血压晨峰与左室肥厚的关系

Relationship between morning blood pressure surge and left ventricular hypertrophy

目的探讨血压晨峰与左室肥厚的关系。方法在浙江省景宁县641名村民中，运用SpaceLab动态血压监测仪记录24h血压。血压晨峰为起床后2h内平均收缩压减去睡眠时最低平均收缩压。血压晨峰高于90百分位数划分为晨峰组（n=63），其他为非晨峰组（n=578）。以心电图的Sokolow—Lyon电压作为诊断左室肥厚的标准。结果晨峰组左室肥厚的患病率显著高于非晨峰组（40％ws24％）（P=0．008）。血压晨峰与左室肥厚的关系受年龄的影响（与年龄交互作用，P=0．05）。在192例年龄≥55岁的人群中，调整其他危险因素后，晨峰组左室肥厚患病危险是非晨峰组的2．47倍（95％CI1．09～5．61，P=0．03）；而在449例年龄〈55岁的人群中，血压晨峰与左室肥厚无显著关联（P=0．21）。结论在≥55岁的人群中，血压晨峰可能是左室肥厚的独立危险因素。

Objective To investigate the relationship between morning blood pressure surge （MBPS） and left ventricular hypertrophy（LVH）. Methods Six hundred and forty-one villagers living in Jingning County, Zhejiang Province were performed 24 h ambulatory blood pressure monitoring with SpaceLab monitors. MBPS was calculated as the difference between mean systolic blood pressure （SBP） during the 2 hours after awaking and the lowest average SBP during sleep. Subjects with MBPS above the 90th percentile were classified as surge group（ n =63） , and the others were classified as non- surge group（n = 578）. LVH was diagnosed by the criteria of Sokolow-Lyon voltage amplitude. Results The prevalence of LVH in surge group was significantly higher than that in non-surge group （40% vs 24% ） （P = 0. 008）. The relationship between MBPS and LVH was dependent on age （P =0.05 for interaction）. In 192 subjects with age ≥ 55 years, after adjustment for the other risk factors, surge group had a 2.47 times higher risk for LVH than non-surge group （95% CI, 1.09-5.61; P =0.03）. In 449 subjects with age 〈 55 years, there was no significant relationship between MBPS and LVH （P=0.21）. Conclusion In subjects with age≥ 55 years, MBPS may be an independent risk factor for LVH.