Grodzicki T, Rajzer M, Fagard R, O'Brien E T, Thijs L, Clement D, Davidson C, Palatini P, Parati G, Kocemba J, Staessen J A
Department of Gerontology and Family Medicine, Jagiellonian University, Cracow, Poland.
J Hum Hypertens. 1998 Mar;12(3):161-5. doi: 10.1038/sj.jhh.1000573.
The present analysis was undertaken to evaluate postprandial (PP) changes in blood pressure (BP) assessed with ambulatory BP monitoring (ABPM) in elderly subjects with isolated systolic hypertension (ISH) on conventional measurement. A total of 530 patients (335 women and 195 men, aged 60-100 years, median 70 years) who performed an ABPM during the placebo run-in period of the Syst-Eur trial were included into the analysis. The PP changes in BP and heart rate (HR) were calculated by subtracting the mean systolic BP (SBP), diastolic BP (DBP) and HR in the 2 h preceding the main meal from the corresponding means covering the 2 h after the meal. The reproducibility of the postprandial fall in BP and heart rate (PPH) was assessed by contrasting the first and second ABPM in a subgroup of 147 patients who performed two ABPM's during the placebo run-in period. The mean SBP and DBP decreased and reached the nadir 2 h after the main meal while HR did not change. When PPH was assessed by comparing BP in the 2 h before and after the meal, both SBP and DBP decreased significantly (respectively -6.6 mm Hg, -5.4 mm Hg; P < 0.001). In 67.6% of all patients a decrease in SBP was observed and in 24.1% it exceeded 16 mm Hg. The corresponding values for DBP were 71.3% and 24.5% (DBP decreased more than 12 mm Hg). A greater fall in DBP was associated with a greater decrease in HR (r = 0.20, P < 0.001), while changes in SBP and HR were not interrelated. Regression analysis did not identify any significant covariate of PPH. Group means of PPH could be reproduced without significant changes in their values, but the within-subject reproducibility of the PP changes was low. There were no differences in PPH according to the place of residence of the patients. In conclusion, the descriptive analysis of the meal-induced changes in ABPM in elderly subjects with ISH showed that in every day circumstances most of them experience falls in both SBP and DBP within 2 h after the meal.
本分析旨在评估采用动态血压监测（ABPM）对常规测量时患有单纯收缩期高血压（ISH）的老年受试者餐后（PP）血压（BP）变化情况。共有530例患者（335例女性和195例男性，年龄60 - 100岁，中位数70岁）纳入分析，这些患者在Syst - Eur试验的安慰剂导入期进行了ABPM。餐后血压和心率（HR）变化通过将主餐开始前2小时的平均收缩压（SBP）、舒张压（DBP）和HR，减去餐后2小时相应的平均值来计算。在147例于安慰剂导入期进行了两次ABPM的亚组患者中，通过对比首次和第二次ABPM评估餐后血压和心率下降（PPH）的可重复性。主餐后2小时平均SBP和DBP下降并达到最低点，而HR未改变。当通过比较餐前和餐后2小时的血压评估PPH时，SBP和DBP均显著下降（分别为 - 6.6 mmHg， - 5.4 mmHg；P < 0.001）。在所有患者中，67.6%观察到SBP下降，24.1%下降超过16 mmHg。DBP的相应值分别为71.3%和24.5%（DBP下降超过12 mmHg）。DBP下降幅度越大，HR下降幅度越大（r = 0.20，P < 0.001），而SBP和HR的变化无相关性。回归分析未发现PPH的任何显著协变量。PPH的组均值能够再现，其值无显著变化，但受试者内PP变化的可重复性较低。根据患者居住地，PPH无差异。总之，对患有ISH的老年受试者ABPM中进餐诱发变化的描述性分析表明，在日常情况下，他们大多数在餐后2小时内SBP和DBP均下降。
