A possible relationship of nocturnal blood pressure variability with coronary artery disease in diabetic nephropathy
A possible relationship of nocturnal blood pressure variability with coronary artery disease in diabetic nephropathy
复制标题
DOI：
10.1080/10641960601096760
复制
发表时间：
2007-01-01
影响因子：
12.3
通讯作者：
Umemura, Satoshi
中科院分区：
文献类型：
--
作者：
Tamura, Kouichi;Tsurumi, Yuko;Umemura, Satoshi
有证据表明短期血压（BP）变异性与心血管靶器官损伤之间存在关系。虽然已证明夜间血压降低和心率变异性降低与糖尿病患者的心血管发病率相关，但关于短期血压变异性的信息很少。在这项研究中，对36例接受动态血压监测的2型糖尿病和明显肾病患者的短期血压变异性进行了评估，并检查了与短期血压变异性相关的因素。24小时收缩压变异性增加的患者中，冠状动脉疾病（CAD）的发生率显著增加（67%对11%; p < 0.0005），而脑血管疾病的发生率没有显著影响（61%对50%）。多元逐步回归分析显示，血清胆固醇胆固醇和血浆去甲肾上腺素是夜间收缩压变异性的重要和独立贡献者。（部分R-2 = 0.490，p < 0.001;部分R-2 = 0.470，p < 0.001），并证明体重指数和p-NE是夜间舒张压变异性的主要决定因素（部分R-2 = 0.539，p < 0.0005;部分R-2 = 0.304，p < 0.05）。糖尿病肾病合并CAD患者的日间收缩压（17.8 mmHg vs 13.1 mmHg，p < 0.0005）、夜间收缩压（17.4 mmHg vs 10.5 mmHg，p < 0.0001）和夜间舒张压（10.4 mmHg vs 7.2 mmHg，p < 0.05）变异性显著增加。Logistic回归分析显示夜间收缩压变异是冠心病的独立危险因素（优势比3.13 [95%CI 1.02 - 9.61]; p < 0.05）。夜间血压变异性的增加与糖尿病肾病患者的交感神经激活成比例相关。在糖尿病人群中，短期血压变异性升高与夜间交感神经的相对患病率相结合可能是心血管事件的重要危险因素。
Evidence suggests a relationship between short-term blood pressure (BP) variability and cardiovascular target-organ damage. Although a blunted nocturnal decrease in BP and reduced heart rate variability have been shown to be associated with cardiovascular morbidity in diabetic patients, little information is available on short-term BP variability. In this study, short-term BP variability was assessed in 36 subjects with type 2 diabetes and overt nephropathy who underwent ambulatory BP monitoring, and the factors that correlated with short-term BP variability were examined. The incidence of coronary artery disease (CAD) was significantly greater in the patients with increased 24-h systolic BP variability (67% versus 11%; p < 0.0005), while that of cerebrovascular disease was not significantly affected (61% versus 50%). Multiple stepwise regression analysis revealed that serum cholesterol (cholesterol) and plasma norepinephrine (p-NE) were significant and independent contributors to nighttime systolic BP variability (partial R-2 = 0.490, p < 0.001; partial R-2 = 0.470, p < 0.001) and demonstrated that body mass index and p-NE were primary determinants of nighttime diastolic BP variability (partial R-2 = 0.539, p < 0.0005; partial R-2 = 0.304, p < 0.05). Diabetic nephropathy patients with CAD had significantly increased daytime systolic (17.8 mmHg versus 13.1 mmHg, p < 0.0005), nighttime systolic (17.4 mmHg versus 10.5 mmHg, p < 0.0001), and nighttime diastolic (10.4 mmHg versus 7.2 mmHg, p < 0.05) BP variability. Furthermore, logistic regression analysis demonstrated that nighttime systolic BP variability was an independent risk factor for CAD (odds ratio 3.13 [95% CI 1.02 - 9.61]; p < 0.05). The increase in nighttime BP variability is associated with a proportional sympathetic activation in diabetic nephropathy. Elevated short-term BP variability combined with relative sympathetic prevalence during the night might represent an important risk factor for cardiovascular events in the diabetic population.