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  • 學位論文

高血壓成年病患晝夜血壓變化與標的器官損傷之關係: 系統性文獻回顧

The relationship between circadian blood pressure variation and target organ damages among adult hypertensive patients: A systemic literature review

指導教授 : 蔡佩姍

摘要


高血壓造成標的器官損傷是導致死亡的主因。近二十年來許多研究顯示人體血壓晝夜變化的異常型態會增加標的器官損傷的危。本研究目的在歸納探討晝夜血壓變化型態對成年高血壓患者標的器官損傷之實證性研究結果。 本研究採系統性文獻回顧研究法。搜尋2005至2010年間發表於MEDLINE、PubMed、以及ProQuest Health and Medical Complete三大資料庫中,關於晝夜血壓變化型態與標的器官損傷關係性之個別性研究。 經過謹慎的篩選及評讀後,找出12篇符合本研究目的之個別性研究論文,結果顯示:左心室肥大與夜間血壓降幅減少、夜間血壓過度下降、夜間血壓上升等三種夜間血壓型態皆無關,但發生心肌缺血者中夜間血壓上升及夜間血壓降幅減少的比率較夜間血壓降幅正常者的比率高。此外,睡眠中至清醒後之清晨血壓激增者的左心質量指數比沒有清晨血壓激增者大,但此現象並未發生在清醒前至清醒後之清晨血壓激增者身上。在低的腎絲球過濾率的高血壓病人中,non-dippers、inverted dippers中出現蛋白尿的人數比dippers多。腦缺血性損傷與夜間血壓降幅減少、夜間血壓上升有關,但與清晨血壓激增無關;顱內出血與夜間血壓降幅減少、夜間血壓上升有關,與夜間血壓過度下降無關;認知缺損或血管型失智與夜間血壓降幅減少、夜間血壓上升有關;腦室旁白質病變與夜間血壓降幅減少相關;夜間血壓過度下降者的小腦幕下的腦白質病變體積最大,其次為夜間血壓降幅者,最小者為夜間血壓降幅減少者。主動脈硬化與夜間血壓降幅減少、夜間血壓上升兩者皆有關;清晨血壓激增與內頸動脈內膜中層增厚有關,但與總頸動脈內膜中層增厚無關。 本研究建議未來能夠發展晝夜血壓變化型態一致性的判斷標準,並廣泛探索目前較少著墨的器官損傷(例如眼睛損傷),以獲得對於本主題更全面性的理解。

並列摘要


The purpose of the study was to systematically retrieve and synthesize the evidence from empirical research to understand the relationship between diurnal blood pressure (BP) variation and target organ damages among adult hypertensive patients. Three databases, MEDLINE, PubMed, and ProQuest Health and Medical Complete, were searched for valid research papers published from 1 January 2005 to 31 December 2010. After careful screening and reviewing, 12 individual studies were included in this review. The association between circadian blood pressure variation and target organ damage was established. Left ventricular hypertrophy was not related to nocturnal non-dipping, extreme dipping, and inverted dipping. Among individuals with myocardial ischemia, the percentages of inverted dippers were higher than that of dippers. Left ventricular mass index was higher in the patients with an exaggerated sleep-trough morning BP surge (MBPS) pattern compared with those without exaggerated MBPS. Among the hypertensive patients with low estimated glomerular filtration rate, more non-dippers and inverted dippers have proteinuria than dippers did. Cerebrovascular accidents, including nonfatal stroke, transient ischemic attack, and silent cerebral infarcts were higher in non-dippers and inverted dippers compared with dippers. Intracerebral hemorrhage was associated with non-dipping and inverted dipping patterns, but not related to extreme dipping. Cognitive/vascular dementia had an association with non-dipping and inverted dipping patterns, while periventricular white matter lesion (WML) was related to the non-dipping pattern. Infratentorial WML volume positively correlated with nocturnal dipping, in that extreme dippers had the largest infratentorial WML volume and non-dippers the smallest volume. Increased aortic stiffness was associated with both non-dipping and inverted dipping patterns. MBPS was related to increased internal carotid artery intima-media thickness, but not to common carotid artery intima-media thickness. The relationship between circadian BP variation and target organ damages has not reached a consensus, which can be attributed to the differences in study designs, study populations, and/or the research terms used in previous studies. It is vital for the medical society to reach an agreement on the definition of ambulatory blood pressure parameters, and to explore more evidence of the less-discussed organ damage, e.g, retinopathy, to gain a more comprehensive view of the influence of day-night blood pressure variation on target organ damage.

參考文獻


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