Jensen L W, Pedersen E B
Research Laboratory of Nephrology and Hypertension, Skejby Hospital, University Hospital in Aarhus, Denmark.
Blood Press. 1997 Nov;6(6):332-42. doi: 10.3109/08037059709062092.
The purpose of this study was to assess the blood pressure profile and to measure vasoactive hormones in patients with essential hypertension (n=61), secondary hypertension (n=32) and chronic renal failure (n=32) matched with healthy control subjects (n=35), and to study the relationship between circadian changes in blood pressure and baseline levels of vasoactive hormones and renal function. Non-invasive, automatic blood pressure measurement was performed for 24 or 48 h. Venous plasma concentrations of renin, angiotensin II, aldosterone, arginine vasopressin, atrial natriuretic peptide and endothelin were measured. The mean 24-h blood pressure was higher in all groups of hypertensive patients than in control subjects. The nocturnal blood pressure fall was preserved in essential hypertension, in contrast to secondary hypertension in which it was attenuated. In the patients with chronic renal failure the 24-h mean blood pressure was the same as in the controls. Night-time blood pressure was higher among the chronic renal failure patients than in the control group, and the nightly blood pressure fall in both diastolic and systolic blood pressure was reduced. Plasma concentrations of renin activity, arginine vasopressin, atrial natriuretic peptide, aldosterone and endothelin were significantly increased in secondary hypertension and chronic renal failure, compared to essential hypertension and control subjects. Plasma angiotensin II was increased in chronic renal failure compared to essential hypertension and controls. Estimated creatinine clearance and nightly blood pressure dips were inversely correlated in essential and secondary hypertension, i.e. with a decreasing renal function both systolic and diastolic nightly blood pressure dips were gradually attenuated. In the whole group of patients the nightly systolic and diastolic blood pressure dips were negatively correlated to basal plasma renin activity, plasma aldosterone and atrial natriuretic peptide levels, i.e. the higher the basal plasma hormone level the lower the blood pressure dip. In conclusion, patients with essential hypertension have elevated but normally configured 24-h blood pressure profiles, and patients with different kinds of secondary hypertension have elevated 24-h blood pressure profiles and attenuated nightly systolic and diastolic blood pressure falls. The more the renal function is reduced and the more the plasma levels of renin and aldosterone are increased, the more the nocturnal fall in blood pressure is reduced. It is suggested that the attenuated or absent decrease in nocturnal blood pressure in secondary renal hypertension is caused by an abnormally increased secretion of vasoactive hormones and/or by so far unknown factors released from the diseased kidney.
本研究旨在评估原发性高血压患者（n = 61）、继发性高血压患者（n = 32）和慢性肾衰竭患者（n = 32）的血压情况并测量血管活性激素水平，这些患者与健康对照者（n = 35）相匹配，同时研究血压的昼夜变化与血管活性激素基线水平及肾功能之间的关系。进行了24或48小时的无创自动血压测量。测量了静脉血浆中肾素、血管紧张素II、醛固酮、精氨酸加压素、心房利钠肽和内皮素的浓度。所有高血压患者组的24小时平均血压均高于对照组。原发性高血压患者夜间血压下降得以保留，而继发性高血压患者夜间血压下降减弱。慢性肾衰竭患者的24小时平均血压与对照组相同。慢性肾衰竭患者的夜间血压高于对照组，且夜间舒张压和收缩压的下降幅度均减小。与原发性高血压患者和对照者相比，继发性高血压和慢性肾衰竭患者血浆肾素活性、精氨酸加压素、心房利钠肽、醛固酮和内皮素的浓度显著升高。与原发性高血压患者和对照者相比，慢性肾衰竭患者血浆血管紧张素II升高。在原发性和继发性高血压中，估计的肌酐清除率与夜间血压下降呈负相关，即肾功能下降时，夜间收缩压和舒张压的下降逐渐减弱。在所有患者组中，夜间收缩压和舒张压下降与基础血浆肾素活性、血浆醛固酮和心房利钠肽水平呈负相关，即基础血浆激素水平越高，血压下降幅度越低。总之，原发性高血压患者24小时血压升高但形态正常，不同类型的继发性高血压患者24小时血压升高且夜间收缩压和舒张压下降减弱。肾功能降低越多，肾素和醛固酮的血浆水平升高越多，夜间血压下降就越明显。提示继发性肾性高血压患者夜间血压下降减弱或消失是由血管活性激素分泌异常增加和/或患病肾脏释放的迄今未知的因素所致。
