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【正文】 llege of Harbin Medical University 夜間高血壓治療 ? 降壓同時(shí)重視 糾正血壓晝夜節(jié)律 , 包括非杓型血壓、血壓晨峰現(xiàn)象。1(6):447455 ? 補(bǔ)鉀可減輕高鹽對(duì)靶器官損害， 可能與其 抗氧化作用 有關(guān)。 The First Clinical College of Harbin Medical University 藥物治療 ?Blockers of the RAAS ? 腎素活性夜間增加，到凌晨達(dá)高峰。 ?對(duì)夜間高血壓治療作用仍 有待大規(guī)模臨床研究證實(shí) 。 11 to 107177。 ?睡眠呼吸暫停 患者常伴夜間血壓增高， CPAP是最有效治療方法之一。 p = ) when pared with patients who were receiving all medications in the morning. The First Clinical College of Harbin Medical University A crosssectional study was performed in 1,794 patients with resistant hypertension ?There was no significant difference between the two groups in terms of daytime BP, but nocturnal BP was significantly lower when the drug regimen included an evening dose of at least 1 antihypertensive agent. Am J Hypertens 2020, 23:432–439 The First Clinical College of Harbin Medical University Hypertension Research 2020, 00:1–7 Decreases in allday, daytime, nighttime and early morning SBP and DBP in patients using a free drug bination were significantly greater pared with the FDC group. 復(fù)方制劑 ？ The First Clinical College of Harbin Medical University The SI and T/P ratio of the allday, daytime and nighttime systolic and diastolic were also significantly higher pared with the FDC group. The First Clinical College of Harbin Medical University ? 睡眠呼吸暫停綜合征 ? 一般治療：減肥、側(cè)臥睡眠、戒煙酒 ? 外科治療： 鼻腔手術(shù)、咽腭區(qū)手術(shù)、聯(lián)合手術(shù) ? 器械治療： CPAP、口腔矯治器 伴隨疾病治療 The First Clinical College of Harbin Medical University 總 結(jié) ? 夜間血壓增高在原發(fā)和繼發(fā)性高血壓患者中 普遍存在 。 The First Clinical College of Harbin Medical University 藥物時(shí)間治療學(xué) 根據(jù)不同藥物的藥代學(xué)特點(diǎn) , 使用不同藥物 劑型、控制藥物 釋放時(shí)間 , 以改變異常的血壓晝夜節(jié)律 , 稱為 藥物時(shí)間治療學(xué) 。 p = ) and a decrease in the number of nondippers from 51% to 35%. Am J Hypertens 2020, 21(8):94854 The First Clinical College of Harbin Medical University ?β受體阻滯劑 ? The BPlowering effects are more pronounced during wakefulness(失眠 ) and OSAHS. ? 非選擇性 β受體阻滯劑（ 普奈洛爾 ） 增加氣道阻力和呼吸暫停次數(shù)，應(yīng)避免使用。 The First Clinical College of Harbin Medical University ? 保證良好睡眠。 ? 鹽敏感性高血壓患者限鹽后血壓可 由非杓型恢復(fù)為杓型 。48(1):e3 The First Clinical College of Harbin Medical University ? 根據(jù) 歐洲高血壓學(xué)會(huì) （ ESH）指南 白天平均值 135/ 85 mm Hg 夜間平均值 125/ 70 mm Hg The First Clinical College of Harbin Medical University ? 中國 ABPM高血壓診斷標(biāo)準(zhǔn)： 24 h 平均值 ≥ 130/ 80 mm Hg 白天平均值 ≥ 135/ 85 mm Hg 夜間平均值 ≥120/ 70 mm Hg 《 中國高血壓防治指南 》 2020 J Formos Med Assoc. 2020. 109(10): 74073 The First Clinical College of Harbin Medical University ABPM局限性 患者佩戴 ABPM ? 覺醒期間運(yùn)動(dòng)明顯減少，坐位時(shí)間平均增加 27分鐘 （ P=） 。83:1417–19 Am J Physiol. 1998。28:139–142 Circulation. 1997。 ? CKD患者血壓非杓型比率高達(dá) 70%80%。38(4):8527. The First Clinical College of Harbin Medical University 發(fā)生機(jī)制 Hypertension Research (2020) 35, 695–701。 The First Clinical College of Harbin Medical University 夜間高血壓危害
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