高血压患者血压和心率昼夜节律变化与左心室肥厚的关系

The correlation between blood pressure, heart rate circadian rhythm change and left ventricular hypertrophy in essential hypertensive patients

目的探讨原发性高血压患者血压和心率24h昼夜节律变化与左心室肥厚的关系。方法对初发未治疗高血压患者296例进行动态血压监测分析,根据患者夜间血压和心率均值较白天平均值下降是否超过10%,将患者分为4组:杓型血压和心率组(血压和心率均杓型,n=163)、非杓型血压组(血压非杓型,心率杓型,n=62)、非杓型心率组(血压杓型,心率非杓型,n=42)、非杓型血压和心率组(血压和心率均非杓型,n=29)。对4组间相关临床资料、超声心动图结果进行比较。结果高血压患者收缩压和舒张压非杓型率分别为25%和27%,非杓型心率的比例为24%。非杓型血压和心率组、非杓型血压组、非杓型心率组左心房内径(LAD)、左心室舒张末期内径(LVEDD)、室间隔厚度(IVST)和左心室质量指数(LVMI)明显高于杓型血压和心率组(均P<0.05),其中非杓型血压和心率组上述指标明显高于其他3组(均P<0.05),非杓型血压组、非杓型心率组之间差异无统计学意义。Logistic回归分析显示,年龄、24h平均收缩压、24h平均舒张压、夜间平均收缩压、夜间平均舒张压、非杓型血压、非杓型心率与左心室肥厚的发生密切相关。经调整相关指标后,非杓型血压和非杓型心率使左心室肥厚发生风险分别增加56%和32%。结论高血压患者血压和心率昼夜节律变化与左心室肥厚明显相关。

Objective To investigate the association between blood pressure （BP）, heart rate （HR） circadian rhythm and left ventricular hypertrophy（LVH） in essential hypertensive （EH） patients. Methods A total of 296 EH patients without previous treatment underwent 24 h ambulatory BP monitoring. According to BP or HR, decreased more than 10 % or not in nighttime compared to those in the daytime, patients were divided into four groups： nondipper BP and HR（ BP-nondip-[- HR-nondip, n = 29 ）, dipper BP and nondipper HR （ BP-dip ＋ HR-nondip, n = 42）, nondipper BP and dipper HR [BP-nondip-[-HR-dip, n= 62）, and dipper BP and HR（BP-dip＋ HR-dip, n= 163）. Results Non-dippers in systolic blood pressure （SBP）, diastolic blood pressure （DBP） and HR was 25%, 27% and 24% respectively of all the subjects. Left atrial diameter （LAD）, left ventricular end-diastolic dimension （LVEDD）, interventricular septum thickness（IVST） and left ventricular mass index （LVMI} in BP-nondip-[-HR- nondip, BP-dip＋ HR-nondip, BP-nondip-[-HR-dip groups were significantly higher than those in BP-dip-I-HR-dip group （all P〈0.05）. The LVMI in BP-nondip＋HR-nondip was the highest in all groups （all P〈0.05 ）, there was no significant difference between BP-dip-[-HR-nondip and BP-nondip-[-HR-dip groups. Logistic regression analysis showed that age, 24hSBP, 24hDBP, nighttime SBP, nighttime DBP, BP non-dippers and HR non-dippers were closely correlated to LVH. After other correlated indexes were adjusted, the odds ratio （OR） of LVH in- duced by BP non-dippers and HR non-dippers were 1.56 and 1.32 respectively. Conclusion Blood pressure and heart rate circadian rhythm change are correlated with left ventricular hypertrophy in essential hypertensive patients.