降压治疗对老年高血压患者左室心肌做功影响的随访研究

Follow-up study on the effect of anti-hypertensive therapy on left ventricular myocardial work in elderly patients with hypertension

目的应用左室压力-应变环(LVPSL)评价不同血压控制水平对原发性老年高血压患者心肌做功的影响。方法回顾性收集2017年1-6月就诊于山西白求恩医院的老年高血压患者158例,随机分为标准降压组75例与强化降压组83例。另选取同期48例年龄、性别相匹配,无心脑血管疾病及影响心功能的其他疾病老年人作为对照组。所有高血压患者均在基线位及降压治疗12、24个月时进行超声心动图检查,应用LVPSL获得心肌做功参数,包括心肌整体做功指数(GWI)、整体有用功(GCW)、整体无用功(GWW)及整体做功效率(GWE)。比较标准组与强化组降压治疗12、24个月组内及组间心肌做功参数的变化及变化量。结果①基线位时,标准组和强化组心肌做功参数GWI、GCW、GWW大于对照组(均P<0.05)。②降压治疗12、24个月后,标准和强化降压组GWI、GCW、GWW持续减小(均P<0.05)。③降压治疗12、24个月强化降压组GWI、GCW、GWW小于标准降压组(均P<0.05)。④降压治疗12个月后,标准和强化降压组GWI、GCW、GWW减小幅度大于降压24个月与12个月间(均P<0.05),强化降压组各时间段GWI、GCW、GWW减小幅度大于标准降压组(均P<0.05)。结论老年高血压患者左室收缩功能降低,心肌做功增加,降压治疗后左室收缩功能改善,强化降压较标准降压改善明显。

Objective To evaluate the effect of different blood pressure control levels on myocardial work by left ventricular pressure-strain loop(LVPSL)in elderly hypertensive patients.Methods Retrospectively,158 elderly patients with hypertension in Shanxi Bethune Hospital from January to June 2017 were randomly divided into standard anti-hypertensive group(n=75)and intensive anti-hypertensive group(n=83).Another 48 cases of age and sex matched elderly without cardiovascular and cerebrovascular diseases and other diseases affecting cardiac function were selected as control group.All patients with hypertension underwent echocardiography at baseline,12 and 24 months after antihypertensive treatment.The parameters of myocardial work,including global work index(GWI),global constructive work(GCW),global wasted work(GWW)and global work efficiency(GWE),were obtained by LVPSL.The changes of myocardial work parameters were compared between the standard group and the intensive group after 12 and 24 months of antihypertensive treatment.Results①At baseline,GWI,GCW,GWW of the standard group and the intensive group were significantly higher than those of the control group(all P<0.05).②After 12 and 24 months of antihypertensive treatment,GWI,GCW and GWW in standard and intensive antihypertensive groups decreased continuously(P<0.05).③The GWI,GCW and GWW of the intensive antihypertensive group were lower than those of the standard antihypertensive group at 12 and 24 months after antihypertensive treatment(P<0.05).④After 12 months of antihypertensive treatment,the reductions of GWI,GCW and GWW in standard and intensive antihypertensive groups were greater than those in 24 and 12 months of antihypertensive treatment(all P<0.05),and the reductions of GWI,GCW and GWW in intensive antihypertensive group were greater than those in standard antihypertensive group(all P<0.05).Conclusions Left ventricular systolic function decreases and myocardial work increases in elderly hypertensive patients.Left ventricular systolic function improves after antihypertensive treatment,and the improvement of intensive antihypertensive is more obvious than that of standard antihypertensive treatment.