Watanabe N, Imai Y, Nagai K, Tsuji I, Satoh H, Sakuma M, Sakuma H, Kato J, Onodera-Kikuchi N, Yamada M, Abe F, Hisamichi S, Abe K
Second Department of Internal Medicine, Tohoku University School of Medicine, Sendai, Japan.
Stroke. 1996 Aug;27(8):1319-27. doi: 10.1161/01.str.27.8.1319.
We conducted a cross-sectional epidemiological survey using ambulatory blood pressure monitoring and brain MRI in a cohort from northern Japan to determine whether an inappropriately low nocturnal blood pressure, or an excess fall in nocturnal blood pressure, might be responsible for silent cerebrovascular lesions in the elderly.
Untreated subjects over 55 years and under 64 years of age (late middle age; 24 men and 46 women, 60% of eligible people) and over 65 years and under 75 years of age (elderly; 29 men and 52 women, 91% of eligible people) participated in the study. We evaluated the relationship between the amplitude (Daytime Average-Nighttime Average) or the rate ([Daytime Average-Nighttime Average]/Daytime Average) of the fall in nocturnal blood pressure and the incidence of silent cerebrovascular lesions on MRI (number of lacunar infarctions or extent of periventricular hyperintensity).
The amplitude or the rate of the fall in nocturnal blood pressure in elderly women with one or two lacunar infarctions was significantly higher than that in those without such infarctions. There was a significant positive correlation between the amplitude or the rate of the fall in nocturnal blood pressure and the extent of periventricular hyperintensity in the elderly women. This relationship was observed in women, but not in men, of late middle age; this was not seen in elderly men.
Results indicate that an inappropriately low nocturnal blood pressure, or an excessive fall in nocturnal blood pressure, is associated with ischemic silent cerebrovascular lesions, at least in elderly women. Treatment of hypertension in such women should be administered with care and with regard to nocturnal blood pressure.
我们在日本北部的一个队列中，采用动态血压监测和脑部磁共振成像（MRI）进行了一项横断面流行病学调查，以确定夜间血压过低或夜间血压过度下降是否可能导致老年人无症状性脑血管病变。
年龄在55岁至64岁之间（中年晚期；24名男性和46名女性，占符合条件人群的60%）以及65岁至75岁之间（老年人；29名男性和52名女性，占符合条件人群的91%）的未经治疗的受试者参与了本研究。我们评估了夜间血压下降幅度（日间平均血压 - 夜间平均血压）或下降率（[日间平均血压 - 夜间平均血压]/日间平均血压）与MRI上无症状性脑血管病变发生率（腔隙性脑梗死数量或脑室周围高信号范围）之间的关系。
有一两个腔隙性脑梗死的老年女性夜间血压下降幅度或下降率显著高于无此类梗死的女性。老年女性夜间血压下降幅度或下降率与脑室周围高信号范围之间存在显著正相关。这种关系在中年晚期女性中观察到，但在男性中未观察到；在老年男性中也未观察到。
结果表明，夜间血压过低或夜间血压过度下降与无症状性缺血性脑血管病变相关，至少在老年女性中如此。对此类女性高血压的治疗应谨慎进行，并考虑夜间血压情况。
