原发性高血压患者左室肥厚与24 h血压负荷及其变异性的关系

目的以血压负荷和血压变异性为观察指标，分析其与高血压左室肥厚（LVH）的相关性。方法对114例原发性高血压（EH）患者进行24h无创性动态血压监测和心脏超声检查，根据左室质量指数（LVMI）分成伴LVH组和不伴LVH组两组，分析比较全天（24h）、白天、夜间的血压、血压负荷及其变异性与LVH的相关性。结果（1）EH伴LVH组24h、白天、夜间的收缩压（SBP）、SBP负荷及其变异性均显著高于不伴LVH组（P〈0．01）；（2）EH患者LVMI与24h、白天、夜间的SBP、SBP负荷及其变异性呈正相关（P〈0．01），与夜间SBP变异性相关性最强（r=0．45）；（3）24hSBP负荷〉25％预测LVH发生的敏感性、特异性、阳性预测值分别为58．7％、89．7％、91．7％。结论（1）在LVH的形成过程中，SBP负荷及其变异性增加比舒张压负荷及其变异性更为重要。全天尤以夜间影响最大；（2）24h血压负荷〉25％可能是中国人群预测高血压靶器官损害的理想指标。

The Relationship Between the Blood Pressure Load and Its Variability and Left Ventricular Hypertrophy in Essential Hypertensive Patients

Objective To evaluate the relationship between the BP load and its variability and left ventricular hypertrophy(LVH) in essential hypertensive patients.Methods One huandred and fourteen EH patients admitted into this hospital were taken the ABPM and echocardiography,then (according) to the LVMI,these patients were divided into two groups with or without LVH,in which we analyzed the relationship between the level of blood pressure,blood pressure load and its variability and LVH.Results (1) The levels of 24 h,daytime and nighttime SBP,SBP load and its variability in the group with LVH,were marked higher than that in the group without LVH(P<0.01).(2)There were positive correlations between the level of 24h,daytime and nighttime SBP,SBP load and its variability and LVMI,but the relationship between the nighttime SBP variability and LVMI was the closest(P<0.01).(3) The sensitivity,specificity and positive predicting value of the 24 h BP load more than 25% used to predict the incidence of LVH were 58.7%,89.7%,91.7% respectively.Conclusion (1) The higher levels of 24 h SBP load and its variability especially in nighttime were risk factors of LVH.(2)24 h BP load which is more than 25% may be better factor to predict the incidence of TOD in the Chinese population.