夜间血压的窘境.pptx

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,The first affiliated hospital of STUMC,*,夜间血压窘境,夜间血压的窘境,第1页,100s:Riva-Rocci and Korotkoff,conventional blood pressure monitoring.,40s:ABPM,it is generally accepted that ABPM estimates true mean BP and has better correlation with end-organ damage and cardiovascular outcomes.(New England Journal of Medicine),24:The dipping phenomenon was first coined by OBrien and colleagues.,Nondipping has been considered an abnormal diurnal rhythm,which is associated with greater cardiovascular and cerebrovascular diseases.,(lancet),Introduction,The first affiliated hospital of STUMC,夜间血压的窘境,第2页,:NBP levels rather than circadian BP pattern are more accurate in predicting mortality and morbidity related to BP,independent of mean BP and daytime BP levels.,:isolated nocturnal hypertension as a potentially novel clinical entity derived from a Chinese population study was examined by Li and colleagues.10.5%,Introduction,The first affiliated hospital of STUMC,夜间血压的窘境,第3页,Introduction,指南更新,指南问世,临床研究,个人经验,100S CBPM,40S ABPM,24 dipping phenomenon,07 INH,The first affiliated hospital of STUMC,夜间血压的窘境,第4页,1.Methods for monitoring NBP;,2.Accurate period of nocturnal time;,3.Diagnostic thresholds of abnormal NBP;,4.whether to control abnormal NBP;,5.how to manage abnormal NBP.,Dilemma,The first affiliated hospital of STUMC,夜间血压的窘境,第5页,Methods for monitoring NBP,ABPM provides the following three types of information,Mean BP level;,The diurnal rhythm of BP;,BP variability.,This fully automatic and theoretical non-sleep disturbance technique is also an ideal method to monitor NBP.,a golden standard for NBP measurement(),The first affiliated hospital of STUMC,夜间血压的窘境,第6页,Methods for monitoring NBP,ABPM has its own vital limitations:,Sonorous stimuli:disturb sleep,the correlation between NBP and TOD,ABPM is not commonly employed in routine clinical practice for evaluating NBP,The first affiliated hospital of STUMC,夜间血压的窘境,第7页,Methods for monitoring NBP,Fully automatic home BP devices,Manual BP device,It is important to recognize that an exact and practical method for the measurement of NBP is essential.,The first affiliated hospital of STUMC,夜间血压的窘境,第8页,Accurate period of nocturnal time,There has been no confirmed period of nocturnal time for NBP.,Patients diary entries:no objectively,Arbitrary fixed time:1 AM to 6 AM 11 PM to 7 AM,Nocturnal Sleep,NBP is generally regarded as the average of BP reading recorded during the period most likely coinciding with sleep time.,The first affiliated hospital of STUMC,夜间血压的窘境,第9页,Diagnostic thresholds of abnormal NBP,The relationship between cardiovascular risk and BP is continuous.,120 70 mm Hg(ESH ESC),125 75 mm Hg(AHA),its distribution in normal reference populations.,outcome-driven thresholds(,IDACO),standard of nocturnal hypotension,More attention should also be paid to the excessive NBP dipping that is associated with cardiac and cerebrovascular risks.,The first affiliated hospital of STUMC,夜间血压的窘境,第10页,Although there is no consistent definition of nocturnal time in the guidelines,there exists a seemingly uniform threshold for nocturnal hypertension.,Dilemma,The first affiliated hospital of STUMC,夜间血压的窘境,第11页,Management of NBP,NBP has been demonstrated to better reflect cardiovascular risk and death than daytime BP in hypertensive patients and population studies.,Therefore,management of abnormal NBP may have positive potential impact on cardiac and cerebrovascular outcomes.,however,the goal of low limits of NBP has never been widely and generally determined.,The first affiliated hospital of STUMC,夜间血压的窘境,第12页,Which level of NBP is good for an individual patient?,the lower,the better vs J-shaped.,Management of NBP,The first affiliated hospital of STUMC,夜间血压的窘境,第13页,Different kinds of related events may require diverse levels of NBP.,NBP was not associated with hemorrhagic stroke but ischemic cardiac and cerebrovascular events.(,Ohasama study),Although both all-cause mortality and cause-specific cardiovascular events are significantly predicted by NBP,knowledge about particularly cerebral events is sparse.,Management of NBP,The first affiliated hospital of STUMC,夜间血压的窘境,第14页,Certain populations may require particular levels of NBP.,Nocturnal dipping is a normal phenomenon in healthy younger persons;,however,it may be harmful for elderly patients leading to cerebral hypoperfusion and even cerebral events.,In the elderly,failure of cerebral autoregulation has shown that even minor falls in BP may lead to cerebral dysfunction,which means that management of NBP in the elderly should be prudent,especially in patients with ischemic or hemorrhagic cerebral events.,Management of NBP,The first affiliated hospital of STUMC,夜间血压的窘境,第15页,Nocturnal Hypertension,Lowering high NBP can significantly decrease mortality and morbidity.,sympathetic nervous system,renin angiotensin system,Atenolol lowered daytime BP but had no significant effect on NBP,Perindopril lowered NBP more than daytime BP.,Sympathetic nervous system likely makes little contribution to NBP.,ACE inhibitors confer a greater drop in NBP than in daytime BP.,The first affiliated hospital of STUMC,夜间血压的窘境,第16页,Nocturnal Hypertension,There is no general consistency in the management of Nocturnal Hypertension,let alone different drugs efficacies.,The first affiliated hospital of STUMC,夜间血压的窘境,第17页,Nocturnal Hypotension,Excessive low NBP also increases cardiac and cerebrovascular risks,the eye.,Studies on whether nocturnal hypotension is associated with visual loss from glaucoma,however,has yielded controversial results.,The first affiliated hospital of STUMC,夜间血压的窘境,第18页,Time of Dosing and Morning BP Surge,Why should antihypertensive drugs be administered in the morning after rising?,The first affiliated hospital of STUMC,夜间血压的窘境,第19页,Time of Dosing and Morning BP Surge,Why should antihypertensive drugs be administered in the morning after rising?,BP values surge rapidly.,Timing of cardiac and cerebrovascular events.,It stands to reason that we should control the morning BP surge by administrating antihypertensive drugs after morning wakening.,The first affiliated hospital of STUMC,夜间血压的窘境,第20页,Time of Dosing and Morning BP Surge,some studies have provided evidences that it would be preferable to administer ACE inhibitors and ARBs before sleep.,divert dosing time to evening.,The first affiliated hospital of STUMC,夜间血压的窘境,第21页,To properly manage morning BP surge,NBP should be seriously taken into account.,Time of Dosing and Morning BP Surge,The first affiliated hospital of STUMC,夜间血压的窘境,第22页,谢谢您倾听,有所思,有所获,THE END,The first affiliated hospital of STUMC,夜间血压的窘境,第23页,