动态血压节律与靶器官损害的临床研究

The clinical study on the relationship between target organ damage and the reproducible patterns of ABPM

目的评价高血压初期重复性的动态血压节律对靶器官损害的影响。方法对有重复性动态血压节律的137例患者进行高血压靶器官检查。结果根据血压节律分为勺形组(N=106)和非勺形组(N=31),非勺形组左房内径(LA)显著大于勺形组(35.7±4.0VS32.6±3.8),E/A值显著减小(0.95±0.32VS1.1±0.34);左室构型组成比方面,非勺形组正常构型者明显少于勺形组,向心性重构者或左心室肥厚者明显多于勺形组;颈总动脉内膜中层厚度(IMT)和IMT增厚发生率非勺形组均大于勺形组。结论有重复性的、持续时间较长的非勺形动态血压节律是加重心脏及大动脉损害的重要因素。

Objective To assess the association of a reduced nocturnal fall in blood pressure with more prominent taget organ damage. The nocturnal fall of blood pressure was established on the basis of two 24-hour ambulatory blood pressure monitoring（ABPM） sessions in a recent diagnosis of hypertension. Methods A more accurate definition of blood pressure pattern based on two concordant ABPMs was adopted. 137 patients showing reproducible dipping or non-dipping patterns were enrolled.The target organ damage of them were carefully examined. Results The patients were divided into two groups ：The dippers （n=106） and non-dippers （n=31）. There were differences between the dippers and non-dippers, such as left artrial-internal diameter and E/A （32.6±3.8 vs 35.7±4.0 and 1.1±0.34 vs 0.95±0.32, respectively, P〈0.05）, There were also differences in the patterns of left ventricular hypertrophy and geometric remodeling, and there was more concentric remodelling in non-dippers than dippers （58.1% vs 37.7%, P〈0.05）, and more left ventricular hypearophy （25.8% vs 9.5%, P〈0.001 ）. The common carotid artery intima-media thickness（IMT）and the prevalence of IM thickening were significantly greater in non-dippers than in dippers （P〈0.05）. Conclusions Despite similar clinic and 48-hour BP values, never-treated hypertensive patients with a persistent non-dipper pattern bane showd a significantly greater extent of cardiac and artery structural alterations compared with a reproducible dipping pattern.