arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2003-9-2-59-63arthyper-876Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESДиспропорциональность суточного ритма артериального давления у больных артериальной гипертонией и сахарным диабетом типа 2Disproportionality of daily blood pressure variations in patients with arterial hypertension and type 2 diabetes mellitusКотовскаяЮ. В.KotovskayaYu. V.noemail@neicon.ruКобалаваЖ. Д.KobalavaZh. D.noemail@neicon.ruЛобанковаЛ. А.LobankovaL. A.noemail@neicon.ruТолкачеваВ. В.TolkachevaV. V.noemail@neicon.ruРоссийский университет дружбы народовRussian Federation200328042003925963Copyright © Котовская Ю.В., Кобалава Ж.Д., Лобанкова Л.А., Толкачева В.В., 20032003Котовская Ю.В., Кобалава Ж.Д., Лобанкова Л.А., Толкачева В.В.Kotovskaya Y.V., Kobalava Z.D., Lobankova L.A., Tolkacheva V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://htn.almazovcentre.ru/jour/article/view/876

Теоретически возможно 16 вариантов сочетаний суточного ритма систолического (САД) и диастолического (ДАД) артериального давления (АД), определенных по традиционным качественным характеристикам (диппер, нон-диппер, найт-пикер, овер-диппер), при этом в 12 случаях однозначная трактовка выраженности суточного ритма АД будет затруднена в виду принадлежности САД и ДАД к разным качественным категориям или диспропорционального суточного ритма АД Целью данного исследования явилось изучение пропорциональности ночного изменения АД у пациентов с артериальной гипертонией (AT) и сахарным диабетом (СД) типа 2 В анализ были включены данные суточного мониторирования АД (СМАД) 137 больных (42 мужчины, 95 женщин, средний возраст 57,3±7,4 года, клиническое АД в положении сидя 166,5±12,8/97,6+8,1 мм рт ст) с АГ и СД типа 2 легкого и среднетяжелого течения и 106 пациентов без СД, сопоставимые по полу, возрасту и клиническому АД (38 мужчин, 68 женщин, средний возраст 55,8±8,0 года, клиническое АД 1бЗ,8±14,2/100,2±10,7 мм рт ст) У больных СД достоверно чаще выявлялся вариант суточного ритма АД с разными качественными характеристиками двухфазного ритма САД и ДАД (44,1% против 24,5%, р<0,05) При сравнении показателей СМАД в зависимости от величины коэффициента пропорциональности независимо от наличия СД наблюдали достоверное уменьшение средних ночных значений систолического и пульсового АД от первого к четвертому квартилю, а также увеличение степени снижения пульсового АД При одинаковом характере суточного профиля САД пациенты с отсутствием ночного снижения пульсового давления характеризуются более тяжелыми нарушениями функции почек Таким образом, низкие значения коэффициента пропорциональности являются маркером отсутствия ночного снижения пульсового АД, а ночная гипертония по этому показателю ассоциирована с более тяжелым поражением почек у больных AT и СД

Theoretically, there may be 16 types of daily variations of systolic blood pressure (SBP) and diastolic blood pressure (DBP), which have been determined by the traditional qualitative characteristics (dipper, non-dipper, night-picker, over-dipper), in 12 cases the unambiguous interpretation of the magnitude of daily BP variations being hampered due to the fact that SBP and DBP belong to different qualitative categories, or that there are disproportional BP variations The purpose of this study was to examine the proportionality of nocturnal BP variations in patients with arterial hypertension (AH) and type 2 diabetes mellitus The data of 24-hour BP monitoring were analyzed in 137 patients (42 males and 95 females, mean age, 57,3±7,4 years, sitting clinical BP, 166,5±12,8/97,6+8,1 mm Hg) with AH and mild and moderate type 2 DM and 106 patients without DM who were matched by sex, age, and clinical BP (38 males and 68 females, mean age, 55,8+8,0 years, clinical BP, 163,8±14,2/100,2±10,7 mm Hg) The patients with DM were more frequently found to have a type of daily BP variations with different qualitative characteristics of two-phase SBP and DBP variations (44,1% versus 24,5%, p<0,05) When 24-hour BP monitoring values were compared in relation to the disproportionality whether DM was present or not, there was a significant reduction in the mean nocturnal values of SBP and pulse BP from the first to fourth quartile, as well as a higher decrease in pulse BP With the same pattern of the daily profile of SBP, the patients without a nocturnal pulse pressure reduction show more severe renal dysfunctions Thus, the low values of the proportionality coefficient are a marker of the absence of a nocturnal decrease in pulse BP, and according to this index, nocturnal hypertension is associated with more severe renal lesion in patients with AH and DM

ReferencesMancia G Gamba PL Ombom S et al. Ambulatory bloodpi essure monitor ing J Hypertens 1996 14(suppl2) S61-S66Mancia G Gamba PL Ombom S et al. Ambulatory bloodpi essure monitor ing J Hypertens 1996 14(suppl2) S61-S66O Brien E Shendan J O Malley K Dippers and non dippers Lancet 1988 n 397O Brien E Shendan J O Malley K Dippers and non dippers Lancet 1988 n 397Ohkubo T Imai Y Tsuji I et al. Relation between nocturnal decline in blood pressure and mortality The Ohasama study AmJ Hypertens 1997 10 1201-7Ohkubo T Imai Y Tsuji I et al. Relation between nocturnal decline in blood pressure and mortality The Ohasama study AmJ Hypertens 1997 10 1201-7Timio M Venanzi S Lolli S et al. Non dipper hypertensive patients and pro gresswe renal insufficiency a 3 year longitudinal study Clin Nephrol 1995 41 382-7Timio M Venanzi S Lolli S et al. Non dipper hypertensive patients and pro gresswe renal insufficiency a 3 year longitudinal study Clin Nephrol 1995 41 382-7Pickenng TG Clinical Significance of diurnal blood pi essure variations Dippers and non dippers Circulation 1990 81 700-2Pickenng TG Clinical Significance of diurnal blood pi essure variations Dippers and non dippers Circulation 1990 81 700-2Verdecchia P Schilacci G Porcelatti C Dippers i ersus non dippers J Hy pertens 1991 9 (suppl 8) S42-S44Verdecchia P Schilacci G Porcelatti C Dippers i ersus non dippers J Hy pertens 1991 9 (suppl 8) S42-S44Verdecchia P Schilacci G Borgiom C et al. Altered circadian blood pressure pro file and prognosis Blood Press Momt 1997 2 347-52Verdecchia P Schilacci G Borgiom C et al. Altered circadian blood pressure pro file and prognosis Blood Press Momt 1997 2 347-52yakano S Fukuda M Hotta F et al. Rei ersed circadian blood pressure rhythm is associated with occw ance of both Jatal and non fatal vascular ei ents in NIDDMsubjects Diabetes 1998 47 1501-6yakano S Fukuda M Hotta F et al. Rei ersed circadian blood pressure rhythm is associated with occw ance of both Jatal and non fatal vascular ei ents in NIDDMsubjects Diabetes 1998 47 1501-6GuidelinesSubcommittee 1999 World Health Organization International Society of Hypertension guidelines for the management of hypertension J Hypertens 1999 17 151-83GuidelinesSubcommittee 1999 World Health Organization International Society of Hypertension guidelines for the management of hypertension J Hypertens 1999 17 151-83Joint National Committee on Detection Evaluation and Treatment of High Blood Pressure The Sixth Report of the Joint National Committee on Prevention Detection and Treatment of High Blood Pressure QNL VI) Arch Intern Med 1997 157 2413-46Joint National Committee on Detection Evaluation and Treatment of High Blood Pressure The Sixth Report of the Joint National Committee on Prevention Detection and Treatment of High Blood Pressure QNL VI) Arch Intern Med 1997 157 2413-46Imat Y Ohkubo T Ambulator blood pressure noi mality expenence in the Ohasama Study Blood Press Momt 1998 3 185-8Imat Y Ohkubo T Ambulator blood pressure noi mality expenence in the Ohasama Study Blood Press Momt 1998 3 185-8Butkevich A Phillips RA Sheinart KF Tuhnm S The effects of vanous definitions of dipping and daytime and night time on charactenzation of 24h profiles of blood pressure Blood Pess Momt 2000 5 19-22Butkevich A Phillips RA Sheinart KF Tuhnm S The effects of vanous definitions of dipping and daytime and night time on charactenzation of 24h profiles of blood pressure Blood Pess Momt 2000 5 19-22Staessen JĄ, Celts H De Cort P et al. Methods Jor describing the diumal blood pressure curve J Hypertens 1991 9 S16-S18Staessen JĄ, Celts H De Cort P et al. Methods Jor describing the diumal blood pressure curve J Hypertens 1991 9 S16-S18Staessen JA FagardR Thys L AmeryA Founei analysis of blood pressure pro files AmJHypertens 1993 6 184S-187SStaessen JA FagardR Thys L AmeryA Founei analysis of blood pressure pro files AmJHypertens 1993 6 184S-187SDawsonSL EvansSN Manktelow BN et al. Diurnal blood pressure change vanes with stroke subtype in the acute phase Stroke 1998 29 1519-24DawsonSL EvansSN Manktelow BN et al. Diurnal blood pressure change vanes with stroke subtype in the acute phase Stroke 1998 29 1519-24Kano K Matsuo T Kobayashi H et al. Nocturnal fall of blood pressure and silent cerebrovascular damage in elderly patients adi anced silent cerebroi ascu Iar damage in extreme dippers/Нуpertension 1996 2. 130 5Kano K Matsuo T Kobayashi H et al. Nocturnal fall of blood pressure and silent cerebrovascular damage in elderly patients adi anced silent cerebroi ascu Iar damage in extreme dippers/Нуpertension 1996 2. 130 5Staessen JA Biemaszewski L OBnen E et al. Nocturnal blood pressure Jall 0n ambulatoiy momtonng in a large international database Hypertension 1997 29 30-9Staessen JA Biemaszewski L OBnen E et al. Nocturnal blood pressure Jall 0n ambulatoiy momtonng in a large international database Hypertension 1997 29 30-9Verdecchia P Schilaci G Reboldi G et al. Different pi ognostic impact oj 24 hour mean blood pressure and pulse pressure on stroke and coronary artery dis ease in essential hypertension Circulation 2001 103 2579-84Verdecchia P Schilaci G Reboldi G et al. Different pi ognostic impact oj 24 hour mean blood pressure and pulse pressure on stroke and coronary artery dis ease in essential hypertension Circulation 2001 103 2579-84Zanchetti A Bond MG Henmg M et al. Calcium antagonist lacidipine slows down progression of asymptomatic catotid atherosclerosis pnncipal results of the EuropeanLactdipme Study on Atherosclerosis (ELSA) a landomized double blind long terminal Circulation 2002 106 2422-7Zanchetti A Bond MG Henmg M et al. Calcium antagonist lacidipine slows down progression of asymptomatic catotid atherosclerosis pnncipal results of the EuropeanLactdipme Study on Atherosclerosis (ELSA) a landomized double blind long terminal Circulation 2002 106 2422-7

The authors declare that there are no conflicts of interest present.