老年高血压患者静息心率与左心室肥厚和肾功能的相关性

Relation of resting heart rate with left ventricular hypertrophy and renal function in elderly hypertensive patients

目的探讨老年原发性高血压患者静息心率与左心室肥厚(LVH)和肾功能损害的相关性。方法入选老年原发性高血压患者1766例,按静息心率水平分为3组:<70/min为A组560例、70~79/min为B组656例、>79/min为C组550例,心脏超声检查左心室结构和收缩功能,比较各组尿微量白蛋白(MAU)、24 h MAU、血肌酐、肌酐清除率等指标,采用logistic回归分析影响LVH的因素。结果 A组、B组、C组收缩压[(156.8±10.3)mm Hg vs(163.2±10.3)mm Hgvs(171.8±9.2)mm Hg,1 mm Hg=0.133 kPa]、脉压[(60.4±5.6)mm Hgvs(62.0±5.5)mm Hgvs(67.4±6.5)mm Hg]、左心室舒张末内径[(4 8.11±2.45)mm vs(49.99±2.72)mm vs(52.08±2.91)mm]、室间隔厚度[(11.07±0.76)mmvs(11.82±1.38)mmvs(12.93±1.13)mm]、左心室后壁厚度[(9.83±1.00)mm vs(10.44±1.16)mm vs(10.94±1.38)mm]、左心室质量[(162.6±29.7)gvs(159.6±24.8)gvs(179.9±24.8)g]、左心室质量指数[(102.8±8.53)g/m^2vs(107.1±7.82)g/m^2 vs(114.2±8.54)g/m^2]及LVH比例[3.04%vs 14.2%vs 33.1%]比较,差异有统计学意义(P<0.05,P<0.01)。多因素回归分析显示,静息心率是LVH的危险因素(OR=4.82,95%CI:3.46~7.83,P=0.009)。结论老年高血压患者静息心率增快与LVH和肾功能损害密切相关,可作为LVH的预测因素,并提示可能有肾功能损伤的趋势。

Objective To study the relation of resting heart rate（RHR） with left ventricular hypertrophy（LVH） and renal function in elderly hypertensive patients.Methods A total of 1766 primary hypertensive patients were divided into RHR 〈70/min group（group A,n = 560）,RHR being 70 —79/min group（group B,n = 656）,and RHR 〉79/min group（group C,n = 550）.Their left ventricular structure and systolic function were assessed by echocardiography,and their MAU,24 h MAU,serum creatinine level and creatinine clearance were measured.Factors influencing LVH were analyzed by logistic regression analysis.Results The systolic blood pressure and pluse pressure were significantly lower,the LVEDD was significantly shorter,the IVST and LVPWT were significantly thinner,the LVM and LVMI were significantly greater,and the LVH was severer in group A than in groups B and C（P〈0.05,P〈0.01）.Multivariate logistic analysis showed that RHR was an independent risk factor for LVH（OR = A.82,95%CI：3.46 — 7.83,P=0.009）.Conclusion Increased RHR is closely related with LVH and renal function damage in elderly hypertensive patients and can thus be used as a predictor of LVH and renal function damage.