Staessen J A, Bieniaszewski L, O'Brien E, Gosse P, Hayashi H, Imai Y, Kawasaki T, Otsuka K, Palatini P, Thijs L, Fagard R
Klinisch Laboratorium Hypertensie, Inwendige Geneeskunde-Cardiologie, Leuven, Belgium.
Hypertension. 1997 Jan;29(1 Pt 1):30-9. doi: 10.1161/01.hyp.29.1.30.
A wide range of definitions is used to distinguish subjects in whom blood pressure (BP) falls at night (dippers) from their counterparts (nondippers). In an attempt to standardize the definition of nondipping, we determined the nocturnal BP fall and night-day BP ratio by 24-hour ambulatory monitoring in 4765 normotensive and 2555 hypertensive subjects from 10 to 99 years old. In all subjects combined, the systolic/diastolic nocturnal fall and corresponding ratio averaged (+/- SD) -16.7 +/- 11.0/ -13.6 +/- 8.1 mm Hg and 87.2 +/- 8.0%/83.1 +/- 9.6%, respectively. In normotensive subjects, the 95th percentiles were -0.3/-1.1 mm Hg for the nocturnal fall and 99.7%/98.3% for the night-day ratio. Both the fall and ratio showed a curvilinear correlation with age. The smallest fall and largest ratio were observed in older (> or = 70 years) subjects. A higher BP on conventional sphygmomanometry was associated with a larger systolic (partial r = .11) and diastolic (r = .12) nocturnal BP fall. The diastolic (r = .08) but not the systolic night-day ratio increased with higher conventional BP. The nocturnal BP fall was larger and the corresponding night-day ratio smaller in oscillometric (n = 5884) than in auscultatory (n = 1436) recordings, in males (n = 3730) than in females (n = 3590), and in Europe (n = 4556) than in the other continents (n = 2764). The distributions of the nocturnal BP fall and night-day ratio showed considerable overlap among normotensive and hypertensive subjects, but the overlap tended to be larger for the ratio than for the fall. Of all subjects, 3.2% had systolic and diastolic ratios of 100% or more. With adjustments applied for confounders, the probability of being a nondipper increased 2.8 times (95% confidence interval, 2.0-4.0) from 30 to 60 years and 5.7 times (4.4-7.4) from 60 to 80 years. The odds ratios were 1.0 (0.8-1.4) for males versus females. 1.6 (1.2-2.1) for subjects with definite hypertension versus normotensive subjects, 2.4 (1.2-4.7) for Asians (n = 2213, 96% Japanese) versus inhabitants of the other continents, and 2.4 (1.5-3.8) for subjects examined with auscultatory versus oscillometric devices. In conclusion, the mathematical definition of nondipping, ie, having a night-day ratio of 100% or more for systolic and diastolic BPs, closely approximated the 95th percentiles of the night-day ratio in normotensive subjects. The ratio depends less on BP level than the nocturnal BP fall and is therefore to be preferred in the definition of dipping status. Notwithstanding the present findings, the reproducibility of nondipping and its prognostic significance need further clarification.
人们采用了多种定义来区分夜间血压（BP）下降的人群（勺型血压者）和非勺型血压者。为了使非勺型血压的定义标准化，我们通过24小时动态血压监测，对4765名10至99岁的血压正常者和2555名高血压患者测定了夜间血压下降幅度及昼夜血压比值。在所有受试者中，收缩压/舒张压的夜间下降幅度及相应比值平均（±标准差）分别为-16.7±11.0/-13.6±8.1 mmHg和87.2±8.0%/83.1±9.6%。在血压正常者中，夜间下降幅度的第95百分位数为-0.3/-1.1 mmHg，昼夜比值为99.7%/98.3%。下降幅度和比值均与年龄呈曲线相关。在年龄较大（≥70岁）的受试者中观察到最小的下降幅度和最大的比值。常规血压计测量的血压较高与较大的收缩压夜间下降幅度（偏相关系数r = 0.11）和舒张压夜间下降幅度（r = 0.12）相关。随着常规血压升高，舒张压昼夜比值（r = 0.08）升高，而收缩压昼夜比值未升高。与听诊法记录（n = 1436）相比，示波法记录（n = 5884）的夜间血压下降幅度更大，昼夜比值更小；男性（n = 3730）比女性（n = 3590）的夜间血压下降幅度更大，昼夜比值更小；欧洲（n = 4556）的受试者比其他大洲（n = 2764）的受试者夜间血压下降幅度更大，昼夜比值更小。血压正常者和高血压患者的夜间血压下降幅度及昼夜比值分布有相当大的重叠，但比值的重叠往往比下降幅度的重叠更大。在所有受试者中，3.2%的受试者收缩压和舒张压比值达到100%或更高。校正混杂因素后，从30岁到60岁，成为非勺型血压者的概率增加2.8倍（95%置信区间为2.0 - 4.0），从60岁到80岁增加5.7倍（4.4 - 7.4）。男性与女性的比值比为1.0（0.8 - 1.4）。确诊高血压患者与血压正常者的比值比为1.6（1.2 - 2.1），亚洲人（n = 2213，96%为日本人）与其他大洲居民的比值比为2.4（1.2 - 4.7），使用听诊法与示波法测量的受试者的比值比为2.4（1.5 - 3.8）。总之，非勺型血压的数学定义，即收缩压和舒张压的昼夜比值达到100%或更高，与血压正常者昼夜比值的第95百分位数非常接近。与夜间血压下降幅度相比，该比值受血压水平的影响较小，因此在定义勺型血压状态时更可取。尽管有目前的研究结果，但非勺型血压的可重复性及其预后意义仍需进一步阐明。
