高血压病患者动态脉压与年龄及左心室肥厚的关系

Relationship between Age, Left Ventricular Hypertrophy and Ambulatory Pulse Pressure in Patients with Essential Hypertension

目的 探讨高血压病患者动态脉压随年龄的变化趋势及其与左心室肥厚的关系。方法 选择 3 3 7例初诊的轻 中度高血压病患者 ,对所有入选病例进行 2 4h动态血压监测和超声心动图检查。①根据动态脉压水平分为 4组 ,即A组 :2 4hPP <40mmHg ;B组 :40mmHg≤ 2 4hPP <5 0mmHg ;C组 :5 0mmHg≤ 2 4hPP <60mmHg ;D组 :2 4hPP≥ 60mmHg。②根据左室重量指数分为左室肥厚组和非左室肥厚组。③根据年龄分 3组 ,Ⅰ组 :40≤年龄 <5 0岁 ;Ⅱ组 :5 0≤年龄 <60岁 ;Ⅲ组 :年龄≥ 60岁。结果 动态脉压与年龄 (r =0 .42 3 ,P <0 .0 1)、动脉僵硬度指数 (r =0 .670 ,P <0 .0 1)、左室重量指数 (r=0 .2 77,P <0 .0 1)和 2 4h平均心率 (r =-0 .168,P <0 .0 1)均呈非常显著的相关性。随着年龄增长 ,高血压病患者的动态脉压呈早期轻度升高 ,60岁以后加速上升趋势。动态脉压和 2 4hSBP在左室肥厚组均明显高于非左室肥厚组 (4 9.0±10 .2mmHgvs 44 .7± 8.9mmHg ,P <0 .0 0 1和 13 2 .1± 13 .1mmHgvs 12 6.5± 12 .7mmHg ,P <0 .0 0 1)。 结论 高血压病患者随着年龄增长 ,特别是 60岁以后 ,脉压呈加速升高趋势 ,大动脉僵硬度的进展是导致脉压升高的主要原因 ;脉压升高是高血压病患者左室肥厚的重要危险因素。

Objective To investigate the relationship between age, left ventricular hypertrophy and ambulatory pulse pressure (PP). Methods Three hundred and thirty seven initially untreated subjects with mild to moderate essential hypertension (age 51.9±8.8; 43.6% men) were involved in this study. All subjects underwent 24h ambulatory blood pressure monitoring and echocardiography. ①They were divided into four groups according to their ambulatory pulse pressure scale, group A: 24h PP<40mmHg; group B: 40mmHg≤24h PP<50mmHg; group C: 50mmHg≤24h PP<60mmHg; group D: 24h PP≥60mmHg. ②Patients were divided into left ventricular hypertrophy and non-LVH group according to their left ventricular mass index (LVMI) level. ③Patients were further divided into three age groups, groupⅠ: 40≤age<50; groupⅡ: 50≤age<60; groupⅢ: age≥60, respectively. Results Ambulatory pulse pressure were significantly correlated with age ( r =0.423, P <0.01), arterial stiffness index ( r =0.670, P <0.01), LVMI ( r =0.277, P <0.01), and 24h heart rate ( r =-0.168, P <0.01). Hypertensive subjects showed a progressive increase in 24h PP earlier, and the rate of rise accelerated after age 60 years. Both 24h PP and 24h SBP were significantly higher in LVH group than non LVH group (49.0±10.2mmHg vs 44.7±8.9mmHg, P <0.001 and 132.1±13.1mmHg vs 126.5±12.7mmHg, P <0.001). Conclusion Pulse pressure rose progressively with aging, and after 60 years, the rate accelerated steeply. In middle aged and elderly subjects, the increase in PP was primarily due to large artery elasticity deterioration. And it was the important determinant of LVH.