老年原发性高血压患者动态血压变异性及其与心脏结构、泵血功能的关系

Dynamic Blood Pressure Variability and Its Relationship with Cardiac Structure and Pumping Function in Elderly Patients with Essential Hypertension

目的 探讨老年原发性高血压(EH)患者心脏结构、泵血功能与动态血压变异性的关系。方法 选取2021年1月至2022年12月在郑州市中医院接受治疗的126例老年EH患者作为A组,其中79例H型高血压(HT)患者为H型HT组,47例非H型HT患者为非H型HT组。同期收治的130例非HT老年患者作为B组。比较A组和B组动态血压变异性指标、泵血功能、心脏结构,H型HT组和非H型HT组动态血压变异性指标、心脏结构、泵血功能,并采用Spearman相关性分析老年EH患者心脏结构、泵血功能与动态血压变异性指标的相关性。结果 A组夜间收缩压标准差(N-SSD)、24 h收缩压标准差(24 h SSD)、白天收缩压标准差(D-SSD)均高于B组(P<0.05)。A组每搏量、心排出量及室间隔厚度高于B组;A组左室射血分数(LVEF)及左心室后壁厚度低于B组(P<0.05)。相比于非H型HT组,H型HT组24 h SSD、N-SSD、D-SSD、每搏量、心排出量及室间隔厚度均更高;LVEF及左心室后壁厚度更低(P<0.05)。老年EH患者每搏量与24 h SSD、N-SSD、D-SSD呈正相关(r=0.548、0.508、0.487),心排出量与24 h SSD、N-SSD、D-SSD呈正相关(r=0.612、0.573、0.490);LVEF与24 h SSD、N-SSD、D-SSD呈负相关(r=-0.603、-0.489、-0.543);室间隔厚度与24 h SSD、N-SSD、D-SSD呈正相关(r=0.576、0.645、0.476);左心室后壁厚度与24 h SSD、N-SSD、D-SSD呈负相关(r=-0.524、-0.603、-0.498)(P<0.05)。结论 不同类型的老年EH患者动态血压变异性、心脏结构及泵血功能有所差异,患者24 h SSD、N-SSD、D-SSD与每搏量、心排出量、室间隔厚度呈正相关,与LVEF、左心室后壁厚度呈负相关。

Objective To explore the relationship with cardiac structure,pumping function and dynamic blood pressure variability in elderly patients with essential hypertension(EH).Methods A total of 126 elderly patients with EH who received treatment at Zhengzhou Traditional Chinese Medicine Hospital from January 2021 to December 2022 were selected as group A.Among them,79 patients with H-type hypertension(HT)were in the H-type HT group,47 patients with non-H-type HT were in the non-H-type HT group.A total of 130 non-HT elderly patients admitted during the same period were selected as group B.The dynamic blood pressure variability indicators,pumping function and cardiac structure between the group A and the group B,the dynamic blood pressure variability indicators,cardiac structure and pumping function between the H-type HT group and the non-H-type HT group were compared.The correlation between cardiac structure,pumping function,and dynamic blood pressure variability indicators in elderly patients with primary HT were analyzed by Spearman correlation analysis.Results The standard deviation of nighttime systolic blood pressure(N-SSD),24-hour systolic blood pressure(24 h SSD),and daytime systolic blood pressure(D-SSD)in the group A were all higher than those in the group B(P<0.05).The stroke volume,cardiac output and interventricular septum thickness in the group A were higher than those in the group B,and the left ventricular ejection fraction(LVEF)and left ventricular posterior wall thickness in the group A were lower than those in the group B(P<0.05).Compared with the non-H-type HT group,the 24 h SSD,N-SSD,D-SSD and stroke volume,cardiac output and interventricular septum thickness in the H-type HT group were higher;the LVEF and left ventricular posterior wall thickness in the H-type HT group were lower(P<0.05).Stroke volume in elderly patients with EH was positively correlated with 24 h SSD,N-SSD,and D-SSD in elderly patients with EH(r=0.548,0.508,0.487),while cardiac output was positively correlated with 24 h SSD,N-SSD,and D-SSD(r=0.612,0.573,0.490).LVEF was negatively correlated with 24 h SSD,N-SSD,D-SSD(r=-0.603,-0.489,-0.543).The thickness of interventricular septum was positively correlated with 24 h SSD,N-SSD,D-SSD(r=0.576,0.645,0.476).The thickness of the left ventricular posterior wall was negatively correlated with 24 h SSD,N-SSD,and D-SSD(r=-0.524,-0.603,-0.498)(P<0.05).Conclusion The ambulatory blood pressure variability,cardiac structure and blood pumping function of different types of elderly patients with EH were different.The 24 h SSD,N-SSD,D-SSD of patients were positively correlated with stroke volume,cardiac output,and interventricular septum thickness,and negatively correlated with LVEF and left ventricular posterior wall thickness.