高血压病人脉压与心脏几何结构的关系

The relationship between pulse pressure and the cardiac geometric structure in patients with essential hypertension

目的 探讨高血压病人脉压与心脏几何结构的关系。方法 对 395例高血压病人进行诊所血压和 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 不同年龄组间诊所脉压的差异有统计学意义 (P <0 0 5 ) ,随着年龄的增大 ,脉压逐渐增大 ,且≥6 0岁组的脉压明显高于其他年龄组 ,差异有统计学意义 (P <0 0 5 )。“非杓型”病人各时段的收缩压 /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或P <0 0 5 )。年龄越大 ,“非杓型”血压病人的比例越大 ,而“杓型”血压者的比例减少。随着年龄的增大 ,左室肥厚的检出率有增大的趋势 ;随着脉压的增大 ,左室重量指数 (LVMI)、左室舒张末内径 (LVIDD)及室间隔厚度 (IVST)均升高 ,≥ 6 0mmHg组明显高于 4 0～ 5 9mmHg组 (P <0 0 5 ) ,更高于 <4 0mmHg组(P <0 0 5 )。随着脉压的增大 ,左室重构、向心性肥厚及离心性肥厚的百分比相应增加 ,且向心性肥厚的比例增加更明显 (占 32 6 % )。结论 高血压病人脉压对左室几何构型存在重要的影响。

objective To evaluate the relationship between the pulse pressure and the cardiac geometric structure in patients with essential hypertension. Methods Three hundred and ninety-five patients,age ranging from 20 to 77 years,were enrolled into the study. Their clinical systolic and diastolic blood pressure (SBP/DBP) were all above 140/90mmHg. All the patients either were initially diagnosed as having essential hypertension,or confirmed after taking a the placebo for 2 weeks after stopping anti-hypertensive drugs. The cardiac geometric structure was determined by the echocardiography at the same time when the patients untook the 24 hours ambulatory blood pressure monitoring. Results The clinical pulse pressure was significantly different among the groups as divided by the age ( P <0.05),and the pulse pressure of the patients above 60 years old were higher than those of other groups ( P <0.05). The pulse pressure,systolic blood pressure and diastolic pressure of patients with 'non-dipping' pattern were higher than those of 'dipping' pattern ( P <0.01 or P <0.05). The percentage of 'non-dipping' pattern increased with advance in age while that of the 'dipping' pattern decreased. The incidence of the left ventricular hypertrophy increased with the advance of age. The LVMI,LVIDD and IVST of the patients with pulse pressure above 60mmHg were significantly higher,compared with those in 40-59mmHg group and below 40mmHg group( P <0.05). With the increase in pulse pressure,the percentages of left ventricular restructure and centripetalism and entrifugal left ventricular hypertrophy were increased significantly,and the centripetalism ventricular hypertrophy was more prominent (about 32.6%). Conclusion The pulse pressure of the hypertensive patients exerts very important influence on the left ventricular geometric structure.