老年高血压病患者24 h 动态脉压与左室结构及功能变化的相关性研究

目的探讨老年高血压病患者24h动态脉压（24hPP）与左室结构及功能变化的相关性。方法对145例老年高血压病患者进行动态血压监测和超声心动图检查。将24hPP≥60mmHg的患者88例列为A组，24hPP〈60mmHg的患者57例列为B组，分别测量两组患者室间隔厚度（IVST）、左室后壁厚度（LVPWT）、左室舒张末期内径（LVEDD），计算左室质量指数（LVMI）、左室射血分数（LVEF）及E／A，进行对比分析。结果A组患者LVMI及影响LVMI的3大因素（IVST，LVPWT，LVEDD）均明显高于B组（均P〈0．01），显示随着脉压增大，出现明显的左心室肥厚；三型肥厚组患者的24hPP均高于无肥厚组；以扩张性肥厚组最显著。A组患者EF及E／A均低于B组，显示随着脉压增大，左室收缩舒张功能减退，以舒张功能受损更显著（P〈0．01）。结论24hPP增高是老年高血压病患者左室肥厚及心功能减退的重要危险因素。

Relationship of 24-hour ambulatory pulse pressure with left ventricular structure and cardiac function in elderly essential hypertension patients

Objective To investigate the relationship of 24-hour ambulatory pulse pressure （24hPP） with left ventricular structure and cardiac function in the elderly essential hypertension patients. Methods Totally, 145 elderly patients with essential hypertension received 24hPP monitoring and echocardiographic examination. The patients were divided into group A （24hPP≥ 60 mmHg, n=88） and group B （24hPP〈60 mmHg, n=57）. The data of interventricular septum thickness （IVST）, left ventricular posterior wall thickness （LVPWT）, left ventricular end-diastolic diameter （LVEDD）, left vetricular mass index （LVMI）, left ventricular ejection fraction （LVEF） and E/A were measured and compared between the two groups. Results In group A, IVST, LVPWT, LVEDD and LVMI were significantly higher than those in group B （P〈0.01）. The pulse pressure had a positive correlation with left ventricular hypetrophy. 24hPP was higher in patients with hypertrophy than in those without hypertrophy. The patients with dilated hypertrophy had the highest 24hPP. EF and E/A were lower in group A than in group B. The increased pulse pressure had negative influence on left ventricular function, especially diastolic dysfunction（P〈0.01）. Conclusion High 24hPP is an important risk factor for left ventricular hypertrophy and left ventricular dysfunction in the elderly essential hypertension patients.