Verdecchia P, Schillaci G, Gatteschi C, Zampi I, Battistelli M, Bartoccini C, Porcellati C
General Hospital R. Silvestrini, Division of Medicine, Perugia PG, Italy.
Circulation. 1993 Sep;88(3):986-92. doi: 10.1161/01.cir.88.3.986.
In essential hypertension, a blunted or absent nocturnal fall in blood pressure (BP) may be associated with increased target organ damage. In this case-control study, we tested the hypothesis that an association exists between a blunted or absent nocturnal fall in BP and future cardiovascular morbid events in patients with essential hypertension.
Case subjects were 32 hypertensive patients with a first fatal or nonfatal major cardiovascular event who had off-therapy ambulatory BP monitoring 1 to 5 years earlier in the context of a registry of morbidity and mortality in hypertensive patients. Control subjects were 49 hypertensive patients free from cardiovascular events. The groups were matched with regard to date of baseline ambulatory BP monitoring, age, sex, clinic systolic and diastolic BP, and daytime ambulatory systolic and diastolic BP. At their baseline evaluation, cases and controls did not differ, in either sex, with respect to clinic BP (men, 164/100 vs 162/99 mmHg; women, 178/96 vs 180/93 mmHg), mean daytime ambulatory BP (men, 151/94 vs 147/95 mm Hg; women, 156/90 vs 158/89 mm Hg), age (men, 55 vs 56 years; women, 69 vs 68 years), sex, body weight, serum cholesterol, known duration and family history of hypertension, smoking habits, renal function, or prevalence of diabetes. Echocardiographic left ventricular mass, determined in a subset of patients, was greater in cases than in controls in men (145 vs 115 g/m2, P = .038) and women (137 vs 102 g/m2, P = .032). The time interval between baseline ambulatory BP monitoring and subsequent cardiovascular event (cases: mean, 2.1 years) or last contact with our center (controls: mean, 2.5 years) did not differ between the groups. In the baseline ambulatory BP profile, the nocturnal reductions of systolic and diastolic BP in men were 9% and 11%, respectively, in cases vs 9% and 12% in controls (all P = NS), whereas in women they were 3% and 8% in cases vs 11% and 16% in controls (P = .002/.004).
This retrospective case-control study suggests an association between the reduction or absence of the usual nocturnal fall in BP and future cardiovascular morbid events in white women with essential hypertension.
在原发性高血压患者中，夜间血压（BP）下降减弱或消失可能与靶器官损害增加有关。在这项病例对照研究中，我们检验了这样一个假设：原发性高血压患者夜间血压下降减弱或消失与未来心血管疾病事件之间存在关联。
病例组为32例首次发生致命或非致命性重大心血管事件的高血压患者，他们在高血压患者发病和死亡登记研究中于1至5年前进行了非治疗状态下的动态血压监测。对照组为49例无心血管事件的高血压患者。两组在基线动态血压监测日期、年龄、性别、诊室收缩压和舒张压、日间动态收缩压和舒张压方面进行了匹配。在基线评估时，病例组和对照组在诊室血压方面无差异（男性：164/100 mmHg对162/99 mmHg；女性：178/96 mmHg对180/93 mmHg），日间平均动态血压也无差异（男性：151/94 mmHg对147/95 mmHg；女性：156/90 mmHg对158/89 mmHg），年龄（男性：55岁对56岁；女性：69岁对68岁）、性别、体重、血清胆固醇、已知高血压病程和家族史、吸烟习惯、肾功能或糖尿病患病率也无差异。在部分患者中测定的超声心动图左心室质量，男性病例组大于对照组（145对115 g/m²，P = 0.038），女性病例组也大于对照组（137对102 g/m²，P = 0.032）。两组在基线动态血压监测与随后心血管事件（病例组：平均2.1年）或与我们中心的最后一次接触（对照组：平均2.5年）之间的时间间隔无差异。在基线动态血压曲线中，男性病例组收缩压和舒张压的夜间下降分别为9%和11%，对照组分别为9%和12%（所有P值均无统计学意义），而女性病例组收缩压和舒张压的夜间下降分别为3%和8%，对照组分别为11%和16%（P = 0.002/0.004）。
这项回顾性病例对照研究表明，原发性高血压白人女性夜间血压正常下降的减少或消失与未来心血管疾病事件之间存在关联。
