【正文】 The First Clinical College of Harbin Medical University Hypertension. 2020 Apr。12:19–24 The First Clinical College of Harbin Medical University A deletion of Cry gene, a major transcriptional factor of the clock gene, causes a plete loss of circadian variation of BP and leads to saltsensitive hypertension via excess aldosterone production. Nat Med 2020。30:163167 Am J Hypertens. 1995。 The First Clinical College of Harbin Medical University ? 約 50%OSAHS患者伴高血壓 , 至少 30%高血壓患者伴有 OSAHS。925931 Hypertension ? Grassi等觀察杓型、極度杓型、非杓型以及反杓型 原發(fā)性高血壓患者 肌肉交感神經(jīng)活性 。 Diabetes Metab. 34(6 Pt 1), 560–567 (2020). Kidney Int. 57(6), 2485–2491 (2020) The First Clinical College of Harbin Medical University ? Ohasama研究證實(shí)，夜間血壓下降每減少 5% ， 心血管死亡率增加 20%。 J Hypertens. 2020。 定 義 The First Clinical College of Harbin Medical University ? 原發(fā)性高血壓和繼發(fā)性高血壓 常見現(xiàn)象 。 The First Clinical College of Harbin Medical University 無論白天血壓正常人群還是白天高血壓人群 , 夜間高血壓 均有較高發(fā)生率 , 常 與非杓型并存 。13:884–891 Am J Hypertens. 2020。295(24):285966 The First Clinical College of Harbin Medical University ? Among older hypertensive patients (n=575, mean age 72 years), subjects with reverse dipping had the highest incidence of stroke。 J. Hypertens. 8(1) 85–95 (1990). The First Clinical College of Harbin Medical University 常伴隨疾病 ? CKD and endstage kidney disease ? DM ? Sleep apnea ? Autonomic neuropathy and autonomic failure ? Primary aldosteronism ? Pheochromocytoma (嗜鉻細(xì)胞瘤） ? Cushing’s syndrome ? Solid an transplantation ? Preeclampsia and eclampsia （子癇和先兆子癇） ? CHF The First Clinical College of Harbin Medical University ? 正常腎臟功能對于保證血壓晝夜節(jié)律非常重要。 Hypertension Res, 2020, 32 (6) : 428 432 Sleep, 2020, 31(6) : 795800. The First Clinical College of Harbin Medical University ? 有證據(jù)提示，夜間血壓下降緩慢、夜間高血壓者與 高鹽飲食 及 鹽敏感 關(guān)系密切。 . 1996。 Hypertension. 2020。 The First Clinical College of Harbin Medical University 生活方式干預(yù) ? 鹽敏感者應(yīng)首先限制鈉攝入，補(bǔ)充鉀鹽。 ? 陜西農(nóng)民調(diào)查，攝取鉀約為 35 mmol/ d ， 而鈉攝入為 230 mmol/ d , 鉀與鈉攝入比 僅 : 1。 ? Evening dosing results in better nocturnal BP reduction and increased dipping than with morning dosing. Pharmaco. Ther. 111(3), 629–651 (2020). J. Hypertens. 23(10), 1913–1922 (2020). Hypertension 50(4), 715–722 (2020). Chronobiol. Int. 26(1), 61–79 (2020). The First Clinical College of Harbin Medical University ?CCB ? 180 patients (50% nondippers) receiving nifedipine GITS in a prospective, openlabel, parallelgroup design paring morning and bedtime administration. Bedtime dosing resulted in better 24h SBP control (9% vs % fall。 P). The First Clinical College of Harbin Medical University ? 噻唑烷二酮類 (格列酮類 ) ? Insulin resistance plays a role in elevation of BP by various mechanisms. ? 增強(qiáng)機(jī)體組織 對胰島素的敏感性 ， 改善胰島 β細(xì)胞功能。 p ). The First Clinical College of Harbin Medical University ? In resistant hypertension（ 578） , receiving at least one of their medications in the evening had signiicantly lower nocturnal BP, lower prevalence of nondipping (57 vs 8