The role of hypothalamo-pituitary-adrenal and vasopressin systems on the regulation of circadian blood pressure variation

血压（BP）变化包括短期和长期变化。前者被认为是数秒、数分钟或数小时内的BP变化，后者被认为是每日BP变化（昼夜BP变化）。前者可用直接动脉内法或间接手指容积法测定，后者可用普通袖带法测定。短期BP变化由以下因素介导：1）中枢心血管调节中心响应内部和外部刺激的输出，2）效应器官对中枢输出的反应性，以及3）缓冲系统的反应性。认为短期血压变化本身以及血压水平反映了高血压血管损害。昼夜血压变化主要由交感神经张力的昼夜节律介导，该节律与身体和精神活动的变化（例如觉醒-睡眠周期）有关。在几个病理生理学合作 关于我们 在诸如自主神经功能障碍、内分泌紊乱、代谢疾病和动脉粥样硬化疾病的情况下，昼夜血压变化被消除或逆转，表明其至少部分由固有节律介导，尽管尚不确定这是原发性还是继发性的。血压昼夜变化，即血压夜间下降和昼夜上升，在大多数原发性高血压患者和正常人中观察到。老年受试者夜间血压下降幅度与年轻或成年受试者相似。几种类型的抗高血压药物，如钙拮抗剂，转换酶抑制剂，和受体阻滞剂没有交感神经作用，诱导一个显着的昼夜血压模式向下移动，表明他们在夜间的降压作用时，血压已经下降在睡眠中。老年人降压治疗后夜间血压过度下降可能导致心脑血管缺血。考虑到上述情况，可以得出结论，血压变化的信息，短期和长期（昼夜），是必不可少的高血压的诊断和治疗。少

Blood pressure (BP) variation includes short-term and long-term variation. The former is regarded as being the BP variation over seconds, minutes or hours and the latter as being the dally BP variation (circadian BP variation). To determine the former, a direct intra-arterial method or indirect finger volume-oscillometric method is useful, while the ordinary arm-cuff method is used for determining the latter. Short-term BP variation is mediated by 1) the output of the central cardiovascular regulatory center in response to internal and external stimuli, 2) the responsiveness of the effector organ to the central output, and 3) the responsiveness of the buffering system. It is considered that the short-term BP variation per se as well as the BP level reflects hypertensive vascular damage. Circadian BP variation is mediated mainly by the circadian rhythm of sympathetic tone linked to the changes in physical and mental activities, e.g. the wake-sleep cycle. In several pathophysiological co … More nditions such as autonomic dysfunction, endocrine disorder, metabolic disease, and atherosclerotic disease, circadian BP variation is eliminated or reversed, indicating that it is mediated at least in part by an inherent rhythm, although it is uncertain whether this is primary or secondary. A circadian BP variation, i.e. nocturnal fall and diurnal rise in BP, is observed in the majority of essential-hypertensive patients as well as in normal subjects. The amplitude of the nocturnal fall in BP in elderly subjects is similar to that in young or adult subjects. Several types of antihypertensive drugs, like calcium-antagonist, converting-enzyme inhibitors, and -blockers without sympathomimetic action, induce a significant downward shift in the circadian BP pattern, indicating their hypotensive effect during the night when the BP is already decreased during sleep. It is possible that excessive nocturnal fall in BP by antihypertensive treatment in old patients induces cerebrovascular and cardiovascular ischemia. Considering the above, it is concluded that information on BP variation, both short-term and long-term (circadian), is indispensable for the diagnosis and treatment of hypertension. Less