高龄高血压患者动态脉压和血脂与左心室肥厚的关系

目的探讨高龄高血压患者动态脉压(APP)和血脂与左心室肥厚(LVH)的相关性。方法入选年龄≥80岁的高血压患者110例,进行24 h动态血压监测、超声心动图检查及血脂检测。根据APP分为高脉压组(≥60mm Hg,1 mm Hg=0.133 kPa)74例和低脉压组(<60 mm Hg)36例,以左心室重量指数(LVMI)作为LVH的诊断标准,又分为LVH组50例和非LVH组60例。并进行相关分析和logistic回归分析。结果与低脉压组比较,高脉压组LVMI、LVH的发生率及各收缩压参数明显升高(P<0.05)。LVH组24 h收缩压、昼间收缩压、APP、脉压指数明显高于非LVH组(P<0.05),2组舒张压差异无统计学意义(P>0.05)。LVMI与APP、脉压指数、24 h收缩压、昼间收缩压、夜间收缩压呈正相关,与HDL-C呈负相关(P<0.05),与所有舒张压参数均无相关性(P>0.05)。APP是LVH的独立危险因素(OR=1.057,95%CI:1.018～1.096,P=0.003)。结论在高龄高血压患者中,APP与LVMI密切相关,是LVH的独立危险因素;HDL-C与LVMI密切相关。

The correlation of ambulatory pulse pressure and blood lipid with left ventricular hypertrophy in very elderly patients with hypertension

Objective To study correlation of ambulatory pulse pressure(APP) and blood lipid with left ventricular hypertrophy(LVH) in very elderly patients with hypertension.Methods 110 patients of≥80 years old with hypertension were enrolled in this study,and underwent 24 h ambulatory blood pressure monitoring,echocardiographic and lipid examinations.They were divided into two groups according to their APP(≥60 mm Hg,n = 74 and<60 mm Hg,n = 36),and were divided into LVH group(n= 50) and non-LVH group(n = 60) according to left ventricular mass index(LVMI).Results Compared with APP<60 mm Hg group,LVMI,the incidence of LVH and all SBP parameters increased significantly(P<0.05) in APP≥60 mm Hg group.24 h SBP, day SBP,APP and PPI were significantly higher in LVH group than in non-LVH group,while there was no obvious difference in all DBP parameters between the 2 groups.LVMI was positively correlated with APP,PPI,24 h SBP,day SBP and night SBP respectively,whereas negatively correlated with HDL-C significantly.There was no correlation between LVMI and all DBP parameters. Taking LVH as the dependent variable,and APP,PPI,24 h SBP,dSBP,nSBP and HDL-C as the independent variables,only APP was involved in the regression equation(OR = 1.057, 95%CI:1.018—1.096,P = 0.003).Conclusion APP was closely correlated with LVMI and was independent risk factor for LVH in very elderly patients.HDL-C was closely correlated with LVMI.