原发性高血压并2型糖尿病患者的动态脉压和心室结构功能的相关性

Relationship between ambulatory pulse pressure and ventricular structure and function in hypertension patients with type 2 diabetes mellitus

目的 研究原发性高血压 (EH)、2型糖尿病 (DM )及DM +EH时全天动态血压和脉压的变化特点及与心结构和功能的关系。方法 将 2 15例患者分为DM组 (n =6 2 )、EH组 (n =86 )及DM +EH组 (n =6 7) ,进行动态血压及超声心动图检查。结果 DM +EH组全天收缩压、全天脉压、左心室重量显著大于DM组及EH组。左心室射血分数、舒张早期血流峰值速度 /舒张晚期血流峰值速度 (E/A)值、等容舒张时间 3组间无显著差异。相关分析表明 ,DM组左心室重量和全天脉压相关 ;EH组左心室重量和全天收缩压相关 ;DM +EH组左心室重量和全天收缩压及全天脉压相关。 3组患者左心室舒张功能异常患者的全天收缩压、全天脉压均显著高于左心室舒张功能正常患者 ,左心室收缩功能正常患者和异常患者比较 ,动态血压和脉压值无显著差异。结论 动态脉压可作为DM及EH心室肥厚及心舒张功能受损的预测因子之一。

Objective To investigate the characteristics of 24 h ambulatory pulse pressure of hypertension with or without type 2 diabetes mellitus(DM) and their correlation with ventricular structure and function. Methods All 215 patients were divided into type 2 DM( n =62),hypertension(EH, n =86), and hypertensive DM( n =67) groups.Echocardiogram and 24 h ambulatory blood pressure monitoring were observed in all patients. Results Twenty four hour systolic blood pressure(SBP 24 h),and 24 hour pulse pressure(PP 24 h) were significantly increased in hypertensive DM compared with type 2 DM or EH,indicating the left ventricular mass(LVM) was larger ( P <0.05).The percentage of cardiac systolic or diastolic dysfunction was significantly low in hypertensive DM compared with type 2 DM or EH.By regression analysis,LVM was related to PP24h in type 2 DM,SBP 24 h in EH,SBP 24 h and PP 24 h in hypertensive DM.SBP had marked impact on left ventricular systolic function. Conclusion Ambulary pulse pressure is an important factor predicting risk for ventricular hypertrophy and diastolic dysfunction in the patients with DM and EH.