血压昼夜节律异常与老年高血压病人心功能损害关系

ASSOCIATION BETWEEN ABNORMAL CIRCADIAN BLOOD PRESSURE PATTERN AND CARDIAC DYSFUNCTION IN ELDERLY HYPERTENSIVE PATIENTS

目的 探讨血压昼夜节律异常与老年高血压病人心功能损害的关系。方法 选择老年高血压病人117例,其日间血压均维持在较稳定范围内,根据夜间血压下降率分为勺型组、非勺型组和反勺型组。比较3组病人的动态血压监测指标及心脏结构和功能参数。结果 勺型、非勺型、反勺型组病人夜间收缩压依次递增,夜间舒张压依次递减,3组病人夜间收缩压和夜间舒张压比较差异有统计学意义(F=6.060、6.755,P<0.05)。3组病人的心脏结构和功能参数比较,室间隔厚度、舒张期左心室后壁厚度、E峰减速时间和二尖瓣舒张早期血流峰速度/二尖瓣舒张早期运动峰速度差异均有统计学意义(F=4.190~7.051,P<0.05)。结论 血压昼夜节律异常可导致老年高血压病人心脏舒张功能损害,尤以反勺型损害最重,其次为非勺型。

Objective To investigate the association between abnormal circadian blood pressure pattern and cardiac dysfunction in elderly hypertensive patients. Methods A total of 117 elderly hypertensive patients were enrolled and their daytime blood pressure was controlled within a relatively stable range. According to the rate of blood pressure drop at night, these patients were divided into dipper pattern group, non-dipper pattern group, and reverse dipper pattern group. The three groups were compared in terms of ambulatory blood pressure monitoring indices and cardiac structure and function parameters. Results The dipper pattern group had the lowest nocturnal systolic blood pressure, followed by the non-dipper pattern group and the reverse dipper pattern group, and there were significant differences between the three groups in nocturnal systolic blood pressure and nocturnal diastolic blood pressure (F =6.060 and 6.755, P <0.05). The comparison of cardiac structure and functional parameters between the three groups showed that there were significant differences between the three groups in interventricular septal thickness, diastolic left ventricular posterior wall thickness, E peak deceleration time, and the ratio of early diastolic transmitral velocity to early diastolic mitral annular velocity (F =4.190-7.051, P <0.05). Conclusion Abnormal circadian blood pressure pattern can cause diastolic dysfunction in elderly hypertensive patients, and patients with a reverse dipper pattern have the highest degree of dysfunction, followed by those with a non-dipper pattern.