DIURNAL-VARIATIONS OF BLOOD-PRESSURE AND MICROALBUMINURIA IN ESSENTIAL-HYPERTENSION
DIURNAL-VARIATIONS OF BLOOD-PRESSURE AND MICROALBUMINURIA IN ESSENTIAL-HYPERTENSION
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DOI：
10.1093/ajh/7.1.23
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发表时间：
1994-01-01
影响因子：
3.2
通讯作者：
CAMPESE, VM
中科院分区：
文献类型：
--
作者：
BIANCHI, S;BIGAZZI, X;CAMPESE, VM
约40%的高血压患者出现微量白蛋白尿。以前的研究未能证明微量白蛋白尿和办公室血压水平之间有任何一致的关系。因为平均动态血压与心血管发病率和死亡率的相关性比办公室血压更好，所以我们研究了尿白蛋白排泄水平与平均白天、夜间或24小时血压的相关性是否比办公室血压更好。63例高血压病患者和21名健康志愿者被纳入研究。24名高血压患者未能显示出夜间血压下降至少10/5毫米汞柱的正常情况，因此被定义为“非勺者”；其余患者被定义为“勺者”。办公室血压在勺子和非勺子之间没有差别。然而，非勺型患者的夜间收缩压和舒张压明显高于勺型患者。非勺型尿白蛋白排泄量的中位数(42 mg/24 h)显著高于勺型(17.5 mg/24 h)和正常人(8.6 mg/24 h)(P<；.001)。所有高血压病患者夜间收缩压、舒张压与尿白蛋白排泄量、24小时收缩压与尿白蛋白排泄量呈显著正相关，非勺型高血压患者24小时舒张压、夜间舒张压与尿白蛋白排泄量呈显著正相关。非勺型高血压患者UAE的增加提示存在比勺型高血压患者更大的肾脏损害。
Microalbuminuria has been shown in approximately 40% of patients with essential hypertension. Previous studies have failed to demonstrate any consistent relationship between microalbuminuria and levels of office blood pressure. Because average ambulatory blood pressure correlates with incidence of cardiovascular morbidity and mortality better than office blood pressure, we have studied whether levels of urinary albumin excretion correlate with average diurnal, nocturnal, or 24-h blood pressure better than with office blood pressure. Sixty-three patients with essential hypertension and 21 healthy volunteers were included in the study. Twenty-four hypertensive patients failed to show the normal nighttime fall in blood pressure of at least 10/5 mm Hg and were defined as ''nondippers''; the remaining were defined as ''dippers.'' Office blood pressure was not different between dippers and nondippers. However, nighttime systolic and diastolic blood pressures were significantly greater in nondippers than in dippers. The median urinary albumin excretion in nondippers (42 mg/24 h) was significantly greater (P < .001) than in dippers (17.5 mg/24 h), and in normal subjects (8.6 mg/24 h). A significant correlation was present between nighttime systolic and diastolic blood pressure and urinary albumin excretion (UAE) and between 24-h systolic blood pressure and UAE in all hypertensive patients; in addition, a significant correlation was present between 24-h diastolic and nighttime diastolic blood pressure and UAE in nondippers. The increased amount of UAE in nondipper hypertensive patients suggests the presence of greater renal damage than in dippers.