药物干预非杓型高血压者恢复杓型血压昼夜节律后对血浆神经肽Y的影响

Effects of pharmacotherapy to restore circadian rhythm of blood pressure on plasma concentration of neuropeptide Y in patients with hypertension

目的 :探讨通过药物干预使非杓型高血压患者恢复杓型血压昼夜节律后对血浆神经肽Y(NPY)的影响。方法 :30例非杓型的高血压患者 (非杓型组 )随机分成两组 ,采用自身对照交叉试验法 ,在总剂量及药物种类 (硝苯吡啶缓释片及依那普利 )不变的前提下 ,通过调整用药时间加强夜间降压恢复杓型节律 (a处理 )或按常规的日间降压不恢复 (或保持 )杓型节律 (b处理 )。第 1阶段两组分别接受其中一种处理 ,第 2阶段分别接受另一种处理。用放免法同步测定每一处理前后的夜间 (2 :0 0 )、日间 (8:0 0 )血浆NPY ,并复查动态血压。同时与同期的 4 5例健康体检者 (对照组 )以及 2 1例同期住院的杓型高血压患者 (杓型组 )作对照。比较非杓型组血压昼夜节律恢复前后NPY的水平。结果 :与对照组比较 ,非杓型组白天及夜间平均血压、NPY均显著增高 [分别为(97.93± 11.6 7)∶(92 .0 0± 7.34)mmHg(1mmHg =0 .133kPa) ,P <0 .0 5 ;(96 .96± 12 .31)∶(77.82± 6 .35 )mmHg ;(137.75± 5 3.6 2 )∶(10 2 .13± 2 0 .6 5 )ng/L ;(135 .4 1± 39.70 )∶(99.83± 15 .88)ng/L ,均 P <0 .0 1]。血压恢复杓型后 ,夜间平均压及NPY显著下降 (P <0 .0 1) ,日间平均压及NPY下降不显著。与杓型组比较 ,非杓型组夜间NPY/日间NPY比值 (U值 )

Objective:To investigate the effects of pharmacotherapy to restore circadian rhythm of blood pressure on plasma concentration of neuropeptide Y (NPY) in patients with hypertension. Method: A randomized two stage cross-over trial was used in the study. 30 patients (age 64.8 ± 11.4 yrs, 22 male and 8 female ) with essential hypertension were selected. Non dipper circadian rhythm of blood pressure was defined by 24 hours ambulatory blood pressure monitoring (ABPM). The patients were randomized to two groups. In stage 1, patents in each group received one of the two regimens : restored dipper circadian rhythm by adjustment of medicine (used nifedepine SR and enalapril in nighttime) without changing the total amount during the whole day, or no restored regimens; In Stage 2 , each group took the other regimen for another 10 days . The level off NPY at daytime(8AM) and nighttime(2AM) NPY were measured by radioimmunoassay, and 24 hours blood pressures were measured before and after each regimen. 45 healthy subjects and 21 inpatients with dipper essential hypertension were included in healthy and dipper control groups, respectively. Result: The levels daytime and nighttime mean blood pressure and NPY were higher significantly in non dipper essential hypertensive patients than those in healthy control group ( 97.93 ± 11.67 ) vs ( 92.00 ± 7.34 ) mmHg,P< 0.05 ;( 96.96 ± 12.31 )vs( 77.82 ± 6.35 ) mmHg;( 137.75 ± 53.62 )vs ( 102.13 ± 20.65 )ng/L;( 135.41 ± 39.70 )vs( 99.83 ± 15.88 )ng/L;P< 0.01 , respectively). With the non dippers converting to the dipper , mean blood pressures and NPY on nighttime were decreased significantly (P< 0.01 ) , but those were decreased insignificantly (P> 0.05 ) on daytime. The levels of nighttime mean blood pressure and ratio of NPY in nighttime to daytime (ie. u value) were also higher significantly in non dipper essential hypertensive patients than those in dipper essential hypertensive patients. The reductions of u value were positively correlated to the reductions of nighttime mean blood pressures in two stages (r= 0.42 ,P< 0.05 ;r= 0.38 ,P< 0.05 )respectively.Conclusion: The levels in daytime and nighttime mean blood pressures and NPY in non-dippers essential hypertensive patients were higher than those in healthy controls . The phamercotherapy to reconvert dipper could reduce the levels of ninghttime mean blood pressure and NPY.