血压动态变量及心率变异性与原发性高血压左室重构的关系

目的利用动态血压和动态心电图监测技术分析其血压动态变量及心率变异性(HRV)指标与原发性高血压患者左室重构的关系。方法选择1,2级原发性高血压病患者168例进行超声心动图、动态血压及动态心电图检查,依据左室构型将高血压病患者分为第1,2,3,4组,4组分别为正常左室构型、向心性重构、向心性肥厚和离心性肥厚的患者。对4组的动态血压各项指标及HRV时域指标进行统计分析。结果4组间收缩压各项指标均有显著差异(P<0.05)。第3,4组的24h平均收缩压、夜间平均收缩压和收缩压负荷值均较第1,2组高,第3组的白昼平均收缩压较其他3组高。第3,4组的夜间舒张压较第1,2组高。第3,4组的HRV各时域指标较第1,2组均下降,其三项指标降低有显著性(P<0.05)。结论收缩压水平和HRV异常是高血压左室构型改变的重要危险因素。     

老年高血压左室肥厚患者左室重构和冠脉病变探析

目的探讨老年高血压左心室肥厚患者左心室以及冠状动脉病变。方法选择曾在海安县人民医院进行治疗的120例老年高血压患者,在这120例患者中,有60例伴有左心室肥厚,将其作为观察组,另外60例患者未伴左心室肥厚,将其作为对照组,对两组患者均行心脏超声检查以及冠状动脉检查,并且对两组患者的检查结果进行比较分析。结果在完成检查之后,比较两组患者左心室扩张、冠状动脉高度狭窄与冠状动脉完全闭塞以及左心室体积增大所出现的患者人数,观察组中患者例数明显高于对照组患者,两组患者之间存在显著差异。结论对于老年高血压患者,若其伴左心室肥厚,则患者左心室重构率以及冠状动脉病变率均比较高,在临床上应加强注意。     

原发性高血压左室重构与血压、胰岛素抵抗的关系

60例原发性高血压（EH）患者监测血压,测定空腹血糖和胰岛素,同时应用超声心动仪测定心脏结构。结果向心性重构组和向心性肥厚组胰岛素敏感指数明显小于正常构型组,向心性肥厚组和离心性肥厚组收缩压显著高于正常构型组;与正常构型组比较,向心性重构组舒张末期左室内径（LVDd）明显缩小,离心性肥厚组LVDd明显增大;向心性重构组、向心性肥厚组和离心性肥厚组室间隔厚度（IVST）、左室后壁厚度（LVPWd）显著厚于正常构型组,差异均有统计学意义（P〈0．05）。认为血压和胰岛素抵抗对高血压患者左室重构存在重要影响。     

高血压左室肥厚的组织重构

高血压左室肥厚的组织重构胡英蔡乃绳在高血压病人中，约有三分之一会出现左室肥厚（ＬＶＨ），ＬＶＨ已被认为是独立于高血压的心血管病的危险因素，部分高血压病人ＬＶＨ甚至会先于高血压出现［１］。超声技术的发展，使人们对高血压病的左室形态及功能有了清晰的了解。...     

缬沙坦与胰激肽原酶合用逆转自发性高血压大鼠左室重构的机制

目的探讨缬沙坦（Val）和胰激肽原酶（PK）联合应用对自发性高血压大鼠（SHR）左心室重构的作用及对血管紧张素Ⅱ（AngⅡ）水平、血清一氧化氮（NO）含量的影响。方法选用雄性15周龄的SHR24只、WKY大鼠8只，分为4组：SHR组、PK组、Val＋PK组、WKY组，实验期4w。放免法测定AngⅡ、化学法检测血浆NO水平、常规测量各组血收缩压（SBP）、左心室重量指数（LVMI）、心肌胶原体积比例（CVF）和心肌血管周围胶原与管腔面积的比例（PVCA）。结果SHR组的SBP、LVMI、CVF、PVCA、AngⅡ水平明显增高而血清NO含量明显下降，较WKY组有显著差异（P〈0．01）；治疗组（PK组、Val＋PK组）SBP、LVMI、CVF及PVCA均显著下降（P〈0．01），血清NO水平明显升高（P〈0．01），Val＋PK组血浆AngⅡ水平显著上升（P〈0．01），而心肌AngⅡ水平明显下降P〈0．01），PK组心肌局部和血浆AngⅡ变化不明显。结论PK能有效的改善高血压左室重构，与Val合用效果更佳。     

高血压病左室肥厚患者动态血压监测结果的分析

为探讨高血压病合并左室肥厚 ( LVH)患者动态血压变化规律及临床意义 ,我们对 70例高血压患者的 2 4小时动态血压 ( ABPM)进行了监测 ,现将结果报告并分析如下。1　资料与方法70例高血压患者均符合 WHO制定的诊断标准 ,除外继发性高血压。高血压病伴 LVH40例 (观察组 ) ,男 2 5例 ,女 1 5例 ;年龄 45～ 64( 5 8± 4)岁。高血压不伴 LVH30例 (对照组 ) ,男 2 0例 ,女 1 0例 :年龄38～ 62 ( 5 2± 6)岁 ;均为 期高血压。两组均停用降压药物 1周 ,采用超声心动图测量舒张期室间隔厚度 ( IVST)、左室后壁厚度 ( PWT)和左室舒张末期内…     

辛伐他汀对高血压左室重构的影响

目的探讨辛伐他汀对高血压左室重构的影响.方法选择1级、2级高血压病患者62例,随机分成辛伐他汀组(32例)和对照组(30例).均以卡托普利(25 mg, Tid)和双克(12.5～25 mg, Qd)控制血压.辛伐他汀组加用辛伐他汀20 mg, Qd.观察治疗12周.分别于药物治疗前后测定左室重量指数(LVMI)和血清Ⅲ型前胶原(PCⅢ)浓度.结果两组患者药物治疗后在血压降低的同时LVMI及血清PCⅢ浓度也较治疗前降低(P<0.05或P<0.01).辛伐他汀组对血清PCⅢ浓度的降低较对照组更明显(P<0.05),而对LVMI的降低两组间则无显著性差异.结论辛伐他汀可能具有逆转高血压心肌纤维化改善左室重构的作用,这些治疗引起的变化可能发生于左室重构逆转之前.     

原发性高血压左室肥厚与动态脉压及血压变异性的关系

目的探讨原发性高血压（EH）病人左室肥厚（LVH）与动态血压及血压变异性的关系。方法EH病人121例,行心脏彩色B超及24h动态血压检查。根据左室质量指数（LVMI）将EH病人分为LVH组与无LVH组,LVH组63例,无LVH组58例,分析两组病人的动态血压各参数的变化。结果LVH组动态脉压（包括24h、白天及夜间平均脉压）均高于无LVH组（P〈0.01）,而24h收缩压变异性低于无LVH组（P〈0.01）,LVMI与夜间平均脉压及24h收缩压变异性分别呈独立相关（偏回归系数分别为0.303与-0.165）。结论动态脉压及血压变异性是EH病人合并LVH的独立预测指标,它们在LVH的发生发展中所起的作用仍有待进一步研究。     

心电图对原发性高血压左室肥厚的诊断意义

目的探讨心电图（ECG）对原发性高血压（EH）左心室肥厚（LVH）的诊断意义。方法收集108例EH者的超声心动图（UCG）与ECG资料。并对两者结果进行对比分析。结果UCG对LVH的检出率为73．15％，ECG对LVH的检出率为34．26％。结论ECG对EHLVH有一定的诊断价值。结合UCG后可提高诊断的准确性。     

厄贝沙坦对原发性高血压患者左心室重构的影响

<正>高血压左室重构是心脏事件的重要独立危险因素,与心率失常、猝死、心力衰竭等密切相关[1]。2008年8月至2009年12月我们对42例原发性高血压伴左心室肥厚的住院患者,用厄贝沙坦治疗6个月,观察其降压疗效及对左心室重构的影响,现总结如下。     

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。     

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.     

Effects of lisinopril vs hydralazine on left ventricular hypertrophy and ambulatory blood pressure monitoring in essential hypertension

In order to compare the long-term effects on ambulatory bloodpressure and left ventricular hypertrophy of hydralazine andlisinopril we studied 30 patients, all , nales, still hypertensive(diastolic blood pressure 95 mmHg) despite combined beta-blockerldiuretictherapy and with echocardiographic evidence of left ventricularhypertrophy (left ventricular mass index 131 g. m^–1)They were randomized to receive hydralazine slow release 50mg twice daily or lisinopril 20mg once daily in addition toprevious therapy (atenolol 50 mglchlorthalidone 125 mg) for6 months. Casual blood pressure, non-invasive ambulatory bloodpressure monitoring (ABPM), M-mode echocardiogram, plasma reninactivity and plasma catecholamines were evaluated before therandomization and after 6 months of treatment. Both drugs significantlyreduced casual as well as daytime systolic and diastolic bloodpressure, without statistical differrences between the two treatments.Lisinopril was sign more effective than hydralazine in reducingnight-time systolic and diastolic blood pressure. Plasma norepinephrinewas significantly reduced by lisinopril and increased by hydralazine.Left ventricular mass was significantly reduced by lisinoprilbut not by hydralazine. The results of linear regression andmultiple regression analysis suggested that the lisinopril-induceddecrease in both day- and night-time blood pressure might accountfor the regression of left ventricular hypertrophy, whereasthe lack of left ventricular hypertrophy regression during hydralazinetreatment could be due mainly to the reflex sympathetic activationinduced by the drug.     

原发性高血压24小时脉压与左心室肥厚

目的：探讨原发性高血压患者脉压与左心室肥厚的关系。方法：97例原发性高血压患者按脉压高低被分为≤60mmHg和〉60mmHg两组。超声心动图测量舒张末期室间隔厚度、舒张末期左心室内径、舒张末期左心室后壁厚度。求出左心室质量指数（LVMI）。结果：高脉压组年龄较大．LVMI显著高于低脉压组[（135．3±23．5：（115．7±25．2）,P〈0．01]。结论：24h脉压高者更易发生左心室肥厚。     

原发性高血压患者血压变异性与左心室质量指数的相关性分析

目的探讨原发性高血压患者血压变异性(blood pressure variability,BPV)与左心室质量指数(left ventricular mass index,LVMI)的相关性。方法选择我院住院的原发性高血压患者95例,根据心电图、彩色超声心动图检查确定是否伴有左心室肥厚(left ventricular hypertrophy,LVH)分为LVH组42例及无LVH组53例,另选择血压正常且无LVH的健康体检者40例为对照组,收集3组一般临床资料,检测同型半胱氨酸(Hcy)水平,进行24 h动态血压监测,比较3组24 h、夜间、昼间平均血压、收缩压标准差和舒张压标准差及LVMI。结果3组年龄、体质量指数、吸烟、尿酸、血红蛋白、血脂、糖化血红蛋白及各时间段内平均血压比较,差异无统计学意义(P>0.05);3组性别、糖尿病比例、Hcy、肌酐、LVMI及24 h、夜间、昼间收缩压标准差和舒张压标准差比较,差异有统计学意义(P<0.05,P<0.01)。LVH组男性比例、Hcy、LVMI及24 h、夜间、昼间收缩压标准差和舒张压标准差明显高于无LVH组和对照组(P<0.05),LVH组和无LVH组糖尿病比例和肌酐水平明显高于对照组,差异有统计学意义[59.5%和56.6%vs 7.5%,(92.0±4.8)μmol/L和(81.3±15.9)μmol/L vs(65.4±13.2)μmol/L,P<0.05]。无LVH组与对照组LVMI及24 h、夜间、昼间收缩压标准差和舒张压标准差比较,差异无统计学意义(P>0.01)。LVH组非杓型高血压比例明显高于无LVH组和对照组(85.7%vs 34.0%、5.0%,P=0.000)。结论BPV与高血压患者的LVH关系密切,其可能作为靶器官损伤最新的独立预测因素。     

Automated versus observer blood pressure as determinants of left ventricular structure.

We studied the contribution of automated blood pressure measurements to the variation in left ventricular structural characteristics, independent of pressure measured by an observer. Thirty eight patients referred for hypertension underwent 24 h blood pressure monitoring. Echocardiography and repeated blood pressure measurements were taken on 2 different days by an observer and by the use of the Dinamap 845 device. Blood pressure by the observer averaged 157/101 mmHg, Dinamap pressure 152/94 mmHg, 24 h pressure 137/92 mmHg, left ventricular mass 218 g and mean wall thickness 12.7 mm. Left ventricular mass and wall thickness were related (P < 0.05) to systolic observer (r = +0.46; r = +0.47), Dinamap (r = +0.42; r = +0.41) and 24 h blood pressure (r = +0.46; r = +0.53); the correlation coefficients were lower (r = +0.35 to +0.51; P < 0.05) for diastolic pressure. These relations were independent of age, gender, height, weight and heart rate. The Dinamap pressure did not contribute to the difference in the left ventricular structural characteristics, independent of the observer pressure. The 24 h ambulatory pressure explained a small but significant (P < 0.05) fraction of the variation in mean wall thickness in addition to the observer pressure. Left ventricular mass and mean wall thickness were not related to the day-night difference in blood pressure (P > 0.25). In conclusion, observer, Dinamap and ambulatory pressures are significantly related to cardiac structural variables. Ambulatory pressure, but not Dinamap pressure, explains a small part of wall thickness variance in addition to well-standardized pressure measured by an observer.     

原发性高血压患者血清尿酸与左室重塑的相关研究

目的探讨高血压左室重塑的代谢因素。方法对80例原发性高血压患者测定血脂、血糖、尿酸、胰岛素及C-肽。将患者分为正常尿酸组和高尿酸组；超声心动图检查测定腔室径大小，计算左室质量。用T检验比较组间差别，多元回归分析代谢因素与左室重塑的关系。结果年龄、血脂、血糖、胰岛素、C-肽在两组差异无统计学意义，左室质量两组差异有统计学意义（P=0．022）；经多元线性回归分析表明：尿酸与左室重量之间有统计学意义（偏回归系数0．168，P=0．013）。结论尿酸可能在原发性高血压左室重塑中起一定作用。     

Increased left ventricular mass index and nocturnal systolic blood pressure in patients with Type 2 diabetes mellitus and microalbuminuria.

AIMS: To compare left ventricular mass (LVM) index and function in patients with Type 2 diabetes mellitus with and without microalbuminuria and to investigate the clinical determinants of left ventricular hypertrophy. METHODS: Echocardiography, electrocardiography and 24-h ambulatory blood pressure monitoring were performed in microalbuminuric (n = 29) and normoalbuminuric (n = 29) patients with Type 2 diabetes and no clinical evidence of heart disease. Groups were individually matched for age, sex and diabetes duration and smoking status. RESULTS: LVM index (62 (34-87) vs. 52 (33-89) g/m2.7, P = 0.04) and LVH prevalence, using two out of three definitions, were greater in patients with microalbuminuria (LVM/height2.7: 72 vs. 59%, P = 0.27, LVM/height: 66 vs. 38%, P = 0.04, LVM/body surface area: 59 vs. 31%, P = 0.03). Night-time systolic blood pressure (126 (99-163) vs. 120 (104-157) mmHg, P = 0.005) and the night/day systolic blood pressure ratio (0.92 (0.08) vs. 0.88 (0.06), P = 0.04) were higher in those with microalbuminuria. Systolic and diastolic function were similar in both groups. Linear regression analyses showed that body mass index (BMI) was significantly related to loge LVM index (R2 = 11.8%, P = 0.005) and a relationship with night/day systolic blood pressure was also suggested (R2 = 4.6%, P = 0.057). CONCLUSIONS: In patients with Type 2 diabetes, LVH is more common and severe in those with microalbuminuria. Its presence may be related to raised night/day systolic blood pressure ratio and is significantly related to BMI. The high prevalence of LVH strengthens the case for echocardiographic screening in Type 2 diabetes to identify high risk patients who might benefit from aggressive cardiovascular risk factor intervention.     

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。