高血压患者左心室肥厚与24h收缩压变异性呈杓型关系

A dipper-shaped relationship was found between left ventricular hypertrophy and 24-hour systolic blood pressure variability in patients with hypertension

目的探讨高血压患者左心室肥厚(LVH)与血压变异性(BPV)及血压昼夜节律的关系。方法2008年1月至2012年6月,入选福建医科大学附属第一医院住院的高血压患者603例,按血压昼夜节律分为杓型(n=130)、非杓型(n=313)和反杓型组(n=160),根据24h收缩压标准差(24hSBPSD)将BPV分为八分位组,比较各组左心室质量指数(LVMI)和LVH检出率。采用Pearson相关分析和多元线性回归分析BPV与LVMI的关系。结果与杓型组比较,非杓型组和反杓型组24hSBPSD降低[(13.1±2.8)、(14.1±3.6)比(16.1±3.2)mm Hg];而LVMI水平[(96.9±22.6)、(103.8±28.6)比(91.2±21.4)g/m2]和LVH检出率(18.8%、33.8%比8.5%)升高(均P<0.05)。24hSBPSD第二八分位的LVMI水平和LVH检出率最低。随着24hSBPSD八分位升高,24h平均收缩压、日间平均收缩压呈上升趋势,而各时间段平均舒张压差异无统计学意义。相关性分析显示:LVMI与24hSBPSD、日间收缩压标准差、夜间收缩压标准差、收缩压加权标准差呈正相关,与夜间平均收缩压(nSBP)呈负相关(均P<0.05)。多元逐步回归显示:nSBP、血肌酐和高血压病程是LVMI的影响因素。结论杓型组LVH检出率最低。非杓型组BPV较低,但LVH检出率却较高,LVH与24h收缩压变异性呈杓型关系。过小的BPV可能导致LVH发生风险增加。

Objective To investigate the relationship between left ventricular hypertrophy（LVH）and blood pressure variability（BPV）and circadian rhythm in patients with hypertension. Methods A total of 603 hypertensive patients were enrolled from the First Affiliated Hospital of Fujian Medical University from January 2008 to June2012. According to blood pressure circadian rhythm,patients were divided into the dipper group（n=130）,the non-dipper group（n=313）and the reverse-dipper group（n=160）. BPV was classified into 8subgroups（octiles）based on the standard deviation of 24-hour systolic blood pressure（SBP）. The left ventricular mass index（LVMI）and the incidence of LVH were compared among the subgroups. Pearson correlation and multiple linear regression analysis were performed to test the relationship between BPV and LVMI. Results The standard deviation of 24-hour SBP was reduced in the non-dipper[（13.1±2.8）mm Hg]and reverse-dipper[（14.1±3.6）mm Hg]groups compared with that in the dipper group [（16.1±3.2）mm Hg]. Contrastingly,LVMI[（96.9±22.6）,（103.8±28.6）vs（91.2±21.4）g/m2]and the incidence of LVH（18.8%,33.8% vs 8.5%）in the non-dipper and reversedipper groups were increased than those in the dipper group. Across the octiles of BPV,LVMI and the incidence rate of LVH were both the lowest in the second subgroup. With the increase in standard deviation of 24-hour SBP,the levels of 24-hour SBP,diurnal SBP exhibited an escalating trend,while the diastolic blood pressure had no significant difference. LVMI was positively associated with the standard deviations of 24-hour SBP,diurnal SBP and nocturnal SBP,as well as weighted mean value of diurnal and nocturnal standard deviation,whereas LVMI was negatively associated with nocturnal SBP decline by correlation analysis. Multivariable stepwise regression analysis indicated nocturnal SBP,blood creatinine and the course of hypertension were the independent and significant risk factors for LVMI. Conclusion The frequency of LVH is the lowest in the dipper group. The BPV is reduced in nondipper group,while the incidence of LVH is increased in non-dipper group. There is a dipper-shape relationship between 24-hour systolic blood pressure variability and LVH. Smaller BPV can lead to the higher risk of LVH.