Omboni S, Fogari R, Palatini P, Rappelli A, Mancia G
From the Cattedra di Medicina Interna, Ospedale San Gerardo, Monza, Università di Milano, Centro di Fisiologia Clinica e Ipertensione, Ospedale Maggiore, and Istituto Scientifico Ospedale San Luca, Istituto Auxologico Italiano, Milano, Italy.
Hypertension. 1998 Sep;32(3):424-9. doi: 10.1161/01.hyp.32.3.424.
The objectives of our study were to assess the reproducibility of the trough-to-peak ratio (T/P) and to see whether a high T/P is accompanied by more organ protection or vice versa. The study included 175 (mean+/-SD age, 51+/-9 years) subjects with mild-moderate essential hypertension who had echocardiographic evidence of left ventricular (LV) hypertrophy taken from the SAMPLE study (Study on Ambulatory Monitoring of Blood Pressure and Lisinopril Evaluation), an open-label multicenter study. The study included a 3-week washout pretreatment period, a 12-month treatment period with lisinopril (n=84) or lisinopril plus hydrochlorothiazide (n=91) once daily, and a 4-week placebo follow-up period. Results of 24-hour ambulatory blood pressure monitoring and echocardiographic determination of left ventricular mass index (LVMI) were obtained before and after 3 and 12 months of treatment. T/Ps were computed in each patient by dividing the systolic and diastolic blood pressure changes at trough (changes in the last 2 hours of the monitoring period) by those at peak (average of the 2 adjacent hours with the maximal blood pressure reduction between the 2nd and 8th hour from drug intake) after 3 and 12 months of treatment. Average 24-hour blood pressure was similarly reduced at 3 and 12 months. Trough blood pressure changes at 3 and 12 months were closely correlated, as were the corresponding peak blood pressure changes. However, the 3- and 12-month T/Ps correlated to a lesser degree (r<0.42). Furthermore, the reduction of LVMI induced by treatment was similarly correlated with the treatment-induced reduction in 24-hour average, trough, and peak blood pressures but not with the T/Ps. This was also evident when the contribution to LV hypertrophy regression by 24-hour blood pressure changes and T/Ps was assessed in a multivariate regression analysis. In patients with a T/P >/=0.5 or <0.5, the regression of LVMI was similar. In conclusion, peak and trough blood pressure changes are reproducible and predict the regression of LVMI induced by treatment as well as average 24-hour blood pressure. T/Ps are less reproducible, and their value does not predict regression of organ damage by antihypertensive treatment.
我们研究的目的是评估谷峰比值（T/P）的可重复性，并观察高T/P是否伴随着更多的器官保护作用，反之亦然。该研究纳入了175名（平均±标准差年龄，51±9岁）患有轻中度原发性高血压的受试者，这些受试者有左心室（LV）肥厚的超声心动图证据，数据来自SAMPLE研究（动态血压监测与赖诺普利评估研究），这是一项开放标签的多中心研究。该研究包括一个为期3周的洗脱预处理期、一个为期12个月的每日一次服用赖诺普利（n = 84）或赖诺普利加氢氯噻嗪（n = 91）的治疗期，以及一个为期4周的安慰剂随访期。在治疗3个月和12个月前后，获取了24小时动态血压监测结果以及左心室质量指数（LVMI）的超声心动图测定结果。在治疗3个月和12个月后，通过将谷值（监测期最后2小时的变化）时的收缩压和舒张压变化除以峰值（服药后第2至8小时之间血压降幅最大的相邻2小时的平均值）来计算每位患者的T/P。在3个月和12个月时，24小时平均血压同样降低。3个月和12个月时的谷值血压变化密切相关，相应的峰值血压变化也是如此。然而，3个月和12个月时的T/P相关性较小（r<0.42）。此外，治疗引起的LVMI降低与治疗引起的24小时平均血压、谷值血压和峰值血压降低相似相关，但与T/P无关。当在多变量回归分析中评估24小时血压变化和T/P对LV肥厚消退的贡献时，这一点也很明显。在T/P≥0.5或<0.5的患者中，LVMI的消退情况相似。总之，峰值和谷值血压变化具有可重复性，可预测治疗引起的LVMI消退以及24小时平均血压。T/P的可重复性较差，其值不能预测降压治疗对器官损伤的消退情况。
