【正文】 相比夜間血壓正常者 , 夜間血壓增高或下降遲緩病人伴發(fā) 心、腦、腎等靶器官損害 （左室肥厚、心衰、腦卒中、微量蛋白尿等） 以及 心血管死亡 風險明顯增加 。53。The First Clinical College of Harbin Medical University 哈醫(yī)大第一臨床醫(yī)學院 心內(nèi)科 李 悅 The First Clinical College of Harbin Medical University ? BP follows a circadian rhythm (Dipping), with 10–20% lower values during sleep than during wakefulness. 靶器官灌注需要最低血壓 正常血壓晝夜節(jié)律 The First Clinical College of Harbin Medical University ? Nocturnal dip 10% of daytime pressure – Nondipping (非杓型） significant increase – Reverse dipping (反杓型） 20% of daytime pressure – Extreme dipping (超杓型） The First Clinical College of Harbin Medical University ? 夜間平均血壓 ≥ 120/ 70 mmHg (ABPM)。466472 Hypertension ? 西班牙 500個初級保健中心 42947 例 高血壓患者，未治療 8384 例，已接受治療 34563 例， ABPM顯示 , 41%未治療 患者及 52%治療 患者呈非杓型曲線。 Expert Rev. Cardiovas . Th r. 7(6), 607–618 (2020) The First Clinical College of Harbin Medical University DM患者中反杓型高血壓患者較其他血壓類型患者心血管不良事件 增加 。 The First Clinical College of Harbin Medical University 發(fā)生機制 The timing and amplitude of BP rhythm is affected by ? Intrinsic factors, such as neurohormonal regulation (., sympathetic nervous system and RAAS system) . ? Extrinsic factors, such as sodium load, sleep quality physical activity, and behavioral and lifestyle factors (smoking and alcohol intake) . ? Demographic factors, such as age and race. Am. J. Hypertens. 6(6 Pt 2), S166–S169 (1993). Am. J. Hypertens. 6(6 Pt 2), S170–S173 (1993). The First Clinical College of Harbin Medical University 2020。 The First Clinical College of Harbin Medical University ? 23% of patients (188 T1D） with clinical normotension had masked nocturnal hypertension. ? Hypertensives with diabetic nephropathy have significantly higher nighttime SBP pared with patients with nondiabetic glomerulopathy (142 versus 132 mmHg。96:1859–1862 Am J Hypertens. 1999。274:R3358 Blood Press Monit. 1997。 ? 夜間睡眠時間減少 98分鐘 （ P＜ ） ， 睡眠效率由 82% 降至 77%（ P=） 。 Circulation. 1997 Sep 16。 ? 睡眠障礙者 非杓型高血壓發(fā)生率增加 3倍 。 ? βblockers have not been well studied to date. . Hypertens. 14(5), 453–459 (2020). Pharmaco. Ther. 111(3), 629–651 (2020). The First Clinical College of Harbin Medical University ?利尿劑 利尿劑對血壓晝夜模式 無明顯影響 （鹽敏感高血壓除外） , 仍有待大規(guī)模臨床研究證實。 ? 長效制劑 有利于夜間高血壓控制， 有助于血壓晨峰控制。 ? 夜間高血壓對心、腦和腎臟等 靶器官損害更嚴重 。 The First Clinical College of Harbin Medical University ?睡前給予 降壓藥物能夠有效降低夜間血壓， 恢復血壓杓型狀態(tài)。50(6):90817 The First Clinical College of Harbin Medical University ? After the shift, dipping increased in 94% of patients, with normal circadian rhythm restored in 88% . ? Nocturnal SBP was significantly decreased (114177。 27: 876–885 The First Clinical College of Harbin Medical University 其他藥物 ?褪黑素 ? 由松果體腺分泌，能夠改善內(nèi)皮功能，增加 NO合成， 導致血管擴張和降壓效應。16(2):1015 The First Clinical College of Harbin Medical University ? 對嚴重自主神經(jīng)病變導致 仰臥位高血壓者 , 睡眠時頭部抬高 有助于降低仰臥位血壓 。 Blood press monit. 1996 Dec。 J Am Soc Nephrol. 2020. 5(2): 2815