沈庆煜卒中的全程血压管理策略(2014-02-21).ppt

平滑指数(smoothness index, SI) 是评价药物疗效平稳的另一项重要指标：它是降压药物治疗后24小时每小时血压下降的均值（ΔH）与其标准差（SD：每小时降压幅度与ΔH差值的均值）的比值。这张幻灯形象的说明了平滑指数的计算方法，各位老师可以直观的看到， SI 越高，药物24 小时降压效果越平稳。 我先介绍一下T/P比率即谷/峰比值，T/P比率是指前一次用药末，下一用药前血压降低的谷值与峰值的比值。从1994年起，T/P比率成为FDA评价降压药物疗效平稳性的金指标；T/P比率越接近1越理想；T/P比率高的降压药物能够带来降压的平稳性。FDA抗高血压药物指南推荐：降压药物的T/P比率应至少达到50％。在常用降压药物中，哪种药物的T/P比率更接近1，降压更平稳呢？ T/P比率是用于评价药物降压作用的持续性。T/P比率的计算方法有两种：1.整个服药期间的波峰与波谷的比值，2. 国际上较为流行的是，取2-6小时血压下降值为降压幅度的最大值，也是拜新同T/P比率的测量方法。如果在24小时末血压下降得更多时，就会出现T/P比大于1的情况。 Types of Morning Hypertension For patients with high BP, this circadian pattern is no different but may be associated with poor health outcomes. In patients with hypertension, BP follows a nadir occurring during the nighttime hours and a surge occurring during the early morning period (6 AM-12 PM). This phenomenon is referred to as morning hypertension. Two types of morning hypertension exist. Patients who demonstrate persistently high BP from nighttime to morning are referred to as nondippers, as their BP remains elevated nocturnally. The second type is morning surge hypertension (MSH), which is associated in part with the extreme dips of nocturnal BP. For these hypertensive patients, their nighttime BP is 20% lower than their daytime BP. 1.Hoshide S, Kario K, Hoshide Y, et al. Associations between nondipping of nocturnal blood pressure decrease and cardiovascular target organ damage in strictly selected community-dwelling normotensives. Am J Hypertens. 2003;16:434-438. 2.Kario K, Yasui N, Yokoi H. Ambulatory blood pressure monitoring for cardiovascular medicine. IEEE Eng Med Biol Mag. 2003;22:81-88. 3.Kario K, Shimada K, Pickering TG. Abnormal nocturnal blood pressure falls in elderly hypertension: clinical significance and determinants. J Cardiovasc Pharmacol. 2003;41 Suppl 1:S61-66. * Elliott WJ 等学者对共包括11816例中风患者的世界范围内的31项中风发作节律研究进行荟萃分析显示：晨6时至中午12时发作危险高于预期的24小时随机平均发作机率49％；亚组分析表明：晨6时至9时和晨9时至中午12时是缺血性、出血性中风、一过性脑缺血发作及所有类型中风的发作高峰期。 Elliott WJ, Circadian variation in the timing of stroke onset