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目的:通过比较动态脉压和诊所脉压对原发性高血压患者左室肥厚的影响,为高血压患者的康复预防和介入提供理论依据。方法:选择初诊的轻-中度原发性高血压患者337例,所有入选病例测量非同日3次诊所血压、进行24h动态血压监测和超声心动图检查。①根据动态脉压水平分为4组、根据诊所脉压水平分为5组并分别比较。②根据左室质量指数分为左室肥厚组和非左室肥厚组。结果:动态脉压和诊所脉压均与年龄、原发性高血压史、左室质量指数、动脉僵硬度指数和24h平均心率呈非常显著的相关性。动脉僵硬度随分组脉压的增大呈显著递增,其与动态脉压的相关性明显强于诊所脉压(r=0.670,P<0.01和r=0.399,P<0.01。24h脉压和24h收缩压在左室肥厚组均明显高于非左室肥厚组(49.0±10.2)mmHg和(44.7±8.9)mmHg,P<0.001和(132.1±13.1)mmHg和(126.5±12.7)mmHg,P<0.001(1mmHg=0.13kPa);动态脉压与左室质量指数的相关性明显强于诊所脉压(r=0.277,P<0.01和r=0.105,P<0.05)。结论:脉压升高是原发性高血压患者左室肥厚的重要危险因素;与诊所脉压比较,动态脉压更能反映高血压靶器官损害的程度。
Objective: To provide a theoretical basis for the prevention and intervention of hypertension in patients with hypertension by comparing the effects of dynamic pulse pressure and clinic pulse pressure on left ventricular hypertrophy in patients with essential hypertension. Methods: A total of 337 patients with newly diagnosed mild to moderate essential hypertension were enrolled in this study. Blood pressure was measured at 3 clinics in different enrolled cases for 24 hours, and ambulatory blood pressure monitoring and echocardiography were performed. According to the dynamic pulse pressure level is divided into 4 groups, according to the clinic pulse pressure level is divided into 5 groups and compared. ② According to left ventricular mass index into left ventricular hypertrophy group and non-left ventricular hypertrophy group. Results: Dynamic pulse pressure and clinic pulse pressure were significantly correlated with age, history of essential hypertension, left ventricular mass index, arterial stiffness index and 24h mean heart rate. The arterial stiffness increased significantly with the increase of group pulse pressure, and its correlation with dynamic pulse pressure was significantly stronger than that of the clinic (r = 0.670, P <0.01 and r = 0.399, P <0.01.24h pulse pressure and 24h Systolic blood pressure was significantly higher in left ventricular hypertrophy group than in non-LV hypertrophy group (49.0 ± 10.2) mmHg and (44.7 ± 8.9) mmHg, P <0.001 and (132.1 ± 13.1) mmHg and (126.5 ± 12.7) mmHg, respectively 0.001 (1mmHg = 0.13kPa). The correlation between ambulatory pulse pressure and left ventricular mass index was significantly higher than that of clinic (r = 0.277, P <0.01 and r = 0.105, Essential hypertension risk factors of left ventricular hypertrophy; Compared with the clinic pulse pressure, dynamic pulse pressure can better reflect the degree of target organ damage in hypertension.