of target organ damage was lower in subjects with normal BP than in the other three groups. The incidence of target organ damage was almost significantly higher in patients with isolated systolic hypertension than in those with isolated diastolic hypertension. No significant difference in the incidence of complications existed between patients with isolated systolic and combined hypertension. These findings demonstrate that the severity of hypertensive complications is more closely related to mean ambulatory SBP than mean ambulatory DBP. The level of systolic BP is important for predicting the severity of target organ damage in patients with high diastolic BP, because there is a significant difference in the incidence of target organ damage between isolated diastolic hypertension and combined hypertension.
长期以来，关于高血压的临床决策和对照研究一直强调偶测舒张压（DBP）。而收缩压（SBP）升高叠加对靶器官损害的影响研究较少。为评估无收缩期高血压叠加干扰的单纯舒张期高血压的作用，我们比较了171例通过24小时动态血压均值确定为血压正常、单纯舒张期高血压（SBP＜140且DBP≥90mmHg）、单纯收缩期高血压（SBP≥140且DBP＜90mmHg）或联合高血压（SBP≥140且DBP≥90mmHg）的受试者在靶器官损害方面的情况，包括与高血压相关的心电图异常、胸部X线显示的心脏扩大、蛋白尿和视网膜病变。血压正常的受试者靶器官损害发生率低于其他三组。单纯收缩期高血压患者的靶器官损害发生率几乎显著高于单纯舒张期高血压患者。单纯收缩期高血压患者和联合高血压患者在并发症发生率上无显著差异。这些发现表明，高血压并发症的严重程度与动态收缩压均值的关系比与动态舒张压均值的关系更为密切。收缩压水平对于预测舒张压高的患者靶器官损害的严重程度很重要，因为单纯舒张期高血压和联合高血压患者在靶器官损害发生率上存在显著差异。
