超越平均血压降低：睡前抗高血压给药的分布效应与应答者效应在非杓型高血压中的表现。一项随机对照研究的二次分析。
摘要
平均血压（BP）差异并不能完全反映治疗反应。我们考察了早晨与睡前抗高血压给药后经调整的血压、目标达成情况及变化分布。这项随机对照试验的事后二次分析纳入60例血压未控制且呈非杓型模式的高血压患者，分配至早晨或睡前给药（每组30例）。采用基线校正的协方差分析比较两个月时的收缩压（SBP）、舒张压（DBP）和平均动脉压（MAP）。…
正文 待译
Mean blood pressure (BP) differences do not fully characterize treatment response. We examined adjusted BP, target attainment and change distributions after morning versus bedtime antihypertensive dosing. This post hoc secondary analysis of a randomized controlled trial included 60 patients with uncontrolled hypertension and a nondipping pattern, assigned to morning or bedtime dosing (30 per group). Two-month systolic BP (SBP), diastolic BP (DBP) and mean arterial pressure (MAP) were compared using baseline-adjusted analysis of covariance. Secondary analyses assessed BP <140/90 mmHg and median and trimmed changes. Adjusted bedtime-minus-morning differences were -18.1 mmHg for SBP (95% CI -22.4 to -13.8), -11.6 mmHg for DBP (-14.5 to -8.8) and -13.9 mmHg for MAP (-16.7 to -11.0); all p < 0.001. Bootstrap intervals were similar. BP <140/90 mmHg was achieved by 29/30 (96.7%) versus 3/30 (10.0%) patients (risk ratio 9.67; 95% CI 3.30-28.34). Median SBP and DBP change differences were -9.5 and -3.0 mmHg, respectively, with confidence intervals including zero. Bedtime dosing was associated with lower adjusted two-month BP and greater target attainment. Change-based estimates were less precise, indicating uncertainty about the distribution of response. These exploratory findings from a small randomized trial warrant prospective confirmation.
English
Mean blood pressure (BP) differences do not fully characterize treatment response. We examined adjusted BP, target attainment and change distributions after morning versus bedtime antihypertensive dosing. This post hoc secondary analysis of a randomized controlled trial included 60 patients with uncontrolled hypertension and a nondipping pattern, assigned to morning or bedtime dosing (30 per group). Two-month systolic BP (SBP), diastolic BP (DBP) and mean arterial pressure (MAP) were compared using baseline-adjusted analysis of covariance.…