左房内径指数与原发性高血压患者血压变异性的关系
|
摘要
目的探讨左房内径指数(LADi)与原发性高血压患者血压变异性(BPV)的关系。方法选择2017年1月至2018年1月于河南省人民医院门诊及住院部收治的原发性高血压患者90例,采用超声心动图检测LADi,将患者分为观察组(左房增大,22例)和对照组(左房正常,68例),所有患者均接受动态血压监测(ABPM),记录各项血压指标,检测各项血生化指标,并分析指标间的相关性。结果观察组患者平均病程显著大于对照组(P<0.05),观察组患者肾小球滤过率(eGFR)显著低于对照组(P<0.05);观察组24 h平均收缩压(24h SBP)、24 h平均舒张压(24h DBP)、24 h收缩压标准差(24h SSD)、24 h收缩压加权标准差(24h wsdSBP)、24 h舒张压加权标准差(24h wsdDBP)、晨峰血压(MBPS)、LADi均显著高于对照组(P<0.05),观察组收缩压(SBP)下降率、舒张压(DBP)下降率均显著低于对照组(P<0.05);患者病程、24h SBP、24h DBP、24h SSD、24h wsdSBP、24h wsdDBP、MBPS均与LADi呈正相关(P<0.05),SBP下降率和DBP下降率均与LADi呈负相关(P<0.05)。结论原发性高血压患者LADi与BPV密切相关,检测BPV对于早期发现左房重构,减少房颤、卒中等不良预后具有重要意义。
Objective To study the association of left atrial diameter index and blood pressure variability(BPV) in patients with essential hypertension. Methods Ninety patients with primary hypertension admitted to the outpatient department and inpatient department of Henan Provincial People's Hospital from January 2017 to January2018 were enrolled. The left atrial diameter index(LADi) was measured by echocardiography and the patients were divided into observation groups. Left atrial enlargement, 22 cases) and control group(normal left atrium, 68 cases),all patients received dynamic blood pressure monitoring(ABPM), recording various blood pressure indicators,testing various blood biochemical indicators, and analyzing the correlation between indicators. Results The course of disease in observation group was significantly higher than that in control group(P<0.05), and the eGFR in observation group was significantly lower than that in control group(P<0.05). The 24 h SBP, 24 h DBP, 24 h SSD,24 h wsdSBP, 24 h wsdDBP, morning peak blood pressure(MBPS) and LADi in observation group were significantly higher than those in control group(all P<0.05). The descending rates of SBP and DBP were significantly lower than those in the control group(P<0.05). The course of disease, 24 h SBP, 24 h DBP, 24 h wsdSBP, 24 h wsdDBP,24 h DSD, MBPS were positively correlated with LADi(all P<0.05), while the decrease rate of SBP and DBP were negatively correlated with LADi(all P<0.05). Conclusion The LADi is related to the blood pressure variability in patients with essential hypertension. Detection of BPV is important for early detection of left atrial remodeling and reduction of adverse prognosis such as atrial fibrillation and stroke.
Objective To study the association of left atrial diameter index and blood pressure variability(BPV) in patients with essential hypertension. Methods Ninety patients with primary hypertension admitted to the outpatient department and inpatient department of Henan Provincial People's Hospital from January 2017 to January2018 were enrolled. The left atrial diameter index(LADi) was measured by echocardiography and the patients were divided into observation groups. Left atrial enlargement, 22 cases) and control group(normal left atrium, 68 cases),all patients received dynamic blood pressure monitoring(ABPM), recording various blood pressure indicators,testing various blood biochemical indicators, and analyzing the correlation between indicators. Results The course of disease in observation group was significantly higher than that in control group(P<0.05), and the eGFR in observation group was significantly lower than that in control group(P<0.05). The 24 h SBP, 24 h DBP, 24 h SSD,24 h wsdSBP, 24 h wsdDBP, morning peak blood pressure(MBPS) and LADi in observation group were significantly higher than those in control group(all P<0.05). The descending rates of SBP and DBP were significantly lower than those in the control group(P<0.05). The course of disease, 24 h SBP, 24 h DBP, 24 h wsdSBP, 24 h wsdDBP,24 h DSD, MBPS were positively correlated with LADi(all P<0.05), while the decrease rate of SBP and DBP were negatively correlated with LADi(all P<0.05). Conclusion The LADi is related to the blood pressure variability in patients with essential hypertension. Detection of BPV is important for early detection of left atrial remodeling and reduction of adverse prognosis such as atrial fibrillation and stroke.
引文
[1]陈伟伟,高润霖,刘力生,等.《中国心血管病报告2016》概要[J].中国循环杂志,2017,32(6):521-30.
[2]Wu Y,Huxley R,Li L,et al.Prevalence,awareness,treatment,and control of hypertension in China:data from the China National Nutrition and Health Survey 2002[J].Circulation,2008,118(25):2679.
[3]赵春辉,洪云飞,况锦,等.高血压病患者左房重构的参与因素[J].医学理论与实践,2007,20(8):873-4.
[4]Cuspidi C,Rescaldani M,Sala C.Prevalence of echocardiographic left-atrial enlargement in hypertension:a systematic review of recent clinical studies[J].Am J Hypertens,2013,26(4):456-64.
[5]Watanabe A,Suzuki S,Kano H,et al.Left Atrial Remodeling Assessed by Transthoracic Echocardiography Predicts Left Atrial Appendage Flow Velocity in Patients With Paroxysmal Atrial Fibrillation[J].Int Heart J,2016,57(2):177-82.
[6]苏定冯.血压变异性与高血压的治疗[J].中华心血管病杂志,2005,33(9):863-5.
[7]Yano Y,Hoshide S,Inokuchi T,et al.Association Between Morning Blood Pressure Surge and Cardiovascular Remodeling in Treated Elderly Hypertensive Subjects[J].Am J Hypertens,2009,22(11):1177.
[8]刘力生.中国高血压防治指南2010[J].中华心血管病杂志,2011,3(7):42-93.
[9]Cuspidi C,Negri F,Muiesan ML,et al.Indexing cardiac parameters in echocardiographic practice:Do estimates depend on how weight and height have been assessed?Astudy on left atrial dilatation[J].J Am Soc Hypertens,2011,5(3):177-83.
[10]Xu JZ,Wu SY,Yan YQ,et al.Left atrial diameter,flow-mediated dilation of brachial artery and target organ damage in Chinese patients with hypertension[J].J Human Hypertens,2012,26(1):41-7.
[11]Teupe C,Takeuchi M,Yao J,et al.Determination of left ventricular mass by three-dimensional echocardiography:In vitro validation of a novel quantification method using multiple equi-angular rotational planes for rapid measurements[J].Int J Cardiovasc Imaging,2002,18(3):161-7.
[12]Keller AM,Gopal AS,King DL.Left and right atrial volume by freehand three-dimensional echocardiography:in vivo validation using magnetic resonance imaging[J].Eur J Echocardiogr,2000,1(1):55-65.
[13]Tsai CT,Hwang JJ,Shih YC,et al.Evolution of left atrial systolic and diastolic functions in different stages of hypertension:distinct effects of blood pressure control[J].Cardiology,2008,109(3):180-7.
[14]Kostis JB,Wilson AC,Freudenberg RS,et al.Long-term effect of diuretic-based therapy on fatal outcomes in subjects with isolated systolic hypertension with and without diabetes[J].Am J Cardiol,2005,95(1):29-35.
[15]Mancia G.Prognostic Value of Long-Term Blood Pressure Variability[J].Hypertension,2011,57(2):141.
[16]Cipollini F,Arcangeli E,Seghieri G.Left atrial dimension is related to blood pressure variability in newly diagnosed untreated hypertensive patients[J].Hypertens Res,2016,39(8):583-7.
[17]Rossignol P,Cridlig J,Lehert P,et al.Visit-to-visit blood pressure variability is a strong predictor of cardiovascular events in hemodialysis:insights from FOSIDIAL[J].Hypertension,2012,60(2):339.
[18]Bilo G,Giglio A,Styczkiewicz K,et al.A new method for assessing24-h blood pressure variability after excluding the contribution of nocturnal blood pressure fall[J].J Hypertens,2007,25(10):2058-66.
[19]曾荣,余振球,王玉红.血压负荷、血压变异性与左室肥厚的相关性[J].中国医刊,2011,46(7):33-5.
[2]Wu Y,Huxley R,Li L,et al.Prevalence,awareness,treatment,and control of hypertension in China:data from the China National Nutrition and Health Survey 2002[J].Circulation,2008,118(25):2679.
[3]赵春辉,洪云飞,况锦,等.高血压病患者左房重构的参与因素[J].医学理论与实践,2007,20(8):873-4.
[4]Cuspidi C,Rescaldani M,Sala C.Prevalence of echocardiographic left-atrial enlargement in hypertension:a systematic review of recent clinical studies[J].Am J Hypertens,2013,26(4):456-64.
[5]Watanabe A,Suzuki S,Kano H,et al.Left Atrial Remodeling Assessed by Transthoracic Echocardiography Predicts Left Atrial Appendage Flow Velocity in Patients With Paroxysmal Atrial Fibrillation[J].Int Heart J,2016,57(2):177-82.
[6]苏定冯.血压变异性与高血压的治疗[J].中华心血管病杂志,2005,33(9):863-5.
[7]Yano Y,Hoshide S,Inokuchi T,et al.Association Between Morning Blood Pressure Surge and Cardiovascular Remodeling in Treated Elderly Hypertensive Subjects[J].Am J Hypertens,2009,22(11):1177.
[8]刘力生.中国高血压防治指南2010[J].中华心血管病杂志,2011,3(7):42-93.
[9]Cuspidi C,Negri F,Muiesan ML,et al.Indexing cardiac parameters in echocardiographic practice:Do estimates depend on how weight and height have been assessed?Astudy on left atrial dilatation[J].J Am Soc Hypertens,2011,5(3):177-83.
[10]Xu JZ,Wu SY,Yan YQ,et al.Left atrial diameter,flow-mediated dilation of brachial artery and target organ damage in Chinese patients with hypertension[J].J Human Hypertens,2012,26(1):41-7.
[11]Teupe C,Takeuchi M,Yao J,et al.Determination of left ventricular mass by three-dimensional echocardiography:In vitro validation of a novel quantification method using multiple equi-angular rotational planes for rapid measurements[J].Int J Cardiovasc Imaging,2002,18(3):161-7.
[12]Keller AM,Gopal AS,King DL.Left and right atrial volume by freehand three-dimensional echocardiography:in vivo validation using magnetic resonance imaging[J].Eur J Echocardiogr,2000,1(1):55-65.
[13]Tsai CT,Hwang JJ,Shih YC,et al.Evolution of left atrial systolic and diastolic functions in different stages of hypertension:distinct effects of blood pressure control[J].Cardiology,2008,109(3):180-7.
[14]Kostis JB,Wilson AC,Freudenberg RS,et al.Long-term effect of diuretic-based therapy on fatal outcomes in subjects with isolated systolic hypertension with and without diabetes[J].Am J Cardiol,2005,95(1):29-35.
[15]Mancia G.Prognostic Value of Long-Term Blood Pressure Variability[J].Hypertension,2011,57(2):141.
[16]Cipollini F,Arcangeli E,Seghieri G.Left atrial dimension is related to blood pressure variability in newly diagnosed untreated hypertensive patients[J].Hypertens Res,2016,39(8):583-7.
[17]Rossignol P,Cridlig J,Lehert P,et al.Visit-to-visit blood pressure variability is a strong predictor of cardiovascular events in hemodialysis:insights from FOSIDIAL[J].Hypertension,2012,60(2):339.
[18]Bilo G,Giglio A,Styczkiewicz K,et al.A new method for assessing24-h blood pressure variability after excluding the contribution of nocturnal blood pressure fall[J].J Hypertens,2007,25(10):2058-66.
[19]曾荣,余振球,王玉红.血压负荷、血压变异性与左室肥厚的相关性[J].中国医刊,2011,46(7):33-5.