高血压新进展__培训课件.ppt

Blood pressure shows a circadian rhythm, with a rapid increase in the early morning hours.1 The degree of blood pressure surge varies among individuals. An unusually high increase in morning blood pressure is termed “morning blood pressure surge”. 3There is a strong relationship between the presence of a morning blood pressure surge (?55 mmHg) and the presence of silent cerebrovascular infarcts, as well as the prospective incidence of clinical stroke in Japanese patients.2 Morning blood pressure surge was calculated as the difference between morning (first 2 h after waking) SBP and the hour with the lowest night-time SBP. Patients were assigned to the ‘morning blood pressure surge’ group if they were in the highest decile. The percentage of patients with silent cerebrovascular infarcts was established using MRI at baseline. Patients were followed up for an average of 41 months. The incidence of clinical stroke during that time was recorded. The risk associated with morning blood pressure surge was independent of age, 24-h SBP and body mass index. Neutel JM. The importance of 24-h blood pressure control. Blood Press Monit 2001;6:9–16. Kario K, et al. Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives. A prospective study. Circulation 2003;107:1401–1406. These data are from 2 studies that have analysed the circadian variation in the onset of acute myocardial infarction (n=2,999) or stroke (n=1,167)1,2 Both studies found a notable increase in the number of events in the early morning period, a time that corresponds to the early morning blood pressure surge. Muller JE, et al. Circadian variation in the frequency of onset of acute myocardial infarction. N Engl J Med 1985;313:1315–1322. Marler JR, et al. Morning increase in onset of ischemic stroke. Stroke 1989;20:473–476. * 晨峰血压升高与心血管事件的关系 中青年高血压的四个特点之三是：精神压力大 在精神压力的应急反应下，大脑边缘系统兴奋，植物神经系统处于不平衡状态，交感神经系统兴奋，通过α受体使末梢血管阻力增加，通过β受体使心输出量增加等，导致血压升高。因此，使用同时