原发高血压老年患者低舒张压对心脏舒张功能的影响  

Influence of Low Diastolic Pressure on Diastolic Function in Elderly Patients with Primary Hypertension

作　　者：张添甜[1] 张潇怡[2] 赵紫薇[1] 孙光[1] 牛一蒙[1] 林杰[1] 

机构地区：[1]中国医科大学附属第一医院老年心血管科,沈阳110001 [2]中国医科大学第96期临床医学系,沈阳110122

出　　处：《中国医科大学学报》2016年第6期514-517,521,共5页Journal of China Medical University

基　　金：辽宁省教育厅高校科研计划(L2010593)

摘　　要：目的探讨原发高血压老年患者低舒张压现象的相关因素及其与左心舒张功能的相关关系。方法选取2014年7月至2015年7月我院就诊的原发性高血压老年患者84例,以24 h平均舒张压(24 h DBP)<60 mmHg为标准分为舒张压正常组(NDBP组,51例)、低舒张压组(L-DBP组,33例),比较2组患者一般资料及24 h动态血压监测、心脏超声及组织多普勒检查指标。结果 L-DBP组患者平均年龄,高血压病程,高血压Ⅲ级发生率,糖尿病、冠心病、缺血性脑血管病、舒张性心功能不全发生率均高于N-DBP组(均P<0.05);L-DBP脉压较N-DBP组显著增大(P<0.01),非杓型血压比例增加(P<0.05);L-DBP组左心房内径、室间隔厚度、左心室质量指数、舒张早期二尖瓣血流速度与舒张晚期二尖瓣血流速度比值,舒张早期二尖瓣血流速度与舒张早期二尖瓣环运动速度的比值及E峰减速时间均高于N-DBP组(均P<0.05),而二尖瓣环舒张早期运动锋速较N-DBP组降低(P<0.01);logistic回归分析显示年龄、糖尿病、冠心病是低舒张压的独立危险因素(均P<0.05);年龄、24 h平均收缩压、低舒张压、脉压、非杓型血压是舒张性心功能不全的独立危险因素(均P<0.05)。结论老年高血压患者合并多种基础疾病,易出现低舒张压;低舒张压与心脏功能结构相关,特别与心脏舒张功能损害密切相关。Objective To explore the related factors of low diastolic blood pressure（DBP）and diastolic function of left heart. Methods A total of 84 cases of primary hypertension patients admitted in our hospital during July 2014-July 2015 were recruited for the study. According to the 24 h mean diastolic blood pressure（24 h DBP）〈60 mmHg,the patients were divided into two groups with 51 case in normal-DBP group and 33 case in low-DBP group. All patients take 24 h ambulatory blood pressure monitoring,cardiac ultrasound and tissue doppler imaging. Results Average age,duration of hypertension,the incidence of hypertension level Ⅲ,coronary heart disease（CHD）,diabetes mellitus（DM）,ischemic cerebral vascular disease（ICVD）and diastolic heart failure（DHF）in low-DBP group was significantly higher than normal- DBP group（all P〈0.05）. In pulse pressure（PP）and the incidence of non-dipper hypertension,low-DBP Group was higher than normal-DBP group（all P〈0.05）. The left atrial diameter（LAD）,interventricular septal thickness（IVSd）,left ventricular mass index（LVMI）,early diastolic transmitral inflow velocity to late diastolic transmitral inflow velocity（E/A）,early diastolic transmitral inflow velocity to early diastolic mitral annulus velocity（E/e′）and E peak deceleration time（EDT）is higher in Low-DBP Group than normal-DBP Group.（all P〈0.05）. While early diastolic mitral annulus velocity（TDIe′）is significantly reduced（P〈0.01）. Logistic regression analysis showed that：Age,CHD,DM were the independent risk factors to low DBP（all P〈0.05）. Age,24 h mean systolic blood pressure（24 h SBP）,low DBP,PP,non-dipper hypertension were the independent risk factors for DHF（all P〈0.05）. Conclusion Lower DBP is easy appeared in elderly patients with hypertension combined a variety of basic diseases. The lower DBP is associated with cardiac function and structure,especially closely related to the cardiac diastolic function damage.

关 键 词：老年 原发性高血压 低舒张压 舒张功能 相关分析 

分 类 号：R541.6[医药卫生—心血管疾病]