老年高血压病患者左心室肥厚危险因素分析

目的　旨在探讨老年高血压病患者伴发左心室肥厚的危险因素。方法　15 5例老年男性高血压病患者分为高血压伴左心室肥厚组(45例)和高血压无左心室肥厚组(110例) ,比较两组患者2 4h血压监测各项指标、纤维蛋白原及血脂等浓度,用多元逐步回归分析,探讨左心室肥厚的可能影响因素。结果　两组患者之间年龄、体重指数、体表面积差异无显著性意义;但高血压病程、2 4h平均脉压、平均收缩压及纤维蛋白原差异有显著性意义;2 4h平均脉压升高可能为左心室肥厚的独立危险因素。结论　高血压伴发左心室肥厚是长期血压控制不良、代谢紊乱等多因素作用的结果,其中,脉压增大者更易出现左心室肥厚。     

老年患者血清护骨素水平与左心室结构和功能的相关性研究

目的探讨老年患者血清护骨素水平对于心脏左心室结构与功能的预测意义。方法选择51 7例老年患者,根据护骨素水平按3分位数分组:护骨素<1.50μg/L组(A组,171例)护骨素1.50～2.72μg/L组(B组,176例),护骨素>2.72μg/L组(C组,1 70例)。ELISA法检测血清护骨素水平;多因素采用多元逐步回归及logistic回归分析。结果随护骨素水平升高,3组LVEF逐渐下降(P<0.01),左心室质量指数逐渐升高(P<0.01),以左心室肥厚为因变量,以性别、年龄、收缩压、舒张压、空腹血糖、血肌酐、TC,LDL-C.HDL-C、TG、sqrt护骨素为自变量,logistic回归分析显示,左心室肥厚与性别、年龄、收缩压、sqrt护骨素独立相关。结论在老年心血管病患者中,血清护骨素水平可能是左心室肥厚的独立危险因素,并且老年女性发生左心室肥厚的风险高于男性。     

老年高血压患者左心室肥厚与动态脉压及动态脉压指数的关系

目的探讨老年高血压患者左心室肥厚与动态脉压(24h APP)及动态脉压指数(24h APPI)的关系。方法入选我院住院确诊的老年高血压患者191例,入选患者均进行24 h无创动态血压监测,按24hAPP分为低脉压组(24hAPP60 mmHg,n=136)和高脉压组(24hAPP≥60 mmHg,n=55);所有患者均行超声心动图检查,并记录左心室舒张末期内径(LVEDD)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)的数值,计算左心室质量指数(LVMI)。结果高脉压组24hAPPI、LVMI、24 h收缩压(24hSBP)的水平大于低脉压组;简单线性回归分析提示:年龄、24hAPP、24hAPPI、24hSBP为左心室肥厚的危险因素;多元逐步线性回归分析提示24hAPPI为LVMI的独立危险因素。结论 24hAPPI可能为老年高血压患者左心室肥厚的独立危险因素。     

老年高血压性左心室肥厚与缺血性脑卒中关系的临床探讨

原发性高血压是缺血性脑卒中的独立危险因素 ,本研究旨在探讨老年高血压性左心室肥厚患者与缺血性脑卒中发病的关系。1　对象与方法海军总医院 2 0 0 0年 1月至 2 0 0 1年 12月间确诊为高血压病的老年男性患者 82例 ,高血压按收缩压≥ 14 0ｍｍＨｇ(1ｍｍＨｇ =0 .1333ｋＰａ)和 (或 )舒张压≥ 90ｍｍＨｇ的诊断标准 ,并排除糖尿病、脑出血、心脏瓣膜病及继发性高血压等。根据二维超声心动图检测按有无左心室肥厚 (ｌｅｆｔｖｅｎｔｒｉｃｕｌａｒｈｙｐｅｒｔｒｏ ｐｈｙ ,ＬＶＨ)分为 2组 :单纯高血压病组 (ＥＨ1) 4 0例 ,年龄 6 0～ 73岁…     

老年高血压病人合并射血分数保留的心力衰竭的临床特征及相关危险因素分析

目的 探讨老年高血压合并射血分数保留的心力衰竭(HFpEF)的临床特点及其相关危险因素。方法 纳入569例老年高血压住院病人,根据是否合并HFpEF分为HFpEF组和对照组,比较2组间临床特点的差异;采用多元Logistic回归分析老年高血压病人发生HFpEF的影响因素。结果 HFpEF组年龄、女性比例、超重、2型糖尿病患病率、血清B型尿钠肽、尿素氮、肌酐水平显著高于对照组(P<0.05)。HFpEF组舒张期室间隔厚度、舒张期左心室内径、舒张期左心室后壁厚度、左心房内径、左心室质量指数均显著高于对照组(P<0.01)。Logistic回归分析显示,老年高血压合并HFpEF的相关危险因素包括女性、超重、2型糖尿病及左心室质量指数。结论 女性、超重、2型糖尿病、左心室质量指数是老年高血压病人合并HFpEF的相关危险因素。     

血清D-二聚体水平与老年高血压患者左心室肥厚的相关性分析

目的分析血清D-二聚体(D-D)水平与老年高血压患者左心室肥厚(LVH)的相关性。方法选取2014年6月—2016年1月应城市人民医院收治的老年高血压患者160例,根据LVH发生情况分为LVH组67例和非LVH组93例。记录两组患者一般资料、实验室检查指标及心脏超声检查指标。相关性分析采用Pearson相关分析;影响因素的分析采用多因素logistic回归分析。结果两组患者年龄、性别、体质指数(BMI)、吸烟率、饮酒率、血脂异常发生率、舒张压(DBP)及血清血肌酐(Scr)、尿素氮(BUN)水平比较,差异无统计学意义(P0.05);LVH组患者高血压病程长于非LVH组,收缩压(SBP)及血清超敏C反应蛋白(hs-CRP)、N-末端脑钠肽(NT-pro BNP)、D-D水平高于非LVH组,差异有统计学意义(P0.05)。Pearson相关分析结果显示,血清D-D水平与老年高血压患者血清NT-pro BNP水平及左心室重量指数(LVMI)、左心室舒张末期内径(LVEDD)、左心房内径(LA)呈正相关(P0.05),与左心室射血分数(LVEF)呈负相关(P0.05),而与室间隔厚度(IVST)、左心室后壁厚度(LVPWT)无直线相关性(P0.05)。多因素logistic回归分析结果显示,高血压病程、SBP及血清NT-pro BNP、hs-CRP、D-D水平是老年高血压患者LVH的独立危险因素(P0.05)。结论血清D-D水平是老年高血压患者LVH的独立危险因素。     

老年高血压合并心力衰竭的相关影响因素分析

目的观察老年高血压合并心力衰竭病人的临床特点,分析高血压病人并发心力衰竭的危险因素。方法收集2015年12月至2018年12月于渭南市中心医院就诊的138例高血压病人的临床资料,其中70例未合并心力衰竭的病人作为高血压组,68例合并心力衰竭的病人作为心力衰竭组。比较2组病人的左心室舒张末内径、心室间隔、SBP及DBP;检测并比较2组病人血清中BNP、CRP、肌酸激酶同工酶(CK-MB)、血管紧张素Ⅱ(AngⅡ)、皮质醇(Cor)、内皮素-1(ET-1)的水平;采用多因素Logistic回归分析老年高血压并发心力衰竭的相关影响因素。结果心力衰竭组左心室舒张末内径、室间隔、SBP、DBP均大于高血压组,差异有统计学意义(P 0. 05)。心力衰竭组的BNP、CRP、CK-MB、AngⅡ、Cor、ET-1水平均高于高血压组,差异有统计学意义(P 0. 05)。多因素Logistic回归分析结果显示,年龄≥70岁、FPG≥7. 0 mmol/L、合并高脂血症、左室肥厚、血压控制不达标是老年高血压病人并发心力衰竭的独立危险因素(P 0. 05)。结论老年高血压病人需严格控制血压,同时密切关注机体血糖、血脂的变化,早期预防心力衰竭的发生。     

臂踝脉搏波传导速度与老年高血压患者大动脉扩张性的相关性探讨

目的探讨臂踝脉搏波传导速度(Brachial Ankle Pulse Wave Velelocity,baPWV)与老年高血压患者大动脉扩张性改变的相关性及其相关因素。方法130例老年高血压患者,按年龄分为三组,比较分析不同组的baPWV值。结果baPWV值随着年龄的增大而增加(P<0.01),多元逐步回归分析结果表明年龄、收缩压和脉压与反映大动脉扩张性的baPWV关系密切(P<0.01),Logistic回归分析baPWV、年龄、收缩压和脉压是影响左室肥厚的主要因素(P<0.01)。结论baPWV是敏感反映高血压大动脉扩张性的指标,是高血压并左室肥厚发生的强力预测因子,年龄、收缩压、脉压是影响baPWV值的主要因素,baPWV可作为全身心血管疾病的一个危险信号,以指导早期预防干预。     

高血压病患者的脑磁共振成像改变

目的　评价高血压病患者脑磁共振成像 (MRI)异常的现患率 ,以及血压水平与脑MRI异常的关系。方法　对95例高血压病患者及与其在年龄、性别等方面 1 1匹配的正常人 ,进行脑MRI及血压、血脂、颈动脉B超等危险因素的检查。结果　高血压病组的脑白质疏松 (LA)现患率为 4 3.2 % (4 1 95 ) ,明显高于对照组 2 5 .8% (2 4 93) ;高血压病组腔隙性脑梗死 (LI)现患率为 13.7% (13 95 ) ,对照组未发现。进行条件logistic回归分析显示 ,舒张压是LA发生的预测因子 ,收缩压和舒张压是LI发生的预测因子。结论　高血压是LA和LI的独立危险因素 ,血压水平与脑MRI异常的发生之间有一定的量效关系     

脑白质疏松症对老年脑梗塞后癫痫的影响

目的：探讨脑白质疏松症（LA）在脑梗塞后癫痫发生中的作用。方法;对289例急性脑梗塞幸存者进行5年的随访,按梗塞后有或无迟发性癫痫发为两组,对两组患者的年龄、有无LA、高血压病、糖尿病、高胆固醇血症及吸烟吸进行分析。结果：在单因素Logistic回归分析中,LA、高血压病史、吸烟史及年龄均为脑梗塞后迟发性癫痫的影响因素;在多因素条件Logistic回归分析中,LA仍为脑梗塞后迟发性癫痫重要的危险因素（OR=2.303;95%CI值1.1074-4.789;P=0.026)。结论：LA是脑梗塞患者迟发性癫痫的危险因素之一。     

Left atrial size in 164 hypertensive patients: an echocardiographic and ambulatory blood pressure study

BACKGROUND: Left atrial enlargement (LAE) is associated with an increased risk of death and cardiovascular (CV) hospitalization. Whether or not LAE reflects early structural change from hypertension is unclear. HYPOTHESIS: The aim of this study was to evaluate the relationship between LA size, 24-h blood pressure measurements, age, body mass index (BMI), and left ventricular mass index (LVMI) in hypertensive patients. METHODS: We studied 164 outpatients (age range 30-76 years, 73 men and 91 women) with mild to moderate hypertension. Physical examination, electrocardiogram, noninvasive blood pressure monitoring (ABPM), Doppler echocardiogram were performed. Left ventricular mass index and LA dimensions were calculated. The sample was divided by age (< 60 and > or = 60 years). RESULTS: Left ventricular hypertrophy (LVH) was present in 45% of patients aged < 60 years and in 70% of patients aged > or = 60 years (p = 0.002). Left atrial enlargement (> 4 cm) was present in 35% of elderly and in 24% of young patients (p = 0.31), and in 36% of patients with and 21% of patients without LVH (p = 0.0057). There was no significant difference in the younger patients with and without LVH. The incidence of obesity was low (31%) in the whole sample. The percentage of overweight in the elderly patients with LVH and higher LA size was equally low. Multivariate analysis showed age (p = 0.044) and LVMI (p = 0.002) as the only significant predictors of LA enlargement. CONCLUSION: Since LAE is associated with a high risk of death and CV hospitalization, we emphasize the importance of development and use of drugs that inhibit LVH.     

Genetic predictors of left ventricular hypertrophy: do polymorphisms of peroxisome proliferator activated nuclear receptor genes play any role?

AIM: To assess possible associations of polymorphic markers of PPARA and PPARG2 genes with presence of left ventricular hypertrophy (LVH) in patients with hypertension. MATERIAL: Patients with hypertension (n=163, mean age 60.93+/-0.82 years) with (n=110) and without (n=53) LVH. METHODS: Echocardiography was used for evaluation of left ventricular mass and mass index and polymerase chain reaction - for identification of alleles and genotypes of polymorphic markers of ACE, NOS3, PPARA, PPARG2 genes. RESULTS AND CONCLUSION: There was no association between presence of LVH and polymorphic marker Pro12AIa. Carriers of 4a allele of a polymorphic marker ecNOS4a/4b of NOS3 gene, A allale of a polymorphic marker G7831A of ACE gene, and C allele of PPARA gene had significantly greater left ventricular myocardial mass index. Monofactorial regression analysis showed that degree of LVH was significantly related to age, duration of hypertension, maximal systolic blood pressure. No relationship was found between left ventricular mass index and smoking, maximal diastolic blood pressure, habitual systolic and diastolic blood pressure, duration of hypertension, presence of ischemic heart disease, diabetes. According to results of multifactorial analysis A allele of a polymorphic marker G7831A of ACE gene, age and maximal systolic blood pressure were while C allele of PPARA gene was not independently related to the presence of LVH.     

老龄高血压患者血压变异性和体位性低血压的相关性

目的 对老龄高血压患者血压变异性和体位性低血压之间的相关性进行分析.方法 选取180例老龄高血压患者,对其数据资料进行分析,分析血压变异性与体位性低血压之间的关系.结果 ①第3三分位患者年龄、收缩压、饮酒高于第1三分位;第3三分位患者收缩压高于第2三分位(P<0.05);其他数据比较无差异(P>0.05).②第3三分位收缩压、舒张压与体位性低血压检出率均高于第1与第2三分位患者(P<0.05).③与第1三分位比较,第3三分位是体位性低血压的危险因素;模型2在模型1的基础上校正年龄、性别,第3三分位为体位性低血压的危险因素;模型3在模型2的基础上校正收缩压、BMI、饮酒等,第3三分位是体位性低血压的阴险因素.结论 老老龄高血压患者血压变异与体位性低血压有着很大的相关性.     

Hypertension and the elderly: more than just blood pressure control

Hypertension is a major risk factor for cardiovascular disease in both young and elderly persons; therefore, good blood pressure control is at the center of improved cardiovascular health. The recently issued seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and the European Society of Hypertension/European Society of Cardiology 2003 guidelines for hypertension management emphasize the importance of treatment efficacy rather than age in treating elderly persons with hypertension. Most hypertension clinical trials have been carried out with younger hypertensives, but this is changing with trials such as the Systolic Hypertension in the Elderly Program, the first Swedish Trial of Old Patients With Hypertension, and the Systolic Hypertension in Europe trial. These trials have clearly demonstrated the benefits of good blood pressure control in reducing the risk of stroke in elderly persons. With many safe and effective antihypertensive drugs on the market, the question becomes how elderly persons should be treated. Elderly patients often have isolated systolic hypertension, which is related to loss of arterial elasticity or compliance with aging and is more recalcitrant to treatment than essential hypertension. In addition, with advancing age there is the likelihood that other disease states are present in addition to hypertension. The newer antihypertensive drugs that interfere with the renin angiotensin system, such as angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers, have the potential of improving cardiovascular outcomes in elderly persons in addition to offering effective blood pressure reduction. Their use should be considered within a comprehensive risk assessment that includes individualized risk-benefit considerations.     

老年SH患者ABPM指标与LVH、MI及心律失常关系

目的探讨老年收缩期高血压(SH)患者的血压各项指标与左心室肥厚(LVH)、心肌缺血(MI)及心律失常的相关性。方法对45例临床已确诊有左心室肥大、心肌缺血的老年收缩期高血压患者(观察组)和36例老年单纯收缩期高血压患者(对照组)进行动态血压(ABPM)和动态心电图(DCG)同步检测。结果与对照组比较,观察组ABPM多项指标即24h、白昼、夜间平均收缩压、脉压、血压负荷值(收缩压)增高,昼夜节律减弱或消失,2组间比较差异有显著性。DCG室性心律失常发生率明显高于对照组。结论老年收缩期高血压患者ABPM多项指标与左心室肥厚、心肌缺血及心律失常有相关性。     

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...     

The benefit of treating isolated systolic hypertension

Isolated systolic hypertension affects over 15% of all people older than 60 years of age. In the elderly, systolic hypertension is a major modifiable cardiovascular risk factor. Systolic blood pressure is associated with higher risk of an adverse outcome. Diastolic blood pressure is inversely correlated with total mortality, independent of systolic blood pressure, highlighting the role of pulse pressure as risk factor. Three placebo-controlled outcome trials on antihypertensive drug treatment in older patients with isolated systolic hypertension have been published: the Systolic Hypertension in the Elderly Program (SHEP), the Systolic Hypertension in Europe (Syst-Eur) Trial, and the Systolic Hypertension in China (Syst-China) Trial. These three trials showed the benefit of antihypertensive drug treatment. A meta-analysis was done by pooling the patients from these three trials with a subset of patients with isolated systolic hypertension from five other trials in the elderly. The pooled results of 15,693 older patients with isolated systolic hypertension prove that antihypertensive drug treatment is justified if systolic blood pressure on repeated clinic measurements is 160 mm Hg or higher.     

高血压患者脉压与左心室肥厚构型及心功能的关系

目的　探讨药物规则治疗下高血压病 (EH)患者的脉压 (PP)与左心室肥厚 (L VH)构型及心功能的关系。方法　本研究回顾性分析 176例有或无 L VH的 EH患者的 PP与 L VH构型及心功能的相关性。结果　 1不对称性室间隔肥厚 (ASH)、对称性室间隔肥厚 (CH)及扩张性肥厚 (DH)三型肥厚组的 PP与无 L VH组相比 ,有明显的差别 ,CH和 DH组较大 (P均 <0 .0 1) ,尤以 DH组较甚。2随着 PP增大 ,左心室收缩及舒张功能均明显的降低。3L ogistic回归分析显示 ,PP与 EH患者左心功能不全发生存在明显的相关性 ,PP每增加 10 m m Hg,左心功能不全增加 30 % (95 % CI:1.2 3～ 1.37,P<0 .0 0 0 1) ;在对年龄和 EH病程进行校正后 ,PP每增加 10 m m Hg显示增加左心功能不全发生率 19% (95 % CI:1.13～ 1.2 5 ,P<0 .0 0 0 1)。结论　在药物规则治疗的 EH患者中 ,PP与 L VH构型具有一定的联系 ,PP是左心功能不全发生的一个重要和独立的相关因素 ;且随着 PP增大 ,左心室收缩及舒张功能均明显的降低。