Bianchi S, Bigazzi R, Baldari G, Sgherri G, Campese V M
U.O. di Nefrologia, Spedali Riuniti, Livorno, Italy.
Am J Hypertens. 1994 Jan;7(1):23-9. doi: 10.1093/ajh/7.1.23.
Microalbuminuria has been shown in approximately 40% of patients with essential hypertension. Previous studies have failed to demonstrate any consistent relationship between microalbuminuria and levels of office blood pressure. Because average ambulatory blood pressure correlates with incidence of cardiovascular morbidity and mortality better than office blood pressure, we have studied whether levels of urinary albumin excretion correlate with average diurnal, nocturnal, or 24-h blood pressure better than with office blood pressure. Sixty-three patients with essential hypertension and 21 healthy volunteers were included in the study. Twenty-four hypertensive patients failed to show the normal nighttime fall in blood pressure of at least 10/5 mm Hg and were defined as "nondippers"; the remaining were defined as "dippers." Office blood pressure was not different between dippers and nondippers. However, nighttime systolic and diastolic blood pressures were significantly greater in nondippers than in dippers. The median urinary albumin excretion in nondippers (42 mg/24 h) was significantly greater (P < .001) than in dippers (17.5 mg/24 h), and in normal subjects (8.6 mg/24 h). A significant correlation was present between nighttime systolic and diastolic blood pressure and urinary albumin excretion (UAE) and between 24-h systolic blood pressure and UAE in all hypertensive patients; in addition, a significant correlation was present between 24-h diastolic and nighttime diastolic blood pressure and UAE in nondippers. The increased amount of UAE in nondipper hypertensive patients suggests the presence of greater renal damage than in dippers.
约40%的原发性高血压患者存在微量白蛋白尿。既往研究未能证实微量白蛋白尿与诊室血压水平之间存在任何一致的关系。由于动态平均血压比诊室血压与心血管疾病发病率和死亡率的相关性更好，我们研究了尿白蛋白排泄水平与日间、夜间或24小时平均血压的相关性是否比与诊室血压的相关性更好。本研究纳入了63例原发性高血压患者和21名健康志愿者。24例高血压患者夜间血压至少下降10/5 mmHg的正常降幅未出现，被定义为“非杓型”；其余患者被定义为“杓型”。杓型和非杓型患者的诊室血压无差异。然而，非杓型患者的夜间收缩压和舒张压显著高于杓型患者。非杓型患者的尿白蛋白排泄中位数（42 mg/24 h）显著高于杓型患者（17.5 mg/24 h）和正常受试者（8.6 mg/24 h）（P<0.001）。在所有高血压患者中，夜间收缩压和舒张压与尿白蛋白排泄（UAE）之间以及24小时收缩压与UAE之间存在显著相关性；此外，在非杓型患者中，24小时舒张压和夜间舒张压与UAE之间存在显著相关性。非杓型高血压患者UAE的增加表明其肾脏损伤程度比杓型患者更严重。
