药物干预原发性高血压患者血压昼夜节律变化与左心室舒张功能的关系

Relationship between the circadian variation and left ventricle diastolic function in patients with essential hypertension interfered by medicine

目的:应用依贝沙坦治疗原发性高血压患者,观察血压昼夜节律变异逆转与左心室舒张功能的关系。方法:选择2000-03/2005-04解放军总医院收治的原发性高血压患者107例,均未经降压治疗,且不伴有左心室收缩功能异常,给予口服依贝沙坦(杭州诺塞菲-圣德拉堡制药)将血压控制在正常范围内。所有患者治疗前后行24h动态血压监测和组织多普勒成像检查,观察心室舒张功能各评价指标的变化。结果:107例全部进入结果分析。根据治疗前血压昼夜节律和治疗后血压昼夜节律逆转情况分为杓型组29例、逆转组34例和未逆转组44例。①3组患者的一般情况和心腔内径、室壁厚度和射血分数等参数比较无显著性差异。②治疗前逆转组和未逆转组的24h平均收缩压和舒张压、夜间平均收缩压和舒张压均显著高于杓型压组(P<0.05)。治疗后逆转组和未逆转组患者各指标均较治疗前显著降低(P<0.05);但未逆转组夜间平均收缩压和舒张压仍高于逆转组[(135.2±25.4),(125.1±29.6)mmHg;(87.4±36.1),(78.3±35.2)mmHg,P<0.05],并且血压昼夜节律仍呈非杓型。③治疗前逆转组和未逆转组的平均组织舒张早期速度和平均组织舒张早、晚期速度比值显著低于杓型组[(5.9±2.1),(6.0±2.4),(7.8±3.1)cm/s;0.68±0.56,0.67±0.49,0.95±0.39,P均<0.05],治疗后上述指标显著升高(P<0.05),但未逆转组仍低于逆转组(P<0.05);治疗前逆转组和未逆转组的平均组织舒张晚期速度明显高于杓型组[(9.5±2.8),(9.6±2.7),(8.6±1.7)cm/s,P<0.05],治疗后显著降低(P<0.05),但未逆转组仍高于逆转组[(9.0±1.8),(8.7±2.1)cm/s,P<0.05]。结论:①血压昼夜节律异常可能与高血压病患者的左心室舒张功能受损有关。②通过有效的降压治疗逆转血压昼夜节律异常,可以显著改善非杓型高血压病患者的左心室舒张功能。

AIM： To study the relationship between the circadian variation reversion of blood pressure and left ventricle （LV） diastolic function in patients with essential hypertension treated by irbesartan. METHODS： 107 patients with essential hypertension between March 2000 and April 2005 were selected from General Hospital of Chinese PLA, who were never treated for depressurization and without LV diastolic function. Patients were required to orally take irbesartan （manufactured by of Hangzhou Sanofi-Synthelabo Group） so as to control the blood pressure in normal range. All subjects underwent 24-hour ambulatory blood pressure monitoring and tissue Doppler imaging respectively before and after the treatment, and the changes in all evaluation indicators of ventricular diastolic function were observed. RESULTS： A total of 107 patients were involved in the analysis of results. According to the circadian type before treatment and circadian variation reversion after treatment, patients were divided into dipper group, reversion group and non-reversion group. ①The general state, left atrial diameter, interventricular wall thickness, ejection fraction （EF） were not significantly different among patients of three groups.②The average systolic pressure （SP） and diastolic pressure （DP） in 24 hours and the nocturnal SP as well as DP before treatment in the reversion group and non-reversion group were higher than those in the dipper group （P 〈 0.05）. However, all indexes in patients of the reversion group and non-reversion group after treatment were greatly decreased than those before treatment （P 〈 0.05）, whereas the average nocturnal SP and DP in the non-reversion group were remarkably higher than those in the reversion group [（135.2 ±25.4）, （125.1 ±29.6）mm Hg; （87.4±36.1）, （78.3 ±35.2）mm Hg, P 〈 0.05], moreover, the circadian rhythm of blood pressure was still in dipper.③ Before treatment, the mean Ea and the ratio of mean Ea and mean Aa in the reversion group and non-reversion group were obviously lower than those in the dipper group [（5.9±2.1 ）,（ 6.0±2.4 ）, （7.8±3.1）cm/s; 0.68 ±0.56, 0.67±0.49,0.95±0.39,P all 〈 0.05], and above-mentioned indexes were markedly increased, while those in the non-reversion group were still lower than those in the non-reversion group （P 〈 0.05）. The mean Aa before treatment in both of reversion group and non-reversion group were remarkably higher than that in the dipper group [（9.5±2.8）, （9.6±2.7）, （8.6±1.7）cm/s, P 〈 0.05], which were significantly decreased after treatment （P 〈 0.05）, however, it was still higher in the non-reversion group than that in the reversion group [（9.0±1.8）, （8.7±2.1）cm./s, P 〈 0.05]. CONCLUSION： ①Abnormal circadian variation of blood pressure may be associated with the lesion in LV diastolic function of patients with hypertension. ②The circadian variation can be reversed by effective depressurization treatment, which can significantly ameliorate the LV diastolic function of hypertensive patients of dipper pattern.