H型高血压不同动态血压模式与左心室结构和功能的关系

Relationship between different dynamic blood pressure patterns and left ventricular structure and function in H-type hypertension

目的分析H型高血压患者血浆同型半胱氨酸血症(Hcy)水平的变化及其不同动态血压模式,探讨Hcy水平和动态血压模式与心脏结构和功能的变化关系。方法收集2015-2017年该院心内科原发性高血压住院患者233例,依据血浆Hcy水平分成H型高血压组(HH组,Hcy≥10μmol/L)128例和非H型高血压组(NHH组,Hcy<10μmol/L)105例,比较性别、年龄、BMI、生化指标、Hcy水平,同时采用心脏超声彩超检测相关数据,计算左心室质量(LVM)和左心室质量指数(LVMI)。结果与NHH组比较,HH组患者Hcy水平、24h平均收缩压(24hASBP)、24h平均脉压(24hAPP)、白天平均收缩压(dASBP)和白天平均脉压(dAPP)、非杓型和反杓型血压发生率,以及HH组室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左心室功能左心室舒张末期内径(LVD)、左心室质量(LVM)和左心室质量指数(LVMI)均高,差异有统计学意义(P<0.05)。结论 Hcy水平升高影响血压变异性(BPV),Hcy和BPV是左心室重构和功能产生改变的主要原因。

Objective To analyze the changes of plasma homocysteineemia (Hcy) level and different dynamic blood pressure patterns in patients with H-type hypertension,and to explore the relationship between Hcy level and dynamic blood pressure pattern and cardiac structure and function. Methods A total of 233 cases of patients with primary hypertension in the department of cardiology of the hospital from 2015 to 2017 were collected.According to the plasma Hcy level,128 patients were in the H-type hypertension group (the HH group,Hcy≥10 μmol/L) and 105 patients were in the non-H-type hypertension group (the NHH group,Hcy<10 μmol/L),then compared gender,age,BMI,biochemical index and Hcy level,the left ventricular mass (LVM) and left ventricular mass index (LVMI) were calculated by echocardiography. Results Compared with the NHH group,plasma Hcy level,24 hours average systolic blood pressure (24 hASBP),24 hours average pulse pressure (24 hAPP),daytime average systolic blood pressure (dASBP) and daytime average pulse pressure (dAPP),the incidence of non-invasive and ruminant type blood pressure,interventricular septal thickness (IVST),left ventricular posterior wall thickness (LVPWT),left ventricular end-diastolic diameter (LVD),left ventricular mass (LVM),and left ventricular mass index (LVMI) in the HH group were higher,the difference was statistically significant ( P <0.05). Conclusion Increased Hcy level affects blood pressure variability (BPV),Hcy and BPV are the main causes of changes in left ventricular remodeling and function.