高血压病患者动态血压参数与左室肥厚及颈动脉内-中膜厚度的关系

The predictive value of the ambulatory blood pressure monitoring parameters on left ventricular hypertrophy and carotid artery intima media thickness in hypertensives

目的 探讨高血压病患者动态血压参数对左室肥厚及颈动脉内 中膜厚度检测的意义。方法 将初诊的高血压病患者 147例经超声心动图和颈动脉超声检查分为左室肥厚组 (n=45例)和非左室肥厚组(n=102例),颈动脉内 中膜增厚组 (n=52例)和非内 中膜增厚组 (n=95例 ),经询问病史、体检、测定动态血压参数,血脂、血糖等生化指标进行比较。结果 (1)左室肥厚组与非左室肥厚组的临床指标比较差异无统计学意义 (P>0. 05)。(2)左室肥厚组与非左室肥厚组的动态血压参数比较分别为: 24h平均收缩压 ( 140. 7±14 .1 )比 ( 128 .3±12 .3 )mmHg( 1mmHg=0. 133kPa), 24h平均舒张压(86 .4±8. 9)比(81. 6±9. 3)mmHg,白昼平均收缩压 (142 .8±13 .9)比 (130 .9±11 .1)mmHg,白昼平均舒张压(86 .9±8. 8)比(83 .4±9. 0)mmHg,夜间平均收缩压(129. 0±13. 2)比(114. 6±11 .4)mmHg,夜间平均舒张压 ( 77 2±9 4 )比 ( 67 .5±8 .1 )mmHg, 24h脉压 ( 54 .2±10 .2)比(46. 9±9. 6)mmHg,白昼脉压(55. 9±10. 5)比(47 .5±9 .1)mmHg,夜间脉压(51. 8±10 .7)比(47. 1±8 .7)mmHg, 24h收缩压变异系数(8 .4±2 .0)比(7 .2±1 .9), 24h舒张压变异系数 (9 .5±2. 2)比(8 .0±2. 1),动态血压非勺型昼夜节律 55 6%比 25 5%。

Objective To investigate the predictive value of the ambulatory blood pressure monitoring parameters on left ventricular hypertrophy (LVH) and carotid artery intima media thickness(IMT) in the hypertensives Methods We evaluated 147 hypertensive patients who were never treated regularly before All patients underwent ultrasound examinations of the heart and the IMT of carotid arteries We classified them as LVH group( n =45) or no LVH group( n =102), and as IMT increased group ( n =52) or no IMT increased group ( n =95) The record of medical history, physical examination and 24 h ambulatory blood pressure monitoring(ABPM) were performed in all the patients The biochemical parameters such as blood lipids、glucose and so on were tested.Then the data comparison was made Results (1) There were no significant differences in clinical manifestations and biochemical parameters between the LVH and no LVH groups( P >0 05) Age(68 3±6 2)year vs(65 6±5 8)year,male 75 6% vs 66 7%,body mass index(24 1±4 1)vs(23 8±4 7)(kg/m 2),diabetes mellitus and(or)impaired glucose tolerance 40 0% vs 38 2%,angina pectoris 42 3% vs 38 9%,cerebral vascular diseases 19 2% vs 15 7%,total cholesterol(5 40±1 42) vs (5 28±1 46)mmol/L, triglycerides(1 80±1 02)vs(1 74±1 08)mmol/L,low density lipoprotein cholesterol(4 03±1 43)vs(4 06±1 48)mmol/L,high density lipoprotein cholesterol (1 00±0 30) vs(0 99±0 26)mmol/L (2) The parameters of ABPM in LVH group were higher than those in no LVH group There were significant differences( P <0 05) in 24 h mean systolic blood pressure(140 7±14 1)vs(128 3±12 3)mm Hg,24 h mean diastolic blood pressure(86 4±8 9)vs(81 6±9 3)mm Hg,daytime mean systolic blood pressure(142 8±13 9)vs(130 9±11 1) mm Hg, daytime mean diastolic blood pressure(86 9±8 8)vs(83 4±9 0)mm Hg,nighttime mean systolic blood pressure(129 0±13 2)vs(114 6±11 4)mm Hg,nighttime mean diastolic blood pressure(77 2±9 4)vs(67 5±8 1)mm Hg,24 h pulse pressure(54 2±10 2)vs(46 9±9 6)mm Hg,daytime pulse pressure(55 9±10 5)vs(47 5±9 1)mm Hg,nighttime pulse pressure(51 8±10 7)vs(47 1±8 7) mm Hg, 24 h systolic blood pressure variance(8 4±2 0)vs(7 2±1 9),24 h diastolic blood pressure variance(9 5±2 2)vs(8 0±2 1),the non dipper rhythm of ambulatory blood pressure 55 6% vs 25 5% (3)There were also no significant differences in clinical manifestations between the IMT increased and no IMT increased group ( P >0 05) While there were significant differences between the IMT increased and no IMT increased group in those parameters of ABPM( P <0 05) Conclusion There were more LVH or IMT increased persons in the hypertensives whose ABPM parameters were abnormal