Circadian variations in blood pressure : implications for chronotherapeutics.
Circadian variations in blood pressure : implications for chronotherapeutics.
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DOI：
10.2165/00129784-200505010-00002
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发表时间：
2005-01-01
期刊：
影响因子：
--
通讯作者：
Burnier, Michel
中科院分区：
文献类型：
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作者：
Hassler, Christopher;Burnier, Michel
高血压患者的管理通常忽视或很少相信疾病过程固有的生物节律及其潜在的临床意义。动态血压监测的发展和患者家庭血压测量的迅速普及，现在已经产生了一系列与心血管系统的时间生物学直接相关的新的临床问题，例如夜间血压下降的临床解释或难以在早晨实现足够的血压控制。今天，越来越多的证据表明，夜间血压，特别是睡眠血压没有下降，会导致靶器官损伤的发生，清晨血压升高会增加发生心血管事件的风险，包括中风，可能与24小时血压水平无关。根据这些观察结果，可能有必要重新考虑抗高血压药物的处方方式，以获得平稳的24小时血压控制，尊重血压的昼夜节律模式。有几种方法存在，包括使用药物，降低血压全天候和尊重昼夜节律。用这种药剂进行的初步研究提供了有趣的结果。然而，显然需要大型临床试验来证明这种方法的临床优越性。无论如何，更好地理解血压昼夜变化的重要性肯定会对我们对高血压患者治疗管理的看法产生重大影响。
The management of hypertensive patients usually ignores or gives little credit to the biologic rhythms inherent to the disease process and their potential clinical implications. The development of ambulatory blood pressure monitoring and the rapidly growing popularity of home blood pressure measurements by patients have now generated a series of new clinical questions that are directly linked to the chronobiology of the cardiovascular system, such as the clinical interpretation of a blunted nocturnal fall in blood pressure or the difficulty of achieving adequate blood pressure control in the morning. Today, there is growing evidence that night-time blood pressure, and particularly the absence of a decrease in sleep blood pressure, contributes to the occurrence of target organ damages, and that the early morning rise in blood pressure increases the risk of developing cardiovascular events, including stroke, perhaps independently of 24-hour blood pressure levels. On the basis of these observations, it may be necessary to reconsider the way antihypertensive drugs are prescribed in order to obtain smooth, 24-hour blood pressure control, respecting the circadian pattern of blood pressure. Several approaches exist, including the use of drugs that lower blood pressure around the clock and respect the diurnal rhythm. Preliminary studies performed with such agents have provided interesting results. However, there is a clear need for large clinical trials demonstrating the clinical superiority of this approach. In any case, a better understanding of the importance of the circadian variations of blood pressure could certainly have a major impact on our view of the therapeutic management of hypertensive patients.