Blood pressure and left ventricular hypertrophy in patients on different peritoneal dialysis regimens.

OBJECTIVE: To examine the relation between the results of ambulatory 24-hour blood pressure monitoring (ABPM) and left ventricular mass index (LVMI), then to find the independent determinant for left ventricular hypertrophy (LVH) in peritoneal dialysis (PD) patients. Finally, to evaluate the differences in the clinical and cardiovascular characteristics between patients on continuous ambulatory PD (CAPD) and continuous cyclic PD (CCPD). DESIGN: An open, nonrandomized, cross-sectional study. SETTING: Divisions of nephrology and cardiology in a medical center. PATIENTS: Thirty-two uremic patients on maintenance PD therapy (22 patients on CAPD, and 10 on CCPD) without anatomical heart disease or history of receiving long-term hemodialysis. INTERVENTIONS: Home blood pressure (BP) and office BP were measured using the Korotkoff sound technique by sphygmomanometer. ABPM was employed for continuous measurement of BP. Echocardiography was performed for measurement of cardiac parameters and calculation of LVMI. MAIN OUTCOME MEASURES: Multivariate logistic regression analysis was performed for independent determinant of LVH in PD patients. The differences in clinical and cardiovascular characteristics between CAPD and CCPD patients were compared. RESULTS: Simple regression analysis showed positive correlations between LVMI and the duration of hypertension, ambulatory nighttime BP/BP load/BP load > 30%, serum phosphate, calcium-phosphate product, ultrafiltration (UF) volume, and percentage of UF volume during the nighttime. A negative correlation was noted between LVMI and dipping. In multiple regression analysis, the duration of hypertension was the only variable linked to LVMI. In multivariate logistic regression analysis, only ambulatory nighttime systolic BP load > 30% had an independent association with LVH.There were correlations between office/home BP and ambulatory 24-hour BP. In addition, CCPD patients had higher LVMI, UF volume during the nighttime, and percentage of UF volume during the nighttime than those of CAPD patients. CONCLUSIONS: In this study, ambulatory nighttime systolic BP load > 30% had an independent association with LVH. Office and home BP measurements were correlated with ABPM in PD patients. The result that CCPD patients had a higher LVMI than CAPD patients may be due to a relative volume overload during the daytime in CCPD patients.     

Circulating natriuretic peptide concentrations in patients with end-stage renal disease: role of brain natriuretic peptide as a biomarker for ventricular remodeling.

OBJECTIVES: To determine levels of natriuretic peptides (NPs) in patients with end-stage renal disease (ESRD) and to examine the relationship of these cardiovascular peptides to left ventricular hypertrophy (LVH) and to cardiac mortality. PATIENTS AND METHODS: One hundred twelve dialysis patients without clinical evidence of congestive heart failure underwent plasma measurement of NP concentrations and echocardiographic investigation for left ventricular mass index (LVMI). RESULTS: Plasma atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) concentrations correlated positively with LVMI and inversely with left ventricular ejection fraction, whereas C-type NP and Dendroaspis NP levels did not correlate with LVMI. In dialysis patients with LVH (LVMI >125 g/m2), plasma ANP and BNP concentrations were increased compared with those in dialysis patients without LVH (both P<001). In a subset of 15 dialysis patients without LVH or other concomitant diseases, plasma BNP concentrations were not significantly increased compared with those in 35 controls (mean +/- SD, 20.1+/-13.4 vs 13.5+/-9.6 pg/mL; P=.06), demonstrating that the BNP concentration was not increased by renal dysfunction alone. Furthermore, the BNP level was significantly higher in the 16 patients who died from cardiovascular causes compared with survivors (mean +/- SD, 129+/-13 vs 57+/-7 pg/mL; P<.003) and was significantly associated with greater risk of cardiovascular death in Cox regression analysis (P<.001), as was the ANP level (P=.002). CONCLUSIONS: Elevation of the plasma BNP concentration is more specifically related to LVH compared with the other NP levels in patients with ESRD independent of congestive heart failure. Thus, BNP serves as an important plasma biomarker for ventricular hypertrophy in dialysis patients with ESRD.     

Hypertensive left ventricular hypertrophy is linked to an enhanced catecholamine response to submaximal exercise.

BACKGROUND: The serial plasma catecholamine response to exercise has not been studied fully in relation to left ventricular hypertrophy (LVH) in patients with hypertension (HT). This study determined whether plasma catecholamine responses to exercise are altered in essential HT in the presence or absence of LVH. MATERIALS AND METHODS: Plasma noradrenaline (NA) and plasma adrenaline (A) were measured at rest, during and after treadmill exercise in 59 hypertensive subjects and 22 age-matched control subjects. Patients were divided into LVH(-) (n = 20) and LVH(+) (n = 39) stratified by left ventricular mass index [LVMI: control subjects, LVH(-), LVH(+): 114 +/- 4, 105 +/- 3, 151 +/- 3 g m-2]. RESULTS: Exercise time (9.9 +/- 0.6, 7.6 +/- 0.7, 7.3 +/- 0.6 min) was shorter in patients with HT. Both systolic and diastolic blood pressures were higher in patients with HT, and no difference was observed between LVH(-) and LVH(+) patients. Resting plasma NA was not different (157 +/- 16, 173 +/- 17, 167 +/- 14 pg mL-1), but plasma NA at stage I (300 +/- 30, 342 +/- 40, 469 +/- 40 pg mL-1) was higher in LVH(+) patients than in LVH(-) patients or control subjects. Plasma A response to exercise was similar among the three groups. There was a positive correlation (r = 0.38, P < 0.001) between LVMI and Deltaplasma NA at stage I in all subjects. CONCLUSIONS: Patients with essential HT with LVH had augmented plasma NA response during submaximal exercise, whereas patients without LVH did not exhibit this augmentation. The positive correlation between LVMI and Deltaplasma NA suggested a possible association between the degree of cardiac hypertrophy and sympathetic activation during exercise.     

Pulse blood pressure (according to 24-hour monitoring) and left ventricular myocardial structural changes in patients with hypertensive disease

AIM: To study a relationship of the magnitude of structural changes in the left ventricle (LV) to the mean daily pulse blood pressure (PBP) in patients with hypertensive disease (HD). MATERIALS AND METHODS: 70 male patients (mean age 49 +/- 1 years) with stages I (n = 54) to 11 (n = 16) HD. LV mass (LVM) was estimated by echocardiography according to the formula derived by R. B. Devereux et al. and normalized to body surface area [the LVM index (LVMI)]. The relative thickness index (RTI) for the posterior wall (PWRTI) and ventricular septum (VSRTI) was calculated as a ratio of the sum of PWRTI and VSRTI to the LV end-diastolic size. LVMI > 125 g/m2 was considered to be a criterion for LV hypertrophy (LVH). 24-hour blood pressure (BP) monitoring was performed with a Spacelabs-90207 device (USA). According to the 24-hour PBP value, the patients were divided into 2 groups: 1) those (n = 17) having PBP24 > 53 mm HG and 2) those (n = 53) having PBP24 < 53 mm Hg. RESULTS: Group 1 patients were found to have significantly higher LVMI, LV WRTI, and incidence of LVH and a complex of changes in the BP profile as higher values of 24-hour systolic, diastolic and mean BP, PBP, and BP variations. Multiple regression analysis revealed a highly significant contribution of PBP24 to the development of LVH. CONCLUSION: The pedictive value of PBP as an index that characterizes a dynamic pressure load in regard to LV structural changes is higher than that of mean BP as a static load index and a BP variation index.     

Regression of left ventricular hypertrophy with moexipril, an angiotensin-converting enzyme inhibitor, in hypertensive patients

Left ventricular hypertrophy (LVH) is a common complication of essential hypertension and an independent risk factor for the development of cardiovascular disease. Therefore, antihypertensive treatment should decrease blood pressure (BP) and reverse LVH. However, antihypertensive drugs have been shown to have different effects on LVH despite similar effects on BP reduction. Although lowering BP produces a beneficial effect on LVH per se, meta-analyses of clinical trials have indicated that angiotensin-converting enzyme (ACE) inhibitors decrease left ventricular mass (LVM) to a greater extent than do some other antihypertensives. The aim of this study was to evaluate the effect of a 24-week treatment with the ACE inhibitor moexipril (15 mg once daily) on the regression of LVH in hypertensive patients. This was a multicenter, international, single-blind, single-group, nonrandomized study. After a wash-out placebo period of 2 weeks, 15 mg moexipril once daily was administered for 24 weeks followed by a 2-week follow-up placebo period. Subjects with mild to moderate essential hypertension were screened; those with LVH [defined as an LVM indexed for body surface area (LVMIs) >111 g/m in men and LVMIs >106 g/m in women] were eligible to participate in this study. Echocardiograms were recorded on videotape and sent to a centralized laboratory for reading by 2 independent experts blinded for treatment, center, and visit; the mean values of these readings were calculated and used for analysis. Valid echocardiographic data were obtained from 72 patients (50 males, 22 females) with a mean age of 49 +/- 11 years. Analysis showed significant decrease of LVMIs (121 +/- 20 versus 103 +/- 17 g/m; P < 0.001) and BP (152 +/- 12/96 +/- 9 versus 140 +/- 13/86 +/- 9 mm Hg; P < 0.001) with moexipril. For patients who met LVMI inclusion criteria after centralized, blinded readings, the decrease from baseline in LVMIs was 23.4 g/m. The decrease in LVMIs was independent from the regression to the mean phenomenon as observed from the follow-up placebo period. Moexipril 15 mg once daily administered for 24 weeks resulted in a significant reversal of LVH in patients with essential hypertension. The result compares favorably with results previously obtained in trials of similar duration with other ACE inhibitors.     

透析治疗对终末期肾病患者左心室肥厚的影响

目的 探讨不同透析方式-血液透析(HD)和腹膜透析(PD)对终末期肾病患者左心室肥厚(LVH)的影响及相关因素.方法入选透析中心透析龄大于3月的HD患者48例和PD惠者62例,并选取慢性肾脏病(CKD)3～5期患者43例作为对照.所有患者均测量血压、血容量、生化指标,行超声心动图检查,获得左心室质量指数(LVMI);HD患者于透后1小时内检查.PD和CKD患者于每月门诊复诊时空腹状态下检查.结果 3组患者的基线资料差异无统计学意义.HD患者的收缩(SBP)(156.7±28.4)mmHg明显高于PD(147.7±20.6)mmHg(P<0.05)和CKD患者(143.4±21.9)mmHg(P<0.01);HD患者透后的细胞外液(ECW)(14.51±2.51)L低于PD(15.67±3.26)L和CKD患者(15.84±3.27)L(P均<0.05);HD患者的LVMI 137.6±38.5显著高于PD 116.2±34.5和CKD患者104.5±30.0(均P<0.01),而PD和CKD患者的LVMI比较差异无统计学意义.根据Framingham标准HD、PD、CKD患者LVH发生率分别为68.8%、45.2%、32.6%.多元逐步回归分析显示SBP、透析方式(HD)、ECW均为LVMI的独立预测因素(r2=0.364,P<0.01).结论HD较PD患者展现出更高更严重的LVH.LVH与高血压、容量超负荷等有关.     

厄贝沙坦、硝苯地平及美托洛尔逆转高血压病左心室肥厚的效果观察

目的比较厄贝沙坦、硝苯地平及美托洛尔治疗原发性高血压逆转左心室肥厚的作用。方法选择150例原发性高血压伴左心室肥厚患者,随机分为厄贝沙坦组(A组)、硝苯地平控释片(B组)及美托洛尔组(C组)各50例。全组患者未曾接受降压治疗(或仅用过利尿剂)或已停用降压药物3周以上。A组服用厄贝沙坦150~300 mg,1次/d,B组服用硝苯地平控释片30~60 mg,1次/d,C组服用美托洛尔25~50 mg,2次/d;疗程均为24周。观察治疗前后血压及超声心动图变化。结果各组患者治疗后血压均显著降低(P<0.01),组间降压幅度无明显统计学差异(P>0.05)。各组患者治疗后舒张期左室后壁厚度、舒张期室间隔厚度、左室舒张末期内径及左室重量指数均有显著改善(P<0.05,0.01)。而且A组左室重量指数下降优于B、C组(P<0.05)。结论三种药物在有效降压的同时均可逆转左心室肥厚,厄贝沙坦对左心室肥厚的逆转作用相对更强。     

Blood pressure control and left ventricular hypertrophy in long-term CAPD and hemodialysis patients: a cross-sectional study.

BACKGROUND: It is still not clear whether hypertension and left ventricular hypertrophy (LVH) are more common in continuous ambulatory peritoneal dialysis (CAPD) than in hemodialysis (HD) patients. METHODS: To examine this subject, the indices of cardiac performance were compared between 50 HD and 34 CAPD patients. Patients were further divided into two subgroups [long-term (L) CAPD and L-HD] according to dialysis modality and duration of dialysis (more than 60 months' duration). RESULTS: The blood pressure and cardiothoracic index of CAPD patients did not differ from HD patients. On average, the left atrial index was 2 mm/m2 higher in HD patients than in CAPD patients. Left ventricular chamber sizes, wall thickness, and left ventricular mass index (LVMI) in patients on CAPD were similar to those of HD patients. Isovolumic relaxation time (IVRT) of CAPD patients was insignificantly less than that of HD patients (101 +/- 22 and 115 +/- 27 msec respectively). There was no significant difference between the two subgroups (L-HD and L-CAPD) in blood pressure, left atrial diameter, left ventricular chamber size, wall thickness, LVMI, ejection fraction, or IVRT. CONCLUSION: If normovolemia and normotension are obtained by strict volume control without using antihypertensive drugs, the effects of the two modalities of chronic dialysis treatment (HD and CAPD) on cardiac structure and function are not different from each other.     

Angiotensin II receptor blocker telmisartan: effect on blood pressure profile and left ventricular hypertrophy in patients with arterial hypertension

In this open-label, non-comparative study, the anti-hypertensive efficacy and effect on left ventricular hypertrophy (LVH) of 24 weeks' treatment with once-daily telmisartan 40-80 mg was evaluated in 24 patients with mild-to-moderate hypertension and LVH. Patients were titrated to the higher dose of study drug at week 4 if they did not achieve blood pressure normalization (i.e. systolic blood pressure [SBP]/diastolic blood pressure [DBP] remained > or = 140/90 mmHg). The anti-hypertensive action of telmisartan was assessed using clinic cuff measurements and 24-h ambulatory blood pressure monitoring, and left ventricular mass index (LVMI) was determined by two-dimensional echocardiography at baseline and after 24 weeks of therapy. Telmisartan significantly reduced mean 24-h, daytime and night-time SBP and DBP compared with baseline after 12 and 24 weeks of therapy. Target blood pressure levels, defined as SBP/DBP < 140/90 mm Hg, were achieved in 16 (69.6%) patients at the end of the treatment period. After 24 weeks of telmisartan treatment, LVMI decreased from 151.6 +/- 5.4 to 135.1 +/- 5.9 g/m2. In conclusion, anti-hypertensive treatment with telmisartan for 24 weeks produced significant reductions in blood pressure and regression of LVH, as assessed by LVMI, in patients with hypertension and LVH.     

老年单纯收缩期高血压患者血压变异性与左心室肥厚的关系

目的：研究老年单纯收缩期高血压患者血压变异性与左心室肥厚（LVHC）的关系,。方法：对31例老年收缩期高血压患者和24例老年正常血压组,分别进行动态血压测定,计算出平均血压、24小时、白天、夜间收缩压和舒张压变异性,超声心动图测量左室内径、室间厚度、左室后壁厚度、计算出左室重量指数（LVMI）。结果：老年收缩期高血压组血压变异性,LVM和LVMI大于老年正常血压组,结论血压变异性和平均血压水平与左室肥厚有关。     

The association of peritoneal transport properties with 24-hour blood pressure levels in CAPD patients.

OBJECTIVES: We aimed to investigate the effects of peritoneal transport characteristics on blood pressure (BP) parameters, measured by 24-hour ambulatory blood pressure monitoring (ABPM), and on the development of left ventricular hypertrophy (LVH) in continuous ambulatory peritoneal dialysis (CAPD) patients. DESIGN: Cross-sectional and prospective design. SETTING: Tertiary-care center. PATIENTS: 25 CAPD patients (11 male, 14 female; mean age 47 +/- 14 years) were included. Mean time on CAPD was 22.9 +/- 18 months and all patients had been dialyzed for more than 6 months. The patients were divided into high, high-average, low-average, and low transport groups according to peritoneal equilibration test results. MAIN OUTCOME MEASURES: Daytime and nighttime systolic and diastolic BP and left ventricular mass index among the different peritoneal transport groups; changes in BP parameters before and after increase in ultrafiltration. RESULTS: On 24-hour ABPM records, 13 patients (52%) were found to be hypertensive. Both mean systolic and diastolic BP were significantly increased in high-transporter groups compared to low transporters in both daytime and nighttime BP parameters. Left ventricular mass index was higher in high transporters compared to low transporters, without reaching statistical significance: 160 +/- 23 vs 119 +/- 41 g/m2, p > 0.05. Following increase in ultrafiltration, mean systolic (145 +/- 13 vs 128 +/- 5 mmHg, p < 0.001) and diastolic (96 +/- 10 vs 81 +/- 3 mmHg, p < 0.001) BP decreased, and BP levels returned to normotensive levels in 6 (46%) of the 13 hypertensive patients, requiring discontinuation of antihypertensive drugs. CONCLUSION: Improvement in volume status resulted in a decrease in both daytime and nighttime BP. Differences in peritoneal transport properties were associated with the development of hypertension and LVH.     

早期慢性肾脏疾病患者左室肥厚及其相关因素分析

目的探讨早期慢性肾脏疾病(CKD)患者左室肥厚(LVH)及其相关因素.方法:回顾性分析110例肾功能稳定的早期CKD患者LVH发生率及其与血压、血红蛋白(Hb)、肾功能、甲状旁腺激素(PTH)等临床资料的关系.结果(1)LVH在CKD早期即已存在,随着内生肌酐清除率(Ccr)的下降,左室质量指数(LVMI)逐渐增加,LVH发生率逐渐增高;(2)与非LVH组相比,LVH组收缩压(SBp)(P＜0.01)、舒张压(DBp)(P＜0.05)、血肌酐(Scr)(P＜0.01)和血尿酸(UA)(P＜0.01)水平显著增高,Hb和Ccr水平显著低下(P均＜0.01);(3)单因素相关分析显示LVMI与SBp、DBp、Scr、UA成显著正相关(r值分别为0.465,0.385,0.599,0.482;P均＜0.01),而与Hb、Ccr成显著负相关(r值分别为-0.561,-0.465;P均＜0.01).多因素逐步回归分析显示DBp、Hb、UA进入回归方程,所得回归方程为y=1.887x1-0.158x1 0.123x3 61.355(y=LVMI;x1=DBP;x2=UA;x3=Hb;66.169为常数).结论LVH在CKD早期即已存在,且随着肾功能减退更加明显,其发生与高血压、贫血、高尿酸血症等因素相关.     

超声心动图研究血液透析病人心脏结构与负荷状态及收缩功能变化的关系

目的:探讨血液透析病人的左室结构、负荷状态、收缩力及收缩功能之间的关系。方法:超声心动图探测72例血液透析病人(按心肌重量指数分为左室重度肥厚组和无-中度肥厚组)及20例正常人的心脏结构。测量左室收缩末期室壁应力(ESS)、ESS与左室收缩末期容积(ESV)的比值及左室射血分数(LVEF)。比较两组参数的不同。结果:血液透析病人中左室肥厚(LVH)62例,占86%。血液透析病人的左室心肌重量指数(LVMI)、收缩压(SBP)、左室舒张末期容积(EDV)、ESS均明显高于对照组。ESS/ESV及LVEF低于对照组,P值均小于0.05。LVMI与EDV(r=0.736,P<0.001)、ESV(r=0.725,P<0.001)、SBP(r=0.558,P<0.001)及ESS(r=0.41,P<0.001)呈正相关。LVMI与LVEF(r=-0.643,P<0.001)及反映心肌收缩力的指标ESS/ESV(r=-0.54,P<0.001)呈负相关。结论:血液透析病人中LVH的程度与左室负荷、收缩力及收缩功能有关。超声心动图是检测心脏结构与功能的重要手段。     

The Effects of Amlodipine on Left Ventricular Mass and Diastolic Function in Concentric and Eccentric Left Ventricular Hypertrophy

BACKGROUND: The effects of the antihypertensive therapy with amlodipine (5-10 mg/day) on left ventricular mass and diastolic function were examined in 30 mild to moderate essential hypertensive patients who have left ventricular hypertrophy (LVH) and diastolic dysfunction. METHODS AND RESULTS: Each patient's left ventricular mass was measured, and left ventricular diastolic function was assessed by echocardiographic Doppler examination at entry, and at 3 and 6 months after the initiation of the treatment. Amlodipine reduced both blood pressure (from 164 +/- 14/104 +/- 6 mmHg to 134 +/- 9/83 +/- 4 mmHg) and left ventricular mass index (from 160 +/- 30 g/m(2) to 137 +/- 26 g/m(2)) significantly at 3 months and both parameters maintained at these levels for 6 months. When the patients were classified according to the type of the LVH, a significant regression in left ventricular mass index was seen only in the patients who had concentric LVH was a relative wall thickness >/=0.44 (n = 16), but not in the eccentric LVH group (n = 14), although both groups were not significantly different from each other regarding the basal hemodynamic parameters, baseline left ventricular mass index and the decrease in blood pressure in response to amlodipine treatment. The mitral inflow E/A ratio did not show any significant change in either group. CONCLUSIONS: Amlodipine produced significant regression in LVH only in the patients with concentric LVH, but not those with eccentric LVH, while it did not change the diastolic dysfunction. Therefore, the type of LVH seems to be an important feature in determining the effects of antihypertensive treatment on left ventricular mass index.     

Heart remodeling in patients with predialysis phase of chronic renal failure

AIM: To investigate remodeling of the heart in patients with predialysis phase of chronic renal failure (CRF). MATERIAL AND METHODS: Patients with predialysis phase of CRF (n = 61; serum creatinine 412.4 +/- 242.69 mumol/l), essential hypertension (EH) (n = 35) and healthy volunteers (n = 20) were assessed with echocardiography. The patients were not significantly different by the level of systolic and diastolic blood pressure, age and gender. RESULTS: Left ventricular mass index (LVMI) was increased in 53(86.9%) patients with CRF. LVMI was not different in patients with CRF and EH (189.9 +/- 71.35 vs. 165.0 +/- 41.83 g/m2; p = 0.3). Relative wall thickness was similar in patients with serum creatinine < 200 mumol/l and patients with more elevated serum creatinine (57.2 +/- 10.33 vs 58.31 +/- 13.33; p = 0.9). The ejection fraction lower than 50% was detected in 14(22.9%) patients with CRF. Multivariate regression analysis showed that LVMI was independently related to systolic blood pressure (p = 0.004) and level of hemoglobin (p = 0.004). Diastolic dysfunction (early and atrial peak filling velocities ratio < 1.0) was detected in 13(50%) from 26 investigated patients with CRF. The independent influence of hemoglobin on isovolumic relaxation time (p = 0.04) and early and atrial peak filling velocities ratio (p = 0.02) are shown. CONCLUSION: In patients with predialysis phase of CRF left ventricular hypertrophy (LVH) is extremely common including patients with mildly elevated serum creatinine. The treatment of patients with renal pathology and normal function must include measures not only to correct renal process but also to prevent development of LVH.     

Impact of day-to-day arterial pressure variability on the left ventricle geometry in patients with predialysis chronic kidney insufficiency

AIM: To estimate the impact of day-to-day variability of blood pressure (BP) on left ventricular geometry in pre-dialysis patients. MATERIAL AND METHODS: We estimate the impact of day-to-day variability of BP on left ventricular geometry in 42 non-diabetic pre-dialysis patients (22 F, 20 M, mean age 47 +/- 12 years) with arterial hypertension (> 140 and 90 mm Hg). Serum creatinine was 286.2 +/- 176.8 micromol/l. BP was measured in the morning during 12 days and M +/- SD and delta systolic blood pressure (dSBP = SBPmax - SBPmin) was calculated. Echocardiography was performed and left ventricular mass index and relative wall thickness (RWT) was estimated. RESULTS: LVH was detected in 35(83.3%) patients. Multiple stepwise regression analysis revealed that mean SBP is a stronger predictor of LVH than clinical SBP (R2 = 0.59; p = 0.000001 and R2 = 0.35; p = 0.0007, resp.). Standard deviation of mean SBP correlated with RWT (R2 = 0.30; p = 0.006). dSBP > 30 mmHg was associated with an increase of RWT. CONCLUSION: Mean SBP during 12 days is a stronger predictor of LVH than clinical SBP. Day-to-day variability of SBP with dSBP > 30 mm Hg was associated with development of concentric LVH.     

血浆脑利钠肽水平与原发性高血压左室肥厚的关系

目的探讨原发性高血压患者血浆脑利钠肽的水平（BNP）以及与左心室肥厚的关系。方法采用电化学发光法测定32例高血压患者无左室肥厚（NLVH组）、30例高血压患者伴左室肥厚（LVH组）、30例血压正常的健康成人（健康对照组）血浆BNP浓度。采用多普勒超声心动图检查并计算左室重量指数（LVMI），观察BNP水平与LVMI的相关性。结果LVH组BNP水平明显高于NLVH组及健康对照组，差异有统计学意义（P〈0．01），而NLVH组也高于健康对照组（P〈0．01）。BNP水平与LVMI呈正相关（r=0．64，P〈0．01）。结论BNP水平可以反映原发性高血压患者左室肥厚状况。     

高血压病左心功能相关性的超声研究

目的 探讨高血压病左心房与左心室功能的相关关系。方法 对照组20例，高血压病左心室心肌质量指数(LVMI)正常组32例，高血压病左心室肥厚组16例，采用声学定量技术，测量左心房助力泵功能(LAEF、AE)、管道功能(CV)和储存器功能(RV)以及左心室舒张功能。结果 左心房助力泵功能与其主动收缩前容量、RV正相关，与CV及左心室舒张功能负相关；左心房管道功能与AE、LAEF、RV和左心房主动收缩前容量显著负相关，与左心室舒张功能正相关；左心房储存器功能与左心房主动收缩前容量、LAEF正相关，与CV负相关，与左心室舒张功能指标无显著相关。结论 高血压病左心室舒张功能减退导致左心房管道功能减低、肺静脉与左心房间压差增大、左心房储存器功能增强、左心室舒张早期充盈增加，而管道功能与储存器功能的改变导致左心房前负荷增加和左心房收缩能力增强、左心房助力泵功能增强、左心室舒张晚期充盈增加。