高血压人群中左室几何模式异常的患病率及危险因素

Prevalence and Risk Factors of Abnormal Left Ventricular Geometrical Patterns in Hypertensive Patients

目的调查中国北方地区高血压人群中异常的左室几何模式的患病率及它们各自的危险因素。方法我们采取以社区为基础的横断面研究,使用多级抽样的方法,对2811名高血压患者进行了调查,男性1558例,女性1253例。每个调查对象均接受超声心动图及体格检查。结果异常的左室几何模式的患病率为:向心性重构37.0%,向心性肥厚15.7%,离心性肥厚10.4%。左室几何模式异常的危险因素为:年龄、性别、收缩压、体重指数、高血压患病时间及高血压药物史。结论在中国北方高血压人群中,超声诊断左室几何模式异常的患病率很高。

Objective The patterns of left ventricular geometry may predict cardiovascular events, but not much data are available in Chinese. We investigated the prevalence of different patterns of left ventricular geometry and their risk factors in hypertension population in northern China. Methods A total of 2811 patients with hypertension were recruited from two Chinese communities. Left ventricular hypertrophy was defined by us- ing the criteria of the left ventricular mass index （LVMI） more than l l5g/m2 for men and 95g/m2 for women, respectively. The left ventricular geometry was classified into four patterns： normal ~ abnormal, defined as concentric remodeling ~ concentric or eccentric hypertrophy based on the values of LVMI and relative wall thickness. Logistic regression model was applied to determine the odds ratio （OR） and 95% confidence intervals （CD of the risk factors of left ventricular hypertrophy.Results The prevalence of left ventricular hypertrophy was 26.0% （n = 732） in patients with hyper- tension （n = 2811）, much higher in women （39.3%, n=492） than in men （15.4%, n = 240） （P〈0.01）. The prevalence of LV geometrical patterns was 37.0%, 15.7%, 10.4~/0 for concentric remodeling, concentric and eccentric hypertrophy, respectively. After adjustment by using Logistic regression model, the risk factors for left ventricular hypertrophy were female （OR 2.555, 95% CI 2.015-3.240, P 〈0.001）, age （OR 1.043, 95% CI 1.033-1.053, P 〈0.001）, systolic blood pressure （OR 1.020, 95% CI 1.015-1.026, P 〈0.001）, body mass index （OR 1.091, 95% CI 1.061-1.122, P 〈0.001）, hyper- tensive medication history（OR 1.915, 95% CI 1.567-2.340, P 〈0.05）, smoking history （OR 1.315, 950 CI 1.006-1.720, P 〈0.01）. Drinking history showed a protective factor for left ventricular hypertrophy （OR 0.657, 95% CI 0.490-0.882, P 〈0.01）. The risk factors for abnormal left ventricular geometry were age, sex, systolic blood pressure, and body mass index, duration of hypertension, hypertensive medication history. And also drinking history showed a protective factor.Conclusions The echocardiographic left veutricular hypertrophy and left ventricular geometric abnormality were much prevalent in hypertensive population in northern China. Echocardiography patterns of left ventricular geometry may be used to guide treatment of hypertension-related heart damage.