高血压患者动态血压与心脏几何结构关系初探

目的 :探讨高血压患者动态血压与心脏几何结构的关系。方法 :对 1 0 2例高血压患者进行 2 4h动态血压监测 ,同时采用超声心动图测定心脏结构。结果 :“非杓型”患者各时段的收缩压 /舒张压 (SBP/DBP)、平均动脉压 (MAP)均明显高于“杓型”血压者 (P <0 .0 1 )。“非杓型”血压患者的左房内径 (LAD)、左室舒张末内径(LVIDD)、左室质量 (LVM)以及左室肥厚指数 (LVHI)均高于“杓型”血压者 (P <0 .0 5 )。除DBP未显示与LVIDD的相关性外 ,2 4h、日间和夜间的SBP和MAP与左室结构的各项参数 (LVIDD、LVPWT、LVM、LVHI)均显著相关 (P <0 .0 1 )。 2 4h、日间和夜间的SBP与左房大小的相关性不显著 (γ =0 .2 2 85～ 0 .1 91 3 ,P =0 .0 2 4～ 0 .0 60 )。偏相关分析显示 ,LVIDD与SBP、DBP和MAP的夜间下降幅度及降低百分率均呈负相关 ,LVM、LVHI与DBP和MAP的降幅及降低百分率呈负相关 (P <0 .0 1 ,P <0 .0 5 ) ;多元回归分析显示 :2 4h和日间DBP、MAP夜间降幅与LVIDD存在线性关系 (P <0 .0 1 )。MAP降低百分率与LVM和LVHI存在线性关系 (γ=-6.89,-0 .1 0 ,P <0 .0 5 )。结论 :高血压患者动态血压及其波动幅度与LVM、LVHI相关 ,尤其以SBP和MAP更为重要。

Relationship between essential hypertensive patient''''s ambulatory blood pressure and the cardiac geometric structure

Objective:To study the relationship between the hypertensive patient's ambulatory blood pressure and the cardiac geometric structure.Methods:One hundred and two 20 70 years old patients enrolled into the study, whose clinical systolic and diastolic blood pressure (SBP/DBP) were above 140/90 mmHg. All the patients were either first confirmed as essential hypertension or from the clinical trail in which they took the placebo for 2 weeks after stopping anti hypertensive medicine. We examined the cardiac geometric structure by echocardiography at the same time when the patients took the 24 hour ambulatory blood pressure monitoring.Results:The 24 hour SBP/DBP as well as mean artery pressure (MAP) of patients with "non dipping" pattern were higher than those of "dipping"pattern ( P < 0.05 ), while their left atrial diameter (LAD), left ventricular internal diameter of diastolic(LVIDD),left ventricular mass (LVM) and left ventricular hypertrophy index (LVHI) were higher in the "non dipping" pattern than those in "dipper" pattern ( P <0.05).Except DBP, SBP and MAP of 24 hour and daytime and nighttime were related with left ventricular structure. LVIDD was negatively related with the reducing extent and percentage of SBP and DBP and MAP ( P <0.05),while there was definite relation between the reducing extent and rate of DBP/MAP and LVM as well as LVHI ( P<0.01,P <0.05).Multiple stepwise regression analysis confirmed that reduction of MAP as well as DBP of 24 hour and daytime were liner related with LVIDD while MAP reduction rate was also in the negative liner relationship with LVM and LVHI.Conclusion:The essential hypertensive patient's blood pressure level and reducing extent, especially for SBP and MAP,are closely related to left ventricular geometric structure