哈醫(yī)大第一臨床醫(yī)學(xué)院心內(nèi)科-文庫(kù)吧資料
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【正文】 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。274:R3358 Blood Press Monit. 1997。27:481490 ＊ ＊正常：血壓正常的個(gè)體 The First Clinical College of Harbin Medical University 褪黑素水平降低 ? Melatonin has been shown to suppress sympathetic activity and to reduced serum norepinephrine levels. ? The normal surge of melatonin during sleep may contribute to the nocturnal suppression of the sympathetic nervous system and contribute to arterial vasodilatation that leads in turn to nocturnal BP fall. Am J Cardiol. 1999。16:1745–1748 鹽與夜間高血壓 The First Clinical College of Harbin Medical University 我國(guó)人群食鹽攝入量嚴(yán)重超標(biāo) 北方 : 每人每天約 1218g 南方 : 每人每天約 78g WHO組織建議每人每日食鹽攝入量 ≤5g of a WHO Forum and Technical meeting 5–7 October 2020,Paris, France 1.《 中國(guó)高血壓指南 2020》 The First Clinical College of Harbin Medical University 我國(guó)高血壓患者鹽敏感型為主 of Hypertension 2020, 26:381–391 正常 鹽抵抗 鹽敏感 正常鹽攝入 低鹽攝入 血壓 (mmHg) 鈉攝入量 我國(guó)鹽敏型高血壓占高血壓總?cè)巳旱?50%60% ，高血壓雜志 1999 7(3):251253 鹽敏感： 鹽敏感型高血壓患者血壓隨鈉的攝入量的增加 (或減少 ) 有更顯著的增加 (或減少 )。30:163167 Am J Hypertens. 1995。96:1859–1862 Am J Hypertens. 1999。 Hypertension. 1996。 ? OSAHS 程度越重 ，平均血氧濃度及最低血氧濃度越低 , 非杓型血壓發(fā)生率越高 。 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。 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。 ? 腎小球?yàn)V過(guò)率 （ GFR） 與夜間 /白天血壓比值 呈反比 。 The First Clinical College of Harbin Medical University ? 研究發(fā)現(xiàn)：主動(dòng)脈瓣膜病變患者夜間血壓下降程度與腎素、醛固酮活性呈 負(fù)相關(guān) , 提示腎素、醛固酮活性增加是 引起夜間高血壓的主要原因之一 。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 。 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. Hypertens. 6(6 Pt 2), S170–S173 (1993). The First Clinical College of Harbin Medical University 2020。 the incidence of hemorrhagic stroke was more prominent in the reverse dipping group (29%) than in other dipping groups (%, P=). Hypertension. 2020 Oct。 JAMA. 2020 Jun 28。 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%。 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(lèi)型患者心血管不良事件 增加
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