正常高值血压者静息心率与左心室肥厚的关系

The relationship between resting heart rate and left ventricular hypertrophy in pre-hypertensives

目的探讨正常高值血压者静息心率与左心室肥厚（LVH）的关系及分析静息心率对LVH发生的预测价值。方法从广东省人民医院心内科门诊收集新诊断和（或）未予以药物治疗的未合并其他心血管疾病的正常高值血压者,按静息心率水平分3组：静息心率〈70次/min为A组、70~〈80次/min为B组、≥80次/min为C组,比较各组间资料的差异,多因素Logistic回归分析影响LVH的因素,并绘制工作特征（ROC）曲线分析静息心率对LVH的预测价值。结果共有394人纳入本研究,年龄（52.0±4.4）岁,其中A组183人（46.4%）、B组136人（34.5%）、C组75人（19.0%）;各组间收缩压、舒张压、室间隔厚度、左心室后壁厚度（LVPWT）、左室质量指数（LVMI）及LVH发生率差异有统计学意义（均P〈0.05）,LVH发生率三组间逐渐升高（分别为2.7%、16.9%、48.0%,P〈0.05）。多因素Logistic回归分析显示,年龄（OR=1.98,P〈0.05）、静息心率（OR=5.28,P〈0.01）是LVH的危险因素。静息心率与LVH间的ROC曲线显示：曲线下面积（AUC）=0.860（P〈0.05）,静息心率对LVH有较好的预测价值。结论在正常高值血压人群中,年龄、静息心率是LVH的危险因素,不同水平的静息心率对LVH的影响存在差异,静息心率对LVH有较好的预测价值。

Objective To investigate the relationship between resting heart rate （RHR） and left ventricular hyper- trophy （LVH）, and assess the predictive value of LVH in pre-hypertensives. Methods All participants, recruited from Cardiovascular Internal Medicine Guangdong General Hospital, were new-diagnosed pre-hypertensives or were free of any drug treatment and with no signs of other cardiovascular diseases. Those cases were divided into three groups depending on RHR： group A （RHR〈70 beats/min）, group B （RHR 70-〈80 beats/min） and group C （RHR≥80 beats/min）. Baseline characteristics was compared between the three groups. Multivariable Logistic regression analysis was performed to identify the risk factors for LVH, and the predictive value of RHR on LVH was evaluated by receiver operating characteristic （ROC） curve. Results A total of 394 participations averaged 152.0±4.4）years old were eligible in this study. There were 183146.4% ）, 136134.5%） and 75119.0%） partici- pants in group A, group B and group C, respectively. The levels of systolic and diastolic blood pressure, interven- tricular septum, left ventricular posterior wall thickness （LVPWT）, left ventricular mass index （LVMI） and the in- cidence of LVH differed significantly between the three groups （all P〈0.05 ）. The incidence of LVH increased gradually, which was 2.7% in group A, 16.9% in group B and 48.0% in group C, respectively （P〈0.05）. Multivariable Logistic regression analysis showed that age （OR= 1.98; P〈0.05） and RHR （OR= 5.28; P〈0.01） were independent risk factors for LVH. In ROC curve, RHR had the largest area under the curve （AUC） of 0. 860 （P〈0.05）, indicating that RHR was a better predictor for LVH. Conclusion In pre-hypertensives, age and RHR are the independent risk factors for LVH. The effects of different resting heart rates on LVH are varied. Resting heart rate has a good predictive value for LVH.