哈醫(yī)大第一臨床醫(yī)學(xué)院心內(nèi)科-資料下載頁
2024-09-29 11:34本頁面
【導(dǎo)讀】夜間平均血壓≥120/70mmHg。有學(xué)者建議用夜間睡眠血壓替代夜間血壓。原發(fā)性高血壓和繼發(fā)性高血壓常見現(xiàn)象。血壓>135/85mmHg）人群夜間血壓模式進(jìn)行研究。血壓均有較高發(fā)生率,常與非杓型并存。西班牙500個初級保健中心42947例高血壓患者，未治。療患者及52%治療患者呈非杓型曲線。許多研究證實，亞洲人和黑人夜間血壓增高比。高加索人（白人）更常見。2020年,上海瑞金醫(yī)院。量蛋白尿等）以及心血管死亡風(fēng)險明顯增加。血管不良事件增加。透析患者伴夜間收縮壓增高者心血管死亡率增加41%。一項愛爾蘭研究顯示：
【正文】 ficant blood pressure reduction was observed in patients who received aspirin at bedtime (P) . ? The reduction in nocturnal BP was double in nondippers () pared with dippers (。 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. ? 增強機體組織 對胰島素的敏感性 ， 改善胰島 β細(xì)胞功能。 ? Have a favorable effect on nocturnal hypertension. J. Hypertens. 24(10), 2047–2055 (2020). Minerva Endocrinol. 29(1), 11–17 (2020). The First Clinical College of Harbin Medical University ?不宜選擇具 中樞鎮(zhèn)靜作用降壓藥 以免加重呼吸暫停，如利血平、可樂定等。 The First Clinical College of Harbin Medical University 藥物時間治療學(xué) 根據(jù)不同藥物的藥代學(xué)特點 , 使用不同藥物 劑型、控制藥物 釋放時間 , 以改變異常的血壓晝夜節(jié)律 , 稱為 藥物時間治療學(xué) 。 ? 長效制劑 有利于夜間高血壓控制， 有助于血壓晨峰控制。 The First Clinical College of Harbin Medical University ? 調(diào)整服藥時間 Minutolo 等發(fā)現(xiàn) （ 32例 CKD伴夜間血壓增高） 將不同降壓藥物服用時間從早改到晚 , 結(jié)果顯示： Am J Kidney Dis. 2020 Dec。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。 11 to 107177。 12 mmHg。 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%。 p ) and lower urinary albumin excretion (31 vs 47 mg/24h。 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 。 ? 夜間高血壓對心、腦和腎臟等 靶器官損害更嚴(yán)重 。 ? ABPM有助于夜間高血壓病人篩查并指導(dǎo)治療， 避免夜間血壓過度降低。 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)。 ?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。 The First Clinical College of Harbin Medical University
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