高血压病患者动态脉压、收缩压、舒张压、平均动脉压与左心室肥厚的相关性研究

Effects of Pulse,Systolic,Diastolic and Mean Blood Pressure on Left Ventricular Hypertrophy in Patients with Essential Hypertension

目的 探讨高血压病患者诊所或动态脉压、收缩压、舒张压及平均动脉压变化与左心室肥厚之间的相互关系。方法 选择 5 5 5名初诊或停药 2周以上的轻中度高血压病患者进行诊室血压、2 4h动态血压监测及超声心动图检查。 5 5 5名患者根据诊室脉压 (CPP)及 2 4h动态脉压 (APP)水平分别分为四组 ,A组 :PP≤ 40mmHg ;B组 :40mmHg <PP≤ 5 0mmHg ;C组 :5 0mmHg <PP≤ 60mmHg ;D组 :PP >60mmHg。以左室心肌质量指数 (LVMI)男性 >13 4g/m2 ,女性 >110g/m2 作为左室肥厚的标准 ,分为年龄匹配的左室肥厚组和非肥厚组 ,其中肥厚组 2 3 7例 ,非肥厚组 3 18例。结果 左室肥厚组较非肥厚组收缩压及脉压明显增高 ,舒张压无明显差异 ,脉压增高的主要因素是收缩压增高。以左室心肌质量指数为因变量 ,以诊所或 2 4h收缩压、舒张压、脉压、平均动脉压为自变量 ,只有诊所或 2 4h收缩压进入回归方程。结论 脉压与收缩压增高均可导致高血压病患者左心室肥厚 ,而收缩压增高是导致高血压病患者左心室肥厚的主要决定因素。舒张压及平均动脉压增高对左心室肥厚无明显影响。

Objective To investigate the relationship between pulse pressure (PP),systolic blood pressure(SBP),diastolic blood pressure (DBP),mean blood pressure (MBP) and left ventricular hypertrophy in patients with essential hypertension.Methods Clinical blood pressure,24 h ambulatory blood pressure monitoring and two-dimensional echocardiography were taken in 555 initially untreated patients (275 men and 280 women,aged 47.1±12.7 years).The patients were divided into four groups according to clinical pulse pressure (CPP) or ambulatory pulse pressure (APP) respectively:Group A:PP≤40 mmHg; Group B:40 mmHg<PP≤50 mmHg; Group C:50 mmHg<PP≤60 mmHg; Group D:PP>60 mmHg.They were also divided into age matched 2 groups according to their left ventricular mass index (LVMI),left ventricular hypertrophy (LVH) group (LVMI >134 g/m 2 in man and >110 g/m 2 in woman) were 237 subjects (aged 53.9±10.2 years) and non-LVH group 318 subjects (aged 54.6±9.9 years).Results SBP and PP were significantly higher in LVH group than in non-LVH group.There were no significant difference in DBP between the two groups.Multiple step analysis was showed that SBP was the only independent factor which influenced LVH.Conclusion SBP was one of the most important factors in influencing LVH,neither can DBP nor MAP can induce LVH.