原发性高血压患者晨峰现象与靶器官损害

The Association Between Morning Blood Pressure Surge and Target Organ Damage in Hypertensives

目的探讨老年原发性高血压晨峰现象(MBPS)对靶器官结构及功能损害的影响。方法老年原发性高血压患者322例根据24 h 动态血压监测(24ABPM)分为 MBPS 组(173例)和非 MBPS 组(149例),常规检查血脂谱、空腹血糖、肌酐,计算体质量指数(BMI)、左室质量指数(LVMI)、颈总动脉(CCA-IMT)和颈内动脉内膜中膜厚度(ICA-IMT),心电图测量计算 QT 间期、校正的 QT 间期(QTc)、QT 离散度(QTd)和校正的 QT 离散度(QTcd)。结果 MBPS 组的24 h、白昼、夜间平均收缩压均显著高于非 MBPS 组动态血压监测水平(P<0.05)。MBPS 组的 LVMI、CCA-IMT、ICA-IMT 指标均高于非 MBPS 组[LVMI:MBPS:(170.1±16.4)比非 MBPS:(143.5±14.8)g/m^2;右侧 CCA-IMT:MBPS:(1.5±0.1)比非 MBPS:(0.9±0.2)mm,右侧 ICA-IMT:MBPS:(1.3±0.2)比非 MBPS:(0.9±0.3)mm,P 均<0.05]。MBPS 组的 QT 间期、QTc、QTd 及 QTcd 指标亦高于非 MBPS 组[MB-PS:QT:(370.0±24.6)比非 MBPS:(352.0±32.4)ms;QTc:MBPS:(414.0±23.7)比非 MBPS:(409.0±31.6)ms;QTd:MBPS:(32.3±10.5)比非 MBPS:(30.1±9.6)ms;QTcd:MBPS:(40.2±10.8)比非 MBPS:(37.5±10.1)ms,P 均<0.05]。结论老年原发性高血压晨峰者有更明显的颈动脉粥样硬化、左心室肥厚,同时有心肌复极时间的延长。

Objective To investigate the association between the target organ damage and morning blood pressure surge（MBPS） in the elderly hypertensives. Methods Three hundred thirty-two patients submitted to 24 h ambulatory blood pressure monitoring were categorized as with MBPS （n= 173）, and non-MBPS（n= 149）. Total cholesterol, body mass index（BMI）, left ventricular mass index（LVMI）, carotid endothelial medium thickness （CCA-IMT and ICA-IMT） and corrected QT dispersion（QTcd） were determined. Results 24 h, day and night mean systolic blood pressure in MBPS group were significantly higher than that in the non-MBPS groupl P〈0. 05）. Compared with the non-MBPS group, the MBPS group had significantly higher LVMI, CCA-IMT and ICA-IMT （LVMI, MBPS：170.1±16.4 vs non-MBPS：143.5±14.8 g/mz ; RCCA-IMT：MBPS：I. 5±0.1 vs non-MBPS：0.9 ±0.2 mm;RICA-IMT： MBPS：I. 3±0.2 vs non-MBPS：0.9±0.3 ram; all P〈0.05）, as well as longer QT, QTc, QTd and QTcd（QT, MBPS：370.0±24.6 vs non-MBPS： 352.0±32.4 ms; QTc, MBPS：414.0±23.7 vs non-MB- PS： 409.0±31.6 ms;QTd, MBPS： 32.3±10.5 vs non-MBPS： 30.1±9.6 ms; QTcd： MBPS： 40.2±10.8 vs non- MBPS： 37.5±10.1 ms, all P〈0.01）. Conclusion Patients of hypertension with MBPs have been shown to have prolongation of cardiac repolarization times, more severe carotid atherosclerosis and left ventricular hypertrophy than that in non-MBPS patients.