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。     

老年男性高血压患者24h平均脉压与左室肥厚的关系

脉压（PP）作为心脑血管病发生和死亡的独立危险因子，已越来越多受到人们的重视。本文回顾性观察并比较老年高血压患者24h平均脉压（ABPP）与左室肥厚的关系，分析其临床意义。     

老年高血压病患者动态脉压与左心室肥厚及主动脉根部扩张的相关研究

目的　研究老年高血压病患者动态脉压 ( 2 4hPP)与左心室肥厚 (LVH)及主动脉根部 (AOD)扩张的相关关系。方法　对 118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 2 4hPP≥ 60mmHg( 1mmHg =0 13 3kPa)的患者 5 8例列为A组 ,2 4hPP <60mmHg的患者 60例列为B组。结果　A、B两组LVH和AOD扩张的发生率有非常显著的差异 (P <0 0 1)。左心室重量指数 (LVMI)与 2 4hPP、2 4h平均收缩压 ( 2 4hSBP)呈密切正相关 (r分别为 0 47、0 42 ,P均 <0 0 1) ,与脉压 (PP)和收缩压 (SBP)呈弱相关 (r分别为 0 2 5和 0 2 1,P均 <0 0 5 )。AOD与 2 4hPP、2 4hSBP、PP、SBP、年龄和病程密切正相关 (r分别为 0 5 9、0 49、0 45、0 3 7、0 2 9和 0 3 4,P均 <0 0 1)。结论　老年高血压病患者的 2 4hPP与LVH及AOD扩张密切相关 ,2 4hPP可作为评价抗高血压药物能否更好地减少高血压患者靶器官损害的重要指标之一     

脉压对高血压患者左室结构的影响

目的:探讨诊所脉压(PP)对高血压患者左室结构的影响。方法:选择291例高血压患者(高血压组)和107例正常血压者(正常组)。所有入选者测量非同日3次诊所血压,并进行超声心动图检查。2组均根据PP水平:<40mmHg(1mmHg=0·133kPa)、≥40~<50mmHg、≥50~<60mmHg、≥60mmHg分为A、B、C、D4个亚组。结果:高血压组左室质量指数(LVMI)随着PP增宽呈增大趋势,D亚组的LVMI为175·56±30·20;而在正常组中,不同亚组间LVMI差异无统计学意义。结论:PP升高是高血压患者左室肥厚及左室结构异常的重要危险因素。     

高血压病患者24小时平均脉压与左室肥厚关系的临床研究

目的探讨高血压病（EH）患者24h平均脉压（APP）与左室肥厚（LVH）的关系。方法对90例高血压病患者进行24h动态血压监测及心脏超声检查，根据有无LVH分为两组：LVH组和非LVH组，再以PP≥60mmHg、PP〈60mmHg分为2个亚组。结果LVH组与非LVH组24hAPP分别为（76．3±16．5）mmHg和（56．3±10．6）mmHg，收缩压分别为（156．4±7．26）mmHg和（146．7±11．0）mmHg，差异均有统计学意义（P〈0.05）；而两组舒张压分别为（92．5±5．17）mmHg和（90．2±6．25）mmHg，差异无统计学意义（P〉0.05）；PP≥60mmHg组LVH发生率较PP〈60mmHg组显著增加（P〈0.01）。结论高血压患者24hAPP与LVH密切相关，脉压增大是心血管病的危险因素。     

老年原发性高血压患者动态脉压与靶器官损害的相关性研究

目的通过对老年原发性高血压患者临床资料分析,探讨老年原发性高血压患者动态脉压与靶器官损害的关系.方法入选老年原发性高血压患者96例,按动态脉压分为脉压40～60mmHg(1 mmHg=0.133kPa)组45例和脉压＞60mmHg组51例.对入选患者做以下检查心电图、超声心动图、24小时动态血压、头颅计算机断层摄影术、颈动脉超声,并查血肌酐、尿白蛋白.结果脉压＞60mmHg组左心室重量指数、颈动脉内膜厚度、尿白蛋白定量、左心室舒张末期内径、颈动脉斑块指数均高于脉压40～60mmHg组(P＜0.05～0.01),靶器官损害发生率高于脉压40～60mmHg组(P均＜0.05);直线相关分析示颈动脉内膜厚度与收缩压、脉压、脉压变异相关.左心室重量指数与收缩压、收缩压变异、舒张压、脉压、脉压变异相关;多因素逐步回归分析得到逐步回归方程,提示颈动脉内膜厚度与脉压呈正相关,左心室重量指数与脉压及脉压变异成正相关.结论老年原发性高血压患者靶器官损害与增大的脉压有关,脉压是颈动脉内膜增厚和左心室肥厚的危险因素之一.     

老年人高血压患者脉压与左室肥厚的临床探讨

目的探讨老年高血压患者24h脉压(PP)与左心室肥厚的关系。方法对175例老年高血压患者分别用动态血压记录仪监测动态血压,根据血压检测结果按24h平均脉压(ABPP)分为≥60mmHg组和<60mmHg组,采用多普勒超声心动图(UCG)测量左室内径(EDd),室间隔厚度(IVST),左室后壁厚度(LVPWT),计算射血分数(EF)、左室重量(LVM)及重量指数(LVMI),并将两组年龄、性别及发生室性心律失常、心力衰竭的临床资料进行分析。结果(1)在年龄、性别上两组差异无显著意义。(2)ABPP≥60mmHg组的LVMI及影响LVMI的3大因素EDd、IVST、LVPWT的值高于ABPP<60mmHg组,EF则低于<60mmHg组(P<0.01)。(3)对两组发生室性心律失常、心力衰竭的例数有显著性意义(P<0.01)。结论老年人24h平均脉压增大与左心室肥厚呈正相关,易发生左心室肥厚、室性心律失常及心力衰竭,有一定的临床意义。     

老年人高血压患者脉压与左室肥厚的临床探讨

目的 探讨老年高血压患者24 h脉压(PP)与左心室肥厚的关系.方法 对175例老年高血压患者分别用动态血压记录仪监测动态血压,根据血压检测结果按24 h平均脉压(AB-PP)分为≥60 mm Hg组和＜60 mm Hg组,采用多普勒超声心动图(UCG)测量左室内径(Edd),室间隔厚度(IVST),左室后壁厚度(LVPWT),计算射血分数(EF)、左室重量(LVM)及重量指数(LVMI),并将两组年龄、性别及发生室性心律失常、心力衰竭的临床资料进行分析.结果 (1)在年龄、性别上两组差异无显著意义.(2)ABPP≥60 mm Hg组的LVMI及影响LVMI的3大因素Edd、IVST、LVPWT的值高于ABPP＜60 mm Hg组,EF则低于＜60 mm Hg组(P＜0.01).(3)对两组发生室性心律失常、心力衰竭的例数有显著性意义(P＜0.01).结论 老年人24 h平均脉压增大与左心室肥厚呈正相关,易发生左心室肥厚、室性心律失常及心力衰竭,有一定的临床意义.     

老年单纯性收缩期高血压的24h血压及脉压特征

目的　了解老年单纯性收缩期高血压的 2 4h动态血压特征及脉压情况。方法　收集 2 0 0 1年以来门诊及病房的老年单纯性收缩期高血压 12 1例 ,男 5 3例 ,女 6 8例 ,年龄≥ 6 0岁。所有患者均作 2 4h动态血压监测。结果　随着年龄的增加 ,老年单纯收缩期高血压患者的诊室、2 4h、白天及夜间的收缩压 (SBP)均有不同程度的升高 ,舒张压 (DBP)却有不同程度的下降 ;所有患者的脉压 (PP)均明显增大 (PP >6 5mmHg) ;不同年龄组之间 2 4h、白天、夜间的PP随着年龄的增大而增加 (P <0 .0 5 )。年龄 >70岁组的 2 4h和白天的DBP水平显著低于年龄≤ 70岁组 (P <0 .0 5 )。体重指数 (BMI)≥ 2 5患者组的 2 4h平均SBP、夜间平均SBP及DBP均高于BMI<2 5组 (P <0 .0 5 )。动态血压的夜间SBP和DBP的下降率分别为 4 .6 %和 7.0 % ,昼夜节律减弱。白天和夜间的SBP负荷明显增加 ,而DBP负荷正常。结论　随着年龄的增大 ,老年单纯收缩期高血压患者的诊室、2 4h、白天及夜间的SBP均有升高 ,SBP负荷和脉压明显增加 ;昼夜节律减弱     

高血压病患者脉压与左室肥厚的关系

左室肥厚 (L VH)是心脏事件的危险因子。近年来的研究表明 :脉压 (PP)增大是预测心血管事件的独立因子 ,用动态血压监测发现 PP的大小与左室的质量指数相关 [1 ]。作者通过 132例高血压病患者的 2 4 h动态血压监测 (2 4 h ABPM) ,探讨其血压及 PP与 L VH的关系。1　对象和方法1.1　对象　　符合 1999- 10发布的《中国高血压防治指南》之诊断标准的高血压病患者 132 (男 75 ,女 5 7)例 ,年龄 5 9± 13岁。排除了继发性高血压。按 L VH(符合 UCG、ECG和X线胸片任一诊断标准者 )与否分为 L VH组和非 L VH组 ;再以 PP≤ 6 0 m m H…     

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.     

尿毒症患者左室结构功能的改变及其影响因素

目的 :了解尿毒症患者心脏收缩和舒张功能、形态结构改变 ,探讨贫血、高血压及营养状况与心脏结构功能改变的关系。　 方法 :回顾性分析 170名尿毒症患者和 4 0名健康志愿者彩色多普勒超声心动图图象及其同期的血压、血红蛋白和血浆白蛋白水平之间的关系。　 结果 :170例尿毒症患者超声心动图的分析结果显示 ,分别有 11 8%和 80 %存在左室收缩功能不全和左室舒张功能不全 ,患者左室心肌质量指数 (LVMI)为 (118 7± 32 2 )g/m2 ,室间隔厚度 (IVST)为 (11 6± 2 14 )mm ,左室后壁厚度 (PWTH)为 (11 4± 1 93)mm ,左房内径 (LAd)为 (39 4±6 5 9)mm ,均显著高于健康对照组 (P <0 0 1)。 6 1 8%患者存在左心室肥厚。患者收缩压 (SBP)、舒张压 (DBP)与LVMI、IVST、PWTH、LAd呈显著正相关 ;血浆白蛋白水平与PWTH、LAd呈显著负相关 ,与射血分数、血红蛋白呈显著正相关。　 结论 :尿毒症患者左室舒张功能不全和左心室肥厚多见 ,且发生较早。上述心脏结构及功能的改变可能与高血压、营养不良等因素相关。     

高血压患者左室肥厚及主动脉根内径与动态血压的关系

目的探讨ＡＢＰ与左室后壁厚度（ＬＶＰＷＴ），室间膈厚度（ＩＶＳＴ）及主动脉内径（ＡＯＤ）之间的联系。方法对８８例原发性高血压患者应用超声心动图及动态血压计同时测定其ＬＶＰＷＴ、ＩＶＳＴ、ＡＯＤ及动态血压各参数值。结果左室肥厚（ＬＶＰＷＴ或／和ＩＶＳ）者５０例，主动脉根扩张者６０例。相关分析显示ＬＶＰＷＴ、ＬＶＳＴ及ＡＯＤ、动态血压各参数平均值呈显著正相关（Ｐ＜０．０５），其中与２４ｈ平均收缩压、最高收缩压及夜间平均收缩压相关最密切（Ｐ＜０．０１），此外ＬＶＰＷＴ，ＩＶＳＴ及ＡＯＤ与２４ｈ最高收缩压与最低收缩压之差（ΔＡＢＰｓ）及２４ｈ最高舒张压与最低舒张压之差（ΔＡＢＰｓ）亦呈正相关（Ｐ＜０．０５），其中与ΔＡＢＰｓ相比更密切（Ｐ＜０．０１）。结论血压波动性是左室肥厚及主动脉根内径的影响因素。     

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     

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.     

高血压并发心脑靶器官损害的动态血压特征

目的探讨高血压有心脑合并症时的昼夜血压变化的规律。方法６８例高血压患者中１６例有左室肥厚，１６例有左室肥厚伴脑血管意外，１２例有脑血管意外；２４例未发现有心脑并发症作为对照。全部患者作动态血压测定。结果有并发症的三组患者以收缩压和舒张压共同升高，夜间下降率＜１０％，血压昼夜波动成为非杓型为特点。心室肥厚组日间血压和对照组无明显差异，而脑血管意外组具有清晨血压升高的特点。结论血压的昼夜波动变化与高血压患者合并症的发生有密切关系。     

高血压病左室结构功能变化与血浆内皮素的相关性

目的 :探讨高血压病患者左室结构 ,功能变化与血浆内皮素 （ET）的关系。方法 :原发性高血压不伴左室肥厚（L VH）组 （EH） 35例 ,伴 L VH组 （EH+ L VH） 2 8例 ,正常对照组 30例。放射免疫法测定血浆 ET水平 ,超声心动图检测心脏结构与功能。计算左室重量指数 （L VMI） ,平均室壁厚度 （MWT） ,相对室壁厚度 （RWT）。结果 :EH组及 EH+ L VH组血浆 ET高于正常对照组 （P<0 .0 1） ,EH + L VH组 ET高于 EH组 （P<0 .0 1） ,ET与 L VMI,MWT室间隔厚度 ,左室后壁厚度呈正相关 （r分别为 0 .42 4,0 .316 ,0 .2 6 8和 0 .317,均 P<0 .0 1） ,ET与 E/ A呈负相关 （r=-0 .30 4,P<0 .0 1）。结论 :ET与高血压和 L VH相关。     

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.     

Nurse-recorded clinic and ambulatory blood pressures correlate equally well with left ventricular mass and carotid intima-media thickness

OBJECTIVE: To assess relationships between noninvasive ambulatory blood pressure (BP), clinic BP (mean value of three readings in the seated position measured by nurses), structural cardiac indices, intima-media thickness of the common carotid artery and several hormones. DESIGN: Cross-sectional study of 75 subjects with hypertension and left ventricular hypertrophy (HTH) according to echocardiography, 35 subjects with hypertension and normal left ventricular dimensions (HT) and 23 normotensive subjects (NT). RESULTS: We found an excellent correlation between mean 24-h ambulatory BP and clinic BP, the r-value for systolic BP being 0.82 and for diastolic levels 0.78 (both P < 0.0001). Clinic and ambulatory BP correlated equally well with left ventricular (LV) mass index (r-values between 0.55 and 0.64, all P < 0.0001) and to intima-media thickness of the carotid artery (r = 0.18-0.34, P < 0.01). The systolic white-coat effect (clinic BP - day-time BP) was higher in the HTH and HT compared with NT and was weakly correlated to LV mass index (r = 0.18, P = 0.04). Nondippers (mean arterial night/day BP ratio of > 0.9) had higher brain (6.1 +/- 7.5 pmol L(-1) vs. 3.7 +/- 3.2 pmol L(-1), P = 0.01) and atrial (14 +/- 3.4 pmol L(-1) vs. 9.3 +/- 5.4 pmol L(-1), P = 0.04) natriuretic peptide levels, and also exhibited a lower ejection fraction (49 +/- 8% vs. 57 +/- 9%, P = 0.006), than dippers. CONCLUSION: Clinic BP recordings performed by nurses as three measurements 1 min apart provide excellent relationship to target organ damage. Nondippers exhibited signs of a more advanced hypertensive organ damage than dippers which corresponds well with the poor prognosis linked to this condition.     

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。