血压节律异常对颈动脉内中膜厚度及左心室肥厚的影响

目的探讨老年原发性高血压病患者血压昼夜节律异常对颈动脉内中膜厚度(IMT)及左心室肥厚(LVH)的影响。方法连续入选280例老年原发性高血压病患者,采集24h动态血压监测(ABPM)、颈动脉超声和超声心动图指标,根据血压昼夜节律及收缩压昼夜差百分比(ΔSBP%)分为4组,杓型组(n=125):ΔSBP%≥10%但20%;非杓型组(n=92):ΔSBP%≥0%但10%;反杓型组(n=41):ΔSBP%0%;超杓型组(n=22):ΔSBP%≥20%。比较分析4组患者间双侧颈动脉IMT增厚及左心室肥厚发生率。结果 4组患者颈动脉IMT增厚发生率由低到高依次为杓型组44.0%、非杓型组58.7%、超杓型组77.3%、反杓型组80.5%,组间比较有显著统计学差异(P0.01)。4组患者左心室肥厚发生率由低到高依次为杓型组30.4%、非杓型组44.6%、超杓型组50.0%、反杓型组61.0%,组间比较有显著统计学差异(P0.01)。4组间颈动脉IMT增厚合并左心室肥厚发生率由低到高依次为杓型组20.8%、非杓型组34.8%、超杓型组40.9%、反杓型组48.8%比较,组间比较有显著统计学差异(P0.01)。多因素logistic回归分析显示低密度脂蛋白胆固醇、空腹血糖对血压昼夜节律形态学特征具有独立预测的能力(P0.05)。结论老年高血压患者随形态节律异常严重程度增加,颈动脉硬化、左心室肥厚发生率显著增高。

Influences of abnormal circadian rhythm of blood pressure on carotid artery intima-media thickness and left ventricular hypertrophy

Objective To investigate the influences of abnormal circadian rhythm of blood pressure （BP） on carotid artery intima-media thickness （CA-IMT） and left ventricular hypertrophy （LVH） in the elderly patients with primary hypertension. Methods The elderly patients （n=280） were chosen and their data were collected by using 24-h ambulatory blood pressure monitoring （ABPM）, carotid ultrasound and echocardiography. All patients were divided, according to circadian rhythm of BP and percentage of systolic BP （ΔSBP%）, into dipper group （n=125,ΔSBP%≥10%but〈20%）, non-dipper group （n=92,ΔSBP%≥0%but〈10%）, reverse-dipper group （n=41,ΔSBP%〈0%） and extreme-dipper group （n=22,ΔSBP%≥20%）. The incidence rates of bilateral CA-IMT thickening and LVH were compared and analyzed in 4 groups. Results The incidence rate of CA-IMT thickening was 44.0%in dipper group, 58.7%in non-dipper group, 77.3%in extreme-dipper group and 80.5%in reverse-dipper group （P〈0.01）. The incidence rate of LVH was 30.4%in dipper group, 44.6%in non-dipper group, 50.0%in extreme-dipper group and 61.0%in reverse-dipper group （P〈0.01）. The incidence rate of CA-IMT thickening complicating LVH was 20.8%in dipper group, 34.8%in non-dipper group, 40.9%in extreme-dipper group and 48.8% in reverse-dipper group （P〈0.01）. The multifactor logistic regression analysis showed that low-density lipoprotein-cholesterol （LDL-C） and fasting plasma glucose had independent predictive effects to the morphological features of BP circadian rhythm （P〈0.05）. Conclusion The incidence rates of CA-IMT thickening and LVH will significantly increase as the severity of abnormal BP circadian rhythm exacerbates in the elderly patients with hypertension.