原发性高血压患者的静息心率与左心室质量指数的关系  

Relationship between resting heart rate and left ventricular mass index in the patients with essential hypertension

作　　者：张玲玉[1,2] 谢良地 沈逸华[2,3] 徐国焱 王庭俊 ZHANG Ling-yu;XIE Liang-di;SHEN Yi-hua;XU Guo-yan;WANG Ting-jun(Department of General Medicine,the First Affiliated Hospital of Fujian Medical University,Fuzhou,Fujian 350005,China;Fujian Branch of the National Clinical Research Center for Geriatric Diseases,Fujian Clinical Research Center for Geriatric Hypertension,National Clinical Research Center for Geriatric Diseases(Huashan);Department of Geriatrics,The First Affiliated Hospital of Fujian Medical University;Fujian Hypertension Research Institute)

机构地区：[1]福建医科大学附属第一医院全科医学科,福建福州350005 [2]国家老年疾病临床医学研究中心福建省分中心,福建省老年高血压疾病临床医学研究中心,国家老年疾病临床医学研究中心(华山) [3]福建医科大学附属第一医院老年病科 [4]福建省高血压研究所

出　　处：《中华高血压杂志》2021年第12期1272-1278,共7页Chinese Journal of Hypertension

基　　金：国家自然科学基金项目(81870316);福建省自然科学基金项目(2021J01211);福建医科大学启航基金项目(2020QH1052)。

摘　　要：目的探讨原发性高血压患者的静息心率与左心室质量指数(LVMI)的关系。方法连续入选2016年1月至2020年12月在福建医科大学附属第一医院门诊就诊及住院治疗的初诊或停服降压药4周以上的原发性高血压患者(n=523);选择同期在门诊及住院的正常血压者作为对照组(n=521)。比较两组身高、体质量、血压和静息心率,测定血生化指标、LVMI水平。将LVMI≥115g/m2(男)或LVMI≥95g/m2(女)定义为左心室肥厚(LVH)。结果与正常血压组比较,高血压组的静息心率、LVMI增加[(68.9±10.4)比(67.2±9.6)次/min,t=-2.769;(99.9±22.1)比(84.1±15.6)g/m^(2),t=-13.432,均P<0.01]。根据静息心率水平将正常血压组和高血压组分别分成4个亚组:≤60、61~70、71~80和>80次/min,正常血压者各亚组间的LVMI差异无统计学意义[(84.6±14.6)、(84.1±16.0)、(83.3±15.2)、(84.1±17.6)g/m^(2),F=0.149,P=0.931],而高血压组的各亚组间LVMI的差异有统计学意义[(106.6±20.4)、(101.3±22.8)、(93.5±19.4)、(97.7±24.2)g/m^(2),F=8.059,P<0.001];在静息心率≤80次/min的高血压患者中,随着静息心率增加,LVMI逐渐降低。多因素线性回归分析在校正其他心血管病危险因素的影响后显示:在正常血压组中,静息心率与LVMI无独立相关;而高血压患者的静息心率与LVMI独立相关(β=-0.148,P<0.001)。按照静息心率分层分析显示,在静息心率≤80次/min的高血压患者中,静息心率与LVMI独立负相关(β=-0.194,P<0.001),而在静息心率>80次/min的高血压患者中,两者无独立相关。在静息心率≤80次/min的高血压患者中,多因素logistic回归分析显示,静息心率增加与LVH患病风险降低之间存在显著关联,静息心率71~80次/min的高血压患者罹患LVH的风险约为静息心率≤60次/min的高血压患者的1/3(OR=0.328,95%CI 0.175~0.613,P<0.001)。结论在静息心率≤80次/min的原发性高血压患者中,静息心率与LVMI独立负相关,静息心率71~80次/min的高�Objective To investigate the relationship between resting heart rate(RHR)and left ventricular mass index(LVMI)in patients with essential hypertension.Methods From January 2016to December 2020,a total of 523patients with essential hypertension who were first diagnosed or stopped taking antihypertensive drugs for more than 4weeks from the First Affiliated Hospital of Fujian Medical University were enrolled.Five hundred twenty one normotensive patients in the same period were selected as the control group.Body height and weight,blood pressure and RHR of the two groups were recorded.Blood biochemical indexes and LVMI were determined.LVMI≥115g/m2(male)or LVMI≥95 g/m2(female)was defined as left ventricular hypertrophy(LVH).Results Compared with the control group,RHR and LVMI in the hypertensive group were significantly increased[(68.9±10.4)vs(67.2±9.6)beats/min,t=-2.769;(99.9±22.1)vs(84.1±15.6)g/m2,t=-13.432,both P<0.01].According to RHR level,the normal blood pressure group and hypertensive group were divided into four subgroups:≤60,61-70,71-80and>80beats/min.There was no significant difference in LVMI among the subgroups of normotensives[(84.6±14.6),(84.1±16.0),(83.3±15.2),(84.1±17.6)g/m2,F=0.149,P=0.931],while significant differences existed in LVMI among the subgroups of hypertensives[(106.6±20.4),(101.3±22.8),(93.5±19.4),(97.7±24.2)g/m2,F=8.059,P<0.001].In hypertensive patients with RHR≤80beats/min,LVMI gradually decreased with the increase of RHR.Multivariate linear regression analysis showed that after adjusting for other cardiovascular risk factors there was no independent correlation between RHR and LVMI in normal blood pressure group and RHR was independently associated with LVMI in patients with hypertension(β=-0.148,P<0.001).Stratified by RHR,further analysis showed RHR was independently and negatively associated with LVMI(β=-0.194,P<0.001)in the hypertensive patients with RHR≤80beats/min.However,there was no independent correlation between them in the hypertensive patients with RHR>

关 键 词：高血压 静息心率 左心室质量指数 左心室肥厚 

分 类 号：R544.11[医药卫生—心血管疾病]