原发性高血压患者血压变异性与左心室舒张功能的关系

Association between left ventricular diastolic function and blood pressure variability in essential hypertensive patients

目的探讨原发性高血压患者血压变异性与左心室舒张功能的关系。方法入选原发性高血压患者252例。采用多普勒超声心动图测量二尖瓣口舒张早期血流峰值速度（E）、二尖瓣环舒张早期峰值速度（Ea），以评价左心室舒张功能。将患者分为2组，E／Ea〈15为舒张功能正常组（n=168）、E／Ea≥15为舒张功能不全组（n=84）。患者均行24h动态血压监测，血压变异性以血压的标准差和变异系数表示。采用多因素logistic回归分析血压变异性与左心室舒张功能的关系。结果舒张功能不全组24h平均舒张压、白天平均收缩压、夜间平均收缩压、夜间平均舒张压、24h平均收缩压标准差、24h平均舒张压标准差、24h平均舒张压变异系数均显著高于舒张功能正常组（P均〈0．05）。多因素logistic回归分析显示，24h平均收缩压标准差（OR：1．126，95％CI：1．054～1．203，P〈0．01）、24h收缩压变异系数（OR：1．127，95％CI：1．036—1．225，P〈0．01）与左心室舒张功能不全显著相关。结论高收缩压变异性与原发性高血压患者左心室舒张功能不全独立相关。

Objective To investigate the relationship between blood pressure variability （BPV） and left ventricular diastolic function in patients with essential hypertension. Methods Left ventrieular diastolic function of 252 hypertensive patients were assessed by early （E） diastolic transmitral flows to early diastolic mitral annular velocity （Ea） （E/Ea） ratio derived from Doppler echocardiography. Patients were divided into two groups according to normal left ventrieular diastolic function group （ E/Ea 〈 15, n = 168 ） and left ventricular diastolic dysfunction group （ E/Ea ≥ 15, n = 84 ）. All patients were monitored by ambulatory blood pressure. Standard deviation （SD） and coefficient of variation （CV） of blood pressure were calculated as the BPV. Relationship between BPV and left ventricular diastolic function were analyzed by multivariate logistic regression analysis. Results All-day average diastolic blood pressure（DBP）, the day systolic blood pressure （SBP）, night SBP, night DBP, SBPSD, DBPSD and DBPCV in the left ventricular diastolic dysfunction group were significantly higher than in the normal diastolic function group （all P 〈 O. 05）. Multivariate logistic regression analysis showed that left ventricular diastolic dysfunction was associated with SBPSD （ OR： 1.126,95 % CI： 1. 054 - I. 203, P 〈 O. 01 ）, SBPCV （ OR： 1. 127,95 % CI： 1. 036 - 1. 225, P 〈 O. 01 ） in this patient cohort. Conclusion High variability of SBP is correlated with left ventricular diastolic dysfunction in hypertensive patients.