血压变异性与脉搏波传导速度及左心室质量指数的相关性

Correlation of blood pressure variability with brachial ankle pulse wave velocity and left ventricular mass index

目的·探讨24 h动态血压监测所测得的血压变异性(blood pressure variability,BPV)尤其是血压昼夜节律与臂踝脉搏波传导速度(brachial ankle pulse wave velocity,baPWV)及左心室质量指数(left ventricular mass index,LVMI)的关系。方法·共纳入184例原发性高血压患者。根据夜间收缩压较日间下降的百分比,将患者分为杓型组、非杓型组、反杓型组和超杓型组。组间比较baPWV和LVMI,对baPWV和LVMI与血压值和BPV指标的关系进行单因素和多因素回归分析。结果·校正年龄、体质量指数、高血压病程、诊室血压、24 h收缩压、24 h舒张压、总胆固醇、低密度脂蛋白胆固醇、脑钠肽和射血分数后,非杓型组和反杓型组baPWV显著高于杓型组和超杓型组(P=0.000),非杓型组的LVMI显著高于杓型组(P=0.001)和超杓型组(P=0.022)。在单因素回归分析中,baPWV及LVMI均与与年龄、24 h收缩压及标准差(SD值)、日间收缩压及SD值、夜间收缩压及SD值、24 h舒张压及SD值、日间舒张压及SD值、夜间舒张压及SD值显著相关(P<0.05)。在多因素线性回归分析中,baPWV与夜间收缩压SD值(β=0.289,P=0.000)、夜间收缩压的下降百分比(β=-0.398,P=0.000)、日间收缩压(β=0.214,P=0.001)以及日间舒张压的SD值(β=0.207,P=0.002)相关。LVMI与24h收缩压(β=0.348,P=0.000)以及夜间收缩压SD值(β=0.196,P=0.026)相关。结论·原发性高血压患者baPWV与夜间收缩压SD值、夜间收缩压下降百分比、日间收缩压以及日间舒张压的SD值独立相关;LVMI与24 h收缩压以及夜间收缩压SD值独立相关。

Objective·To explore the association of blood pressure variability(BPV), especially diurnal blood pressure rhythm with brachial ankle pulse wave velocity(baPWV) and left ventricular mass index(LVMI). Methods·A total of 184 hypertensive patients participated this cross sectional study. Patients were divided into dippers, non-dippers, inverted dippers and extreme dippers groups according to nocturnal systolic blood pressure(SBP) decline. baPWV and LVMI in different groups were compared. Correlation of baPWV and LVMI with blood pressure and BPV variables were analyzed by univariate and multivariate regression analysis. Results·After adjusted by age, BMI, hypertension duration, blood pressure in consulting room, SBP and diastolic blood pressure(DBP) in 24 h, total cholesterol, low density lipoprotein cholesterin, brain natriuretic peptide and ejection fraction, baPWV in non-dippers group and inverted-dippers group were significantly higher than that in dippers group and extreme dippers group(P=0.000), and LVMI was significantly higher in non-dippers group than in dippers group(P=0.001) and extreme-dippers group(P=0.022). baPWV and LVMI were both significantly correlated to age, 24h SBP and 24h DBP, SD value of 24h SBP and 24h DBP, daytime SBP and DBP, nocturnal SBP and DBP, SD values of daytime SBP and DBP, SD values of nocturnal SBP and DBP in univariate linear regression models(P<0.05). In multivariate linear regression model, baPWV was independently associated to SD value of nocturnal SBP(β=0.289, P=0.000), nocturnal SBP decline(β=-0.398, P=0.000), daytime SBP(β=0.214, P=0.001) and SD value of daytime DBP(β=0.207, P=0.002), while LVMI was independently associated to 24h SBP(β=0.348, P=0.000) and SD value of nocturnal SBP(β=0.196, P=0.026). Conclusion·baPWV was independently correlated to SD value of nocturnal SBP, nocturnal SBP decline, daytime SBP and SD value of daytime DBP, while LVMI was independently correlated to 24h SBP and SD value of nocturnal SBP.