Roman M J, Pickering T G, Schwartz J E, Cavallini M C, Pini R, Devereux R B
Department of Medicine, New York Hospital-Cornell Medical Center, New York 10021, USA.
J Hypertens. 1997 Sep;15(9):969-78. doi: 10.1097/00004872-199715090-00007.
To determine whether the failure to decrease blood pressure normally during sleep is associated with more prominent target organ damage.
Cardiac and vascular structure and function were characterized in 183 asymptomatic, unmedicated hypertensive patients and compared with their ambulatory blood pressures.
The 104 patients with a normal (> 10%) nocturnal fall in systolic blood pressure (dippers) were similar to the 79 patients with an abnormal fall (nondippers) in sex, race, body size, smoking history, and average awake ambulatory blood pressure. Nondippers tended to be older (57 versus 54 years, P = 0.06). The supine blood pressure upon completion of the ultrasound studies was higher in the nondippers (156/93 versus 146/89 mmHg, P < 0.005) as was the variability of the awake diastolic blood pressure. There were no differences between dippers and nondippers in left ventricular mass (170 versus 172 g), mass index (90 versus 91 gm/m2), prevalence of abnormal ventricular geometry, common carotid artery diameter (5.74 versus 5.75 mm), and vascular strain. Although nondippers were more likely to have carotid artery plaque (41 versus 27%, P = 0.053) and an increased intimal-medial thickness (0.84 versus 0.79 mm, P < 0.05), adjustment for age rendered the differences insignificant. There were no differences in the relation of awake and sleeping systolic pressures to the left ventricular mass (r = 0.36 and 0.35, respectively, both P < 0.005) or to the carotid wall thickness (r = 0.28 and 0.29, respectively, both P < 0.005). When the 114 men and 69 women were considered separately, similar findings were obtained. When the 109 whites and 56 blacks (African-Americans and Afro-Caribbeans) were considered separately, there were no differences in left ventricular structure in either group, and differences in vascular structure were confined to the white subgroup.
The lack of a normal nocturnal fall in blood pressure is not associated with an increase in left ventricular mass or in arterial disease independently of age. Age-related changes in carotid artery wall thickness and plaque among nondippers may reflect a contribution of an altered baroreceptor function to the lack of normal nocturnal and supine blood pressure decreases.
确定睡眠期间血压未能正常下降是否与更显著的靶器官损害相关。
对183例无症状、未接受药物治疗的高血压患者的心脏和血管结构及功能进行特征分析，并与其动态血压进行比较。
104例夜间收缩压下降正常（>10%）的患者（杓型血压者）与79例夜间收缩压下降异常（非杓型血压者）的患者在性别、种族、体型、吸烟史及平均清醒时动态血压方面相似。非杓型血压者往往年龄较大（57岁对54岁，P = 0.06）。超声检查完成时，非杓型血压者的仰卧位血压较高（156/93 mmHg对146/89 mmHg，P < 0.005），清醒时舒张压的变异性也较高。杓型血压者与非杓型血压者在左心室质量（170 g对172 g）、质量指数（90 g/m²对91 g/m²）、异常心室几何形状的患病率、颈总动脉直径（5.74 mm对5.75 mm）及血管应变方面无差异。尽管非杓型血压者更可能有颈动脉斑块（41%对27%，P = 0.053）且内膜中层厚度增加（0.84 mm对0.79 mm，P < 0.05），但经年龄校正后差异无统计学意义。清醒和睡眠时收缩压与左心室质量的关系（分别为r = 0.36和0.35，均P < 0.005）或与颈动脉壁厚度的关系（分别为r = 0.28和0.29，均P < 0.005）无差异。当分别考虑114名男性和69名女性时，得到了类似的结果。当分别考虑109名白人和56名黑人（非裔美国人和非洲加勒比人）时，两组的左心室结构均无差异，血管结构的差异仅限于白人亚组。
夜间血压缺乏正常下降与左心室质量增加或动脉疾病增加无关，独立于年龄因素。非杓型血压者中与年龄相关的颈动脉壁厚度和斑块变化可能反映了压力感受器功能改变对夜间和仰卧位血压未能正常下降的影响。
