高血压患者血压和心率昼夜节律变化与左心室肥厚的关系

目的探讨原发性高血压患者血压和心率24h昼夜节律变化与左心室肥厚的关系。方法对初发未治疗高血压患者296例进行动态血压监测分析,根据患者夜间血压和心率均值较白天平均值下降是否超过10%,将患者分为4组:杓型血压和心率组(血压和心率均杓型,n=163)、非杓型血压组(血压非杓型,心率杓型,n=62)、非杓型心率组(血压杓型,心率非杓型,n=42)、非杓型血压和心率组(血压和心率均非杓型,n=29)。对4组间相关临床资料、超声心动图结果进行比较。结果高血压患者收缩压和舒张压非杓型率分别为25%和27%,非杓型心率的比例为24%。非杓型血压和心率组、非杓型血压组、非杓型心率组左心房内径(LAD)、左心室舒张末期内径(LVEDD)、室间隔厚度(IVST)和左心室质量指数(LVMI)明显高于杓型血压和心率组(均P<0.05),其中非杓型血压和心率组上述指标明显高于其他3组(均P<0.05),非杓型血压组、非杓型心率组之间差异无统计学意义。Logistic回归分析显示,年龄、24h平均收缩压、24h平均舒张压、夜间平均收缩压、夜间平均舒张压、非杓型血压、非杓型心率与左心室肥厚的发生密切相关。经调整相关指标后,非杓型血压和非杓型心率使左心室肥厚发生风险分别增加56%和32%。结论高血压患者血压和心率昼夜节律变化与左心室肥厚明显相关。

The correlation between blood pressure, heart rate circadian rhythm change and left ventricular hypertrophy in essential hypertensive patients

Objective To investigate the association between blood pressure (BP), heart rate (HR) circadian rhythm and left ventricular hypertrophy(LVH) in essential hypertensive (EH) patients. Methods A total of 296 EH patients without previous treatment underwent 24 h ambulatory BP monitoring. According to BP or HR, decreased more than 10% or not in nighttime compared to those in the daytime, patients were divided into four groups: nondipper BP and HR(BP-nondip+HR-nondip, n=29), dipper BP and nondipper HR(BP-dip+HR-nondip, n=42), nondipper BP and dipper HR (BP-nondip+HR-dip, n=62), and dipper BP and HR(BP-dip+HR-dip, n=163). Results Non-dippers in systolic blood pressure (SBP), diastolic blood pressure (DBP) and HR was 25%, 27% and 24% respectively of all the subjects. Left atrial diameter (LAD), left ventricular end-diastolic dimension(LVEDD), interventricular septum thickness(IVST) and left ventricular mass index (LVMI) in BP-nondip+HR-nondip, BP-dip+HR-nondip, BP-nondip+HR-dip groups were significantly higher than those in BP-dip+HR-dip group (all P<0.05). The LVMI in BP-nondip+HR-nondip was the highest in all groups (all P<0.05), there was no significant difference between BP-dip+HR-nondip and BP-nondip+HR-dip groups. Logistic regression analysis showed that age, 24hSBP, 24hDBP, nighttime SBP, nighttime DBP, BP non-dippers and HR non-dippers were closely correlated to LVH. After other correlated indexes were adjusted, the odds ratio (OR) of LVH induced by BP non-dippers and HR non-dippers were 1.56 and 1.32 respectively. Conclusion Blood pressure and heart rate circadian rhythm change are correlated with left ventricular hypertrophy in essential hypertensive patients.