Robinson T, James M, Ward-Close S, Potter J
University Division of Medicine for the Elderly, Glenfield Hospital, Leicester, UK.
J Hum Hypertens. 1995 Dec;9(12):993-9.
Diurnal blood pressure (BP) variation can be assessed by cusums-derived measures and by the day-night BP difference from time-, activity- and diary-defined 'night' periods. Reproducibility of diurnal systolic BP (SBP) variation by these different methods was studied in 19 active elderly normotensives, mean age 68.5 years. Subjects underwent simultaneous 24 h BP (Spacelabs 90207) and activity (Gaehwiler wrist actigraph) monitoring on two occasions (median interval 70 days). On the first occasion, mean diurnal SBP variation was 15.1 +/- 8.1 mm Hg by fixed-time definition of 'night' (22.07). When compared with 22-07 defined 'night' period, actigraph- and diary-defined 'night-time' was significantly reduced (-60 +/- 49, and -48 +/- 51 min, respectively) and consequently diurnal SBP variation was significantly greater at 18.2 +/- 8.1 mm Hg and 17.6 +/- 8.4 mm Hg, respectively. Actigraph recordings were also used to exclude 'night' BP readings associated with activity, but this did not significantly alter the diurnal SBP variation. Cusums-derived circadian alteration magnitude resulted in the greatest value for SBP variation (23.4 +/- 6.7 mm Hg). However, reproducibility of diurnal SBP variation was poor by fixed-time method with a coefficient of variation (CV) of > 50%, and only improved to 40% with diary use. Actigraph measurements, even if used to exclude BP values associated with disturbed sleep, did not improve this further. Cusums-derived measures of diurnal variation slightly improved reproducibility with a CV of 34.6% and may be a better method in the assessment of diurnal BP variation in the elderly.
昼夜血压（BP）变化可通过累积和法衍生的测量方法以及根据时间、活动和日记定义的“夜间”时段的昼夜血压差值来评估。在19名平均年龄为68.5岁的活跃老年血压正常者中，研究了这些不同方法对昼夜收缩压（SBP）变化的可重复性。受试者在两个时间段（中位间隔70天）同时进行24小时血压（Spacelabs 90207）和活动（Gaehwiler腕部活动记录仪）监测。在第一个时间段，根据“夜间”的固定时间定义，平均昼夜SBP变化为15.1±8.1 mmHg（22:07）。与22:07定义的“夜间”时段相比，活动记录仪和日记定义的“夜间”时间显著缩短（分别为-60±49分钟和-48±51分钟），因此昼夜SBP变化分别显著增大至18.2±8.1 mmHg和17.6±8.4 mmHg。活动记录仪记录还用于排除与活动相关的“夜间”血压读数，但这并未显著改变昼夜SBP变化。累积和法衍生的昼夜节律改变幅度导致SBP变化值最大（23.4±6.7 mmHg）。然而，固定时间法对昼夜SBP变化的可重复性较差，变异系数（CV）>50%，使用日记时仅提高到40%。即使使用活动记录仪测量来排除与睡眠干扰相关的血压值，也没有进一步改善这一情况。累积和法衍生的昼夜变化测量方法使可重复性略有提高，CV为34.6%，可能是评估老年人昼夜血压变化的更好方法。
