Sothern R B
St. Paul-Ramsey Medical Center, Minneapolis, MN.
Chronobiologia. 1994 Jan-Jun;21(1-2):7-20.
A normotensive, clinically healthy, diurnally-active man, 20.5 years of age at start of study, used an aneroid sphygmomanometer to self-measure systolic (S) and diastolic (D) blood pressure (BP) in triplicate several times daily during waking-only for > 340 days/year for 25 years. The 39,321 mean values (from 117,963 readings) were analyzed by year after editing for time-zone changes and overt illness. A significant time-effect of day and year could be demonstrated by ANOVA at p < 0.001 during each year for both SBP and DBP. Notwithstanding the lack of data during sleep, a circadian rhythm was described by the least-squares fit of a 24h cosmic (Single Cosinor analysis) at p < 0.001 for each BP during each year. Acrophases for SBP and DBP remained remarkably stable, with the circadian acrophase of DBP consistently occurring at midday (13(44) h) and that of SBP consistently occurring in the early evening (19(32) h). A circannual rhythm could be demonstrated in 24 out of 25 years for both SBP and DBP, with acrophases generally occurring between late Fall and early Spring. No trend over the 25-year observation span was found in SBP (p = 0.61), but one of +0.16 mmHg/y was detectable in DBP (p = 0.02), much less than the average circadian (3 - 5 mmHg) and circannual amplitudes (0.9 - 1.3 mmHg). As a complement to automatic around-the-clock monitoring, long-term self-measurement of BP (and other physiologic variables) is feasible and can cost-effectively provide individualized reference values (ranges, MESOR, amplitude, acrophase) in conjunction with the assessment of 1) multiple rhythmic components, 2) age, and 3) trends, thereby providing a reasonable guide for prognosis and diagnosis.
一名血压正常、临床健康、日间活动的男性，研究开始时20.5岁，在25年中每年超过340天仅在清醒时使用手动血压计每日多次自行测量收缩压（S）和舒张压（D），每次测量三次。对39321个平均值（来自117963次读数）进行逐年分析，同时针对时区变化和明显疾病进行编辑。通过方差分析（ANOVA）可证明，每年收缩压和舒张压在p<0.001时均存在显著的日和年时间效应。尽管缺乏睡眠期间的数据，但通过每年对每个血压进行24小时余弦拟合（单余弦分析），在p<0.001时描述了昼夜节律。收缩压和舒张压的峰值相位保持相当稳定，舒张压的昼夜峰值相位始终出现在中午（13（44）时），收缩压的昼夜峰值相位始终出现在傍晚（19（32）时）。在25年中的24年里，收缩压和舒张压均可证明存在年度节律，峰值相位通常出现在深秋和早春之间。在25年的观察期内，收缩压未发现趋势（p=0.61），但舒张压可检测到每年升高0.16 mmHg的趋势（p=0.02），远低于平均昼夜波动幅度（3 - 5 mmHg）和年度波动幅度（0.9 - 1.3 mmHg）。作为全天候自动监测的补充，长期自行测量血压（以及其他生理变量）是可行的，并且可以结合对1）多个节律成分、2）年龄和3）趋势的评估，经济高效地提供个性化参考值（范围、MESOR、幅度、峰值相位），从而为预后和诊断提供合理指导。
