中年原发性高血压患者151例动态血压监测及不同类型血压变化对心脏影响的观察

The clinical observation of 151 cases ambulatory blood pressure monitoring and the variation of cardiac structure in middle aged patients with essential hypertension

目的探讨151例中年原发性高血压患者动态血压监测参数及其与心脏结构和功能改变的关系。方法对初诊无其他器质性疾病的中年原发性高血压患者行24 h动态血压监测及进行超声心动检查。根据血压动监测的昼夜节律将其分成杓型、非杓型、反杓型、超杓型等类型;计算出脉压(PP)、脉压指数(PPI)和血压负荷(BPL)。探讨不同类型血压变化对患者心脏结构和功能的影响。结果男性24 h DBP、d DBP和n DBP水平都高于女性(P<0.05)。男性杓型高血压组患者LVEF值均值(P<0.01)、非杓型高血压组患者LVEF值均值(P<0.01)、超杓型高血压组患者LVEF值均值(P<0.01)均大于反杓型高血压组患者,差异具有统计学意义(P<0.05)。女性杓型高血压组患者LVEF值均值无统计学意义(P>0.05)。PPI对LVEF的影响大于PP及BPL。结论动态血压监测出的不同昼夜节律高血压患者临床分型对心室重构有临床指导意义,并且PPI对心功能影响大于PP及BPL,PPI是监测心脏结构改变的敏感指标。

Objective To investigate the relationship of the parameters of 24 hours ambulatory blood pressure monitoring（24 h ABPM） and the variation of cardiac structure and function in middle aged patients with essential hypertension. Methods The middle aged patients with essential hypertension were chosen, whose blood pressure were more than 140/90 mm Hg without other organic diseases. Patients were measured by 24 h ABPM and UCG. According to the results of 24 h ABPM, patients were divided into four groups, and the PP, PPI and BPL were calculated. Multivariate regression analysis were used to investigate the relationship of ABPM results and the cardiac structure. Results 24 h DBP, d DBP, n DBP of male group were significantly higher than that of the female group. There have been statistical difference（P〈0.05）. In male group, EF values of dippers hypertension group, shallow or non-dippers hypertension group, and extreme-dippers hypertension group were higher than reverse-dippers hypertension group（P〈0.01）. PPI has greatest influence on heart function damage. Conclusion The classification of the circadian rhythm has instructional significance for ventricular remodeling. PPI has greatest influence on heart function damage.