【正文】 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 82%。 ? 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。 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。 . 1996。 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。13:884–891 Am 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 。 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%。 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。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。 Blood press monit. 1996 Dec。 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(dǎo)致血管擴(kuò)張和降壓效應(yīng)。 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(fù)血壓杓型狀態(tài)。 ? 長效制劑 有利于夜間高血壓控制， 有助于血壓晨峰控制。 ? 睡眠障礙者 非杓型高血壓發(fā)生率增加 3倍 。 ? 夜間睡眠時(shí)間減少 98分鐘 （ P＜ ） ， 睡眠效率由 82% 降至 77%（ P=） 。96:1859–1862 Am J Hypertens. 1999。 The First Clinical College of Harbin Medical University 發(fā)生機(jī)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. Hyp