高血压左心室肥厚与脉压关系的临床观察

目的　探讨高血压病（essentialhypertension,EH）左心室肥厚（leftventricularhypertrophy,LVH)与脉压（pulsepressure,PP)和大动脉内径变化的关系。方法　应用诊所血压测量和超声心动图检查,测量并计算92例高血压患者脉压,左室重量指数及大动脉内径。分左室肥厚组和无左室肥厚组,分别进行统计学比较。结果　脉压和主动脉根部内径在高血压左室肥厚组和无左室肥厚组之间均有显著性差异（P<0.01）,左室重量指数与脉压（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　脉压和大动脉内径增大,提示大动脉顺应性下降,在高血压左室肥厚中起重要作用。     

高血压左心室肥厚与脉压关系的临床观察

目的　探讨高血压病 (essentialhypertension ,EH)左心室肥厚 (leftventricularhypertrophy ,LVH)与脉压 (pulsepressure,PP)和大动脉内径变化的关系。方法　应用诊所血压测量和超声心动图检查 ,测量并计算 92例高血压患者脉压 ,左室重量指数及大动脉内径。分左室肥厚组和无左室肥厚组 ,分别进行统计学比较。结果　脉压和主动脉根部内径在高血压左室肥厚组和无左室肥厚组之间均有显著性差异 (P <0 0 1) ,左室重量指数与脉压 (r =0 3,P <0 0 1)和主动脉根部内径 (r =0 5 ,P <0 0 1)之间存在一定的正相关。结论　脉压和大动脉内径增大 ,提示大动脉顺应性下降 ,在高血压左室肥厚中起重要作用     

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。     

原发性高血压患者24h平均脉压与靶器官损害的关系

目的探讨原发性高血压(EH)患者24 h平均脉压(PP)与靶器官损害(TOD)的关系.方法对58例EH患者进行24 h无创性动态血压监测,并根据有无左室肥厚(LVH)分为两组非LVH组(21例)、LVH组(37例),其中LVH伴心功能不全者17例,心功能正常者20例进行观察.结果①LVH组心功能正常者24 h平均收缩压(SBP)、24 h平均PP显著大于非LVH组(P＜0.01);②左室质量指数、相对室壁厚度与24 h平均SBP、PP呈正相关(P＜0.01);③LVH组伴或不伴心功能不全者24 h平均SBP、PP明显高于非LVH组(P＜0.01),LVH组伴心功能不全者24 h平均PP高于LVH心功能正常组(P＜0.05).结论24 h平均PP增大在EH伴LVH的发展中起作用,且对靶器官损害程度有预测价值.     

老年高血压病患者左室肥厚独立相关因素的研究

目的通过筛选老年高血压病(EH)患者左室重量指数(LVMI)的独立相关因素,来寻找延缓或逆转EH患者左室肥厚(LVH)的途径。方法对年龄在65～89(76.00±5.00)岁的302名老年EH患者进行问卷调查、体格检查、24h动态血压检测、心脏超声检查和实验室检测,运用多元线性回归分析筛选EH患者LVMI的独立相关因素。结果老年EH患者LVMI的独立相关因素包括24h平均收缩压(β=0.332,P<0.05)和血尿酸(β=0.079,P<0.01)。结论降低24h平均收缩压水平和血尿酸浓度,可能是延缓或逆转老年EH患者LVH的重要途径。     

代谢综合征与左心室肥厚关系的分析

目的:探讨代谢综合征(MS)与左心室肥厚(LVH)的关系。方法:在体检人群中选择598例,其中男性392例,女性206例,年龄40～80岁,平均(56.9±14)岁。根据1999年WHO高血压诊断标准及2004年中华医学会糖尿病分会MS诊断标准,将其分为正常人组100例,单纯高血压病组(EH)100例,血压正常的代谢综合征组(NMS)108例,高血压代谢综合征组(HMS)290例。用彩色多普勒超声诊断仪,利用二维超声心动图检测室间隔厚度、左心室后壁厚度、左心室舒张末期内径,计算出左心室心肌重量指数(LVMI,g/m2)。结果:NMS组的舒张末期室间隔厚度(IVS)、舒张末期左心室后壁厚度(LVPW)、左心室重量(LVM)、左心室重量指数(LVMI)、LVH大于正常人组(P<0.05)。HMS组的IVS、LVPW、LVM、LVMI及LVH显著大于EH组(P<0.01);HMS组的IVS、LVMI、LVH显著大于NMS组(P<0.01),LVPW、LVM大于NMS组(P<0.05)。结论:高血压患者如合并糖尿病或肥胖或血脂紊乱,则随着代谢性危险因素的增加,LVH则更明显。对有高血压的MS则应控制血压,同时降糖、降脂和减轻体重,以防止多种危险因素聚集而导致的LVH。     

老年高血压病左心室肥厚与昼夜动态血压的关系

目的探讨老年高血压病患者24小时动态血压参数比值与左心室肥厚(LVH)的关系。方法289例>60岁老年高血压病患者依据左心室状况分为左心室肥厚组简称(LVH组)与无左心室肥厚组(简称无LVH组)并进行动态血压比较分析。结果(1)LVH与无LVH组比较24MSBP、24hPP、dMSBP、nMSBP、BPF、BPL、LVMI差异有显著性(P<0.01或0.05)。(2)LVH组以非杓型血压为主占76%,而无LVH组以杓型血压为主占78.43%。(3)LVH组LVMI与24hMSBP、24hPP、dMSBP、nMSBP、SBPL正相关(r=0.599～0.792,P<0.001),与SBPF、DBPF负相关(r=-0.358,-0.289,P<0.01)。结论老年高血压病引起LVH与24hMSBP、24HPP、SBPL、BPF密切相关。     

血清胰岛素样生长因子-1与原发性高血压患者左心室肥厚和蛋白尿的关系

目的探讨血清胰岛素样生长因子-1(IGF-1)与原发性高血压(EH)患者心脏和肾脏损害的关系。方法选择51例EH患者和30例正常受试者,根据是否合并左心室肥厚(LVH)将EH病患者分为EH组和EH+LVH组,同时按不同血压等级分为3个组。用酶联免疫分析方法测定血清IGF-1水平,用散射比浊法测定尿白蛋白排泄率(UAER)。根据心脏超声各参数计算左心室质量指数(LVMI)。结果不同血压水平各组中,随着动脉血压水平的升高,血清IGF-1、LVMI、UAER均升高,组间差异有统计学意义;EH组血清IGF-1高于正常对照组(P<0.05),EH+LVH组血清IGF-1高于EH组(P<0.05),并显著高于正常对照组(P<0.01);EH组UAER显著高于正常对照组(P<0.01),EH+LVH组UAER显著高于正常对照组和EH组(P<0.01,P<0.01);血清IGF-1与LVMI、UAER均存在正相关性(r=0.41,P<0.05;r=0.53,P<0.05)。结论(1)循环血IGF-1水平与LVMI、UAER均密切相关,表明IGF-1参与了EH病的发生发展,并且很可能在EH心脏、肾脏损害的病理生理过程中起到了至关重要的作用。(2)EH病患者心脏、肾脏受损程度基本平行。     

高血压左心室肥厚患者结缔组织生长因子和B型钠尿肽的变化及临床意义

目的观察原发性高血压左心室肥厚(left ventricular hypertrophy,LVH)患者结缔组织生长因子(CTGF)及B型钠尿肽(BNP)含量的变化并探讨其临床意义。方法选择120例高血压患者,分为LVH组62例和未合并LVH组(NLVH组)58例,另选择健康体检者30例为对照组。采用酶联免疫吸附法测定血清CTGF和血浆BNP的含量。采用彩色多普勒超声检查各组心脏舒张期室间隔厚度、左心室后壁厚度、左心室舒张末内径及LVEF。结果与对照组比较,NLVH组患者左心室质量指数明显升高(P<0.01),血清CTGF和血浆BNP比较,差异无统计学意义(P>0.05);LVH组血清CTGF和血浆BNP含量及左心室质量指数均明显升高,差异有统计学意义(P<0.01),且血清CTGF和血浆BNP含量与左心室质量指数呈正相关(r=0.51,r=0.64,P<0.01),NLVH组血清CTGF和血浆BNP含量与左心室质量指数比较差异无统计学意义(P>0.05)。结论血清CTGF和血浆BNP含量监测,对高血压LVH患者的诊治和预后判断具有重要临床意义。     

厄贝沙坦抗高血压疗效及其对左室肥厚的逆转作用

目的观察血管紧张素Ⅱ受体拮抗剂(厄贝沙坦)降压疗效及其对原发性高血压(EH)左心室肥厚(LVH)的逆转作用。方法65例EH患者口服厄贝沙坦75~150 mg,每天1次,治疗12周后用动态BP监测仪记录降压效果,用超声心动图测量LVH患者的左心室肥厚的改善情况。结果厄贝沙坦可使24 h BP平稳下降,且左心室重量指数较治疗前明显减低(P<0.01)。结论厄贝沙坦可有效地控制BP的升高,并对EH患者的LVH有逆转作用。     

老年原发性高血压患者24小时动态血压与左室肥厚的关系

目的观察老年原发性高血压患者24h动态血压与左室肥厚的关系。方法选择老年原发性高血压患者58例，分别作24小时动态血压及心脏超声心动图检查，观察24h动态血压（包括24h平均收缩压、24h平均舒张压、24h平均脉压）与室间隔厚度、左室后壁厚度的关系。结果24h平均收缩压、24h平均脉压与室间隔厚度、左室后壁厚度有相关性（分别为前者：r=0.415、P〈0.01，r=0.363、P〈0.01；后者：r=0.336，P〈0.05，r=0.346，P〈0.05）。结论老年原发性高血压患者随着24h平均收缩压增高、24h平均脉压增大而左室肥厚。     

Relationships between cardiovascular remodelling and the pulse pressure in never treated hypertension

The role of pulse pressure (PP) in cardiovascular remodelling was studied in 61 never treated hypertensive subjects who were selected on the criteria of ambulatory blood pressure (BP) monitoring (mean BP over 24 h: 147 +/- 14/96 +/- 10 mm Hg). Echocardiography and carotid ultrasonography were performed and the vascular images analysed using a specific automatic measuring program. Thirty percent of subjects had left ventricular hypertrophy (LVH). Left ventricular mass index (LVMI) was related to the clinic (r = 0.35) and ambulatory (r = 0.41 over 24 h, r = 0.38 daytime and r = 0.42 night-time) PP and to the systolic BP. PP was higher when there was LVH. Vascular thickening was found in 6.6% of subjects (carotid intima-media thickness (IMT) >/=1.0 mm). Among the BP parameters, IMT and cross-sectional area (CSA) were related only to the clinic PP (r = 0.27, r = 0.29 respectively) and to the ambulatory PP (over 24 h: r= 0.29, r = 0.28; daytime: r = 0.22, r = 0.23; night-time: r = 0.32, r = 0.30). In men, the relationship between CSA and PP (clinic and over 24 h) was independent of age. A total of 16.7% of subjects with LVH had intima-media thickening in contrast to 2.3% in the group without LVH. LVMI was related to the CSA (r = 0.37) and to the IMT (r = 0.31). However, after multivariate analysis taking into account the PP, relationships between IMT or CSA and LVMI disappeared. Our data showed that the PP was the most important BP parameter in the development of cardiac and arterial remodelling in hypertension.Journal of Human Hypertension (2000) 14, 23-30.     

左心室肥厚及脉压与老年高血压并发脑梗死的相关性分析

目的探讨左心室肥厚(LVH)及脉压(PP)与老年原发性高血压(EH)患者并发脑梗死之间的关系及其临床检测意义.方法使用超声方法检测52例老年并发脑梗死的EH患者及45例老年非并发症脑梗死的EH患者左心室质量指数(LVMI),结合患者血压及PP情况进行比较和综合分析.结果并发脑梗死组的LVMI及PP显著高于非脑梗死组,其差异有统计学意义(P＜0.01).并且LVMI随PP增加而增加,LVMI与PP呈显著正相关,脑梗死组和非脑梗死组LVMI与PP相关系数分别为0.632和0.645(P＜0.01),所有患者LVMI与PP之间相关系数为0.360(P＜0.01).结论脑梗死患者LVMI及PP显著增加,且LVMI与PP呈显著正相关.同时监测LVMI和PP有助于了解老年EH患者疾病的不同状态,便于判断病程及预后.     

Relationship between left ventricular mass index and 24-h urinary free cortisol and cortisone in essential arterial hypertension

OBJECTIVE: Besides arterial blood pressure, nonhemodynamic factors are known to induce cardiac hypertrophy. In Cushing's syndrome, severe ventricular hypertrophy has been linked not only to increased aortic pressure, but also to elevated plasma cortisol. The aim of this study was to examine the relationship between the cortisol/cortisone levels and left ventricular mass index (LVMI) in essential arterial hypertension with and without echocardiographic left ventricular hypertrophy (LVH). DESIGN: Eighteen untreated Caucasian patients (nine men, nine women, mean age 48+/-6 years) with essential hypertension (163+/-26/100+/-14 mm Hg) were enrolled. An age-matched control group of 13 subjects (seven men, six women) with normotension (121+/-9/79+/-7 mm Hg) were enrolled also. Left ventricular dimensions were echocardiographically assessed and cortisol production evaluated by 24-h urinary free cortisol and cortisone concentrations. RESULTS: LVMI averaged 115+/-31 g/m2 and 24-h urinary free cortisol and cortisone were 23+/-14 microg per 24 h and 31+/-18 microg per 24 h. Prevalence of echocardiographic LVH was 56%. LVMI correlated significantly with 24-h urinary free cortisol (r = 0.61, P = 0.007) and cortisone (r = 0.60, P = 0.009). Patients with echocardiographic LVH were characterized by higher daytime ambulatory blood pressure, LVMI (particularly the posterior wall), and 24-h urinary cortisol, while office blood pressure, septal: posterior wall ratio and 24-h urinary cortisone were comparable in all patients. In control individuals, LVMI averaged 91+/-18 g/m2 and 24-h urinary free cortisol and cortisone, respectively, were 34.7+/-6.6 microg per 24 h and 64.3+/-10.8 microg per 24 h (P<0.05 versus patients). Neither LVMI nor the contributing ventricular dimensions showed significant correlation with 24-h urinary free cortisol or cortisone in the control group. CONCLUSIONS: Our data provide evidence for a significant relationship between LVMI and cortisol production independently of arterial blood pressure in untreated mild to moderate hypertension.     

收缩压及昼夜节律对左室肥厚的影响

目的探讨老年高血压病患者收缩压、昼夜节律对左室肥厚（LVH）的影响。方法对141例老年高血压病患者进行24h动态血压监测（ABPM）,根据左室质量指数（LVMI）将其分为LVH组（A组）63例和非LVH组（B组）78例,比较两组动态血压参数与LVH的关系。结果（1）A组与B组比较,24hSBP、dSBP、nSBP、nDBP和24hPP差异有统计学意义（P〈0．01或0．05）;（2）A组与B组杓型血压率差异有统计学意义（P〈0．01）;（3）LVMI与24hSBP、dSBP、nSBP、nDBP、24hPP正相关（r=0．140～0．479,P〈0．01或0．05）,与SBPF、DBPF负相关（r=-0．395,-0．376,P〈0．01）。结论老年高血压病患者收缩压水平、昼夜节律对左室肥厚的发生、发展有重要作用。     

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。     

Blood pressure circadian rhythm and heart rate turbulence in hypertensive patients: relationship with left ventricular hypertrophy

Objective To investigate the relationship of blood pressure circadian rhythm with myocardial hypertrophy and the changes of autonomic nerve function in patients with essential hypertension (EH). Methods Eighty-two female patients with essential hypertension (EH) underwent 24-hours ambulatory blood pressure monitorings (ABPM), dynamic electrocardiogram (Holter) and echocardiography examination. Patients were classified into non-dipping group (n=40) and dipping group (n=42) according to the result of ABPM. Left ventricular mass index (LVMI), heart rate variability (HRV) in time domain (including SDNN, SDANN, rMSSD, PNN50) and heart rate turbulence (HRT) parameters (including turbulence onset [TO] and turbulence slope [TS]) were measured. Results Compared with those in dipping group, patients in non-dipping group have higher incidence of LVH (19.0% vs 52.5%, P<0.01), greater mean LVMI (112.39±12.79 g/m2 vs 121.98±13.35 g/m2, P<0.01), decreased PNN50 and rMSSD. TS value was decreased while TO was increased in non-dipping group compared with those in dipping group (both P <0.01); patients with LVH showed decreased TS and increased TO, compared with those without LVH. Conclusion In female patients with EH, non-dipping blood pressure circadian is associated with higher incidence of LVH. The HRV and HRT were more remarkably blunted in non-dipping patients, as well as those with LVH.     

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。