Left ventricular hypertrophy in relation to systolic blood pressure and the angiotensin converting enzyme I/D polymorphism in Chinese

Objective There is little population-based data on the prevalence and the environmental or genetic determinants of left ventricular hypertrophy （LVH） in China. The purpose of this paper is to study LVH in relation to systolic blood pressure and the angiotensin converting enzyme （ACE） insertion/deletion（I/D） polymorphism in Chinese. Methods We recorded 12- lead ECG （CardioSoft, v4.2） in 1365 residents in the Jingning County, Zhejiang Province, China. LVH was defined according to the gender-specific Sokolow-Lyon and Cornell product ECG criteria. Results Regardless of whether the Sokolow-Lyon or Cornell product ECG criteria was used, the prevalence of LVH （20.7% and 4.8%, respectively） significantly （P〈0.0001） increased with male gender （odds ratio [OR] 2.33 and 7.15） and systolic blood pressure （per 10 mm Hg increase, OR 1.46 and 1.33）. If the Sokolow-Lyon criteria was used, the prevalence of LVH was also influenced by alcohol intake （OR 1.44, P=-0.03） and body mass index （OR 0.83, P=0.0005）. The association between the Sokolow-Lyon voltage amplitude and the ACE I/D polymorphism was dependent on antihypertensive therapy （P=0.01）. In 1262 untreated subjects, but not 103 patients on antihypertensive medication, the ACE DD compared with II subjects had significantly higher Sokolow-Lyon voltage amplitudes （29.8：-0.6 vs. 28.0-3：0.5 mV, P=-0.02） and higher risk of LVH （OR 1.74, 95% CI： 1.12-2.69, P=-0.01）. Conclusion LVH is prevalent in Chinese, and is associated with systolic blood pressure and the ACE D allele. The genetic association might be modulated by antihypertensive therapy（J Geriatr Cardio12009; 6：131-136）.

The Correlation between Morning Blood Pressure Surge, Homocysteine and Left Ventricular Hypertrophy in Elderly Patients with Primary Hypertension

Objective: To investigate the correlation between morning blood pressure surge, homocysteine (Hcy) and left ventricular hypertrophy (LVH) in elderly patients with primary hypertension. Method: 215 cases of patients with hypertension from January 2015 to June 2016 were randomly selected from TianYou Hospital attached to WUST.Blood pressure was monitored 24 hours;according to the results, patients were divided into 81 cases of morning blood pressure surge group (study group) and 134 cases of non-morning blood pressure surge group (control group). Biochemical indicators of the two groups were measured, such as Hcy, Glu, blood lipid (TC, TG, LDL-C, HDL-C). The ventricular structure index (IVST, LVDD, LVPWT, LVMI) were measured by color doppler ultrasound.Result: 1) The IVST, LVDD, LVPWT and LVMI were significantly higher in study group than in control group (P 0.05), and the incidence of left ventricular hypertrophy (LVH) (74.1%) was significantly higher in study group than in control group (22.4%) (P 0.05). 2) There was no statistical difference in TC, TG, LDL-C and HDL-C between the two groups (P > 0.05). The serum levels of Hcy [(16.89 ± 5.84) mmol/L] in study group were significantly higher than those in control group [(10.88 ± 4.07) mmol/L] (P 0.05). 3) Multivariate logistic regression analysis showed that morning blood pressure surge and Hcy were the risk factors of left ventricular hypertrophy. Conclusion: In elderly patients with?hypertension, the higher the morning blood pressure surge and Hcy level, the more probability of left ventricular hypertrophy and the more obvious degree.

Combined Effects of Blood Pressure and Aldosterone on Cardiac Left Ventricular Mass Index—Ethnic Differences between Kazakh, Uygur and Han Subjects

Previous Background: Hemodynamic factors, like blood pressure, have been established to be major determinants of cardiac left ventricular structure. However, several factors other than blood pressure to influence cardiac mass have been implicated. When we did medical survey, cardiac left ventricular mass index (LVMI) of one ethnic group that had higher blood pressure was found to be smaller than that of the other ethnic groups with a lower blood pressure. Such contradicted data from the present study were analyzed combining blood pressure, LVMI and chemical parameters obtained from blood and urine. Methods: In a medical survey conducted in Xinjiang, China, 279 people (65 - 70 years old) from three ethnic groups (Kazakh, Uygur and Han) from two separated regions provided blood and urine samples and underwent echocardiography and 24-h ambulatory blood pressure monitoring (ABPM). Results: Systolic and diastolic blood pressure obtained from ABPM and urinary sodium excretion values were significantly higher in Kazakh than that in Uygur and Han. However, LVMI in Kazakh was lower than that in other 2 groups. Plasma aldosterone concentration (PAC) and plasma renin activity (PRA) were significantly lowest in Kazakh. The values of LVMI in all ethnic groups were positively related to both blood pressure and PAC. An inverse correlation was identified between PAC and urinary sodium excretion value. Conclusion: Although higher blood pressure in Kazakh subjects, their LVMI was lower than those of Uygur and Han, whose blood pressure was lower than that in Kazakh. These results suggest that blood pressure is not always a determinant for LVMI value. There is a possibility that relatively lower PAC resulted from higher sodium intake suppressed the rise in LVMI caused by higher blood pressure in Kazakh.

IN PATIENTS WITH HYPERTENSIVE LEFT VENTRICULAR HYPERTROPHY AND CORONARY HEART DISEASE,CORONARY FLOW RESERVE IS SIMILARLY IMPAIRED

Coronary blood flow reserve (CFR) was assessed by transesophageal Doppler echocardiography in normal subjects (group A. n=20),hypertensive non-left ventricular hypertrophy (non-LVH)Patients (group B,n=22). hypertensive patients with LVH(group C.n=32)and coronary heart disease patients (group D. n=33) with the volume sample placed at the bifurcation of the left main and left main and left descending coronary artery. Coronary blood flow velocity (CBFV)was evaluated at rest.2 minutes after dipyridamole (0. 56mg/kg. i. v.) . and 2 minutes after aminophylline i.v. The ratio of dipyridamole to rest maximal diastolic velocity (D/R PDV) was considered the index of coronary blood flow reserve.It was found that D/R PDV was significantly less in groups C and D compared with that in groups A and B (D PDC,1.84±0. 57. 1. 57±0. 41 versus 2.59±0.70 and 2.22+0.58,respectively),with no difference in D/R PDV between groups C and D.Twenty-four out of 32 patients in group C with D/R PDV were less than 2.0 compared to 29 out of 33 patients in group D (P>0.05).Significant negative correlation was found between D/R PDV. D/R PSV and interseptal thickness. left ventricular mass index in hypertensive patients.These data show that impaired CFR in hypertensive patients with LVH is comparable to that in patients with coronary heart disease.

Carvedilol suppresses ventricular arrhythmia in a pressure over-load rabbit model through relieving transmural dispersion of repolarization with long-term administration

Objective： To investigate the effects of carvedilol （CVD） on transmural dispersion of repolarization（TDR） and arrhythmia in pressure over-load rabbits. Methods： Left ventricular hypertrophied（LVH） rabbit models were established by pressure over-load; All animal models were assigned into CVD group or LVH group randomly. The action potentials of endocardium, cpicardium and transmural ECG of arterially perfused left ventricular preparations were recorded concurrently. Action potential duration （APD）, TDR, ventricular arrhythmia and ultrasonic parameters, ratio of LVM to body weight （LVMI） were compared correspondingly. The stable plasma concentration of carvedilol in CVD group was detected by HPLC. APD, TDR and arrhythmia of LVH models were compared just preor post-perfusion with stable concentration of CVD. Results： In Contrast with values in LVH group, LVEFof CVD group were significantly elevated while the LVMI was remarkably reduced, TDRs were significantly shortened, and ratio of ventricular arrhythmia was lowered remarkably. No significant difference of APD, TDR and ratio of arrhythmia was found preor post-perfusion at stable plasma concentration of CVD. Conclusion： CVD can ameliorate the structure and function of pressure over-load ventricles; CVD contributes to the improvement of ventricular arrhythmia associated with its long-term effect on APD,TDR shortening ,whereas has nothing to do with its transient function on ionic channel blockade

Is hepatic steatosis associated with left ventricular mass index increase in the general population?

AIM To investigate the association between hepatic steatosis and change in left ventricular mass index(LVMI) over five years, and examine whether systolic and diastolic blood pressures are mediators of the association between hepatic steatosis and LVMI using a general population sample.METHODS We analyzed data from the Study of Health in Pomerania. The study population comprised 1298individuals aged 45 to 81 years. Hepatic steatosis was defined as the presence of a hyperechogenic pattern of the liver together with elevated serum alanine transferase levels. Left ventricular mass was determined echocardiographically and indexed to height2.7. Path analyses were conducted to differentiate direct and indirect paths from hepatic steatosis to LVMI encompassing systolic and diastolic blood pressure as potential mediating variables.RESULTS Hepatic steatosis was a significant predictor for all measured echocardiographic characteristics at baseline. Path analyses revealed that the association of hepatic steatosis with LVMI change after five years was negligibly small(β =-0.12, s.e. = 0.21, P = 0.55). Systolic blood pressure at baseline was inversely associated with LVMI change(β =-0.09, s.e. = 0.03, P < 0.01), while no association between diastolic blood pressure at baseline and LVMI change was evident(β = 0.03, s.e. = 0.05, P = 0.56). The effect of the indirect path from hepatic steatosis to LVMI via systolic baseline blood pressure was small(β =-0.20, s.e. = 0.10, P = 0.07). No indirect effect was observed for the path via diastolic baseline blood pressure(β = 0.03, s.e. = 0.06, P = 0.60). Similar associations were observed in the subgroup of individuals not receiving beta-blockers, calcium channel blockers, or drugs acting on the reninangiotensin system.CONCLUSION Baseline associations between hepatic steatosis and LVMI do not extend to associations with LVMI change after five years. More studies are needed to study the longitudinal effects of hepatic steatosis on LVMI.

急性脑卒中患者心脏电学改变研究

目的通过分析急性脑卒中患者心脏电学变化,探讨心电图评估急性脑卒中患者血压控制效果的临床价值。方法选取2023-06—2024-01郑州大学第二附属医院收治入院的急性脑卒中患者103例(脑出血50例,脑梗死53例)为研究组,原发性高血压患者61例为对照组,分析研究组临床资料和心电图特点,比较研究组和对照组的心电图改变。将研究组分为血压异常组和血压正常组,比较不同血压状态下脑出血和脑梗死患者心电图改变。结果急性脑卒中患者中脑出血患者年龄偏小,糖尿病占比高,入院收缩压/舒张压、血糖较高,差异有统计学意义(P<0.05)。脑卒中患者心电图异常率高于原发性高血压患者,以P波时限≥120 ms、P波双峰(峰间距>40 ms)、Macrua指数、左心室高电压、左心室肥大、快速性心律失常检出率较高,差异有统计学意义(P<0.05)。脑出血患者心电图异常率高于脑梗死患者,左心房/左心室肥大、心肌缺血比较差异有统计学意义(P<0.05)。血压异常的脑出血患者心电图异常率高于血压正常者,左心房/左心室肥大、心肌缺血比较差异有统计学意义(P<0.05)。血压异常的脑梗死患者快速性心律失常检出率高于血压正常者,差异有统计学意义(P<0.05)。结论急性脑卒中患者心电图异常率高,尤其高血压合并脑卒中患者心电图异常表现更加明显,心电图检查可作为诊断和评估急性脑卒中患者血压控制效果的重要依据。

高血压患者短期血压变异与左室舒张功能的相关性分析

目的探讨原发性高血压患者血压变异与左室舒张功能的关系。方法对2021年10月至2022年1月我院门诊138例初诊原发性高血压患者的临床资料进行回顾性分析,根据超声心动图测量平均E/e′结果分两组(舒张功能正常组E/e′<14、舒张功能降低组E/e′≥14),比较两组间24 h动态血压指标结果(血压变异以血压变异系数、平均收缩压及舒张压标准差表示),分析左室舒张功能与血压变异指标及临床生化指标的相关性。结果左室舒张功能降低组患者的24 h收缩压变异系数(24hSBPCV)、24 h收缩压标准差(24hSBPSD)、24 h舒张压变异系数(24hDBPCV)、日间收缩压变异系数(dSBPCV)、日间舒张压变异系数(dDBPCV)、日间收缩压标准差(dSBPSD)、24 h收缩压平均水平(24hSBP)、夜间收缩压平均水平(nSBP)均高于舒张功能正常组,24hDBP、dDBP及nDBP低于舒张功能正常组,差异有统计学意义(P<0.05)。相关性分析提示:24hSBPCV、24hSBPSD、dSBPCV、dSBPSD、24hSBP、nSBP、年龄均与E/e′呈正相关(r=0.136、0.182、0.170、0.205、0.195、0.322、0.568,P=0.032、0.004、0.007、0.001、0.022、0.000、0.000);24hDBP、dDBP及nDBP均与E/e′呈负相关(r=-0.322、-0.334、-0.198,P=0.000、0.000、0.020);Logistic回归分析显示:dSBPSD及年龄是左室舒张功能的独立影响因素[OR=3.062(1.314~7.133)、1.094(1.058~1.132)]。结论原发性高血压患者短期血压变异及年龄是左室舒张功能的影响因素。

透析充分性对维持性血液透析患者血压变异性和血管钙化的影响

目的探究透析充分性与维持性血液透析患者心血管结构功能指标的关系。方法回顾性收集四川大学华西第四医院门诊维持性血液透析患者的临床资料及连续12次透析治疗的血压(blood pressure,BP)。将血清尿素下降率(urea reduction rate,URR)≥65%及单室尿素清除率(single-pool urea clearance,spKt/V)≥1.2定义为充分透析。计算最大和最小BP差值(△BP)、平均实际变异(average real variation,ARV)等指标。采用多变量逐步线性回归和二元Logistic回归分析探索透析充分性对血压变异性、冠状动脉钙化等心血管并发症的影响。结果共纳入90例患者,年龄(59.8±17.4)岁,中位透析龄28.3(12.3,46.8)月。透析不充分者(45例)较充分者(45例)的透析期收缩压△BP(t=-2.035,P=0.045)、收缩压ARV(t=-2.228,P=0.028)及冠状动脉钙化积分(t=-2.045,P=0.041)更高。年龄(β=0.305,P=0.003)、冠心病(β=-0.255,P=0.014)、spKt/V(β=-0.290,P=0.006)与透析期收缩压ARV水平相关。糖尿病(OR=6.048,95%CI:1.168~31.330,P=0.032)、低白蛋白水平(OR=0.817,95%CI:0.681~0.982,P=0.031)、低spKt/V(OR=0.886,95%CI:0.786~0.998,P=0.047)是钙化积分≥400的独立危险因素。结论透析不充分与维持性血液透析患者透析期收缩压变异性增高密切相关,并且是严重冠状动脉钙化的独立危险因素。

甘油三酯-葡萄糖乘积指数与女性非糖尿病高血压左心室肥厚的相关性探讨

目的:探讨女性非糖尿病高血压患者甘油三酯-葡萄糖乘积(TyG)指数与左心室肥厚(LVH)的相关性。方法:回顾分析133名女性非糖尿病高血压患者,采用Pearson相关性分析与左室质量指数(LVMI)相关的因素,通过二元logistic回归分析获得LVH的影响因素,并通过ROC曲线分析TyG指数预测LVH的最佳截断值以及灵敏度和特异度。结果:在女性非糖尿病高血压患者中,与TyG指数低值组比较,TyG指数高值组其LVMI也较高。Pearson相关性分析发现LVMI与TyG指数、收缩压及夜间舒张压呈正相关(P<0.05)。二元Logistic回归分析显示,TyG指数和夜间收缩压是LVH的预测因素(OR=3.486,95%CI:1.417~8.577;OR=1.048,95%CI:1.019~1.077)。TyG指数与夜间收缩压联合预测LVH的AUC为0.75(95%CI:0.659~0.847),灵敏度为64.7%,特异度为76.8%。结论:在女性非糖尿病高血压患者中,TyG指数和夜间收缩压与左室质量指数呈正相关,可以作为左心室肥厚的预测因子。

扩张型心肌病左心室辅助装置植入术后脑出血一例

1病例资料患者男性,66岁,因“间断胸闷气短10年,加重9 h”于2020年9月12日入院。患者入院前10年出现活动后胸闷气短,休息后可缓解,当地医院诊断“扩张型心肌病、心力衰竭”,于3年前行心脏再同步治疗除颤器(CRT-D)治疗。2020年1月7日开始,患者因活动后呼吸困难加重,活动耐量下降,伴乏力、纳差、恶心、下肢水肿,反复住院10余次。

基于高通量测序分析miRNA在左心室心肌肥厚中的表达及意义

目的探讨基于高通量测序的表达差异microRNA(miRNA)在左心室心肌肥厚(left ventricular hypertrophy,LVH)患者中的表达水平及临床意义,并揭示可能的调控作用机制。方法分别在4例LVH患者和4例健康志愿者血浆样本中进行miRNA测序,并在25例健康志愿者和35例LVH患者血浆样本中进行实时荧光定量PCR(qRT-PCR)验证。通过预测差异性miRNA的靶基因、基因本体富集分析、京都基因与基因组百科全书信号通路分析、构建蛋白质-蛋白质相互作用网络等生物信息学分别进行分析,并通过ROC曲线下面积(AUC^(ROC))评估miRNA对LVH的诊断价值。结果共鉴定出945个差异表达的miRNA,其中1个显著上调,9个显著下调。经qRT-PCR验证,hsa-miR-942-5p和hsa-miR-184的表达水平显著下调;hsa-miR-942-5p的AUC^(ROC)为0.6946,hsa-miR-184的AUC^(ROC)为0.8804。生物信息学分析显示,靶基因主要富集在细胞衰老、鞘脂代谢、TGF-β信号通路、p53、糖尿病代谢相关通路。结论LVH患者血浆样本中hsa-miR-942-5p和hsa-miR-184的表达水平显著降低,提示其具有良好的诊断潜力。

心电及血压指标在高血压合并左心室肥厚中的应用进展

高血压是常见的心血管疾病,左心室肥厚(left ventricular hypertrophy,LVH)是其常见的并发症。心电及血压指标是临床上用于评估心血管疾病的常见指标。近年来,随着检测技术的进步,它们在评价LVH方面展现出重要的应用价值。本文综述心电及血压指标在LVH中的临床应用进展,并对未来的研究趋势进行展望。

血压节律与水平和左心室舒张功能的相关性分析

目的 探讨原发性高血压患者的血压昼夜节律、不同血压水平与左室舒张功能之间的关系。方法 纳入解放军总医院第一医学中心心内科2022年1月~2023年4月收治的678例原发性高血压住院患者,所有患者均接受动态血压监测(ambulatory blood pressure monitoring, ABPM)和超声心动图检查。根据血压昼夜节律分为杓型血压组(n=46)、非杓型组(n=451)、反杓型组(n=181)。采用左房容积指数(left atrial volume index, LAVI)、二尖瓣口舒张早期血流峰值速度/二尖瓣环处侧壁和间隔舒张早期速度的平均值(E/e′)、二尖瓣环处侧壁和间隔舒张早期速度的平均值(e′)评估3组患者左室舒张功能。采用方差分析和多元线性回归分析诊室血压、24 h收缩压平均值(24 h-mSBP)、24 h舒张压平均值(24 h-mDBP)、日间收缩压平均值(D-mSBP)、日间舒张压平均值(D-mDBP)、夜间收缩压平均值(N-mSBP)、夜间舒张压平均值(N-mDBP)、24 h收缩压变异性(24-SBPV)、24 h舒张压变异性(24-DBPV)、日间收缩压变异性(D-SBPV),日间舒张压变异性(D-DBPV),夜间收缩压变异性(N-SBPV),夜间舒张压变异性(N-DBPV)与左室舒张功能之间的关系。结果 反杓型血压组的LAVI明显高于杓型血压组,差异有统计学意义(P<0.05)。多元线性回归的结果显示,24 h-SBP、D-mSBP和N-mSBP与LAVI独立相关(B=0.06,P<0.05);24 h-mSBP、D-mSBP、N-mSBP、诊室收缩压、24-SBPV、24-DBPV、D-SBPV和D-DBPV与E/e′独立相关(B=0.03、0.03、0.02、0.01、0.09、0.10、0.05、0.07,P<0.05);24 h-mSBP、24 h-mDBP、N-mDBP和诊室舒张压与e′独立相关(B=-0.01、-0.02、-0.02、-0.01,P<0.05)。结论 反杓型血压节律和收缩压平均值(mSBP)与左房扩大相关。mSBP及诊室收缩压均与左室舒张功能相关,且mSBP与左室舒张功能的相关性强于诊室血压。ABPM可用于早期识别高血压患者中左房扩大和左心室舒张功能障碍的高风险人群。

组织多普勒成像技术评价高血压患者左心室舒张功能的价值分析

目的:分析组织多普勒成像技术评价高血压患者左心室舒张功能的价值。方法:选取2021年6月—2022年6月东莞市横沥医院收治的高血压患者100例作为研究对象,根据是否发生左心室肥厚分为对照组(n=43,无左心室肥厚)与观察组(n=57,有左心室肥厚)。对所有患者实施常规超声检查,并使用组织多普勒成像技术评估左心室的舒张功能。比较两组常规超声检查结果及组织多普勒成像技术测量结果。结果:观察组左心室舒张末期内径、左心室舒张末期室间隔厚度、舒张末期左心室后壁厚度、左心室质量指数、二尖瓣舒张晚期峰值流速高于对照组,二尖瓣舒张早期峰值流速低于对照组,差异有统计学意义(P<0.05)。观察组心肌舒张早期速度(e')、心肌等容收缩期峰值速度(s')、e'/瓣环最大运动速度(a')低于对照组,a'高于对照组,差异有统计学意义(P<0.001)。结论:组织多普勒成像技术评价高血压患者左心室舒张功能的效果确切,可清晰显示患者二尖瓣血流频谱状况,值得推广应用。

高血压患者血压昼夜节律、B型脑钠肽与左心室肥厚的关系

目的探讨原发性高血压患者血压昼夜节律、B型脑钠肽(BNP)与左心室肥厚(LVH)的关系。方法纳入349例原发性高血压患者(74例有LVH,275例无LVH)进行超声心动图检测及24 h动态血压监测,计算左心室重量指数(LVMI)、夜间血压下降率、24 h动脉脉压(24 h PP)及动态脉压指数(PPI)。根据昼夜血压变异性将研究对象分为超杓型组(n=7)、杓型组(n=77)、非杓型组(n=173)及反杓型组(n=92)。采集患者一般资料及空腹血样,测定血糖、血脂、血尿素氮、血肌酐、胱抑素C、血尿酸及BNP水平。结果 LVH高血压的3级高血压所占比例(85.1%比46.9%;χ~2=34.428,P<0.001)、24 h平均收缩压(134 mm Hg比129 mm Hg;t=3.175,P=0.002)(1 mm Hg=0.133 k Pa)、白天平均收缩压(134 mm Hg比130 mm Hg;t=2.197,P=0.029)、夜间平均收缩压(132 mm Hg比121 mm Hg;t=4.763,P<0.001)、24 h PP(57 mm Hg比52 mm Hg;t=4.120,P<0.001)及PPI(0.43比0.41;t=3.335,P=0.001)均显著高于非LVH高血压患者,而夜间血压下降率[(1.30±8.02)%比(5.68±7.25)%;t=-4.510,P<0.001]显著低于对照组。LVH高血压患者BNP(87.8 pg/ml比28.8 pg/ml;t=2.170,P=0.034)和LVMI(135.1 g/m^2比88.7 g/m^2;t=15.285,P<0.001)均显著高于非LVH患者。超杓型组、杓型组、非杓型组及反杓型组高血压患者的BNP水平差异无统计学意义(P=0.137),而LVMI差异有统计学意义(P=0.001),其中反杓型组患者的LVMI显著高于杓型组(100.3 g/m^2比86.3 g/m^2;t=4.335,P<0.001)和非杓型组(100.3 g/m^2比93.7 g/m^2;t=1.987,P=0.048),非杓型组患者的LVMI显著高于杓型组(93.7 g/m^2比86.3 g/m^2;t=2.693,P=0.008)。多因素线性相关及Logistic回归分析显示,BNP和高血压分级水平与LVMI相关。结论高血压LVH与血压昼夜节律减弱或消失、血压分级水平密切相关,并伴随血浆BNP升高。

高龄老年高血压患者左室肥厚的相关因素研究

目的对高龄老年高血压患者左室肥厚的相关因素进行分析。方法对168例高龄老年高血压患者〔年龄(85.4±5.0)岁〕进行超声心动图检查和动态血压监测,按Devereux公式计算左心室质量指数(LVMI)。将患者分为左室肥厚组(n=74)和非左室肥厚组(n=94),对比分析两组间临床资料和动态血压参数的差异。以LVMI为因变量,进行多元逐步回归分析。结果 (1)左室肥厚组的高血压病程、三酰甘油、空腹血糖、空腹胰岛素、血尿酸、平均收缩压(24 h、白天、夜间)、脉压和24 h收缩压变异系数均明显高于非左室肥厚组,差异有统计学意义(P<0.05);两组非杓型血压节律者分别为56.7%和31.9%,差异有统计学意义(P<0.05);两组间血脂、平均舒张压和24 h舒张压变异系数比较,差异均无统计学意义(P>0.05)。(2)多元线性逐步回归分析显示,LVMI依次与白天平均收缩压、夜间平均收缩压、24 h收缩压变异系数、空腹胰岛素密切相关(R2=0.511,P<0.05)。结论高龄高血压病患者LVMI与多种因素相关,有效控制白天和夜间的收缩压,降低血压变异性和胰岛素抵抗,可能对改善左室肥厚有益。

高血压病患者动态脉压、收缩压、舒张压、平均动脉压与左心室肥厚的相关性研究

目的 探讨高血压病患者诊所或动态脉压、收缩压、舒张压及平均动脉压变化与左心室肥厚之间的相互关系。方法 选择 5 5 5名初诊或停药 2周以上的轻中度高血压病患者进行诊室血压、2 4h动态血压监测及超声心动图检查。 5 5 5名患者根据诊室脉压 (CPP)及 2 4h动态脉压 (APP)水平分别分为四组 ,A组 :PP≤ 40mmHg ;B组 :40mmHg <PP≤ 5 0mmHg ;C组 :5 0mmHg <PP≤ 60mmHg ;D组 :PP >60mmHg。以左室心肌质量指数 (LVMI)男性 >13 4g/m2 ,女性 >110g/m2 作为左室肥厚的标准 ,分为年龄匹配的左室肥厚组和非肥厚组 ,其中肥厚组 2 3 7例 ,非肥厚组 3 18例。结果 左室肥厚组较非肥厚组收缩压及脉压明显增高 ,舒张压无明显差异 ,脉压增高的主要因素是收缩压增高。以左室心肌质量指数为因变量 ,以诊所或 2 4h收缩压、舒张压、脉压、平均动脉压为自变量 ,只有诊所或 2 4h收缩压进入回归方程。结论 脉压与收缩压增高均可导致高血压病患者左心室肥厚 ,而收缩压增高是导致高血压病患者左心室肥厚的主要决定因素。舒张压及平均动脉压增高对左心室肥厚无明显影响。

血压晨峰与左室肥厚的关系

目的探讨血压晨峰与左室肥厚的关系。方法在浙江省景宁县641名村民中，运用SpaceLab动态血压监测仪记录24h血压。血压晨峰为起床后2h内平均收缩压减去睡眠时最低平均收缩压。血压晨峰高于90百分位数划分为晨峰组（n=63），其他为非晨峰组（n=578）。以心电图的Sokolow—Lyon电压作为诊断左室肥厚的标准。结果晨峰组左室肥厚的患病率显著高于非晨峰组（40％ws24％）（P=0．008）。血压晨峰与左室肥厚的关系受年龄的影响（与年龄交互作用，P=0．05）。在192例年龄≥55岁的人群中，调整其他危险因素后，晨峰组左室肥厚患病危险是非晨峰组的2．47倍（95％CI1．09～5．61，P=0．03）；而在449例年龄〈55岁的人群中，血压晨峰与左室肥厚无显著关联（P=0．21）。结论在≥55岁的人群中，血压晨峰可能是左室肥厚的独立危险因素。

有效控制血压对高危高血压患者左室肥厚的长期影响

目的对“1999WHO/ISH高血压防治指南”危险分层为高危和极高危组的患者单用或联合使用指南推荐的一线降压药,以血压<140/90mmHg作为目标血压,观察有效控制血压对高危高血压患者左室肥厚的长期影响。方法763例患者确定危险分层入选后,随机进入目标治疗组(n=382)和对照组(n=381)。目标治疗组在高血压专科门诊定期随访,按5步法治疗方案,直到达到或接近目标血压为止。对照组在普通门诊治疗。测定基线和治疗后的超声心动图。结果两组患者的基线特征无明显差异。在平均4.4年随访期间,目标治疗组平均收缩压/舒张压为(133.8±6.6/79.7±5.5)mmHg,明显低于对照组(151.7±12.7/87.7±8.0)mmHg,P<0.0001)。共有437例患者复查超声心动图1次以上。目标治疗组(n=270)左室重量指数由124.9降至119.7g/m2,下降4.2%(P=0.007);对照组由131.0增至136.9g/m2,增加4.5%(P=0.05)。233例患者在基线时患有左室肥厚,目标治疗组142例;对照组91例。最后1次测量与基线相比,目标治疗组左室重量指数降低14.8g/m2(10.1%,P<0.0001);对照组下降2.9g/m2(1.8%,P=0.53)。目标治疗组66例左室肥厚消失,左心室肥厚逆转率为46.5%,显著高于对照组的31.9%(91例中29例左室肥厚消失,P=0.03)。在基线没有左室肥厚的204例患者中,目标治疗组(n=128)左室重量指数增加5.3g/m2(5.3%,P=0.03);对照组(n=76)增加16.4g/m2(16.8%,P<0.0001)。复查达到左室肥厚标准者,目标治疗组34例(26.6%);对照组27例(35.5%),两组间无显著差异(P=0.12)。结论与一般治疗相比,长期严格控制血压能降低高血压左室肥厚患者的左心室重量,并显著提高左室肥厚逆转率。