老年原发性高血压患者血压晨峰与左心室肥厚的关系

目的探讨老年原发性高血压患者血压晨峰与左心室肥厚的关系。方法选择老年原发性高血压患者80例,根据24 h动态血压监测分为2组:血压晨峰值≥55 mm Hg(1 mm Hg=0.133 kPa)为晨峰组,血压晨峰值<55mm Hg为非晨峰组,每组40例,均常规行超声心动图检查,计算左心室重量指数(LVMI)。结果晨峰组24h、昼间、夜间收缩压及血压晨峰均明显高于非晨峰组(P<0.05),晨峰组LVMI明显高于非晨峰组;左心室肥厚比例明显高于非晨峰组(P<0.05)。结论老年原发性高血压患者血压晨峰与左心室肥厚密切相关。     

高龄高血压患者动态脉压和血脂与左心室肥厚的关系

目的探讨高龄高血压患者动态脉压(APP)和血脂与左心室肥厚(LVH)的相关性。方法入选年龄≥80岁的高血压患者110例,进行24 h动态血压监测、超声心动图检查及血脂检测。根据APP分为高脉压组(≥60mm Hg,1 mm Hg=0.133 kPa)74例和低脉压组(<60 mm Hg)36例,以左心室重量指数(LVMI)作为LVH的诊断标准,又分为LVH组50例和非LVH组60例。并进行相关分析和logistic回归分析。结果与低脉压组比较,高脉压组LVMI、LVH的发生率及各收缩压参数明显升高(P<0.05)。LVH组24 h收缩压、昼间收缩压、APP、脉压指数明显高于非LVH组(P<0.05),2组舒张压差异无统计学意义(P>0.05)。LVMI与APP、脉压指数、24 h收缩压、昼间收缩压、夜间收缩压呈正相关,与HDL-C呈负相关(P<0.05),与所有舒张压参数均无相关性(P>0.05)。APP是LVH的独立危险因素(OR=1.057,95%CI:1.018～1.096,P=0.003)。结论在高龄高血压患者中,APP与LVMI密切相关,是LVH的独立危险因素;HDL-C与LVMI密切相关。     

动态脉压对老年高血压病患者左心室肥厚及主动脉根部扩张的影响

目的研究老年高血压病患者动态脉压(24 h PP)与左心室肥厚(LVH)及主动脉根部(AOD)扩张的相关关系。方法对60例老年高血压病患者进行动态血压(ABP)和超声心动图等检查,分别测量ABP和超声心动图的各种参数。将24 h PP≥60 mm Hg(1 mm Hg=0.133 kPa)的患者30例作为A组,24 h PP<60 mm Hg的患者30例作为B组。结果A、B两组LVH和AOD扩张的发生率差异有显著性意义(P<0.01)。左心室重量指数与24 h PP2、4 h平均收缩压(24 h SBP)密切相关(P<0.01),与脉压和收缩压呈正相关(P<0.05)。AOD与24 h PP、24 h SBP、年龄和病程密切相关(P<0.01)。结论老年高血压病患者的24 h PP与LVH及AOD扩张密切相关,24 h PP可作为评价抗高血压药物能否更好地减少高血压病患者靶器官损害的重要指标之一。     

Reclassification of adolescent hypertension by ambulatory blood pressure monitoring using adult norms and association with left ventricular hypertrophy

2017 pediatric blood pressure (BP) guidelines applied adult BP norms to define clinic hypertension (HTN) in patients ≥ 13 years. 2014 pediatric ambulatory BP monitor (ABPM) guidelines recommend age‐ and sex‐specific percentile norms for patients < 18 years. The authors evaluated reclassification of HTN when applying adult ABPM norms in patients ≥ 13 years and assessed the association of left ventricular hypertrophy (LVH) with HTN. Charts of patients 13–17 years with ABPM 9/2018–5/2019 were reviewed for sex, age, height, weight, BP medication, ABPM results, and left ventricular mass index (LVMI). American Heart Association 2005 (AHA 2005), AHA 2017 (AHA 2017), and European Society of Hypertension 2018 (ESH 2018) guidelines for adult ABPM were compared with 2014 AHA pediatric norms (pABPM). HTN was defined by each guideline using only ABPM. ABPM and clinic BP were used to classify white coat hypertension (WCH) and masked hypertension (MH). LVH was defined as LVMI > 51 g/m^2.7. 272 patients had adequate ABPM. 124 patients also had echocardiogram. All adult norms resulted in significant reclassification of HTN. LVMI correlated significantly with systolic BP only. The odds of a patient with HTN having LVH was significant using AHA 2005 (OR: 8.75 [2.1, 36.4], p = .03) and ESH 2018 (OR: 4.94 [1, 24.3], p = .002). Significant reclassification of HTN occurs with all adult norms. HTN is significantly associated with LVH using AHA 2005 and ESH 2018. Applying pediatric norms for ABPM while using adult norms for clinic BP causes confusion. Guideline selection should balance misdiagnosis with over‐diagnosis.     

老年原发性高血压患者晨峰现象与左心室肥厚

目的: 探讨老年原发性高血压晨峰现象与左心室肥厚的关系。方法: 老年原发性高血压患者107例根据24 h动态血压监测分为有晨峰现象（MBPS）组（40例）和无晨峰现象（NMBPS）组（67例）,检查空腹血脂、血糖和肌酐,并计算体质量指数（BMI）和左室质量指数（LVMI）。结果: MBPS组的24 h动态血压监测收缩压高于NMBPS组（P<0.05）。MBPS组的LVMI显著高于NMBPS组［（132±28）g/m2 vs.(113±28)g/m2,P<0.01］。结论: 老年原发性高血压有晨峰现象者更易发生左心室肥厚。     

The influence of ambulatory blood pressure profile on left ventricular geometry

Besides causing a hypertrophy in the left ventricle, hypertension results in a change in the geometry of the left ventricle. The blood pressure, which does not decrease enough during the night, leads to structural changes in the left ventricle. In this study, the influence of 24-hour blood pressure profile on the left ventricular geometry was examined. Ambulatory blood pressure monitoring was applied to 60 patients with mild to moderate hypertension who had never been treated and standard echocardiographic evaluation was conducted thereafter. The patients were divided into two groups with respect to the ambulatory blood pressure profiles: the patients whose night blood pressure levels decreased by more than 10% compared to their daytime blood pressure levels (dipper) and those whose levels did not decrease that much (nondipper). The left ventricle mass index and the relative wall thickness of the patients were calculated. With respect to the left ventricle geometry, mass index and relative wall thickness of the patients were determined as: having normal geometry, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy. Age, gender, systolic, and diastolic blood pressure were similar within the dipper and nondipper groups. Normal geometry, concentric remodeling, and concentric hypertrophy ratios were similar in both groups. Eccentric hypertrophy was higher in the nondipper group compared to the dipper group (42.9% vs 6.3%, P < 0.03). Patients with mild to moderate hypertension, whose blood pressure does not decrease enough, develop eccentric hypertrophy.     

原发性高血压左心室肥厚与24小时平均脉压相关性的探讨

目的探讨原发性高血压(EH)左心室肥厚(LVH)与24h平均脉压(PP)和大动脉内径变化的关系。方法应用24h动态血压监测和超声心动图检查,测量并计算80例EH患者24h平均PP,左心室重量指数及主动脉根部内径。分LVH组和无LVH组,分别进行统计学比较。结果24h平均PP和主动脉根部内径在EH有LVH组和无LVH组之间均有显著性差异(P<0.01),左心室重量指数与PP(r=0.3,P<0.01)和主动脉根部内径(r=0.5,P<0.01)之间存在一定的正相关。结论24h平均PP和大动脉内径增大,提示大动脉顺应性下降,在EH发生LVH中起重要作用。     

原发性高血压与肾性高血压的动态血压特点及其与心肌肥厚的关系

目的:观察原发性高血压与肾性高血压的动态血压特点,以了解其致心肌肥厚原因。方法:128例高血压患者被分为原发性高血压组64名,肾性高血压组64名,2组患者心脏B超均提示有心肌肥厚。比较2组的脉压(PP)、血压变异性(BPV)、白天平均收缩压(dSBP)、白天平均舒张压(dDBP),夜间平均收缩压(nSBP)、夜间平均舒张压(nDBP);彩色多普勒测定心肌重量指数(LVMI),统计分析LVMI与各动态血压指标的相关性。结果:肾性高血压组的PP、BPV较原发性高血压组明显增高(P<0.01),2组的dSBP、dDBPnSBP、nDBP差异无显著性;2组的LVMI均与PP、BPV明显相关。结论:原发性高血压与肾性高血压的心肌肥厚均与PP、BVP相关,提示PP、BPV可能是心肌肥厚的预测因子;在平均动脉压相同的情况下,肾性高血压比原发性高血压对心肌的损害作用更大。     

Effects of bisoprolol on left ventricular hypertrophy in essential hypertension

Summary Previous studies have shown that beta-adrenergic blocking drugs can reverse ventricular hypertrophy in patients with systemic hypertension. Thirty patients with essential hypertension and left ventricular hypertrophy were studied at baseline after withdrawing all previous treatments and after 6 months of treatment with 5–20 mg of bisoprolol, a new beta-selective agent, to assess its possible action on left ventricular mass. Three patients did not finish the study. Blood pressure was reduced to below 160/90 mmHg in 22 of the remaining 27 patients. At the end of follow-up, the left ventricular mass (echocardiography) was reduced from 308.1±89 g to 262.3±51 g (p<0.001) and left ventricular mass index from 165±47.4 g/m² to 141.03±26.7 g/m² (p<0.001). The ratio of E wave/A wave velocity of transmitral blood flow measured by Doppler increased from 0.86±0.44 to 1.07±0.45 (p=0.005). Peak filling rate, derived from nuclear ventriculography, changed from 2.05±0.4 EDV/sec before the treatment to 2.23±0.47 EDV/sec after it (p=0.0046). Serum lipids as well as other biochemical tests were unchanged. Left ventricular volumes and ejection fraction did not change, and treadmill exercise time increased from 343±125 seconds to 420±135 seconds (p=0.002). Maximal systolic blood pressure during exercise decreased from 197.2±19.7 mmHg to 182.9±25.8 mmHg (p=0.011). There were few side effects. We conclude that bisoprolol reduces left ventricular mass, preserves systolic function, and improves diastolic function of the left ventricle in hypertensive subjects with left ventricular hypertrophy.     

原发性高血压与肾性高血压的动态血压特点及其与心肌肥厚的关系

目的：观察原发性高血压与肾性高血压的动态血压特点，以了解其造成心肌肥厚的原因。方法：将未予治疗的高血压患分为原发性高血压组64名，肾性高血压组64名，比较2组的脉压（PP）、血压变异性（BPV）、白天平均收缩压（dSBP)、白天平均舒张压（dDBP),夜间平均收缩压（nSBP)、夜间平均舒张压（nDBP);彩色多普勒测定心肌重量指数（LVMI），统计分析LVMI与各动脉血压指标的相关性。结果：肾性高血压组的PP、BPV、LHVI较原发性高血压组明显增高，2组的dSBP、dDBP、nSBP、nDBP差异无显性；2组的LHVI均与PP、BPV明显相关。结论：原发性高血压与肾性高血压的心肌肥厚均与PP、BPV相关，提示PP、BPV可能是心肌损害的预测因子；而在平均动脉压相同的情况下，肾性高血压比原发性高血压对心肌的损害作用更大。     

老年高血压病患者24 h 动态脉压与左室结构及功能变化的相关性研究

目的探讨老年高血压病患者24h动态脉压（24hPP）与左室结构及功能变化的相关性。方法对145例老年高血压病患者进行动态血压监测和超声心动图检查。将24hPP≥60mmHg的患者88例列为A组,24hPP〈60mmHg的患者57例列为B组,分别测量两组患者室间隔厚度（IVST）、左室后壁厚度（LVPWT）、左室舒张末期内径（LVEDD）,计算左室质量指数（LVMI）、左室射血分数（LVEF）及E／A,进行对比分析。结果A组患者LVMI及影响LVMI的3大因素（IVST,LVPWT,LVEDD）均明显高于B组（均P〈0．01）,显示随着脉压增大,出现明显的左心室肥厚;三型肥厚组患者的24hPP均高于无肥厚组;以扩张性肥厚组最显著。A组患者EF及E／A均低于B组,显示随着脉压增大,左室收缩舒张功能减退,以舒张功能受损更显著（P〈0．01）。结论24hPP增高是老年高血压病患者左室肥厚及心功能减退的重要危险因素。     

Nighttime mean arterial pressure is associated with left ventricular hypertrophy in white‐coat hypertension

White‐coat hypertension (WCH) is associated with increased cardiovascular risks. To investigate the relationship between WCH and left ventricular hypertrophy (LVH), the authors recruited 706 participants who underwent anthropometric measurements, blood laboratory analysis, 24h ambulatory blood pressure monitoring (ABPM), and echocardiography. The authors defined WCH as elevated office BP but normal ABPM over 24h, daytime, and nighttime periods. The authors compared the proportion of LVH between the true normotension (NT) and the WCH population, and further assessed the associations between BP indexes and LVH in the two groups, respectively. The proportion of LVH was significantly higher in the WCH group than in NT participants (19.70% vs. 13.12%, P = .036). In the NT group, 24h SBP, 24h PP, daytime SBP, daytime PP and SD of nighttime SBP were associated with LVH after adjustment for demographic and blood biochemical data (all P < .05). In the WCH population, LVH was associated with 24h SBP, nighttime SBP, nighttime MAP, and office SBP after adjustment (all P < .05). However, on forward logistic regression analysis with all the BP indexes listed above, only 24h SBP (OR = 1.057, 1.017–1.098, P < .001) in the NT group, and nighttime MAP (OR = 1.114, 1.005–1.235, P < .05) and office SBP (OR = 1.067, 1.019–1.117, P < .001) in the WCH group were still significantly associated with LVH. Our study suggests that the proportion of LVH is higher in WCH patients than in the NT population. Furthermore, elevated nighttime MAP and office SBP may play critical roles in the development of LVH in the WCH population.     

Gender differences in the relationship between left ventricular size and ambulatory blood pressure in borderline hypertension: The HARVEST Study

AIM: To assess whether there are gender differences in cardiac adaptationto raised blood pressure levels in young subjects with borderlineto mild hypertension. METHODS AND RESULTS: In 499 18–45-year-old stage I hypertensive subjects (377men and 122 women) with a mean age of 33±9 years andoffice blood pressure of 146±11/94±6 mmHg, ambulatoryblood pressure monitoring in duplicate, echocardiography and24-h urinary catecholamines measurement were performed. RESULTS: The whole group was divided into quartiles of increasing daytimeblood pressure and differences in left ventricular echocardiographicdata were analysed in the two sexes separately. In men no leftventricular parameter differed across the quartiles, while inwomen left ventricular mass, posterior wall thickness and interventricularseptum thickness showed a clear tendency to increase with increasinglevels of systolic blood pressure. In multiple regression analysis,daytime systolic blood pressure explained only a small fractionof the variance in left ventricular parameters in men, whilein women daytime systolic blood pressure was a main determinantof left ventricular mass and posterior wall and septal thicknesses.Body weight explained most of the variance in all dimensionalparameters in men. In women weight was an important predictorof left ventricular mass and diameter, but was unrelated toleft ventricular posterior wall and septal thicknesses. CONCLUSIONS: Daytime systolic blood pressure is the most important predictorof left ventricular mass and geometry in pre-menopausal womenwith stage I hypertension, while in men left ventricular dimensionalindeces are chiefly explained by body weight.     

Ambulatory pulse pressure, left ventricular hypertrophy and function in arterial hypertension

BACKGROUND: A wide pulse pressure (PP) can provide important risk assessment information about myocardial infarction, carotid artery atherosclerosis, and global cardiovascular risk. Ambulatory pulse pressure (APP) does not have a well-known prognostic value in hypertensive patients. METHODS:To evaluate the relationship among high APP, atrial volumes, and cardiac function, an observational study was performed on 108 untreated non-elderly hypertensive patients (mean age 54.23 +/- 7.12). Twenty-four-hour ambulatory blood pressure monitoring, Doppler and echocardiographic measurements of systolic, diastolic function, left and right atrial volumes, left ventricular mass index and dimensions, were performed in subjects with both clinic and APP > 60 mmHg (APP1 Group). A control group of hypertensive selected subjects with both clinic and APP < 60 mmHg was chosen (APP 2 Group). RESULTS: The APP1 group showed left atrial volume enlargement, high left ventricular mass index, and impaired diastolic function. A positive correlation was found in the APP1 group results among left ventricular end diastolic diameter (r = 0.39, P < 0.01), left atrial volume (0.38, P < 0.05), and left ventricular mass index (r = 0.33, P < 0.05); clinic PP showed a statistically significant correlation with left atrial volume, left ventricular end diastolic diameter, and left ventricular mass index only in the APP1 group. CONCLUSIONS: These results suggest that elevated APP can be considered an effective predictor of cardiovascular risk in hypertensive subjects. In these patients echocardiographic evaluation of left ventricular function and morphology can increase the prognostic value of PP.     

脉压对老年高血压病患者左心室肥厚的影响

目的　比较动态脉压和诊所脉压对老年高血压病患者左心室肥厚的影响。方法　选择初诊的轻 中度高血压病患者 118例。所有入选病例测量非同日 3次诊所血压、进行 2 4h动态血压监测和超声心动图检查。根据动态脉压和诊所脉压水平各分为 3组 ,并分别比较。结果　动态脉压与年龄、高血压病史、左心室重量指数、动脉僵硬度指数和体重指数呈显著的相关性。动脉僵硬度随分组脉压的增大呈显著递增 ,其与动态脉压的相关性明显强于诊所脉压。动态脉压与左心室重量指数的相关性明显强于诊所脉压。结论　脉压升高是老年高血压病患者左心室肥厚的重要危险因素 ,与诊所脉压比较 ,动态脉压更能反映高血压靶器官损害的程度。     

缬沙坦治疗高血压逆转左室肥厚改善左室功能

目的探讨缬沙坦对高血压左室肥厚的逆转作用。方法应用24h动态血压监测和超声心动图技术评价缬沙坦对高血压患者的降压效果、对左室肥厚的逆转作用及左室收缩和舒张功能的研究,并与一代血管紧张素转换酶抑制剂卡托普利的作用进行比较。结果二者均能降低血压,逆转左室肥厚,改善左室收缩和舒张功能,但缬沙坦作用较卡托普利更明显。二者对心率和肾功能均无明显影响,提示二者在保护靶器官方面都有效果,但缬沙坦的效果更好。结论缬沙坦对肾素-血管紧张素系统有完全阻断作用,患者将在长期应用中获益,不仅高效降压,同时对靶器官有保护作用,能改善心功能,提高生活质量。     

Structural cardiac changes in relation to 24-h ambulatory blood pressure levels in borderline hypertension

Abstract. Objectives. To investigate left ventricular hypertrophy (LVH) in relation to 24-h ambulatory blood pressure (24-ABPM) and insulin levels in borderline hypertension. Design. A case-control study. Subjects. Borderline hypertensive men (diastolic blood pressure (DBP) 85–94 mmHg, n = 69) and age-matched normotensive controls (DBP ≤ 80 mmHg. n = 69) from a population screening programme. Main outcome measures. Echocardiography (M-mode). insulin (RIA) and 24-APBM (Del Mar P-IV) levels. Results. The borderline group showed a significant increase in septal thickness (10.4±1.5 vs. 9.7±1.5 mm. P < 0.01), peak systolic wall stress (218±38 vs. 202±38 10³ dynes cm^?2, P < 0.05) and a decrease in LV ejection time (28.4±2.5 vs. 29.5±2.1s, P < 0.01). The septum vs. posterior wall thickness ratio was significantly higher in the borderline group (1.13±0.14 vs. 1.06±0.14, P < 0.01). Casual BP levels did not correlate with LVH indices, while 24-ABPM systolic levels correlated strongly with LVH indices in the borderline group (r = 0.22–0.52, P < 0.05) but not in the normotensive group. Insulin levels correlates strongly with LVH indices in the normotensive group (r = 0.34–0.47, P < 0.01) but not the borderline, group. Conclusions. Signs of asymmetric LVH and altered ventricular function are already detectable in borderline hypertension. The data also suggest that early structural cardiac changes are related to ambulatory blood pressure profile, but not to casual blood pressure or trophic factors such as insulin.     

高血压病左室肥厚患者心率变异及动态血压分析

观察高血压左室肥厚（ＬＶＨ）患者的心率变异（ＨＲＶ）及血压昼夜节律变化，以期了解三者之间的关系。选择伴有左心室肥厚的高血压病患者２１例，不伴有左心室肥厚的高血压患者２８例，选择年龄与患者可比的健康人２５例作为正常对照组，进行动态心电图及动态血压监测，分析２４ｈＨＲＶ时域指标及血压昼夜节律。结果:高血压伴左室肥厚患者ＨＲＶ各指标均显著低于对照组（Ｐ＜０．０５），也比不伴左室肥厚患者进一步降低。ＰＮＮ５０昼夜节律明显减弱。动态血压结果显示:不伴左室肥厚组与左室肥厚组血压昼夜节律消失者分别占各组总数的１７．９％及４７．６％，组间比较差异显著（Ｐ＜０．０５）。结论:副交感神经调节功能减弱可能与以上变化相关。高血压治疗应注意改善ＨＲＶ，重视恢复血压的昼夜节律     

高血压合并糖尿病患者左心室肥大与血压变异性指数的相关性分析

目的研究高血压合并糖尿病患者左心室肥大与血压变异性(BPV)指数的相关性。方法纳入高血压合并糖尿病患者120例,并根据患者的临床确诊资料信息及心电图资料将患者分为左心室肥大(LVH)组和非LVH组,比较两组的BPV相关指数,Logistic回归分析患者左心室肥大的相关危险因素,Pearson相关分析左心室质量指数(LVMI)与BPV各指标之间的相关性。结果高血压合并糖尿病LVH组患者较非LVH组患者的白天收缩压变异系数(dSBPCV)、白天舒张压变异系数(dDBPCV)、24 h收缩压变异系数(24hSBPCV)、24 h舒张压变异系数(24hDBPCV)均显著上升(P<0.05);Logistic回归分析结果提示dSBPCV、dDBPCV、24hDPBCV、24hSBPCV水平的上升是高血压合并糖尿病患者左心室肥大的相关危险因素(OR>1,P<0.05);Pearson相关分析结果提示:LVMI与24hSBPCV、24hDBPCV以及dSBPCV、dDBPCV均呈正相关(r分别为0.345、0.412、0.387、0.441,P<0.05)。结论高血压合并糖尿...     

老年高血压患者动脉僵硬度与左心室肥厚关系

目的探讨老年高血压患者动脉僵硬度与左心室肥厚的关系。方法选择原发性老年高血压患者68例,以左心室重量指数(LVMI)作为评价左心室肥厚指标,将患者分为左心室肥厚组(32例)和非左心室肥厚组(36例)。以颈动脉-股动脉肢体动脉搏动波(cfPWV)和脉压作为评价动脉僵硬度指标,进行24 h动态血压监测、cfPWV及超声心动图检测,并进行多因素相关分析。结果左心室肥厚组较非左心室肥厚组患者cfPWV高[(14.45±1.83)m/s vs(10.89±1.94)m/s]、脉压大[(78.66±9.05)mm Hg(1 mm Hg=0.133 kPa)vs(60.39±7.74)mm Hg],两组比较,差异有统计学意义(P<0.01),logistic回归分析显示,LVMI与cfPWV、脉压呈正相关。结论动脉僵硬度增加是老年高血压患者左心室肥厚的重要危险因素。