Ambulatory blood-pressure monitoring, antihypertensive therapy and the risk of fall injuries in elderly hypertensive patients

BackgroundFall 损害是普通的在之中老。这研究的目的是调查是否血压模式由 24-h 测量了监视的回廊血压( ABPM )，或跟随 24-h ABPM 的 antihypertensive 治疗的增强，可以在高血压的老 patients.MethodsIn 与秋天损害被联系回顾的研究，是的基于社区的老病人(年龄 70 年)指了 24-h ABPM 在一个年 post-ABPM 以内为秋天损害被评估。我们比较了临床的特征， 24-h ABPM 模式和高血压的治疗追随者 24-h ABPM 的增强，在有或没有秋天 injury.ResultsOverall 的病人之间 1032 个高血压的老病人被评估。(5.3%) 55 在跟随 ABPM 的一年有一个秋天损害事件。有秋天损害的病人显著地更老，并且与以前的下降的更高的率。更低的 24-h 心脏舒张的血压(到 2014 年 12 月的 67.3 2011 年 1 月) ， 1164 个病人作为有尖锐大动脉的解剖被识别。corr？？

A survey of recent reports on ambulatory blood pressure monitoring

This article is a review of 25 publications on ambulatory blood pressure monitoring(ABPM) and the importance of its results in everyday clinical practice. These studies, published in 2008-2011, were selected from the Scopus database, but are also available in Pubmed. They were prepared by researchers from around the world, concerned with the problems of proper control of blood pressure(BP), and of abnormalities in the circadian pattern of BP in patients with arterial hypertension, diabetes mellitus or renal failure. In the first part of this article, I analyse publications focused on some nuances in the methodology of ABPM and recommend ways to avoid some traps, related not only to the individual patient but also to the device used and the technical staff. The next section is devoted to the advantages of ABPM as a diagnostic tool which enables clinicians to learn about patients' BP during sleep, and emphasizes the practical implications of this information for so-called chronotherapy. This section also presents some new studies on the prognostic value of ABPM in patients with cardiovascular(CV) risk. Some recent articles on the results of various methods of pharmacological treatment of arterial hypertension in different agegroups are then described. The observations presented in this article may be helpful not only for researchers interested in the chronobiology of the CV system, but also for general practitioners using ABPM.

Could Ambulatory Blood Pressure Monitoring Be a Routine Investigation for Patients with Mild Cognitive Impairment?

Objectives: To study the ambulatory measured blood pressure (ABPM) profile in normotensive patients with mild cognitive impairment (MCI). Patients and Methods: The study was designed as a case control study including 50male patients with mild cognitive impairment in the age group of 30 - 50 years old. The control group included 30 volunteers with no cognitive impairment and in the same age group (30 - 50 years old) and same gender. Mini-mental estate examination, office and ABP monitoring (ABPM) and brain MRI scans were done for cases and controls. Results: Thirty patients (60%) with MCI revealed a non-dipper blood pressure pattern. Sleeping systolic blood pressure and sleeping systolic load were significantly higher in patients with MCI than in normal volunteers (p = 0.01). MRI brain showed more white matter lesions (WMLs) in patients with MCI than in normal volunteers;however, this didn’t reach significance level (p = 0.056). Conclusion: MCI in normotensive young adult patients could reflect an abnormal circadian blood pressure rhythm. Ambulatory blood pressure monitoring could be an essential investigation in young adult MCI patients.

The Clinical Application of Ambulatory Blood Pressure Monitoring in Pediatrics

Management of hypertension (HTN) largely relies on proper and accurate measurement of blood pressure (BP). Even following the criteria for HTN diagnosis defined in the Fourth report on high BP in children and adolescents, inaccurate diagnosis and misdiagnosis can occur with white coat effect and masked HTN. The use of Ambulatory Blood Pressure Monitoring (ABPM) has been increasing in pediatrics in the last 20 years. The main use of ABPM is to differentiate between sustained HTN and white coat HTN in patients who have elevated casual BP measurements and to detect masked HTN in high risk patients. ABPM is most useful in patients with casual BP within 20% of the 95th percentile for age, gender, and height. This report will highlight the use of ABPM in the evaluation of elevated BP and management of HTN in pediatrics. The discussion includes a review of various non-invasive BP measuring techniques, a description of ABPM and ABPM-unique data and diagnoses, updated ABPM clinical data more specific to pediatrics, its use in HTN clinical trials, and future outlook and direction of ABPM in pediatrics.

Individualized Isonatremic and Hyponatremic Dialysate Improves Blood Pressure in Patients with Intradialytic Hypertension: A Prospective Cross-Over Study with 24-h Ambulatory Blood Pressure Monitoring

Background. Intradialytic hypertension, a paradoxical rise in systolic blood pressure from pre- to postdialysis, is a poorly understood and difficult-to-treat phenomenon. We examined the effects of individually adjusted isonatremic and hyponatremic dialysate on intradialytic and interdialytic blood pressure in patients with intradialytic hypertension. Methods. We enrolled 11 patients with intradialytic hypertension in a prospective randomized cross-over study, with 4 treatment periods of different dialysate sodium concentrations. Period 1 (run-in) and 3 (wash-out) were standardized at 140 mEq/L;period 2 and 4 with iso- or hyponatremic sodium dialysate. Blood pressure was recorded each dialysis session, and 24-hour ambulatory blood pressure monitoring was performed at the end of each treatment period. Results. Isonatremic and hyponatremic dialysate were associated with significantly lower pre- and post-dialysis blood pressure as compared to baseline 140 mEq/L dialysate (predialysis 148.3 ± 24.7/67.7 ± 12.0 and 144.4 ± 16.5/68.8 ± 13.3 vs. 158.0 ± 18.3/75.6 ± 11.4 mmHg, resp p = 0.04 and 0.007 for systolic and p = 0.004 and 0.04 for diastolic blood pressure;postdialysis 154.2 ± 25.5/76.6 ± 14.1 and 142.5 ± 20.7/73.0 ± 12.9 vs. 159.1 ± 21.6/80.3 ± 12.1 mmHg, resp NS and p = 0.01 for systolic and NS and p = 0.04 for diastolic blood pressure). Postdialysis and 24 h systolic blood pressure tended to be lower with hyponatremic compared to isonatremic dialysate. Conclusion. Individually tailoring dialysate sodium concentration, based on the sodium set-point of each patient, resulted in a lower pre- and post-dialysis blood pressure in patients with intradialytic hypertension. 24 h blood pressure values tended to be lower as well with hyponatremic dialysate.

Twenty-four-hour ambulatory blood pressure changes in older patients with essential hypertension receiving monotherapy or dual combination antihypertensive drug therapy

Objective To evaluate the differences in 24-hour ambulatory blood pressure (BP) in older patients with hypertension treated with the five major classes of antihypertensive drugs,as monotherapy or dual combination therapy,to improve daytime and nighttime BP control. Methods We enrolled 1920 Chinese community-dwelling outpatients aged ≥ 60 years and compared ambulatory BP values and ambulatory BP control (24-hour BP < 130/80 mmHg;daytime mean BP < 135/85 mmHg;and nighttime mean BP < 120/70 mmHg),as well as nighttime BP dip patterns for monotherapy and dual combination therapy groups. Results Patients’ mean age was 71 years,and 59.5% of patients were women. Calcium channel blockers (CCBs) constituted the most common (60.3% of patients) monotherapy,and renin–angiotensin system (RAS) blockers combined with CCBs was the most common (56.5% of patients) dual combination therapy. Monotherapy with beta-blockers (BB) provided the best daytime BP control. The probabilities of having a nighttime dip pattern and nighttime BP control were higher in patients receiving diuretics compared with CCBs (OR = 0.52,P = 0.05 and OR = 0.41,P = 0.007,respectively). Patients receiving RAS/diuretic combination therapy had a higher probability of having controlled nighttime BP compared with those receiving RAS/CCB (OR = 0.45,P = 0.004). Compared with RAS/diuretic therapy,BB/CCB therapy had a higher probability of achieving daytime BP control (OR = 1.27,P = 0.45). Conclusions Antihypertensive monotherapy and dual combination drug therapy provided different ambulatory BP control and nighttime BP dip patterns. BB-based regimens provided lower daytime BP,whereas diuretic-based therapies provided lower nighttime BP,compared with other antihypertensive regimens.

Characteristic of Ambulatory Blood Pressure in Normotensive Subjects With Type 2 Diabetes Mellitus

Objectives To observe the characteristic of ambulatory blood pressure monitoring in normotensive diabetic subjects with normoalbuminuria or microalbuminuria. Methods Fifty-two normotensive patients with type 2 diabetes received ambulatory blood pressure monitoring were divided into normoalbuminuric and microalbuminuric groups according to their albumin excretion rate, the other 28 normotensive subjects without diabetes were contributed as control group. Ambulatory blood pressure monitoring was performed on a working day and measurement of blood pressure circadian rhythm was analyzed. Results Normotensive microalbuminuric diabetic patients had higher night-time systolic blood pressure and more blood pressure burden than normotensive normoalbuminuric diabetic patients. Additionally, the microalbuminuric patients had a higher frequency of non-dippers than normoalbuminuric ones, although they were all normotensive. Compared to the normotensive non-diabetic control subjects, the night- time systolic blood pressure and frequency of non- dippers of the normoalbuminuric diabetic patients were significantly higher. Conclusions Intensive attention should be paid in control of blood pressure in diabetic patients to prevent and limit damage of target organ including kidney, even in those normotensive subjects.

Night time blood pressure dip

The advent of ambulatory blood pressure monitoring permitted examination of blood pressures during sleep and recognition of the associated circadian fall in pressure during this period. The fall in pressure,called the "dip",is defined as the difference between daytime mean systolic pressure and nighttime mean systolic pressure expressed as a percentage of the day value. Ten percent to 20% is considered normal. Dips less than 10%,referred to as blunted or absent,have been considered as predicting an adverse cardiovascular event. This view and the broader concept that white coat hypertension itself is a forerunner of essential hypertension is disputable. This editorial questions whether mean arterial pressures over many hours accurately represent the systolic load,whether nighttime dipping varies from measure to measure or is a fixed phenomenon,whether the abrupt morning pressure rise is a risk factor or whether none of these issues are as important as the actual night time systolic blood pressure itself. The paper discusses the difference between medicated and nonmedicated white coat hypertensives in regard to the cardiovascular risk and suggests that further work is necessary to consider whether the quality and duration of sleep are important factors.

Effects of seasonal variation on blood pressure nocturnal fall in hypertensive patients

Objective Knowledge of seasonal variation of circadian blood pressure(BP)rhythm is still limited.The present study aimed to evaluate the seasonal influences on circadian BP variation based on a telemonitoring system in a large-scale hypertensive patients.Methods Between May 2017 and March 2018,10,988 participants received ambulatory blood pressure monitoring(ABPM),of which the values were automatically and immediately transmitted through the mobile internet to a Hypertension Management Cloud Platform which stored and analyzed the data.The patients from 63 centers residing in the northern cities of China and measured in summer(June-August)and winter(December-February)were included in the analyses.

The relation between prognosis and nocturnal blood pressure variation in hypertensive patients with lacunar infarct

Objective We conducted a study using MRI and ambulatory blood pressure monitoring(ABPM) to determine whether an in-apporpriately low nocturnal blood pressure, or an excess fall in nocturnal blood pressure, might be responsible for lacunar infarct. Method ABPM and Casul blood pressure(CBP) were examined in 35 hypertentives with lacunar infarct(LI)and 33 hypertentives without lacunar infarct as control group. Results There is no significant difference of CBP between two groups. But the mean nighttime systolic blood pressure (nSBP) and diastolic blood pressure (nDBP) in patients with lacunar infarct were significantly smaller than in patients without lacunar infarct. The ratio of nSBP/dSBP and nDBP/dDBP in SI were smaller than in control group respectively. Conclusions The results indicate that an inap-propriately low nocturnal blood pressure, or an excessive fall in nocturnal blood pressure, is associated with lacunar infarct. It is necessary not only to control high blood pressure but also to pay attention to circadian changes of blood pressure during the course of anti-hypertensive treatment.

The Relationship between Abnormal Circadian Blood Pressure Rhythm and Risk of Readmission in Patients with Heart Failure with Preserved Ejection Fraction

Objective:Abnormal circadian blood pressure rhythm has been revealed to be associated with hypertensive target organ damage and cardiovascular events,but its association with readmission risk in patients with heart failure with preserved ejection fraction(HFpEF)remains unknown.We conducted a retrospective study to explore the relationship between circadian blood pressure rhythm and readmission risk in HFpEF patients.Methods:We retrospectively collected baseline and follow-up data on HFpEF patients who underwent ambulatory blood pressure monitoring(ABPM)from May 2015 to October 2019.Patient circadian blood pressure rhythms defi ned by ABPM were grouped as dipper,nondipper,or riser patterns.Univariate and multivariate linear regression analyses were performed to assess the association between circadian blood pressure rhythm and readmission risk.Results:A total of 122 patients were enrolled in this study.The mean age and ejection fraction were 69.87 years and 61.44%,respectively,with mean the N-terminal pro-B-type natriuretic peptide(NT-proBNP)level being 1048.15 pg/mL.There were signifi cant differences in the 24-hour systolic blood pressure(SBP),sleep SBP,and sleep diastolic blood pressure(DBP)among the three groups,where the 24-hour SBP,sleep SBP,and sleep DBP in the riser pattern group were markedly higher than in the dipper pattern group.Notably,serum NT-proBNP levels,the proportion of patients readmitted for heart failure and the mean number of admissions differed markedly among three groups.Instructively,multivariate linear regression analysis showed that the riser pattern was a signifi cant and independent risk factor for increased serum NT-proBNP level(β=929.16,95%confi dence interval 178.79–1679.53,P=0.016).In multivariate logistic regression analysis,the riser pattern was demonstrated to be a signifi cant risk factor for readmission(odds ratio 11.23,95%confi dence interval 2.01–62.67,P=0.006)in HFpEF patients.Conclusion:The riser blood pressure pattern is a potential risk factor for elevated serum NT-proBNP level and readmission in HFpEF patients.

Predictive Value of Blood Pressure,Heart Rate,and Blood Pressure/Heart Rate Ratio in a Chinese Subpopulation with Vasovagal Syncope

Objective:The head-up tilt test(HUTT)is widely used but is time-consuming and not cost-effective to evaluate patients with vasovagal syncope(VVS).The present study aims to verify the hypothesis that ambulatory blood pressure(BP)monitoring(ABPM)and the simplistic tilt test may be potential alternatives to the HUTT.Methods:The study consecutively enrolled 360 patients who underwent the HUTT to evaluate VVS.BP),heart rate(HR),and BP/HR ratios derived from ABPM and the simplistic tilt test were evaluated to predict the presence,pattern,and stage of syncope during the HUTT.Results:Mixed response was the commonest pattern,and syncope occurred frequently with infusion of isoproterenol at a rate of 3μg/min.During the simplistic tilt test,the cardioinhibitory group had higher tilted BP/HR ratios than the vasodepressor group,while the vasodepressor group had a faster tilted HR and a larger HR difference than the cardioinhibitory group.The higher the BP/HR ratio in the tilted position,the higher the isoproterenol dosage needed to induce a positive response.During ABPM,BP/HR ratios were signifi cantly higher in the cardioinhibitory group than in the vasodepressor group.The higher the ABPM-derived BP,the higher the dosage of isoproterenol needed to induce syncope.There were signifi cant correlations in BP/HR ratios between ABPM and the supine position in the vasodepressor group,while signifi cant correlation was found only for the diastolic BP/HR ratio between ABPM and the tilted position in the cardioinhibitory group.The mixed pattern shared correlative features of the other two patterns.Conclusion:ABPM and the simplistic tilt test might be used as promising alternatives to the HUTT in VVS evaluation in clinical settings.

THE CIRCADIAN ALTERATIONS OF BLOOD PRESSURE IN PATIENTS WITH SECONDARY HYPERTENSION

Objective To study the pattern of circadian blood pressure changes in patients with se-condary hypertension. Methods The 24h ambulatory blood pressure monitoring was performed in 80 patients with secondary hypertension (SH) including primary aldosteronism in 44, pheochromocytoma in 11, renovas-cular hypertension in 10, renoparenchymal hypertension in 15 and compared with 80 patients with essential hy-pertension (EH) matched by age and sex. Results The diurnal rhythm in patients with SH was different from that of patients with EU. The diurnal curves in SU and EU was overlapped in daytime and separated from each other at nighttime. The nocturnal blood pressure fall was less and average blood pressure at nighttime was higher in patients with SH than those in patients with Eli (P <0. 01). The nighttime blood pressure loading and non-dipper phenomenon were much more frequently seen in patients with SH than those in patients with Eli (P <0. 01). The nighttime blood pressure/daytime blood pressure ratio was significantly higher in patients with SH than that in patients with Eli (P <0. 01). Conclusion The non-invasive 24h ambulatory blood pressure monitoring may be a useful method in screening for

老年人群24h动态血压监测中清晨高血压与脑血管储备功能相关性

目的研究老年人群24 h动态血压监测中清晨高血压与脑血管储备功能(CVR)的相关性。方法回顾性选取2021年1月至12月到济南市妇幼保健院行24 h动态血压监测的300例老年受试者,依据监测结果分为A组、B组和C组。A组158例为清晨血压升高的高血压患者,男88例,女70例,年龄(66.02±4.35)岁;B组74例为清晨血压正常的高血压患者,男41例,女33例,年龄(65.42±4.42)岁;C组68例为血压正常者,男37例,女31例,年龄(65.77±4.38)岁。以两侧大脑中动脉屏气指数均值<0.69%为CVR减低,屏气指数均值≥0.69%为CVR正常,将300例受试者分为CVR降低组(52例)和CVR正常组(248例)。比较A、B、C 3组患者的临床资料,CVR指标;比较CVR降低组、CVR正常组一般资料,行单因素分析、多因素分析和相关性分析。采用F检验、独立样本t检验、χ^(2)检验、logistic回归分析和Pearson相关性分析。结果300例24 h动态血压监测的老年受试者,清晨血压升高的高血压患者158例,占52.67%;清晨血压正常的高血压患者74例,占24.67%;血压正常者68例,占22.67%。3组收缩压(24 h均值、日间均值、夜间均值)、晨峰指数:A组>B组>C组(均P<0.05);舒张压(24 h均值、日间均值、夜间均值):A组>B组、C组(均P<0.05),B组、C组舒张压比较,差异均无统计学意义(均P>0.05)。CVR:A组[(21.37±7.89)%]<B组[(25.58±8.14)%]<C组[(28.56±8.10)%](均P<0.05);屏气指数:A组[(0.89±0.23)%]<B组[(1.13±0.21)%]、C组[(1.20±0.24)%](均P<0.05),B组、C组屏气指数比较,差异无统计学意义(P>0.05);脉动指数:A组[(1.49±0.36)]>B组[(1.15±0.31)]、C组[(1.06±0.29)](均P<0.05),B组、C组脉动指数比较,差异无统计学意义(P>0.05)。CVR降低组年龄[(73.14±3.21)岁]、清晨收缩压[(132.42±9.64)mmHg](1 mmHg=0.133 kPa)、清晨舒张压[(68.85±6.59)mmHg]均高于CVR正常组[(64.28±4.36)岁、(121.58±7.26)mmHg、(65.36±7.23)mmHg](均P<0.05)。logistic回归分析结果显示:年龄、清晨收缩压、清晨舒张压均为CVR降低的影响因素(均P<0.05)。清晨收缩压与屏气指数呈负相关(P<0.05),与脉动指数呈正相关(P<0.05);清晨舒张压与屏气指数呈负相关(P<0.05),与脉动指数呈正相关(P<0.05)。结论老年人群24 h动态血压监测中清晨高血压患者占比较大,清晨高血压患者CVR、屏气指数较低,脉动指数较高,清晨收缩压、清晨舒张压均与屏气指数呈负相关,与脉动指数呈正相关。

基于远程血压网络系统的新疆塔城地区托里县居民非杓型血压特点及影响因素

目的探讨新疆塔城地区托里县居民非杓型血压(non-dipping blood pressure,NDBP)的特点及其影响因素。方法回顾性分析托里县1547例患者的动态血压监测结果,并据此将他们分为杓型组及非杓型组,其中杓型组363例(男150例、女213例),非杓型组1184例(男456例、女728例)。比较两组患者的性别、年龄、24hSBP、24hDBP、24hMAP、24hHR、dSBP、dDBP、dMAP、dHR、nSBP、nDBP、nMAP、nHR等相关指标。利用ROC曲线评估24hMAP、nSBP、nMAP预测NDBP的效能。结果两组患者年龄、24hSBP、24hMAP、nSBP、nDBP、nMAP及nHR差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,nSBP(OR=1.313,95%CI 1.232~1.400,P<0.01)、nMAP(OR=1.302,95%CI 1.249~1.356,P<0.01)是发生NDBP的独立危险因素。ROC曲线显示,24hMAP、nSBP和nMAP的AUC分别为0.537、0.726和0.769。结论NDBP与24hMAP、nSBP及nMAP水平密切相关,nMAP对NDBP有较高的诊断效能。利用动态血压监测来诊断NDBP简便、易操作,对临床早期诊断及治疗NDBP具有重要临床价值。

老年人群血压变异性与无症状性未破裂颅内动脉瘤直径的相关性研究

目的探讨老年患者血压变异性与无症状性未破裂颅内动脉瘤直径的关系。方法回顾性分析2021年1月1日至2022年12月31日于北京老年医院神经内科住院经脑血管造影确诊为无症状颅内未破裂动脉瘤(UIA),并完成24小时动态血压监测(24h ABPM)的老年患者83例。比较两组的一般资料与24h ABPM参数,采用Spearman相关性分析探讨24h ABPM参数与动脉瘤直径的相关性,并采用多元Logistic回归分析探讨老年颅内未破裂动脉瘤直径的独立影响因素。结果两组患者相比,目前吸烟、高血压病程、血清同型半胱氨酸(HCY)、血清超敏C反应蛋白(hs-CRP)水平之间存在统计学差异(P<0.05),其中大动脉瘤组患者目前吸烟比例更高,高血压病程更久,血清HCY、hs-CRP水平更高。大动脉瘤组24小时收缩压标准差(24hSSD)、24小时舒张压标准差(24hDSD)、夜间收缩压标准差(nSSD)、夜间舒张压标准差(nDSD)高于小动脉瘤组,两组相比差异有统计学意义(P<0.05),Spearman相关性分析显示24hSSD、24hDSD、nSSD、nDSD与动脉瘤直径呈正相关(P<0.05)。二元Logistic回归分析显示目前吸烟、高血压病程、24hDSD是动脉瘤直径大小的影响因素。结论大动脉瘤的老年患者高血压病程更长、血压变异性(BPV)更高。舒张压标准差对预测动脉瘤增长有一定的意义。

清醒时不同时间血压水平预测夜间高血压的价值

目的:比较清醒时不同时间血压水平预测夜间高血压的价值。方法:连续入选2023年4月至7月就诊于福建医科大学附属第一医院门诊的204例高血压患者,所有患者均接受规范的诊室血压和诊室外血压测量。诊室外血压测量使用动态血压监测装置及血压日志记录,具体包括傍晚血压、睡前血压、清晨血压及清晨平均血压。夜间高血压定义为夜间平均血压≥120/70 mmHg(1 mmHg=0.133 kPa)。采用ROC曲线分析不同时间血压水平预测夜间高血压的价值,并采用联合序列试验评价两个指标联合预测夜间高血压的价值。采用Logistic回归分析评估夜间高血压的预测因素。结果:204例高血压患者中,104例(51.0%)有夜间高血压。夜间平均收缩压与睡前收缩压最接近(P=0.641)。睡前收缩压≥120 mmHg的患者中有75.7%(84/111)存在夜间高血压,睡前收缩压≥135 mmHg患者中有94.2%(49/52)存在夜间高血压;清晨平均收缩压≥135 mmHg患者中有88.2%(75/85)存在夜间高血压。ROC曲线分析表明,清晨平均收缩压(AUC:0.903,P<0.05)预测夜间高血压的价值明显优于诊室收缩压、傍晚收缩压、睡前收缩压、清晨收缩压。多因素Logistic回归分析显示,睡前收缩压125~134 mmHg(OR=2.95,95%CI:1.02~8.49,P=0.045)、睡前收缩压≥135 mmHg(OR=17.55,95%CI:3.61~85.38,P<0.001)、清晨平均收缩压125~134 mmHg(OR=6.08,95%CI:1.73~21.41,P=0.005)、清晨平均收缩压≥135 mmHg(OR=25.41,95%CI:6.02~107.32,P<0.001)对夜间高血压有预测价值。ROC曲线分析显示,睡前收缩压和清晨平均收缩压联合预测夜间高血压价值更高(AUC:0.929,P<0.05)。进一步行联合序列试验表明,当睡前收缩压≥130 mmHg且清晨平均收缩压≥135 mmHg灵敏度最高,患者中有98.0%(49/50)存在夜间高血压。结论:清晨血压和睡前血压是预测夜间高血压的两个有效指标,联合这两个指标预测价值更高,可为夜间高血压的识别诊断提供临床指导。

甘油三酯-葡萄糖乘积指数与女性非糖尿病高血压左心室肥厚的相关性探讨

目的:探讨女性非糖尿病高血压患者甘油三酯-葡萄糖乘积(TyG)指数与左心室肥厚(LVH)的相关性。方法:回顾分析133名女性非糖尿病高血压患者,采用Pearson相关性分析与左室质量指数(LVMI)相关的因素,通过二元logistic回归分析获得LVH的影响因素,并通过ROC曲线分析TyG指数预测LVH的最佳截断值以及灵敏度和特异度。结果:在女性非糖尿病高血压患者中,与TyG指数低值组比较,TyG指数高值组其LVMI也较高。Pearson相关性分析发现LVMI与TyG指数、收缩压及夜间舒张压呈正相关(P<0.05)。二元Logistic回归分析显示,TyG指数和夜间收缩压是LVH的预测因素(OR=3.486,95%CI:1.417~8.577;OR=1.048,95%CI:1.019~1.077)。TyG指数与夜间收缩压联合预测LVH的AUC为0.75(95%CI:0.659~0.847),灵敏度为64.7%,特异度为76.8%。结论:在女性非糖尿病高血压患者中,TyG指数和夜间收缩压与左室质量指数呈正相关,可以作为左心室肥厚的预测因子。

ABPM、TCD联合颈动脉血管超声检查诊断早期大脑中动脉粥样硬化伴急性脑梗死的临床价值分析

目的探讨动态血压监测(ABPM)、经颅彩色多普勒超声(TCD)联合颈动脉血管超声检查诊断大脑中动脉(MCA)粥样硬化伴急性脑梗死(ACI)患者的临床价值。方法选取2014年7月到2016年1月我院收治的早期MCA粥样硬化伴ACI患者80例作为观察组,选取同期在我院进行健康体检的志愿者80例作为对照组。分别对两组研究对象进行ABPM、TCD及颈动脉血管超声检查分析。结果观察组患者的全天平均收缩压(24h-mSBP)、白天平均收缩压(dm SBP)、夜间平均收缩压(nm SBP)、全天平均脉压(24h-mPP)、白天平均脉压(dm PP)及夜间平均脉压(nm PP)水平均明显高于对照组,晨峰血压异常发生率(66. 25%)明显高于对照组(3. 75%),差异有统计学意义(P <0. 05);两组研究对象的全天平均舒张压(24h-mDBP)、白天平均舒张压(dm DBP)及夜间平均舒张压(nm DBP)比较差异无统计学意义(P> 0. 05)。观察组患者双侧的颈动脉收缩时血管直径(CCA-Ds)、颈动脉内中膜厚度(CCA-IMT)均明显大于对照组(P <0. 05),双侧的大脑中动脉阻力指数(MCA-RI)、大脑中动脉搏动指数(MCA-PI)明显高于对照组(P <0. 05)。观察组患者的斑块出现率(96. 3%)明显高于对照组(26. 3%),血管内斑块数目> 1个的比例(83. 8%)明显高于对照组(22. 5%),不稳定斑块出现率(71. 3%)明显高于对照组(15. 0%),血流速度异常率(86. 3%)明显高于对照组(10. 0%),差异有统计学意义(P <0. 05)。结论进行ABPM、TCD、颈动脉血管超声联合检查能同时反映出机体的昼夜血压变化情况、血流动力学参数及动脉粥样硬化程度,为早期诊断MCA粥样硬化伴ACI提供参考。

血压节律与水平和左心室舒张功能的相关性分析

目的 探讨原发性高血压患者的血压昼夜节律、不同血压水平与左室舒张功能之间的关系。方法 纳入解放军总医院第一医学中心心内科2022年1月~2023年4月收治的678例原发性高血压住院患者,所有患者均接受动态血压监测(ambulatory blood pressure monitoring, ABPM)和超声心动图检查。根据血压昼夜节律分为杓型血压组(n=46)、非杓型组(n=451)、反杓型组(n=181)。采用左房容积指数(left atrial volume index, LAVI)、二尖瓣口舒张早期血流峰值速度/二尖瓣环处侧壁和间隔舒张早期速度的平均值(E/e′)、二尖瓣环处侧壁和间隔舒张早期速度的平均值(e′)评估3组患者左室舒张功能。采用方差分析和多元线性回归分析诊室血压、24 h收缩压平均值(24 h-mSBP)、24 h舒张压平均值(24 h-mDBP)、日间收缩压平均值(D-mSBP)、日间舒张压平均值(D-mDBP)、夜间收缩压平均值(N-mSBP)、夜间舒张压平均值(N-mDBP)、24 h收缩压变异性(24-SBPV)、24 h舒张压变异性(24-DBPV)、日间收缩压变异性(D-SBPV),日间舒张压变异性(D-DBPV),夜间收缩压变异性(N-SBPV),夜间舒张压变异性(N-DBPV)与左室舒张功能之间的关系。结果 反杓型血压组的LAVI明显高于杓型血压组,差异有统计学意义(P<0.05)。多元线性回归的结果显示,24 h-SBP、D-mSBP和N-mSBP与LAVI独立相关(B=0.06,P<0.05);24 h-mSBP、D-mSBP、N-mSBP、诊室收缩压、24-SBPV、24-DBPV、D-SBPV和D-DBPV与E/e′独立相关(B=0.03、0.03、0.02、0.01、0.09、0.10、0.05、0.07,P<0.05);24 h-mSBP、24 h-mDBP、N-mDBP和诊室舒张压与e′独立相关(B=-0.01、-0.02、-0.02、-0.01,P<0.05)。结论 反杓型血压节律和收缩压平均值(mSBP)与左房扩大相关。mSBP及诊室收缩压均与左室舒张功能相关,且mSBP与左室舒张功能的相关性强于诊室血压。ABPM可用于早期识别高血压患者中左房扩大和左心室舒张功能障碍的高风险人群。