Dipping pattern of nocturnal blood pressure in patients with hypertension.
Dipping pattern of nocturnal blood pressure in patients with hypertension.
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DOI：
10.1586/erc.09.35
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发表时间：
2009-06-01
影响因子：
2
通讯作者：
Fagard, Robert H
中科院分区：
文献类型：
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作者：
Fagard, Robert H
根据24小时动态血压记录的夜间血压比率，已经描述了四种类型：极端勺型(夜间昼夜血压比率=0.8)、勺型(0.8；比率=0.9)、非勺型(0.9；比率；或=1.0)和反勺型(比率1.0)。这篇文章的主要目的是讨论这四种血压下降类型在高血压预后中的意义，主要是基于对个别患者数据的大型荟萃分析。在基线无心血管疾病的高血压患者中，在对混杂因素和24小时血压进行统计调整后，极端勺型患者的死亡率低于勺型患者，而心血管事件的发生率高于反向勺型患者。在基线水平上，有主要心血管疾病的高血压患者的预后也是最差的。在一项基于人群的综合荟萃分析中还发现，与基于人群的研究的综合荟萃分析相比，反向勺子的心血管事件和死亡率更高，但结果在极端勺子和勺子之间没有显着差异。基于这些发现，似乎毫无疑问，反向下沉与更糟糕的预后有关。一些研究表明，与勺子相比，非勺子和极端勺子的预后相似，但其他研究表明，非勺子的预后略差，或者极端勺子的预后更好或更差。
Four dipping categories have been described, based on the night-day blood pressure ratio from 24-h ambulatory blood pressure recordings: extreme dippers (night-day blood pressure ratio < or = 0.8), dippers (0.8 < ratio < or = 0.9), nondippers (0.9 < ratio < or = 1.0) and reverse dippers (ratio > 1.0). The main purpose of this article is to discuss the prognostic significance of these four dipping categories in hypertension, mainly based on a large meta-analysis of individual patient data. In hypertensive patients without cardiovascular disease at baseline and with statistical adjustment for confounders and 24-h blood pressure, mortality was lower in extreme dippers than in dippers, whereas the incidence of cardiovascular events was higher in reverse dippers. The worst prognosis for reverse dippers was also observed in hypertensive patients with major cardiovascular disease at baseline. Higher incidences of cardiovascular events and mortality were also found in reverse dippers in comparison with dippers in a comprehensive meta-analysis of population-based studies but outcome was not significantly different between extreme dippers and dippers. Based on these findings, there appears to be little doubt that reverse dipping is associated with a worse prognosis. Some studies suggest that prognosis is similar in nondippers and extreme dippers in comparison with dippers, but other studies suggest a somewhat worse prognosis in nondippers, or a better or worse prognosis in extreme dippers.