综合睡眠中断,饮食改变和治疗评估斋月禁食对血压的影响

IF 2.5 3区 医学 Q2 PERIPHERAL VASCULAR DISEASE
Mucahit Yetim, Abdullah Sarıhan, Macit Kalçık
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引用次数: 0

摘要

尊敬的编辑,我们饶有兴趣地阅读了Tezcan和b y kterzi关于斋月禁食对新诊断的高血压患者[1]血压和肾功能影响的文章。这项研究为独特的文化背景提供了宝贵的数据。然而,我们想提出几个方法学和解释性问题,这些问题可能会影响结论的普遍性。回顾性设计和单中心设置可能会限制因果推断的强度。先前的研究强调,前瞻性、多中心队列更适合于捕捉禁食在不同人群中的异质影响[10]。作者承认这一局限性,但其含义值得更加强调,特别是考虑到饮食、生活方式和药物依从性的可变性。研究中所有患者均接受含利尿剂治疗。虽然这提供了一致性,但它限制了外部有效性。其他抗高血压药物,如钙通道阻滞剂或β受体阻滞剂,可能与禁食生理有不同的相互作用。饮食钠摄入量和水合作用模式对血压和肾功能的影响没有系统评估。使用结构化食物频率问卷和生化标记的前瞻性试验表明,这些参数实质上改变了斋月期间的结果。忽视它们可能会低估重要的混杂因素。因此,研究结果是否适用于不同治疗方案的高血压患者仍不确定。另一个值得注意的重要因素是斋月期间睡眠模式的改变。起床吃suhoor(黎明前的晚餐)的做法经常导致夜间睡眠不完整,白天嗜睡。已知昼夜节律紊乱会影响血压变异性和自主神经平衡,可能混淆观察到的结果[b]。由于本研究未对睡眠质量进行评估,因此其与禁食期间血压和肾功能的相互作用仍不确定。虽然作者报告肾功能没有明显恶化,但长期随访是必要的。肾脏对每年反复禁食期的适应可能与短期观察不同。事实上,纵向研究强调,微妙的累积效应可能只会在数年内出现,而不是一个月。总之,这篇文章为理解新诊断的高血压患者斋月禁食提供了一个有用的基础,但进一步的前瞻性、多中心和方案多样化的研究——也考虑到睡眠模式和生活方式的改变——有必要建立强有力的临床建议。衷心感谢土耳其科鲁姆希提特大学医学院心脏病学的Mucahit Yetim, Abdullah Sarıhan和Macit KalçıkDepartment所有作者都对计划,写作和修订做出了贡献。作者声明他们没有利益冲突。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Integrating Sleep Disruption, Dietary Changes, and Therapy in Assessing the Effects of Ramadan Fasting on Blood Pressure

Dear Editor,

We have read with great interest the article by Tezcan and Büyükterzi on the effect of Ramadan fasting on blood pressure and kidney function in newly diagnosed hypertensive patients [1]. The study contributes valuable data on a unique and culturally relevant context. However, we would like to raise several methodological and interpretative issues that may affect the generalizability of the conclusions.

The retrospective design and single-center setting may limit the strength of causal inferences. Previous studies have emphasized that prospective, multicenter cohorts are better suited to capture the heterogeneous impact of fasting across different populations [2]. The authors acknowledge this limitation, but its implications deserve stronger emphasis, particularly considering dietary, lifestyle, and medication adherence variability.

All patients in the study received a diuretic-containing regimen. While this provides uniformity, it restricts external validity. Other antihypertensive classes, such as calcium channel blockers or beta-blockers, may interact differently with fasting physiology. Dietary sodium intake and hydration patterns that strongly influence blood pressure and renal function were not systematically assessed. Prospective trials with structured food-frequency questionnaires and biochemical markers have shown that these parameters substantially modify outcomes during Ramadan [3]. Neglecting them may underestimate important confounders. Therefore, it remains uncertain whether the findings apply broadly to hypertensive patients treated with varied regimens.

Another important factor that warrants attention is the alteration of sleep patterns during Ramadan. The practice of waking up for suhoor (pre-dawn meal) often leads to fragmented nocturnal sleep and daytime somnolence. Disrupted circadian rhythms are known to influence blood pressure variability and autonomic balance, potentially confounding the observed outcomes [4]. Since sleep quality was not evaluated in the present study, its interaction with blood pressure and kidney function during fasting remains uncertain.

Although the authors report no significant deterioration in kidney function, longer follow-up is essential. Renal adaptation to repeated annual fasting periods may differ from short-term observations. Indeed, longitudinal studies highlight that subtle cumulative effects may only emerge over years rather than a single month [5].

In conclusion, this article provides a useful foundation for understanding Ramadan fasting in newly diagnosed hypertensive patients, but further prospective, multicenter, and regimen-diverse studies—also accounting for sleep patterns and lifestyle changes—are warranted to establish robust clinical recommendations.

Sincerely,

Mucahit Yetim, Abdullah Sarıhan, and Macit Kalçık

Department of Cardiology, Faculty of Medicine, Hitit University, Corum, Turkey

All of the authors contributed to planning, writing, and revision.

The authors declare that they have no conflict of interest.

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来源期刊
Journal of Clinical Hypertension
Journal of Clinical Hypertension PERIPHERAL VASCULAR DISEASE-
CiteScore
5.80
自引率
7.10%
发文量
191
审稿时长
4-8 weeks
期刊介绍: The Journal of Clinical Hypertension is a peer-reviewed, monthly publication that serves internists, cardiologists, nephrologists, endocrinologists, hypertension specialists, primary care practitioners, pharmacists and all professionals interested in hypertension by providing objective, up-to-date information and practical recommendations on the full range of clinical aspects of hypertension. Commentaries and columns by experts in the field provide further insights into our original research articles as well as on major articles published elsewhere. Major guidelines for the management of hypertension are also an important feature of the Journal. Through its partnership with the World Hypertension League, JCH will include a new focus on hypertension and public health, including major policy issues, that features research and reviews related to disease characteristics and management at the population level.
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