Sex, cardiac hypertrophy and diurnal blood pressure variations in essential hypertension.

OBJECTIVE: To test the hypothesis of a difference between men and women in the left ventricular hypertrophic response to diurnal variations of ambulatory blood pressure in essential hypertension. DESIGN: Non-invasive ambulatory blood pressure monitoring and echocardiography in untreated hypertensive patients and healthy normotensive subjects. SETTING: Community-based ambulatory population in tertiary care centers. PATIENTS: Two hundred and sixty hypertensive patients and sixty-three healthy normotensive subjects. MAIN OUTCOME MEASURE: Patients with average daytime systolic blood pressure (SBP) and diastolic blood pressure (DBP) falling by less than 10% during the night were defined as non-dippers, the others as dippers. RESULTS: In the hypertensive group, dippers and non-dippers did not differ, in either gender, in several covariates possibly affecting left ventricular structure, including daytime ambulatory blood pressure, prevalence of white coat hypertension, age, body mass index, family history and known duration of hypertension, funduscopic changes, diabetes, alcohol consumption and renal function. Left ventricular mass (LVM) did not differ between dippers and non-dippers in hypertensive men whilst in hypertensive women it was significantly lower in dippers than in non-dippers. This sex difference held for all quartiles of the distribution of mean daytime blood pressure. In hypertensive women there was an inverse correlation between LVM and the per cent reduction of SBP and DBP from day to night, but this relationship was absent in hypertensive men. Other indices of left ventricular structure differed between dippers and non-dippers in both genders, as did LVM. CONCLUSIONS: For any level of daytime ambulatory blood pressure, a reduction of SBP and DBP by less than 10% from day to night identifies a subset of hypertensive patients at increased risk of left ventricular hypertrophy only in the female gender. These data suggest that, compared with men, hypertensive women require a longer duration of exposure to high blood pressure levels during the 24 h to develop left ventricular hypertrophy.     

White-coat effect in normotension and hypertension

OBJECTIVES: The difference between clinic and daytime ambulatory blood pressure is referred to as the white-coat effect. In this study, we investigated (i) the magnitude of the white-coat effect in subjects with different daytime ambulatory blood pressure levels, and (ii) the association of the white-coat effect with left ventricular mass. METHODS: A total of 1581 subjects underwent clinic blood pressure readings, 24-h ambulatory blood pressure monitoring and left ventricular echocardiographic assessment. Their mean daytime systolic blood pressure varied from 88.0 to 208.9 mmHg and their mean daytime diastolic blood pressure from 40.3 to 133.0 mmHg. RESULTS: A negative correlation was found between the systolic or diastolic white-coat effect and the systolic or diastolic daytime ambulatory blood pressure (r = -0.22, P < 0.000 and r = -0.50, P < 0.000, respectively). Left ventricular mass significantly correlated with ambulatory blood pressure (P < 0.001), but there was no association between left ventricular mass and clinic blood pressure or white-coat effect. Furthermore, the white-coat effect was reversed at the highest level of systolic or diastolic daytime ambulatory blood pressure (systolic over 170 mmHg or diastolic over 100 mmHg) when systolic or diastolic daytime ambulatory blood pressure was higher than systolic or diastolic clinic blood pressure (ambulatory blood pressure hypertension). CONCLUSIONS: The white-coat effect shows an inverse association with daytime ambulatory blood pressure level (systolic or diastolic), being significantly more prominent for levels below 140/80 mmHg for systolic/diastolic daytime ambulatory blood pressure and reversed with daytime ambulatory blood pressure levels above 170/100 mmHg.     

Relation between exercise-induced hypertension and sustained hypertension in adult patients after successful repair of aortic coarctation

OBJECTIVES: To investigate whether exercise-induced hypertension in successfully repaired adult post-coarctectomy patients is associated with hypertension on 24-h blood pressure measurement and increased left ventricular mass. METHODS: One hundred and forty-four consecutive post-coarctectomy patients (mean age 31.5 years, range 17-74 years; mean age at repair 7.9 years, range 0-45 years) from three tertiary referral centres were studied using ambulatory blood pressure monitoring, treadmill exercise testing and echocardiography. RESULTS: Of the 144 patients, 27 (19%) were known to have sustained hypertension, based on their history, and all were on antihypertensive medication. However, 32 (27%) of the remaining 117 patients showed elevated mean daytime systolic blood pressure readings at 24-h ambulatory blood pressure monitoring (systolic blood pressure > or = 140 mmHg). Of the remaining 85 patients with normal mean daytime systolic blood pressure, 18 patients (21%) had exercise-induced hypertension (maximal exercise systolic blood pressure > 200 mmHg). Mean daytime systolic blood pressure was higher in the exercise-induced hypertensive patients compared to the normotensive patients with normal exercise blood pressure (134 +/- 5 versus 129 +/- 7 mmHg, P = 0.008). By multivariate analysis, both maximal exercise systolic blood pressure (P = 0.007) and resting systolic blood pressure (P < 0.0001) were independently associated with mean daytime systolic blood pressure. Maximal exercise systolic blood pressure had no independent predictive value for left ventricular mass (P = 0.132). CONCLUSIONS: In adult post-coarctectomy patients, maximal exercise systolic blood pressure is independently associated with mean daytime systolic blood pressure at ambulatory blood pressure monitoring. In this study no independent predictive value of maximal exercise systolic blood pressure for left ventricular mass could be demonstrated.     

Blood pressure, cardiac structure and severity of obstructive sleep apnea in a sleep clinic population.

OBJECTIVES : We investigated whether the severity of obstructive sleep apnea (OSA) predicts blood pressure or cardiac left ventricular thickness in a clinical population of OSA patients, if adjustments are made for age, gender, use of antihypertensive agents, smoking, body mass index, history of coronary artery disease, hypercholesterolemia and circulating C-peptide concentrations. DESIGN : Relationships in this cross-sectional study were investigated with correlation analysis and multiple regression procedures. PATIENTS AND METHODS : Apnea-hypopnea index (AHI, polysomnography) and office systolic and diastolic blood pressures (SBP and DBP) were measured in 81 subjects referred to a university hospital sleep laboratory. Ambulatory blood pressures were recorded during one 24 h cycle. Left ventricular (LV) muscle size was quantified as two-dimensionally directed M-mode-derived end-diastolic thickness of interventricular septum and posterior chamber wall. RESULTS : After adjustment for separate or the entire set of covariates, AHI predicted office SBP and DBP as well as daytime ambulatory DBP and night-time ambulatory SBP and DBP, but not daytime ambulatory SBP. In contrast, associations between AHI and LV muscle thickness reflected complex inter-relationships with confounding variables. Smoking and age suppressed, whereas body mass index (BMI) and hypertension inflated the relationship between OSA severity and LV muscle thickness in this study. CONCLUSIONS : AHI is an independent predictor of several measures of blood pressure. OSA severity and LV muscle thickness appear to be primarily linked via increased blood pressure.     

Relations of ambulatory blood pressure level and variability to left ventricular and arterial function and to left ventricular mass in normotensive and hypertensive adults

OBJECTIVE: To assess the relationships between the level and variability of ambulatory blood pressure and left ventricular and arterial function. METHOD: We related 24 h ambulatory systolic blood pressure (SBP) and diastolic blood pressure (DBP), measures of their variability and clinic blood pressures to echocardiographic measures of left ventricle geometry and systolic function, total peripheral resistance, and the pulse pressure: stroke volume ratio as a measure of arterial stiffness in 58 normotensive and 222 unmedicated hypertensive adults. RESULTS: For hypertensive patients and for the entire population, awake and home ambulatory as well as technician-measured DBP were negatively related to left ventricle midwall fractional shortening (MWS) and to MWS as a percentage of the value predicted for end-systolic stress (afterload-corrected MWS), with inconsistent relations with SBP. Similarly, the SD and coefficient of variation of awake ambulatory DBP, but not SBP, were negatively related to both measures of left ventricle midwall function. Hypertensive patients in the lowest quintile of afterload-corrected MWS had similar physician-measured but higher ambulatory awake and home as well as technician-measured DBP, but not SBP, and higher SD of awake SBP and DBP than did those with higher afterload-corrected MWS. Ambulatory awake, home, and sleep as well as technician-measured DBP, but not SBP, were positively related to total peripheral resistance at rest whereas all components of ambulatory SBP, but not DBP, were positively related to the resting p;ulse pressure: stroke index ratio, a measure of arterial stiffness. We detected no relation between the nocturnal dip in blood pressure and any measure of left ventricular or arterial function or left ventricle geometry. Finally, left ventricle mass and relative wall thickness were related most strongly to awake and home ambulatory SBP whereas left ventricular relative wall thickness was also related to the SD of awake DBP. CONCLUSION: For this population of predominantly hypertensive unmedicated adults, ambulatory blood pressures during waking hours and at home were related to left ventricular and arterial function, the strongest relations being negative ones of DBP with left ventricular midwall function and positive ones of ambulatory DBP with peripheral resistance and ambulatory SBP with a measure of arterial stiffness. For this population the nocturnal dip of blood pressure was not related to measures either of cardiovascular function or of left ventricular structure.     

Is a Series of Blood Pressure Measurements by the General Practitioner or the Patient a Reliable Alternative to Ambulatory Blood Pressure Measurement?: A Study in General Practice With Reference to Short-term and Long-term Between-Visit Variability

We studied thereproducibility of a series of blood pressure measurements by general practitioner (GP) and patient in comparison with that of ambulatory blood pressure measurement (ABPM), with reference to short-term and long-term between-visit variability using a prospective, comparative diagnostic study. The study group was 88 potentially hypertensive primary care patients (initial systolic blood pressure [SBP] between 160 and 200 mm Hg or with diastolic blood pressure [DBP] between 95 and 115 mm Hg). ABPMs were measured on 2 separate days (at a 6 month interval). Two series of measurements by the doctor (at 1 to 6 month intervals), and the patient (at a 1 week interval) were measured. Mean differences and standard deviations of mean differences (SDD) between two successive series of measurements, and between two ABPMs were computed. The Wilcoxon signed-ranks test was used to compare these standard deviations. Mean initial office-blood pressures were 161 (SBP) and 102 (DBP) mm Hg. Long-term between-visit variability (measurements by GP) was larger than short-term between-visit variability: SDDs were 16 v 11 mm Hg (SBP), and 10 v 8 mm Hg (DBP). The differences in average SBP and DBP between successive ABPMs and between successive series of office measurements by GP and home measurements by patient were not statistically significant. Mean differences between two series of measurements by GP and patient, and between two ABPMs, were 0 ± 1 mm Hg. SDDs between successive ABPMs and series of measurements by GP and patient ranged from 8 to 11 mm Hg (SBP), and were 6 mm Hg (DBP). No statistically significant differences were found between the SDDs of the studied measurement procedures (SBP and DBP). In our study the reproducibility of ambulatory blood pressure measurement was not found to be better than that of a series of four duplicate measurements by GP or patient. Long-term (6 months interval) between-visit variability was larger than the short-term (1 week interval) between-visit variability.     

Relation of arterial pressure level and variability to left ventricular geometry in normotensive and hypertensive adults

OBJECTIVES: To assess the impact of blood pressure level and variability on left ventricular geometry. METHODS: Twenty-four-hour ambulatory systolic blood pressure (SBP) and diastolic blood pressure (DBP) were related to echocardiographic left ventricular geometry in 76 normotensive and 245 hypertensive adults. RESULTS: The differences in SBP and DBP between hypertensive patients with concentric hypertrophy - the most prognostically adverse left ventricular pattern - and those with other ventricular geometric patterns were greater for ambulatory awake and home blood pressure (+8 to +15/+3 to +7 and +11 to +16/+4 to +7 mmHg) than they were for physician-measured clinic bloiod pressure (+7 to +15/0 to +5 mmHg). The white-coat effect (clinic minus ambulatory awake SBP) was greatest in hypertensive patients with eccentric left ventricular hypertrophy (17 +/- 19 mmHg) and was least in those with concentric hypertrophy (9 +/- 14 mmHg); no patient with concentric hypertrophy had a normal ambulatory blood pressure. The within-patient SD of awake ambulatory blood pressure was increased in patients with concentric hypertrophny, independent of covariates, as was the dip between ambulatory awake and asleep SBP. In analyses that also considered sex, age, measures of body habitus and clinic blood pressure, left ventricle mass was related most closely to ambulatory awake SBP and relative left ventricular wall thickness was related most closely to ambulatory awake DBP (both P < 0.0005). CONCLUSIONS: Left ventricular geometric adaptations associated with an adverse prognosis were related more strongly to the level and variability of ambulatory blood pressure than theyh were to clinic blood pressure measurements, but were not associated with loss of the nocturnal dip in blood pressure.     

Age and blood pressure measurement: experience with the TM2420 ambulatory blood pressure monitor and elderly people.

The accuracy of the TM-2420 ambulatory blood pressure monitor was assessed in elderly people. Ninety-four subjects (44 men and 50 women), aged 60-94 with systolic blood pressure (SBP) of 97-208 mmHg and diastolic blood pressure (DBP) of 45-109 mmHg, including 23 with isolated systolic hypertension, were studied in three centres. The monitor was compared simultaneously with pairs of observers using the Hawksley random zero sphygmomanometer. The standard deviation of the difference (SDD) between observers was 4.2 mmHg (SBP), 2.9 mmHg (DBP). The mean difference was 0.49 mmHg (SBP) and 0.27 mmHg (DBP). The SDD between the monitor and the average of the observers' readings was 6.7 mmHg (SBP), 5.5 mmHg (DBP); the mean differences were 4.4 mmHg (SBP) and 4.8 mmHg (DBP). There were no significant differences between the two versions of the monitor used (5 and 7) or between the three pairs of observers. The monitor was equally accurate in isolated systolic hypertension (SDD observers and monitor 6.2 mmHg for SBP, 3.9 mmHg for DBP, mean differences 4.3 mmHg for SBP, 4.5 mmHg for DBP). Twenty-four-hour ambulatory blood pressure monitoring was carried out in 129 subjects aged 60-79; 89% of the monitoring attempted were successful with error rates of < 10%. The mean error rate was 3.8%. The device was well tolerated with only 4.7% of the subjects not completing a monitoring.     

Factors correlated with left ventricular mass in hypertensive patients

Left ventricular hypertrophy (LVH) is an independent risk factor in hypertensive patient. THE AIM: Of our study is to evaluate prospectively the relationship between left ventricular mass and clinical, echocardiographical and ambulatory blood pressure data in hypertensive subjects. METHODS: We studied 88 hypertensive patient who underwent clinical and laboratory investigation, echocardiography and 24 hours ambulatory blood pressure monitoring. Correlations were made between these data and left ventricular mass. RESULTS: Clinical data, which correlated well with left ventricular mass, were duration of hypertension, systolic arterial pressure and pulse arterial pressure. In echocardiography left atrial area and left ventricular dysfunction correlated significatively with left ventricular mass. Data from 24 hours blood pressure monitoring as daytime systolic pressure, nighttimes diastolic pressure, ambulatory systolic pressure and ambulatory pulse pressure. CONCLUSION: In hypertensive patient, left ventricular mass correlated well with left atrial dilation and diastolic left ventricular dysfunction. It also correlated with 24 hours ambulatory blood pressure monitoring data.     

Relationship between left ventricular mass and blood pressure in treated hypertension

This study evaluated prospectively whether there is still a relationship between left ventricular mass and blood pressure once hypertension is treated and determined the relative importance of daytime vs night-time blood pressure, systolic vs diastolic blood pressure and office vs ambulatory blood pressure. A total of 649 patients (305 or 47% female) with essential hypertension, treated with antihypertensive drugs for at least 3 months, underwent office blood pressure measurement and both daytime and night-time ambulatory blood pressure measurement, electrocardiography and echocardiography. Correlations were made between blood pressure values and parameters of left ventricular mass. Electrocardiographic voltage criteria and even more so echocardiographic parameters correlate significantly albeit weakly (r < or = 0.28) with blood pressure in treated hypertension. Correlations are consistently higher when systolic blood pressure is considered. Overall, the best correlations are found between 24-h ambulatory systolic or night-time blood pressure and the Sokolow-Lyon voltage as well as the echocardiographic age and body mass index adjusted left ventricular mass. In conclusion, once hypertension is treated, the relationship between blood pressure and left ventricular mass is low. Nevertheless, in this the largest single centre study of its kind, echocardiographic parameters of left ventricular mass in treated hypertensive subjects correlate better with blood pressure than electrocardiographic parameters. Parameters of hypertrophy are more closely related to systolic blood pressure than to diastolic blood pressure. In accordance with the finding that dippers have a better prognosis than non-dippers, night-time blood pressure consistently correlates better with left ventricular mass than daytime blood pressure.     

高血压病患者动态血压与左心功能相关关系的研究

目的观察收缩压、舒张压分别对左室收缩及舒张功能的不同影响。方法应用诊所血压、２４小时动态血压监测及超声心动图，观察３８例Ⅰ、Ⅱ期高血压病患者血压与左室心肌质量、左室收缩及舒张功能的相关关系。结果２４小时及白天平均收缩压及诊所收缩压均与舒张早期充盈峰值流速（ＥＰＦＶ）呈负相关（Ｐ值均＜００５），２４小时、白天及夜间平均舒张压均与年龄呈负相关（Ｐ值均＜０．０５），与舒张功能各参数之间无相关关系，诊所收缩压与年龄、心房收缩期充盈峰值流速（ＡＰＦＶ）呈正相关（Ｐ＜０．００１及０．０５），夜间平均收缩压及诊所收缩压与左室心肌质量指数呈正相关（Ｐ＜０．０１及０．０５）。而２４小时平均收缩压、白天平均收缩压、２４小时平均舒张压、白天及夜间平均舒张压则均与左室心肌质量指数无明显相关关系。结论２４小时平均收缩压是影响左室舒张功能的重要因素之一，２４小时平均舒张压与左室舒张功能无相关关系。夜间平均收缩压增高是导致左心室肥厚的重要因素之一。随年龄增长，收缩压增高，舒张压下降     

高龄和日间舒张压高及反杓型是高血压患者心电图碎裂 QRS波的独立影响因素

目的：分析高血压患者碎裂QRS波（fQRS）产生的危险因素及其与非杓型和反杓型血压模式的关系。方法：选择2019年3月至2019年12月海口市人民医院全科医学科338例连续新诊断尚未治疗的高血压患者，且无左心室肥厚并接受24h动态血压监测。根据动态血压监测结果，患者被分为杓型、非杓型和反杓型。比较各组心电图fQRS发生率。结果：90例（26.6%）患者在心电图上有fQRS。与无fQRS患者相比，fQRS患者年龄较大(P=0.005)，日间、夜间、24h平均收缩压（SBP）和舒张压（DBP）显著升高（P均＜0.05）。单因素Logistic回归分析结果发现：日间DBP、夜间SBP、年龄、非杓型、反杓型是高血压患者fQRS波的影响因素。多因素Logistic回归分析显示，日间DBP（P＜0.001，95%CI:0.901~0.955）；年龄（P＜0.001，95%CI:0.814~0.941）;、反杓型（P=0.018，95%CI：1.132~3.684）是高血压患者fQRS波的独立影响因素。结论：高龄、日间舒张压高及反杓型高血压患者心电图可能较易出现fQRS波，虽然此类患者无明显左心室肥大，但可提示心肌纤维负荷增加。     

尼群地平对老年人单纯收缩期高血压的疗效

目的观察尼群地平治疗老年人单纯收缩期高血压的疗效。方法４６名老年单纯收缩期高血压患者，随机分成尼群地平治疗组和安慰剂组。疗程１年。两组均在治疗前及治疗终结后，分别进行偶测血压、２４ｈ动态血压及超声心动图检查。结果与安慰剂相比尼群地平能明显降低平均２４ｈ收缩压、白天收缩压、夜间收缩压、偶测收缩压。但对舒张压的影响无统计学意义。服尼群地平１年后室间隔厚度、左室后壁厚度、左室心肌质量及左室重构指标均显著改善。结论尼群地平能有效降低老年单纯收缩期高血压患者的收缩压，逆转靶器官损害。     

Temporal stability of twenty-four-hour ambulatory hemodynamic bioimpedance measures in African American adolescents

BACKGROUND: The reliability of ambulatory impedance cardiography has not been evaluated. OBJECTIVE: The purpose of this study was to determine the reproducibility of daytime and night-time ambulatory bioimpedance-derived measures of hemodynamic function in youth. METHODS: Thirty-five African American adolescents (ages 16.2+/-1.4 years, 14 girls, 21 boys) with high normal systolic resting blood pressure (BP) were evaluated twice, separated by a 2-month interval. Measures were collected using the AIM-8-V3 Wearable Cardiac Performance Monitor (Bio-impedance Technology, Inc., Chapel Hill, North Carolina, USA) and the Spacelabs ambulatory BP monitor 90207 (Spacelabs Inc., Redmond, Washington, USA) from 0600 h to midnight every 20 min and from midnight to 0600 h every 30 min in the natural environment. RESULTS: There were no significantly different means (P>0.15) between the two visits for daytime ambulatory heart rate (HR, r = 0.81), stroke volume (SV, r = 0.54), cardiac output (CO, r = 0.56), pre-ejection period (PEP, r = 0.59), left ventricular ejection time (LVET, r = 0.74), Heather Index (HI, r = 0.79), systolic BP (SBP, r = 0.79), diastolic BP (DBP, r = 0.66), mean arterial pressure (MAP, r = 0.65) and total peripheral resistance (TPR, r = 0.47). Overall means for night-time ambulatory HR (r = 0.76), SV (r = 0.49), CO (r = 0.45), LVET (r = 0.43), HI (r = 0.82), SBP (r = 0.65), DBP (r = 0.62), MAP (r = 0.63) and TPR (r = 0.20) were not significantly different between visits (P > 0.06). Mean differences (P < 0.01) were observed for PEP (r = 0.57). CONCLUSIONS: The findings demonstrate that across 2 months in youth daytime and night-time ambulatory bioimpedance-derived measures of HR, HI, SBP, DBP and MAP are highly repeatable and SV, CO, PEP and LVET are moderately repeatable. This methodology should prove useful in cardiovascular research and clinical care.     

Analysis of blood pressure in children and adolescents reporting siesta during ambulatory blood pressure monitoring

BACKGROUND: In adults, a siesta yields a blood pressure profile similar to that seen in nocturnal sleep. It is therefore stressed that siestas should not be included in daytime blood pressure measurement. OBJECTIVES: To evaluate blood pressure profiles in pediatric and adolescent patients who reported a siesta during 24 h ambulatory blood pressure monitoring (ABPM). METHODS: Patients' diaries of actual sleep times were used to determine the periods of sleep (night-time and siesta) and daytime wakefulness. Ambulatory systolic and/or diastolic daytime and/or night-time hypertension was determined by comparing patients' measurements with normal values taken from published standards for healthy children and adolescents. Data obtained from 12 patients with ambulatory normotension and 12 patients with ambulatory hypertension, who were referred for an evaluation of hypertension or management of known hypertension, were analysed separately. RESULTS: Mean systolic (SBP) and diastolic (DBP) blood pressure values during the daytime awake period were significantly higher than the mean values for the period of daytime, including the siesta, both in patients with ambulatory normotension and in those with ambulatory hypertension (P<0.001 and P<0.01 for SBP and DBP, and P<0.001 and P<0.001 for SBP and DBP, respectively). The percentage night-time falls in SBP and DBP were 12.9+/-0.5 and 19.1+/-1.4 in patients with ambulatory normotension, and 7.1+/-1.5 and 12.9+/-2.2 in patients with ambulatory hypertension. These values were significantly higher when the siesta was excluded from the analysis in both groups (13.9+/-0.5% and 20.7+/-1.5%, P<0.001 and P<0.01 for SBP and DBP in patients with ambulatory normotension; 8+/-1.6% and 14.8+/-2.4%, P<0.001 and P<0.001 for SBP and DBP in patients with ambulatory hypertension, respectively). CONCLUSIONS: By ignoring the effect of the siesta, both the calculation of daytime blood pressure values and the analysis of day-night variability in children and adolescents undergoing ABPM may be erroneously interpreted.     

舒张压达到3级的青年高血压患者心脏结构和功能改变

目的 探究青年高血压患者中,单纯舒张压达到3级的高血压（DBP）和合并收缩压达到3级的高血压（DBP+SBP）两种类型的高血压对心脏结构和功能的影响情况。 方法 收集健康对照组（CON）93例、DBP组86例、DBP+SBP组101例,利用超声心动图检测各组的心脏结构、功能,计算左心室质量分数（LVMI）和相对室壁厚度（RWT）,比较三组人群心脏结构和功能的差异。 结果 DBP组、DBP+SBP组患者体质量指数（BMI）、吸烟史、家族史均比CON组高（均P<0.05）,而2组间均无明显差异。DBP组的收缩压、舒张压、平均动脉压均高于CON组（均P<0.01）。而DBP+SBP组的收缩压、平均动脉压均高于DBP组（均P<0.01）。但DBP组与DBP+SBP组中的舒张压未见明显差异。3组中代表心脏结构的左室短轴横径、左室短轴前后径、右室前后径、右室横径、左房横径、右房横径均无明显差异。但与CON组相比,DBP组与DBP+SBP组的左房前后径均增加（均P<0.05）,而后两者组间无明显差异。代表心脏外大血管结构主动脉内径、肺动脉内径也无明显差异。三组中的射血分数（EF）、短轴缩短率（FS）均无明显差异。与CON组相比,DBP 组和DBP+SBP组的E/A值均降低（均P<0.05）。但后2组组间无明显差异。 结论 舒张压达到3级的青年高血压患者,可出现左心室肥厚、左心房前后径增加等结构改变,同时左心室的舒张能力显著下降。而是否合并收缩压升高对上述改变无明显影响。     

动态血压监测参数血压负荷、曲线下面积与左室肥厚的关系

目的　研究高血压患者动态血压监测参数 :血压负荷、曲线下面积与左室肥厚的关系。对象　 75例高血压病人 ,男性 51例 ,女性 2 4例 ,平均年龄 63± 8(46～ 74)岁。方法　动态血压测定 2 4h血压 ,超声心动图测定室间隔、左室后壁厚度 ,左室舒张末直径并按Devereux校正公式计算左心室重量指数 (LVMI)。结果　多元逐步回归分析显示 :收缩压、收缩压负荷 ,收缩压曲线下面积值以及夜间的舒张压、舒张压负荷、舒张压曲线下面积与LVMI有关 (P <0 0 1 )。结论　曲线下面积能较好地反映动脉血压的变化与左心室肥厚的关系。     

Left ventricular mass and exercise responses predict future blood pressure. The Muscatine Study

Increased blood pressure and left ventricular mass are associated with increased morbidity and mortality in adults with coronary heart disease. To define the predictors of subsequent childhood blood pressure and left ventricular mass, serial echocardiograms and blood pressure responses during exercise were studied in 274 children aged 6 to 15 years, whose systolic blood pressures were in the high, middle, or low range. Persistence of rank order for left ventricular mass and blood pressure, at rest and during exercise, was maintained over a mean follow-up period of 3.4 years, with correlations ranging from 0.33 to 0.44. Subsequent systolic blood pressure was best predicted from initial resting and maximal exercise systolic blood pressures and left ventricular mass. Subsequent left ventricular mass was best predicted from initial left ventricular mass and maximal exercise diastolic blood pressure, but resting systolic blood pressure did not add to this latter prediction. Since left ventricular mass relates best to exercise blood pressure and not to resting blood pressure, left ventricular mass may provide an integrated view of the effects of blood pressure both at rest and during stress. We speculate that increased left ventricular mass in childhood may be an important predictor of subsequent hypertension and its consequences.     

原发性高血压患者血压变异性及昼夜节律与左室肥厚的关系

目的 探讨原发性高血压患者血压变异性及血压昼夜节律与心室肥厚的关系.方法 连续入选2010 年8 月至2012 年1 月,于中国医科大学附属第一医院心血管内科住院的原发性高血压患者共93例,根据超声心动图测量指标计算所得的左心室重量指数(LVMI)分为左心室肥厚(LVH)组与无LVH 组;再根据24 h 动态血压监测获得的结果分为血压晨峰组与无血压晨峰组,杓型血压组与非杓型血压组.分析比较24 h 血压、白昼和夜间血压均值、血压变异性、血压昼夜节律及晨峰与心室肥厚的相关性.结果 ①与无LVH 组相比,LVH 组24 小时收缩压(24 h SBP)、24 小时舒张压(24 h DBP)、白昼收缩压(dSBP)、白昼舒张压(dDBP)、夜间收缩压(nSBP)和夜间舒张压(nDBP)均升高,P<0.01;LVH 组24 小时平均收缩压标准差(24 hSSD)高于无LVH 组,P<0.05,但两组24 小时平均舒张压标准差(24 h DSD)无差别;与无LVH 组相比,LVH组夜间收缩压标准差(nSSD)和夜间舒张压标准差(dDSD)升高,P<0.01;但白昼收缩压标准差(dSSD)和白昼舒张压标准差(dDSD)无差别.②血压晨峰组LVMI 高于无血压晨峰组,P<0.05;血压晨峰组LVH 比率也高于无血压晨峰组,P<0.01;与无血压晨峰组相比,血压晨峰组24 h SBP、dSBP 和nSBP 均增高,P<0.05,但两组24 h DBP、dDBP 和nDBP 无差别.③杓型血压组LVMI 低于非杓形血压组,P<0.05;杓型血压组LVH 比率低于非杓形血压组,P<0.01;与非杓形血压组相比,杓型血压组nSBP、nDBP 均降低,P<0.01;而两组24 hSBP、24 h DBP、dSBP、dDBP 差异无统计学意义.结论 原发性高血压患者LVH 的发生与血压变异性和血压晨峰密切相关.具有血压晨峰的患者和血压昼夜节律消失的非杓型高血压患者更易出现LVH.     

Detecting white coat and reverse white coat effects in clinic settings using measures of blood pressure habituation in the clinic and patient self-monitoring of blood pressure

To examine the utility of blood pressure (BP) habituation within and across multiple clinic visits and patient-determined home BP monitoring for detecting white coat (WCE) and reverse white coat effects (RWCE) commonly observed in medical settings, 54 patients undergoing evaluation for hypertension in an internal medicine group practice were categorized according to the magnitude of differences between systolic BP (SBP) and diastolic BP (DBP) obtained in the clinic and through ambulatory BP monitoring. BPs were measured four times during three separate clinic visits, during a 1-week home BP monitoring period, and during a single 24-h ambulatory monitoring period. Patients whose mean clinic and average daytime BPs were within +/-5 mm Hg were categorized as having stable BP; patients whose clinic BPs were >5 mm Hg of their daytime BPs were categorized as showing a WCE and patients whose average daytime BPs were >5 mm Hg of their clinic BPs were categorized as showing a RWCE. Results revealed that degree of habituation occurring between the first and third clinic visits significantly predicted magnitude of both the WCE and RWCE for SBP, with greater habituation being associated with the WCE and lesser habituation associated with the RWCE. Greater SBP habituation within clinic visits was associated with the WCE for SBP and greater DBP habituation within clinic visits was associated with the WCE for DBP. Lesser DBP habituation within clinic visits was associated with the RWCE for both SBP and DBP. Home BP monitoring did not contribute to predicting either WCE or RWCE.