老年性高血压患者的静息心率增加与靶器官损害的相关性研究

The relationship between resting heart rate and target organs damage in senile essential hypertension

目的 探讨老年高血压病患者静息心率 (restingheartrate ,RHR)与靶器官损害的关系。方法 入选老年高血压病患者 2 0 6例 ,按收缩压 (SBP)水平分为三组 :SBP <16 0mmHg(1mmHg =0 133kPa) ,16 0mmHg≤SBP <180mmHg ,SBP≥ 180mmHg。在以上每一组中 ,又按RHR水平分为 :RHR1组 ,<6 5次 /min ;RHR2组 ,6 5次 /min≤RHR <6 9次 /min ;RHR3组 ,70次 /min≤RHR <74次 /min ;RHR4组 :75次 /min≤RHR <79次 /min ;RHR5组 ,RHR≥ 80次 /min。对入选患者做以下检查 :心电图、超声心动图、颈动脉超声、肌酐清除率以及尿微量白蛋白。结果 (1)RHR5组的尿微量白蛋白定量和左心室质量指数均高于RHR1～RHR4各组 (P <0 0 5或P <0 0 1)。RHR5组或RHR4组的颈动脉内膜厚度和颈动脉内径大于RHR1和RHR2组 ;而左室射血分数和肌酐清除率小于RHR1和RHR2组 (P <0 0 5或P <0 0 1)。(2 )RHR与颈动脉内膜厚度、颈动脉内径、左心室质量指数、尿微量白蛋白定量呈正相关 (r分别为 0 312、0 2 89、0 6 30、0 5 76 P <0 .0 1) ,而与左室射血分数、肌酐清除率呈负相关 (r分别为 - 0 5 6 3、- 0 5 10 ,P <0 .0 1)。结论 RHR的增加是老年高血压病患者靶器官损害的重要危险因素。

Objective To investigate the relationship between resting heart rate (RHR)and target organs damage in senile essential hypertension. Methods All 206 elderly essential hypertensive patients (age: 60-85 years) were divided into three groups according to the levels of systolic blood pressure (SBP): SBP<160 mm Hg, 160 mm Hg≤SBP<180 mm Hg,SBP≥180 mm Hg.Each of the groups mentioned above were divided into five groups according to the levels of RHR [RHR1 group:RHR<65 beats/minute(bpm); RHR2: 65 bpm≤RHR<69 bpm; RHR 3: 70 bpm≤RHR<74 bpm; RHR4: 75 bpm≤RHR<79 bpm; RHR5: RHR≥80 bpm]. Electrocardiography, carotid ultrasonography, echocardiography, creatinine clearance rate(CCr) and quantitative test for 24 hours′ urinary microalbuminuria (MAU) were performed. Results (1) Compared with RHR1- RHR4 groups, the RHR5 group showed with lower levels of MAU and left ventricular ejection fraction(LVEF) (P<0.05 or P<0.01). Compared with RHR1 and RHR2 groups, RHR5 or RHR4 group showed with higher levels of carotid intima-medial thickness (IMT) and carotid arterial diameter(CAD), lower CCr and MAU (P<0.05 or P<0.01). (2)The levels of IMT、CAD、LVMI、MAU were positively correlated to RHR(r=0.312、0.289、0.630、0.563、0.576 respectively, all P<0.01),however, the levels of LVEF、CCr were negatively correlated to RHR(r=-0.563、-0.510. all P<0.01). Conclusions Target organ damage(TOD) seems not only related with PP、SBP、DBP, but also related with RHR in senile essential hypertension. RHR may be one of the important risk factors in TOD.