高龄高血压患者动态脉压和血脂与左心室肥厚的关系

摘要

目的 探讨高龄高血压患者动态脉压(APP)和血脂与左心室肥厚(LVH)的相关性.方法 入选年龄≥80岁的高血压患者110例,进行24 h动态血压监测、超声心动图检查及血脂检测.根据APP分为高脉压组(≥60mm Hg,1 mm Hg=O.133 kPa)74例和低脉压组(<60 mm Hg)36例,以左心室重量指数(LVMI)作为LVH的诊断标准,又分为LVH组50例和非LVH组60例.并进行相关分析和logistic回归分析.结果 与低脉压组比较,高脉压组LVMI、LVH的发生率及各收缩压参数明显升高(P<0.05),LVH组24 h收缩压、昼间收缩压、APP、脉压指数明显高于非LVH组(P<0.05),2组舒张压差异无统计学意义(P > 0.05).LVMI与APP、脉压指数、24 h收缩压、昼间收缩压、夜间收缩压呈正相关,与HDL-C呈负相关(P<0.05),与所有舒张压参数均无相关性(P > 0.05),APP是LVH的独立危险因素(OR=1.057,95% CI:1.018～1.096,P = 0.003),结论在高齡高血压患者中,APP与LVMI密切相关,是LVH的独立危险因素;HDL-C与LVMI密切相关.%Objective To study correlation of ambulatory pulse pressure(APP) and blood lipid with left ventricular hypertrophy(LVH) in very elderly patients with hypertension.Methods 110 patients of ≥80 years old with hypertension were enrolled in this study,and underwent 24 h ambulatory blood pressure monitoring, echocardiographic and lipid examinations.They were divided into two groups according to their APP(≥60 mm Hg, n = 74 and ＜60 mm Hg, n = 36) ,and were divided into LVH group (n = 50) and non-LVH group (n = 60) according to left ventricular mass index(LVMI).Results Compared with APP＜60 mm Hg group, LVMI,the incidence of LVH and all SBP parameters increased significantly (P ＜0.05) in APP≥ 60 mm Hg group.24 h SBP,day SBP,APP and PPI were significantly higher in LVH group than in non-LVH group, while there was no obvious difference in all DBP parameters between the 2 groups.LVMI was positively correlated with APP, PPI, 24 h SBP,day SBP and night SBP respectively, whereas negatively correlated with HDL-C significantly.There was no correlation between LVMI and all DBP parameters.Taking LVH as the dependent variable,and APP, PPI, 24 h SBP, dSBP, nSBP and HDL-C as the independent variables, only APP was involved in the regression equation (OR = 1.057,95％ CI: 1.018-1.096, P = 0.003).Conclusion APP was closely correlated with LVMI and was independent risk factor for LVH in very elderly patients.HDL-C was closely correlated with LVMI.