ALTERED CIRCADIAN BLOOD-PRESSURE RHYTHM IN PATIENTS WITH CUSHINGS-SYNDROME
ALTERED CIRCADIAN BLOOD-PRESSURE RHYTHM IN PATIENTS WITH CUSHINGS-SYNDROME
复制标题
DOI：
10.1161/01.hyp.12.1.11
复制
发表时间：
1988-07-01
期刊：
影响因子：
8.3
通讯作者：
YOSHINAGA, K
中科院分区：
文献类型：
--
作者：
IMAI, Y;ABE, K;YOSHINAGA, K
比较了库欣综合征、原发性高血压和原发性醛固酮增多症患者的昼夜血压节律。在患有原发性高血压或原发性醛固酮增多症的患者中，观察到收缩压和舒张压以及心率在夜间明显下降。这种下降见于未经治疗的受试者以及接受钙拮抗剂、利尿剂、转化酶抑制剂、α-阻滞剂和β-阻滞剂或交感神经药物联合治疗的患者。在这些组中，心率与收缩压或舒张压之间存在正相关。另一方面，库欣综合征患者的夜间血压没有下降，但在某些患者中观察到血压上升。所有患者的夜间心率均有所下降。因此，这些患者的心率和血压之间不存在显着相关性。外源性糖皮质激素消除了慢性肾小球肾炎或系统性红斑狼疮患者夜间血压的正常下降。这些结果表明，库欣综合征患者昼夜血压模式的改变不是由于抗高血压治疗或伴随该疾病的盐皮质激素过多，而是由于糖皮质激素过多或促肾上腺皮质激素-糖皮质激素系统的相关紊乱（或两者兼而有之）。这一结论还意味着正常的血压昼夜节律可能至少部分受到促肾上腺皮质激素-糖皮质激素系统的调节。
The circadian blood pressure rhythm was compared in patients with Cushing''s syndrome, essential hypertension, and primary aldosteronism. In patients with essential hypertension or primary aldosteronism, a clear nocturnal fall in systolic and diastolic blood pressure and heart rate was observed. This fall was seen in untreated subjects as well as in patients receiving combined treatment with a calcium antagonist, diuretic, converting enzyme inhibitor, .alpha.-blocker and .beta.-blocker, or sympatholytic drug. In these groups, there was a positive correlation between heart rate and systolic or diastolic blood pressure. On the other hand, in patients with Cushing''s syndrome, there was no nocturnal fall in blood pressure but in some patients a rise was observed. In all patients there was a nocturnal fall in heart rate. Thus, there was no significant correlation between heart rate and blood pressure in these patients. Exogenous glucocorticoid eliminated the normal nocturnal fall of blood pressure in patients with chronic glomerulonephritis or systemic lupus erythematosus. These results suggest that the changed circadian blood pressure pattern in patients with Cushing''s syndrome is not due to antihypertensive treatment or to the mineralocorticoid excess accompanying this disease, but it is attributable to excess glucocorticoid or the associated disturbance in the adrenocorticotropic hormone-glucocorticoid system (or both). This conclusion also implies that the normal circadian rhythm of blood pressure may be regulated at least in part by the adrenocorticotropic hormone-glucocorticoid system.