Tochikubo O, Hishiki S, Miyajima E, Ishii M
From the Second Department of Internal Medicine, Urafune Hospital of Yokohama City University, and the Second Department of Internal Medicine, School of Medicine, Yokohama City University Yokohama, Japan.
Hypertension. 1998 Sep;32(3):430-6. doi: 10.1161/01.hyp.32.3.430.
The purpose of this study was to calculate statistically the minimum (base) blood pressure (BP) of nighttime (sleep-time) BP values obtained by ambulatory BP monitoring (ABPM) and to investigate its clinical significance. Twenty-four-hour recording of ECG with ABPM was performed directly (n=89) or indirectly (n=117) in 206 patients with essential hypertension. A telemeter was used for the direct method and a multi-biomedical recorder (TM2425) was used for indirect measurement. First, minimum heart rate (HR0=60/RR0) was determined from sleep-time ECG. The mean product of sleep-time diastolic BP (DBP) and pulse interval (RR) was divided by RR0 to obtain DBP0 [DBP0=(DBPxRR)s/RR0]. The correlation between systolic BP (SBP) and DBP was used to determine SBP0 corresponding to DBP0. Statistical base mean BP (MBP0) was calculated from these values, and its reproducibility and relation to hypertension severity were investigated. MBP0 values were similar to true base values of sleep-time MBP obtained by the direct method (mean+/-SD difference, 2.0+/-4.2 mm Hg). Direct MBP0 criteria predicted hypertension severity (mild, moderate, or severe target organ damage) more accurately (predictive accuracy, 89%) than daytime MBP criteria (53%, P<0.01). Almost the same results were obtained using indirect MBP0 criteria. Day-to-day indirect MBP0 variation (mean absolute difference) was smaller (2.4+/-1.8 mm Hg) than day-to-day daytime and nighttime MBP variation (6.3+/-5.3 and 5.4+/-3.4 mm Hg, respectively; n=61, P<0.01), and the correlation coefficient between day-to-day variations of daytime MBP and physical activity (measured by an acceleration sensor) was 0.38 (P<0.05). In conclusion, statistical base BP was almost equal to true base (minimum) BP of sleep-time BP distribution. It was closely related to the severity of hypertensive organ damage, was highly reproducible, and is considered likely to serve stochastically and physiologically as a representative BP value in an individual subject.
本研究的目的是通过动态血压监测（ABPM）对夜间（睡眠时间）血压值进行统计学计算，得出最低（基础）血压（BP），并探讨其临床意义。对206例原发性高血压患者直接（n = 89）或间接（n = 117）进行24小时动态心电图记录与ABPM。直接法使用遥测仪，间接测量使用多生物医学记录器（TM2425）。首先，从睡眠时间心电图确定最低心率（HR0 = 60/RR0）。将睡眠时间舒张压（DBP）与脉搏间期（RR）的平均乘积除以RR0，得到DBP0 [DBP0 =(DBPxRR)s/RR0]。利用收缩压（SBP）与DBP之间的相关性确定与DBP0对应的SBP0。根据这些值计算统计基础平均血压（MBP0），并研究其重复性以及与高血压严重程度的关系。MBP0值与直接法获得的睡眠时间MBP的真实基础值相似（平均±标准差差值，2.0±4.2 mmHg）。直接MBP0标准比日间MBP标准更准确地预测高血压严重程度（轻度、中度或重度靶器官损害）（预测准确性，89% 对53%，P<0.01）。使用间接MBP0标准也获得了几乎相同的结果。日间间接MBP0的变化（平均绝对差值）小于日间和夜间MBP的日间变化（分别为6.3±5.3和5.4±3.4 mmHg；n = 61，P<0.01），并且日间MBP的日间变化与身体活动（通过加速度传感器测量）之间的相关系数为0.38（P<0.05）。总之，统计基础血压几乎等于睡眠时间血压分布的真实基础（最低）血压。它与高血压器官损害的严重程度密切相关，具有高度重复性，并且被认为有可能在个体受试者中随机地和生理地作为代表性血压值。
