H型高血压患者的血压变异性与左心室肥厚的关系

Relationship between blood pressure variability and left ventricular hypertrophy in H-type hypertensive patients

目的探讨H型高血压患者的血压变异性(BPV)及其对高血压左心室肥厚(LVH)的影响。方法连续入选2014年1月至2016年12月在福建医科大学附属第一医院急诊科病房及心血管内科门诊就诊的首次确诊未服药或已确诊但已自行停用降压药>2周的原发性高血压患者241例,同时纳入69例健康体检者作为对照。根据血浆同型半胱氨酸(Hcy)水平将高血压患者分为高Hcy组(Hcy≥10μmol/L,n=121)和Hcy正常组(Hcy<10μmol/L,n=120)。进行24h动态血压监测及彩色多普勒超声心动图检查,采用Pearson相关分析、多元线性逐步回归和Logistic回归分析Hcy和BPV与LVH的关系。结果与Hcy正常组比较,高Hcy组Hcy[(13.8±6.4)比(8.1±1.4)μmol/L]、左心室质量指数(LVMI)[(105.9±28.6)比(98.7±25.3)g/m2]、白昼平均舒张压变异系数(dDCV)(0.13±0.04比0.12±0.04)、夜间平均舒张压标准差(nDSD)[(9.7±3.9)比(8.8±3.3)mm Hg]较高。多元逐步线性回归分析显示:LVMI与Hcy(β=0.180)、24h平均收缩压(24hSBP,β=0.195)、肌酐(β=0.129)呈正相关(均P<0.05)。Logistic回归分析显示:Hcy与nDSD对高血压患者LVMI存在协同作用(OR=1.197,P<0.05)。结论高Hcy血症是高血压患者发生LVH的独立危险因素,升高的Hcy与夜间舒张压变异性的增加共同促进高血压患者的LVH。

Objective To study the relationship between blood pressure variability and left ventricular hypertrophy（LVH）in H-type hypertensive patients. Methods Two huandred and forty-one essential hypertensive patients in First Affiliated Hospital of Fujian Medical University were enrolled from January 2014 to December 2016 and 69 health subjects were included as controls. Based on level of serum Hcy,all the hypertensive patients were divided into two groups：high Hcy hypertensive group（HH group,Hcy≥10μmol/L,n=121）and normal Hcy hypertensive group（NH group,Hcy〈10μmol/L,n=120）.Left ventricular mass index（LVMI）,ambulatory blood pressure,and blood pressure variability were measured. The Pearson correlation analysis,multiple stepwise linear regression analysis and Logistic regression analysis were used to analyze the relationships between serum Hcy,blood pressure variability and LVH.Results Compared with the NH group,the level of serum Hcy [（13.8±6.4）vs（8.1±1.4）μmol/L],LVMI[（105.9±28.6）vs（98.7±25.3）g/m2],daytime diastolic blood pressure variation coefficient（dDCV）（0.13±0.04 vs 0.12±0.04）and nighttime average diastolic blood pressure standard deviation（nDSD）[（9.7±3.9）vs（8.8±3.3）mm Hg]were higher in the HH group. Multiple linear stepwise regression analysis showed that LVMI was positively related with Hcy（β=0.180）,24 hsystolic blood pressure（24 hSBP,β=0.195）and serum creatinine（β=0.129,all P〈0.05）. Logistic regression analysis indicated that Hcy and nDSD had synergy effects on LVMI in hypertensive patients（OR=1.197,P〈0.05）. Conclusion High level of serum Hcy is an independent risk factor for LVH in hypertensive patients. The increases of Hcy and nighttime diastolic pressure variability have synergy effects on LVH in hypertensive patients.