Nielsen F S, Rossing P, Bang L E, Svendsen T L, Gall M A, Smidt U M, Parving H H
Steno Diabetes Center, Gentofte, Denmark.
Diabetes. 1995 Jul;44(7):783-9. doi: 10.2337/diab.44.7.783.
Nondiabetic hypertensive patients lacking the normal nocturnal decline in arterial blood pressure have enhanced cardiovascular complications. Since cardiovascular morbidity and mortality are increased in non-insulin-dependent diabetes mellitus (NIDDM), we performed a prospective cross-sectional case-controlled study comparing the diurnal variation in arterial blood pressure, prevalence of dippers, cardiac autonomic nervous function (beat-to-beat variation during deep breathing), and extracellular fluid volume (51Cr-labeled EDTA) in 55 NIDDM patients with diabetic nephropathy (group 1), 55 NIDDM patients with normoalbuminuria (group 2), and 22 nondiabetic control subjects (group 3). All antihypertensive treatments were withdrawn at least 2 weeks before the study. The nocturnal blood pressure reduction (daytime-to-nighttime)/daytime (mean +/- SE) was impaired in group 1 (6.6 +/- 1.5%) and group 2 (11.1 +/- 1.4%) as compared with group 3 (17.6 +/- 1.7%), and it was impaired in group 1 as compared with group 2 (P < 0.05 for each comparison). The prevalence of dippers (95% confidence interval) was lower in group 1 (42% [29-56]) as compared with group 2 (58% [44-71]; P = 0.08) and group 3 (86% [65-97]; P < 0.001) and in group 2 as compared with group 3 (P < 0.01). Abolished beat-to-beat variation was more prevalent in group 1 (63% [50-76]) as compared with group 2 (15% [7-27]) and with group 3 (5% [0-23]) (P < 0.001). Nocturnal blood pressure reduction was associated with beat-to-beat variation during deep breathing (r = 0.22, P < 0.01). Extracellular fluid volume (mean +/- SE) was higher in group 1 (15.9 +/- 0.5 l/m2) as compared with group 3 (14.1 +/- 0.8 l/m2) (P < 0.05) with group 2 between the two (15.1 +/- 0.4 l/m2).(ABSTRACT TRUNCATED AT 250 WORDS)
缺乏正常夜间动脉血压下降的非糖尿病高血压患者心血管并发症增加。由于非胰岛素依赖型糖尿病（NIDDM）患者的心血管发病率和死亡率升高，我们进行了一项前瞻性横断面病例对照研究，比较了55例糖尿病肾病的NIDDM患者（1组）、55例尿白蛋白正常的NIDDM患者（2组）和22例非糖尿病对照者（3组）的动脉血压昼夜变化、杓型血压者的比例、心脏自主神经功能（深呼吸时逐搏变化）和细胞外液容量（51Cr标记的依地酸）。在研究前至少2周停用所有抗高血压治疗。与3组（17.6±1.7%）相比，1组（6.6±1.5%）和2组（11.1±1.4%）的夜间血压下降幅度（白天至夜间）/白天（平均值±标准误）受损，且1组与2组相比也受损（每次比较P<0.05）。1组杓型血压者的比例（95%置信区间）低于2组（58%[44 - 71]；P = 0.08）和3组（86%[65 - 97]；P<0.001），2组低于3组（P<0.01）。与2组（15%[7 - 27]）和3组（5%[0 - 23]）相比，1组中逐搏变化消失更为普遍（P<0.001）。夜间血压下降与深呼吸时的逐搏变化相关（r = 0.22，P<0.01）。与3组（14.1±0.8 l/m2）相比，1组的细胞外液容量（平均值±标准误）更高（15.9±0.5 l/m2）（P<0.05），2组介于两者之间（15.1±0.4 l/m2）。（摘要截断于250字）
