动态脉压与原发性高血压患者左室肥厚的关系及预测价值

The relationship and predictive value of ambulatory pulse pressure on left ventricular hypertrophy in essential hypertensive patients

目的探讨动态脉压与原发性高血压患者左室肥厚的关系,为预防高血压患者心脏损害提供有用线索。方法采用回顾性队列研究设计,共纳入2017年1月~2019年3月在我科住院的672名进行了动态血压监测及心脏超声检查的原发性高血压患者。采用多重线性回归分析动态脉压与左室肥厚的关系,受试者特征工作曲线分析动态脉压对左室肥厚的预测价值。结果672名原发性高血压患者中,258(38.39%)例患者检出左室肥厚。多重线性回归分析显示,24小时动态脉压与左室质量指数显著相关(P<0.002)。受试者工作特征曲线分析显示,24小时动态脉压预测左室肥厚的AUC为0.64,24小时收缩压预测左室肥厚的AUC为0.58;在经过AUC比较后,24小时动态脉压比24小时收缩压更好地预测左室肥厚(P<0.001)。结论24小时动态脉压与原发性高血压患者左室肥厚密切相关,其是发生左室肥厚的独立危险因素;动态脉压对左室肥厚有一定的预测价值,且其预测价值优于24小时收缩压。

Objective To investigate the relationship between ambulatory pulse pressure and left ventricular hypertrophy in essential hypertensive patients and provide useful message for preventing heart damage in hypertensive patients.Method This hospital-based retrospective cohort study was included 672 essential hypertensive patients underwent ambulatory blood pressure monitoring and echocardiography.Multiple linear regression was used to investigate the relationship between ambulatory pulse pressure and left ventricular hypertrophy,and the receiver characteristic(ROC)curve was used to evaluate the predictive value.Results Among 672 patients with essential hypertension,258(41.4%)had left ventricular hypertrophy.Multiple linear regression analysis showed that 24-hour ambulatory pulse pressure was significantly correlated with left ventricular mass index(P<0.002).The AUC of 24-hour ambulatory pulse pressure in predicting left ventricular hypertrophy was 0.64,and that of 24-hour systolic pressure was 0.58.After AUC comparison,24-hour ambulatory pulse pressure was better than 24-hour systolic pressure in predicting left ventricular hypertrophy(P<0.001).Conclusion 24h ambulatory pulse pressure is closely related to left ventricular hypertrophy in essential hypertensive patients,and it is superior to 24h systolic pressure in the prediction of left ventricular hypertrophy.