高血压病心血管重构与血压昼夜节律性

Cardiovascular remodeling and circadian blood pressure rhythms in patients with essential hypertension

目的 :研究血压昼夜节律性变化对高血压病患者心脏和大动脉重构的影响。方法 :对 64例 1～ 2级高血压病患者进行 2 4h动态血压监测 ,并以超声检测心脏结构指标及主动脉、股动脉、月国动脉管腔内径、内膜中层厚度等动脉结构指标及反映动脉顺应性或扩张性的功能指标。以协方差分析校正可能的混杂因素影响后 ,对比动态血压昼夜节律呈杓型和非杓型的高血压病患者心血管重构指标的差异 ,并以 3 6例正常血压者作对照。结果 :血压昼夜节律异常的非杓型组高血压病患者与正常血压对照组相比 ,左房内径、左室壁厚度、左室肌重量明显增加 ,主动脉、股动脉及月国动脉内膜中层厚度及面积增大 ,内膜中层厚度 /腔径比值及内膜中层面积 /管腔面积比值显著增高 ;主动脉还有管腔内径及面积增大 ,脉搏波速度明显增快 ,差异有统计学显著性 ,经协方差分析校正年龄、性别、体重指数、心率、吸烟情况、血糖血脂水平等可能对心血管重构的影响后 ,显著性仍然存在 ,仅股动脉重构性指标统计学显著性降低。而昼夜节律正常的杓型高血压组与正常血压对照组相比 ,心脏和血管重构性变化指标多无显著性差异 ,结论 :轻中度高血压病时 。

AIM: To investigate the effects of circadian blood pressure rhy thms on the remodeling of heart and large arteries in patients with essential hypertens ion. METHODS: Ambulatory blood pressure was monitored, and measur ements of card iac remodeling and the internal dimension, wall intimal-medial thickness of ao r tic, femoral, and popliteal arteries and indices of some functions representing arterial compliance or dilatability were performed by echocardiography and vascu lar ultrasound technique in 64 mild to moderate patients with essential hyperten sion. After the confounding effects of other variables were adjusted by analysis of covariance, the differences of indices of cardiac and arterial remodeling we re compared between the dipper and non-dipper hypertensive groups and 36 normot ensive subjects as control. RESULTS: The non-dipper hypertensive pat ients have increased left atrial dimension (LAD), left ventricular thickness (LV T) and mass (LVM), and wall intimal-medial thickness (IMT) and area (WSA) or in timal-medial thickness/ internal dimension ratio (T/D) of aortic and popliteal arteries, aortic internal dimension (AoDd) and pulse wave velocity (PWV) as compared with the normotensive control group. After the confounding effects of other variables including Age, Sex, BMI, HR, Sm oke, FPG, LDL, TG were adjusted,the statistical significance of differences of i ndex of aortic and popliteal arteries remained except that statistical significa nce of the remodeling index of femoral artery reduced. But no or little signific ant differences were found when the hypertensive group with normal cireadian rhy thm (the dippers) were compared with that of normotensive control group. CONCLUSION: abnormality of circadian blood pressure rhythms may deteriorate cardiovascular remodeling in mild or moderate patients with essential hypertensi on.