急诊住院中老年高血压患者动态血压监测与心脏结构及功能损伤的相关性

Study on the relationship of ambulatory blood pressure monitoring with cardiac structure and functional damage in the middle-aged and elderly patients with hypertension in emergency ward

目的探讨急诊住院中老年患者动态血压监测(ambulatory blood pressure monitoring,ABPM)与心脏结构及功能损伤的相关性。方法回顾性分析2018年1月至2021年12月在天津某三甲医院急诊医学科住院的中老年高血压病患者基本信息、ABPM报告、超声心动图检查和实验室检查数据。采用线性回归分析,探索ABPM与心脏结构及功能损伤的关联,并对潜在混杂因素进行控制,计算调整前后的回归系数。结果本研究共纳入患者165例,男性75例,女性90例,最小年龄35岁,最大年龄91岁。线性回归分析发现,室间隔厚度(IVST)与日间收缩压标准差、24 h收缩压负荷、24 h舒张压负荷、日间收缩压负荷、日间舒张压负荷、夜间收缩压负荷独立正相关,调整后回归系数分别为0.06、1.50、2.10、1.40、2.08、0.81;左室后壁厚度(LVPWT)与日间收缩压标准差、24 h收缩压负荷、24 h舒张压负荷、日间收缩压负荷、日间舒张压负荷、夜间收缩压负荷独立相关,调整后回归系数分别为0.07、1.52、1.62、1.44、1.67、1.04;左室质量指数(LVMI)与24 h收缩压及日间收缩压负荷独立相关,调整后回归系数分别为21.75、17.92;左房内径指数(LADI)与24 h收缩压负荷和日间收缩压负荷独立相关,调整后回归系数分别为1.86和1.96;左室射血分数(LVEF)与24 h舒张压负荷和日间舒张压负荷和夜间舒张压负荷相关,调整后回归系数分别为-0.070、-0.070和-0.054。结论急诊住院中老年高血压患者ABPM参数与心脏结构及功能损伤指标存在相关性,LVMI和LADI主要受收缩压负荷的影响,LVEF主要受舒张压负荷的影响,IVST及LVPWT受日间收缩压标准差、收缩压和舒张压负荷的影响。

Objective To investigate the correlation of ambulatory blood pressure monitoring(ABPM)with cardiac structure and functional damage in hypertensive middle-aged and elderly patients hospitalized by the Emergency Department.Methods Retrospective analysis of clinical baseline data,ABPM reports,echocardiographic findings and laboratory tests for 165 hypertensive middle-aged and elderly patients admitted to a general hospital in Tianjin between January 2018 and December 2021 was performed.Linear regression analysis was used to explore the relationship of ABPM with cardiac structure and functional damage,control potential confounding factors,and calculate the regression coefficient before and after adjustment.Results 75 males and 90 females,aged 35-91 years old were enrolled.The linear regression analysis showed that interventricular septum thickness(IVST)was independently and positively related to daytime systolic blood pressure(SBP),24 h SBP load,24 h diastolic blood pressure(DBP)load,daytime SBP load,daytime DBP load and nighttime SBP load and the adjusted regression coefficients were 0.06,1.50,2.10,1.40,2.08,0.81,respectively.Left ventricular posterior wall thickness(LVPWT)showed an independent association with daytime SBP,24 h SBP load,24 h DBP load,daytime SBP load,daytime DBP load and nighttime SBP load and the adjusted regression coefficients were 0.07,1.52,1.62,1.44,1.67,1.04,respectively.Left ventricular mass index(LVMI)showed an independent correlation with 24 h SBP load and daytime SBP load,and the adjusted regression coefficients were 21.75 and 17.92,respectively.Left atrial dimension index(LADI)was independently related to 24 h SBP load and daytime SBP load with adjusted regression coefficients of 1.86 and 1.96,respectively.Left ventricular ejection fraction(LVEF)was independently associated with 24 h DBP load,daytime DBP load and nighttime DBP load with adjusted regression coefficients of-0.070,-0.070 and-0.054,respectively.Conclusions ABPM parameters correlate with echocardiographic indicators reflecting cardiac structure and functional damage.LVMI and LADI are most strongly affected by SBP load.DBP load is a major influencing factor for LVEF while standard deviation of daytime SBP,SBP load and DBP load all affect IVST and LVPWT.