反杓型血压节律使老年高血压患者心脏功能受损更显著
|
摘要
目的
探讨血压异常节律变化类型对老年单纯收缩期高血压患者心脏功能和结构的影响。
方法
对94名老年单纯收缩期高血压患者进行24小时动态血压监测,同时行心脏超声多普勒检查。根据血压类型进行分组,观察不同血压类型的规律性变化,并将非杓型及反杓型血压类型与心脏功能和结构的各项指标进行分析。
结果
1、24小时动态血压结果表明老年单纯收缩期高血压患者异常血压类型占93%；其中,非杓型血压类型占58%,反杓型血压类型占35%。2.心脏功能和结构指标观察,反杓型组与非杓型组比较：主动脉根部内径(mm)(31.36±5.12,26.57±4.49)、室间隔厚度(mm)(11.21±2.50,9.66±1.13)、左室后壁厚度(mm)(9.76±1.41,9.02±1.02)、每搏量(ml)(45.05±17.36,61.10±16.24)组间具有显著统计学差异(p<0.01)；射血分数(%)(46.26±12.66,55.21±10.53)、左室质量(g)(224.89±43.32,192.72±61.02)、左室质量指数(g／m2)(124.13±22.54,105.39±32.62)组间具有统计学差异(p<0.05)。
结论
老年单纯收缩期高血压患者,血压异常节律变化是引起心脏靶器官损害的重要因素,其中反杓型血压节律变化使心脏功能和结构受损更为显著。
Objective
The aim of this study is to investigate the effects of non-dipper and reverse dipper blood pressure patterns on the cardiac structure and function in elderly systolic hypertensive patients.
Methods
94 elderly systolic hypertensive patients were evaluated with echocardiography and ambulatory 24-hour blood pressure monitoring,84 patients with non-dipper blood pressure pattern and reverse dipper blood pressure pattern are included into our further research. Tissue Doppler-derived systolic and diastolic parameters were compared between non-dipper group and reverse dipper group. All the patients received fixed antihypertensive drug therapy for at least 3 months prior to the evaluation. Results
Abnormal blood pressure patterns were found in 93% elderly systolic hypertensive patients, including 55 non dipper blood pressure patterns (58%) and 22 reverse blood pressure patterns (35%). Compared with non-dipper blood pressure pattern, reverse dipper patients had significant difference for aortic diameter(mm) (31.36±5.12, 26.57±4.49)、left ventricular septum thickness(mm) (11.21±2.50,9.66±1.13)、left ventricular posterior wall thickness(mm) (9.76±1.41,9.02±1.02)、stroke volume(ml) (45.05±17.36,61.10±16.24) (p<0.01). There is difference between reverse dipper group and non-dipper group for ejection fraction (%)(46.26±12.66,55.21±10.53)、left ventricular mass(g)(224.89±43.32,192.72±61.02)、left ventricular mass index(g/m2) (124.13±22.54,105.39±32.62)
Conclusion
Blood pressure rhythm is one of the most important effect factors on target organ in elderly systolic hypertensive patients. Reverse dipper blood pressure patterns influence more on left ventricular structure and functions than non-dipper group.
探讨血压异常节律变化类型对老年单纯收缩期高血压患者心脏功能和结构的影响。
方法
对94名老年单纯收缩期高血压患者进行24小时动态血压监测,同时行心脏超声多普勒检查。根据血压类型进行分组,观察不同血压类型的规律性变化,并将非杓型及反杓型血压类型与心脏功能和结构的各项指标进行分析。
结果
1、24小时动态血压结果表明老年单纯收缩期高血压患者异常血压类型占93%；其中,非杓型血压类型占58%,反杓型血压类型占35%。2.心脏功能和结构指标观察,反杓型组与非杓型组比较：主动脉根部内径(mm)(31.36±5.12,26.57±4.49)、室间隔厚度(mm)(11.21±2.50,9.66±1.13)、左室后壁厚度(mm)(9.76±1.41,9.02±1.02)、每搏量(ml)(45.05±17.36,61.10±16.24)组间具有显著统计学差异(p<0.01)；射血分数(%)(46.26±12.66,55.21±10.53)、左室质量(g)(224.89±43.32,192.72±61.02)、左室质量指数(g／m2)(124.13±22.54,105.39±32.62)组间具有统计学差异(p<0.05)。
结论
老年单纯收缩期高血压患者,血压异常节律变化是引起心脏靶器官损害的重要因素,其中反杓型血压节律变化使心脏功能和结构受损更为显著。
Objective
The aim of this study is to investigate the effects of non-dipper and reverse dipper blood pressure patterns on the cardiac structure and function in elderly systolic hypertensive patients.
Methods
94 elderly systolic hypertensive patients were evaluated with echocardiography and ambulatory 24-hour blood pressure monitoring,84 patients with non-dipper blood pressure pattern and reverse dipper blood pressure pattern are included into our further research. Tissue Doppler-derived systolic and diastolic parameters were compared between non-dipper group and reverse dipper group. All the patients received fixed antihypertensive drug therapy for at least 3 months prior to the evaluation. Results
Abnormal blood pressure patterns were found in 93% elderly systolic hypertensive patients, including 55 non dipper blood pressure patterns (58%) and 22 reverse blood pressure patterns (35%). Compared with non-dipper blood pressure pattern, reverse dipper patients had significant difference for aortic diameter(mm) (31.36±5.12, 26.57±4.49)、left ventricular septum thickness(mm) (11.21±2.50,9.66±1.13)、left ventricular posterior wall thickness(mm) (9.76±1.41,9.02±1.02)、stroke volume(ml) (45.05±17.36,61.10±16.24) (p<0.01). There is difference between reverse dipper group and non-dipper group for ejection fraction (%)(46.26±12.66,55.21±10.53)、left ventricular mass(g)(224.89±43.32,192.72±61.02)、left ventricular mass index(g/m2) (124.13±22.54,105.39±32.62)
Conclusion
Blood pressure rhythm is one of the most important effect factors on target organ in elderly systolic hypertensive patients. Reverse dipper blood pressure patterns influence more on left ventricular structure and functions than non-dipper group.
引文
1 Addo J, Smeeth L, Leon DA. Hypertensive target organ damage in Ghanaian civil servants with hypertension. PLoS One,2009,18:66-72.
2 Volpe M, Tocci G. 2007 ESH/ESC Guidelines for the management of hypertension, from theory to practice:global cardiovascular risk concept. J Hypertens,2009,27: 3-11.
3 Rodrigues CS, Bloch KV. da Rocha Nogueira A. Office blood pressure and 24-hour ambulatory blood pressure measurements:high proportion of disagreement in resistant hypertension. J Clin Epidemiol.2009,5:123-4.
4 刘力生.中国高血压防治指南.中华心血管病杂志,2004,12：1060-4.
5 Endeshaw YW, White WB, Kutner M,et al. Sleep-Disordered Breathing and 24-Hour Blood Pressure Pattern Among Older Adults. Biological Sciences and Medical Sciences,2009,64:280-5
6 Fagard RH, Thijs L, Staessen JA, et al. Prognostic significance of ambulatory blood pressure in hypertensive patients with history of cardiovascular disease. Blood Press Monit,2008,13:325-32.
7 Roman MJ, Okin PM, Kizer JR, et al. Relations of central and brachial blood pressure to left ventricular hypertrophy and geometry:the Strong Heart Study. J Hypertens,2010,5:1-4.
8 Kumar A, Meyerrose G, Sood V, et al. Diastolic heart failure in the elderly and the potential role of aldosterone antagonists. Drugs Aging,2006,23:299-308.
9 Nesbitt SD. Lessons in hypertension from new clinical trials. Postgrad Med,2009, 121:34-43.
10 Kusat Tigen, M.D, Tansu Karaahmet, M.D, Hakan Fotbolcu, et al. The influence of dipper and non-dipper blood pressure patterns on left ventricular functions in hypertensive patients:a tissue Doppler study. Turk Kardiyol Dern Ars-Arch Turk Soc Cardiol,2009,37:101-6.
11 Garcia-Ortiz L, Gomez-Marcos MA, Martin-Moreiras J, et al. Pulse pressure and nocturnal fall in blood pressure are predictors of vascular, cardiac and renal target organ damage in hypertensive patients. Blood Press Monit,2009,14:145-51.
12 Soylu A, Duzenli MA, Yazici M,et al.The effect of non-dipping blood pressure patterns on cardiac structural changes and left ventricular diastolic functions in normotensives. Echocardiography,2009,26:378-87.
13 Fagard RH, Thijs L, Staessen JA, et al. Prognostic significance of ambulatory blood pressure in hypertensive patients with history of cardiovascular disease. Blood Press Monit,2008,13:325-32.
1 Kusat Tigen, MD, Tansu Karaahmet, MD, Hakan Fotbolcu, et al. The influence of dipper and nondipper blood pressure patterns on left ventricular functions in hypertensive patients: a tissue Doppler study, Turk Kardiyol Dern Ars-Arch Turk Soc Cardiol 2009, vol(2):101-106.
2 Francisco J. Felix-Redondo. Level of blood pressure control in a hypertensive population when measurements are performed outside the clinical setting. Cardiology Journal 2009, vol(16): 57-67.
3 徐艳秋,崔炜,刘英华.动态动脉硬度指数与脉搏波速度的相关性研究.中国医师进修杂志2008,Vol(31)：21-23.
4 Zhao Hong-wei, Wu An-shi. Assessment of right ventricular function by pressure volume loops in off-pump coronary artery by pass surgery. Chin Med J 2008, vol(10):932-938.
5 范穗光,张久松,陈佩贞.老年高血压并2型糖尿病患者动态血压特点,中国基层医药,May 2008,Vol(15)：715-716.
6 刘洪宇,王贵杰,高血压病人24小时动态血压参数值与正常参照值的比较。白求恩医科大学学报.1994,Vol(20)：374-376.
7 张宏宇,胡荣芳,动态血压监测在老年原发性高血压并左室肥厚临床中的应用.沈阳医学院学报,2003 Vol(5)：23-34.
8 李巧英,李志军,王少军.血压昼夜节律临床意义的探讨.Chinese National Conference on Chronobiology,2004vol(2):3-8.
9 范利斌,查秋云,于辉.老年高血压病患者血压波动规律的临床研究.临床误诊误治Aug2007,Vol(20):9-11.
10 Rodrigues CS, Bloch KV. Office blood pressure and 24-hour ambulatory blood pressure measurements:high proportion of disagreement in resistant hypertension. J Clin Epidemiol. 2009 vol(5):123-124.
11 Yohannes W. Endeshaw. Sleep-Disordered Breathing and 24-Hour Blood Pressure Pattern Among Older Adults. Biological Sciences and Medical Sciences 2009 Vol(2):280-285.
12邱原刚,姚雪艳等.高血压患者治疗后血压昼夜节律及影响因素的调查.中华流行病学 杂志.2004,Vol(125)：710-714.
13廖俊龙,郭林翠等.高血压腔隙性脑梗死患者血压负荷变化.中国医师杂志2005,11vol(7)：1547-1548.
2 Volpe M, Tocci G. 2007 ESH/ESC Guidelines for the management of hypertension, from theory to practice:global cardiovascular risk concept. J Hypertens,2009,27: 3-11.
3 Rodrigues CS, Bloch KV. da Rocha Nogueira A. Office blood pressure and 24-hour ambulatory blood pressure measurements:high proportion of disagreement in resistant hypertension. J Clin Epidemiol.2009,5:123-4.
4 刘力生.中国高血压防治指南.中华心血管病杂志,2004,12：1060-4.
5 Endeshaw YW, White WB, Kutner M,et al. Sleep-Disordered Breathing and 24-Hour Blood Pressure Pattern Among Older Adults. Biological Sciences and Medical Sciences,2009,64:280-5
6 Fagard RH, Thijs L, Staessen JA, et al. Prognostic significance of ambulatory blood pressure in hypertensive patients with history of cardiovascular disease. Blood Press Monit,2008,13:325-32.
7 Roman MJ, Okin PM, Kizer JR, et al. Relations of central and brachial blood pressure to left ventricular hypertrophy and geometry:the Strong Heart Study. J Hypertens,2010,5:1-4.
8 Kumar A, Meyerrose G, Sood V, et al. Diastolic heart failure in the elderly and the potential role of aldosterone antagonists. Drugs Aging,2006,23:299-308.
9 Nesbitt SD. Lessons in hypertension from new clinical trials. Postgrad Med,2009, 121:34-43.
10 Kusat Tigen, M.D, Tansu Karaahmet, M.D, Hakan Fotbolcu, et al. The influence of dipper and non-dipper blood pressure patterns on left ventricular functions in hypertensive patients:a tissue Doppler study. Turk Kardiyol Dern Ars-Arch Turk Soc Cardiol,2009,37:101-6.
11 Garcia-Ortiz L, Gomez-Marcos MA, Martin-Moreiras J, et al. Pulse pressure and nocturnal fall in blood pressure are predictors of vascular, cardiac and renal target organ damage in hypertensive patients. Blood Press Monit,2009,14:145-51.
12 Soylu A, Duzenli MA, Yazici M,et al.The effect of non-dipping blood pressure patterns on cardiac structural changes and left ventricular diastolic functions in normotensives. Echocardiography,2009,26:378-87.
13 Fagard RH, Thijs L, Staessen JA, et al. Prognostic significance of ambulatory blood pressure in hypertensive patients with history of cardiovascular disease. Blood Press Monit,2008,13:325-32.
1 Kusat Tigen, MD, Tansu Karaahmet, MD, Hakan Fotbolcu, et al. The influence of dipper and nondipper blood pressure patterns on left ventricular functions in hypertensive patients: a tissue Doppler study, Turk Kardiyol Dern Ars-Arch Turk Soc Cardiol 2009, vol(2):101-106.
2 Francisco J. Felix-Redondo. Level of blood pressure control in a hypertensive population when measurements are performed outside the clinical setting. Cardiology Journal 2009, vol(16): 57-67.
3 徐艳秋,崔炜,刘英华.动态动脉硬度指数与脉搏波速度的相关性研究.中国医师进修杂志2008,Vol(31)：21-23.
4 Zhao Hong-wei, Wu An-shi. Assessment of right ventricular function by pressure volume loops in off-pump coronary artery by pass surgery. Chin Med J 2008, vol(10):932-938.
5 范穗光,张久松,陈佩贞.老年高血压并2型糖尿病患者动态血压特点,中国基层医药,May 2008,Vol(15)：715-716.
6 刘洪宇,王贵杰,高血压病人24小时动态血压参数值与正常参照值的比较。白求恩医科大学学报.1994,Vol(20)：374-376.
7 张宏宇,胡荣芳,动态血压监测在老年原发性高血压并左室肥厚临床中的应用.沈阳医学院学报,2003 Vol(5)：23-34.
8 李巧英,李志军,王少军.血压昼夜节律临床意义的探讨.Chinese National Conference on Chronobiology,2004vol(2):3-8.
9 范利斌,查秋云,于辉.老年高血压病患者血压波动规律的临床研究.临床误诊误治Aug2007,Vol(20):9-11.
10 Rodrigues CS, Bloch KV. Office blood pressure and 24-hour ambulatory blood pressure measurements:high proportion of disagreement in resistant hypertension. J Clin Epidemiol. 2009 vol(5):123-124.
11 Yohannes W. Endeshaw. Sleep-Disordered Breathing and 24-Hour Blood Pressure Pattern Among Older Adults. Biological Sciences and Medical Sciences 2009 Vol(2):280-285.
12邱原刚,姚雪艳等.高血压患者治疗后血压昼夜节律及影响因素的调查.中华流行病学 杂志.2004,Vol(125)：710-714.
13廖俊龙,郭林翠等.高血压腔隙性脑梗死患者血压负荷变化.中国医师杂志2005,11vol(7)：1547-1548.