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高血压病心血管重构与血压昼夜节律性(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2003年第6期
页码:
537-541
栏目:
临床研究
出版日期:
2003-11-01

文章信息/Info

Title:
Cardiovascular remodeling and circadian blood pressure rhythms in patients with essential hypertension
作者:
王兆禹1; 陈明2; 孙瑄1; 丁云川2
1.昆明医学院第一附属医院, 云南 昆明 650032; 2.昆明市延安医院，云南 昆明 650041
Author(s):
WANG Zhao-yu1;  CHEN Ming2;  SUN Xuan1;  DING Yun-chuan2
1.First Affiliated Hospital of Kunming Medical Collige, Kunming, Yunnan 650032, China; 2.Yanan Hospital of Kunming
关键词:
高血压; 昼夜节律; 心血管重构
Keywords:
hypertension;  circadian blood pressure rhythm;  cardiovascular remodeling
分类号:
R544.1
DOI:
-
文献标识码:
A
摘要:
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24h 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36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, 血压昼夜节律异常可能对心脏和大动脉重构有不利影响。
Abstract:
AIM: To investigate the effects of circadian blood pressure rhythms on the remodeling of heart and large arteries in patients with essential hypertension. METHODS: Ambulatory blood pressure was monitored, and measurements of cardiac remodeling and the internal dimension, wall in timal-medial thickness of aortic, femoral, and popliteal arteries and indices of some functions representing arterial compliance or dilatability were performed by echocardiography and vascular ultrasound technique in 64 mild to moderate patients with essential hypertension. After the confounding effects of other variables were adjusted by analysis of covariance, the differences of indices of cardiac and arterial remodeling were compared between the dipper and non-dipper hypertensive groups and 36 normotensive subjects as control. RESULTS: The non-dipper hypertensive patients have increased left atrial dimension (LAD), left ventricular thickness (LVT) and mass (LVM), and wall in timal-medial thickness (IMT) and area (WSA) or in timal-medial thickness/internal dimension ratio (T/D) of aortic and popliteal arteries, aortic in ternal 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, Smoke, FPG, LDL ,TG were adjusted, the statistical significance of differences of index of aortic and popliteal arteries remained except that statistical significance of the remodeling index of femoral artery reduced. But no or little significant differences were found when the hypertensive group with normal cireadian rhythm (the dippers) were compared with that of normotensive control group. CONCLUSION: abnormality of circadian blood pressu rerhythms may deteriorate cardiovascular remodeling in mild or moderate patients with essential hypertension..

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备注/Memo

备注/Memo:
收稿日期：2002-11-18.
更新日期/Last Update: 2003-11-01