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Abstract：
Increased blood pressure variability (BPV) is associated with higher cardiovascular risk. The association between BPV and fluid status in hypertensive patients has not been investigated so far. The aim of the present study was to determine the contribution of fluid balance to BPV and impact on endothelial and cardiac functions among primary hypertensive patients.
This is a prospective interventional study conducted in primary hypertensive patients with one-year follow-up. Volume status measurements by a body composition monitor, ambulatory blood pressure (BP) monitoring, echocardiographic and carotid intima-media thickness (CIMT) measurements were performed at enrollment and at twelfth. Patients in one of the two groups were kept negative hydrated during trial with diuretic treatment. Patients in other group were positively hydrated (hypervolemic) at enrollment, antihypertensive drugs other than diuretics (vasodilator agents) were added or intensified according to the BP monitoring. Average real variability (ARV) index was used for establishing the prognostic significance of BPV.
The study population consisted of 50 patients with a mean age of 54.5±8.8 years. At the end of one-year follow-up, patients in negative hydrated group were found to have significantly lower BP, CIMT, left ventricle mass index (LVMI) and systolic and diastolic ARV. More weight gain and higher systolic BP were major risk factors of high systolic ARV. Patients who have improvement in CIMT and LVMI were considered as target organ damage (TOD) recovery present. In negatively hydrated group, TOD significantly reduced during trial. In patients who have TOD recovery, BPV significantly more reduced like systolic and diastolic BP. Significant risk factors associated with the presence of TOD were 24h systolic BP and daytime and night time diastolic ARV and night time diastolic BP.
Addition of diuretic to established treatment or intensified diuretic treatment and keeping patients in negative hydration status resulted in reduction in BPV at twelfth month of follow-up. More weight gain and higher systolic BP are major risk factors of high systolic ARV, but not hypervolemia. BPV, especially diastolic ARV, was significantly associated with TOD.
This is a prospective interventional study conducted in primary hypertensive patients with one-year follow-up. Volume status measurements by a body composition monitor, ambulatory blood pressure (BP) monitoring, echocardiographic and carotid intima-media thickness (CIMT) measurements were performed at enrollment and at twelfth. Patients in one of the two groups were kept negative hydrated during trial with diuretic treatment. Patients in other group were positively hydrated (hypervolemic) at enrollment, antihypertensive drugs other than diuretics (vasodilator agents) were added or intensified according to the BP monitoring. Average real variability (ARV) index was used for establishing the prognostic significance of BPV.
The study population consisted of 50 patients with a mean age of 54.5±8.8 years. At the end of one-year follow-up, patients in negative hydrated group were found to have significantly lower BP, CIMT, left ventricle mass index (LVMI) and systolic and diastolic ARV. More weight gain and higher systolic BP were major risk factors of high systolic ARV. Patients who have improvement in CIMT and LVMI were considered as target organ damage (TOD) recovery present. In negatively hydrated group, TOD significantly reduced during trial. In patients who have TOD recovery, BPV significantly more reduced like systolic and diastolic BP. Significant risk factors associated with the presence of TOD were 24h systolic BP and daytime and night time diastolic ARV and night time diastolic BP.
Addition of diuretic to established treatment or intensified diuretic treatment and keeping patients in negative hydration status resulted in reduction in BPV at twelfth month of follow-up. More weight gain and higher systolic BP are major risk factors of high systolic ARV, but not hypervolemia. BPV, especially diastolic ARV, was significantly associated with TOD.
摘要：
血压变异性（BPV）增加与更高的心血管风险相关。到目前为止，尚未研究BPV与高血压患者的液体状态之间的关联。本研究的目的是确定原发性高血压患者中液体平衡对BPV的贡献以及对内皮和心脏功能的影响。
这是一项对原发性高血压患者进行为期一年随访的前瞻性干预研究。通过身体成分监测器进行的体积状态测量，动态血压（BP）监测，在入组时和第12天进行超声心动图和颈动脉内中膜厚度（CIMT）测量。在使用利尿剂治疗的试验期间，两组中的一组患者保持阴性水分。其他组的患者在入组时呈正水合（高容量），根据血压监测，添加或强化了除利尿剂（血管扩张剂）以外的抗高血压药物。平均真实变异性（ARV）指数用于确定BPV的预后意义。
研究人群包括50名患者，平均年龄为54.5±8.8岁。在为期一年的随访结束时，阴性水合组的患者血压明显降低，CIMT,左心室质量指数（LVMI）和收缩和舒张性ARV。体重增加和收缩压升高是高收缩期ARV的主要危险因素。CIMT和LVMI改善的患者被认为是靶器官损害（TOD）恢复存在。在负水合组中，试验期间TOD显著降低。在TOD恢复的患者中，BPV明显更降低，如收缩压和舒张压。与TOD相关的重要危险因素是24h收缩压，白天和夜间舒张性ARV和夜间舒张性BP。
在既定治疗或强化利尿剂治疗中加入利尿剂，并使患者保持阴性水合状态，可在随访的第12个月时降低BPV。更多的体重增加和更高的收缩压是高收缩期ARV的主要危险因素，但不是血容量过高.BPV,尤其是舒张性ARV,与TOD显著相关。
这是一项对原发性高血压患者进行为期一年随访的前瞻性干预研究。通过身体成分监测器进行的体积状态测量，动态血压（BP）监测，在入组时和第12天进行超声心动图和颈动脉内中膜厚度（CIMT）测量。在使用利尿剂治疗的试验期间，两组中的一组患者保持阴性水分。其他组的患者在入组时呈正水合（高容量），根据血压监测，添加或强化了除利尿剂（血管扩张剂）以外的抗高血压药物。平均真实变异性（ARV）指数用于确定BPV的预后意义。
研究人群包括50名患者，平均年龄为54.5±8.8岁。在为期一年的随访结束时，阴性水合组的患者血压明显降低，CIMT,左心室质量指数（LVMI）和收缩和舒张性ARV。体重增加和收缩压升高是高收缩期ARV的主要危险因素。CIMT和LVMI改善的患者被认为是靶器官损害（TOD）恢复存在。在负水合组中，试验期间TOD显著降低。在TOD恢复的患者中，BPV明显更降低，如收缩压和舒张压。与TOD相关的重要危险因素是24h收缩压，白天和夜间舒张性ARV和夜间舒张性BP。
在既定治疗或强化利尿剂治疗中加入利尿剂，并使患者保持阴性水合状态，可在随访的第12个月时降低BPV。更多的体重增加和更高的收缩压是高收缩期ARV的主要危险因素，但不是血容量过高.BPV,尤其是舒张性ARV,与TOD显著相关。
