不同状态下血压值与左心室肥厚的相关性

Complicated Relationship between Blood Pressure and Left Ventricular Hypertrophy

分析１１５例高血压病人在不同状态下血压测定值（偶测，入院一周后偶测，亚极量运动时血压，２４ｈ动态血压测定）与超声心动图测量的左室重量的相关性，发现在各种测定值中，２４ｈ平均ＳＢＰ值与夜间血压是否下降，是判断高血压病情严重程度的２个良好指标。夜间最低收缩压＞１２０ｍｍＨｇ提示高血压病情较重、左心室肥厚明显。午间休息时血压下降与夜间血压下降水平无明显区别，可以用午间血压代替没有条件行２４ｈ血压监测病人的夜间血压。研究还证明血压在左心室肥厚发生发展过程的不同阶段所起的作用不同，轻型高血压病人，ＬＶＨ与２４ｈ平均ＳＢＰ只有微弱的相关，与ＤＢＰ无关，随着血压升高，ＳＢＰ与左室肥厚相关明显。当夜间最低收缩压＞１３０ｍｍＨｇ时，舒张压与左室肥厚也明显相关。可见不同严重程度的高血压病人收缩压和舒张压对左室肥厚的影响不一样。降低２４ｈ平均血压和恢复夜间睡眠时血压下降的正常昼夜节律是治疗高血压的目标。

Relationship between blood pressure (BP)measured under various conditions and left ventricular hypertrophy (LVH) detected by echocardiography was studied in 115 hypertensive patients. The level of minimum SBP in the nighttime and 24 hour average SBP were two best markers for distinguishing the severity of hypertension and LVH.There was no difference between noon rest BP and nighttime BP,Noon rest BP may be an alternative index for the patients who is not able to undertake ambulatory blood pressure monitoring (ABPM),The impact of BPon the development of LVH varies in the different stages of hypertension.In mild hypertension,SBP correlates weakly with LVH,and no relation between DBP and LVH was found. With the advancement of hypertension SBP become to correlate LVH. DBP become related with LVH significantly only the severity of hypertension reaches to a certain degree manifested by remarkable elevation of night time BP>130 mmHg.It was thus concluded that the effects of SBP and DBP on LVH may be various in hypertensive patients of differing severity.Reduction of 24 h average BP and recovery of normal circadium with the appearance of nighttime BP dip seems to be two reliable indices for the effective antihypertensive treatment.