Effects of Time of Day of Treatment on Ambulatory Blood Pressure Pattern of Patients With Resistant Hypertension
Effects of Time of Day of Treatment on Ambulatory Blood Pressure Pattern of Patients With Resistant Hypertension
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DOI：
10.1161/01.hyp.0000172757.96281.bf
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发表时间：
2005-10
期刊：
影响因子：
8.3
通讯作者：
R. Hermida;D. Ayala;C. Calvo;J. E. López;A. Mojón;M. J. Fontao;R. Soler;J. Fernández
中科院分区：
文献类型：
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作者：
R. Hermida;D. Ayala;C. Calvo;J. E. López;A. Mojón;M. J. Fontao;R. Soler;J. Fernández
顽固性高血压患者非杓型血压的患病率较高。最近的研究结果表明，非浸渍部分相关的24小时治疗覆盖率在接受单次早晨剂量治疗的患者中的缺乏。因此，我们调查了治疗时间对700例顽固性高血压患者的血压模式的影响，这些患者在48小时动态监测的临床测量的基础上进行了研究。其中，299例患者在觉醒时接受了所有药物治疗，401例患者在睡前服用了≥1种抗高血压药物。在睡前服用1种药物的患者中，动态血压控制的患者百分比是服用1种药物的患者的两倍（P=0.008）。在578例真正的顽固性高血压患者中，睡前服用1种药物的受试者显示24小时收缩压和舒张压平均值显著降低（分别为3.1和1.6 mm Hg; P<0.011）。这种降低在夜间更为显著（5.1和3.0 mm Hg; P<0.001）。因此，在睡前服用1种药物的患者中，昼夜血压比显著增加2.7，非浸渍的患病率降低（56.9%对81.9%; P<0.001）。与清醒时服用所有药物的患者相比，睡前服用1种药物的患者血糖、胆固醇、纤维蛋白原和尿白蛋白排泄的平均值也显著降低（P<0.011）。对于顽固性高血压患者，药物治疗应考虑何时根据每位患者的休息-活动周期进行治疗，以改善控制并避免与较高心血管风险相关的非杓型模式。
Patients with resistant hypertension present high prevalence of a non-dipper blood pressure pattern. Recent results indicate that non-dipping is related partly to the absence of 24-hour therapeutic coverage in patients treated with single morning doses. Accordingly, we investigated the impact of treatment time on the blood pressure pattern in 700 patients with resistant hypertension on the basis of clinic measurements who were studied by 48-hour ambulatory monitoring. Among them, 299 patients received all their medication on awakening, and 401 were taking ≥1 antihypertensive drug at bedtime. The percentage of patients with controlled ambulatory blood pressure was double in patients taking 1 drug at bedtime (P=0.008). Among the 578 patients with true resistant hypertension, subjects receiving 1 drug at bedtime showed a significant reduction in the 24-hour mean of systolic and diastolic blood pressure (3.1 and 1.6 mm Hg, respectively; P<0.011). This reduction was much more prominent during nighttime (5.1 and 3.0 mm Hg; P<0.001). Accordingly, the diurnal/nocturnal blood pressure ratio was significantly increased by 2.7 and the prevalence on non-dipping reduced (56.9 versus 81.9%; P<0.001) in patients taking 1 drug at bedtime. Compared with patients receiving all drugs on awakening, subjects with 1 drug at bedtime also showed significant reductions in the average values of glucose, cholesterol, fibrinogen, and urinary albumin excretion (P<0.011). In patients with resistant hypertension, pharmacological therapy should take into account when to treat with respect to the rest–activity cycle of each patient to improve control and to avoid the non-dipper pattern associated to higher cardiovascular risk.