老年高血压患者动态脉压与心肌重构 颈动脉粥样硬化的关系

The relationship between ambulatory pulse pressure,myocardial remodeling and carotid atherosclerosis in elderly people with hypertension

目的探讨老年高血压患者动态脉压与心肌重构、颈动脉粥样硬化的关系。方法将120例老年原发性高血压病患者分别测定24h动态血压、超声心动图、颈动脉超声，按照脉压的不同，分为三组：PP1组（脉压〈51mmHg），PP2组（脉压51～65mmHg），PP3组（脉压〉65mmHg），分析各组病例间超声心动图特点及颈动脉粥样硬化斑块程度。结果随着脉压增高，左室质量指数增加，颈动脉粥样硬化斑块分级增高，PP3〉PP2〉PP1（P〈0．05）；EF斜率降低，PP3〈PP2〈PP1（P〈0．05）；左室射血分数、短轴缩短率无显著性差异（P〉0．05）。结论老年高血压患者动态脉压增高可导致左室肥厚、左室舒张功能减退，加重颈动脉粥样硬化，而对左室收缩功能无明显影响。保持合理的脉压，可减轻和改善心肌重构，改善患者左室舒张功能，防止动脉粥样硬化的进展。

Objective To investigate the relationship between ambulatory pulse pressure, myocardial remodeling and carotid atherosclerosis in elderly people with hypertension. Method 120 elderly hypertensive patients were divided into 3 groups according to the grade of pulse pressure, PP1 group （pulse pressure〈 51mmHg）, PP2 group（51mmHg≤pulse pressure≤65mmHg） , PP3 group （pulse pressure 〉 65mmHg）. The two-dimensional echocardiography and carotid arterial ultra sonography were done at the same time. Results With increased pulse pressure, LVMI and carotid atheroma increased, PP3 〉 PP2 〉 PP1 （ P 〈 0.05 ） ; EF slope proportion decreased on the contrary, PP3 〈 PP2 〈 PP1 （ P 〈 0.05）. There were no changes in LVEF% or FS with increased pulse pressure. Conclusion The results show that increased pulse pressure induces left ventricular hypertrophy, cardiac diastolic dysfunction and carotid atherosclerosis formation. It might be concluded that maintaining moderate pulse pressure could revert myocardial remodeling, improve cardiac diastolic function and prevent the progression of atherosclerosis.