夜间收缩压与亚临床心脑血管疾病超声指标的相关性研究
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摘要
目的探讨夜间收缩压与亚临床心功能和亚临床血管损伤之间的关系。方法通过斑点追踪超声心动图检测整体纵向应变(GLS)。在颈总动脉远端1 cm处测量颈动脉内中膜厚度(CIMT),记录颈动脉斑块是否存在。通过线性和Logistic回归分析夜间收缩压与GLS、CIMT和颈动脉斑块的关系。结果单纯夜间高血压组受试者CIMT和颈动脉斑块与对照组间差异存在统计学意义(P <0.05),单纯日间高血压组受试者各项指标与对照组比较差异均无统计学意义(P>0.05)。在单变量模型中,夜间收缩压与GLS(β=0.81,95%CI 0.33～1.47)和颈动脉斑块(OR=1.99,95%CI 1.14～3.28)显著相关,日间收缩压的单因素分析差异无统计学意义。在年龄和性别调整模型中,夜间收缩压和GLS(β=0.68,95%CI 0.11～1.25)仍显著相关,与颈动脉斑块的相关性无统计学意义。结论夜间收缩压与亚临床心血管疾病相关,且夜间收缩压比日间收缩压是一个更好的预后参数。
Objective To examine the association of nocturnal systolic blood pressure(SBP)with subclinical cardiac dysfunction and sub-clinical vascular damage.Methods Global longitudinal strain(GLS)was measured by speckle-tracking analysis of echocardiogram ima-ges.Carotid intima-media thickness(CIMT)was measured at the distal 1 cm of the common carotid artery.The presence of carotidplaques was recorded.The association of nocturnal SBP with GLS,CIMT and carotid plaques was analyzed using linear and logistic regres-sion.Results There were significant differences in CIMT and carotid plaques between the nocturnal hypertension group and the controlgroup(P <0.05).There was no significant difference in the indexes between the daytime hypertension group and the control group(P >0.05).In the univariate model,nocturnal SBP was significantly associated with GLS(Beta=0.81,95%CI:0.33-1.47)and carotidplaque(OR=1.99,95%CI:1.14-3.28).Univariable analysis of daytime SBP did not show any significant associations.In the age andgender adjustment models,nocturnal systolic pressure and GLS(Beta=0.68,95%CI:0.11-1.25)were still significantly correlated,andthere was no statistically significant correlation with carotid plaque.Conclusion Nocturnal SBP is associated with subclinical cardiovascu-lar disease.Nocturnal SBP is a better prognostic parameter compared with daytime SBP.
Objective To examine the association of nocturnal systolic blood pressure(SBP)with subclinical cardiac dysfunction and sub-clinical vascular damage.Methods Global longitudinal strain(GLS)was measured by speckle-tracking analysis of echocardiogram ima-ges.Carotid intima-media thickness(CIMT)was measured at the distal 1 cm of the common carotid artery.The presence of carotidplaques was recorded.The association of nocturnal SBP with GLS,CIMT and carotid plaques was analyzed using linear and logistic regres-sion.Results There were significant differences in CIMT and carotid plaques between the nocturnal hypertension group and the controlgroup(P <0.05).There was no significant difference in the indexes between the daytime hypertension group and the control group(P >0.05).In the univariate model,nocturnal SBP was significantly associated with GLS(Beta=0.81,95%CI:0.33-1.47)and carotidplaque(OR=1.99,95%CI:1.14-3.28).Univariable analysis of daytime SBP did not show any significant associations.In the age andgender adjustment models,nocturnal systolic pressure and GLS(Beta=0.68,95%CI:0.11-1.25)were still significantly correlated,andthere was no statistically significant correlation with carotid plaque.Conclusion Nocturnal SBP is associated with subclinical cardiovascu-lar disease.Nocturnal SBP is a better prognostic parameter compared with daytime SBP.
引文
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[17]IWAKIRI T,YANO Y,SATO Y,et al.Usefulness of carotid intima-media thickness measurement as an indicator of atherosclerosis:findings from autopsy analysis[J].Atherosclerosis,2012,225:359-362.
[18]SERA F,JIN Z,RUSSO C,et al.Ambulatory blood pressure control and subclinical left ventricular dysfunction in treated hypertensive subjects[J].J Am Coll Cardiol,2015,66:1408-1409.
[19]DEN RUIJTER H M,PETERS S A,ANDERSON T J,et al.Common carotid intima-media thickness measurements in cardiovascular risk prediction:a meta-analysis[J].JAMA,2012,308:796-803.
[20]INABA Y,CHEN J A,BERGMANN S R.Carotid plaque,compared with carotid intima-media thickness,more accurately predicts coronary artery disease events:a meta-analysis[J].Atherosclerosis,2012,220:128-133.
[21]WANG C,DENG W J,GONG W Y,et al.Nocturnal hypertension correlates better with target organ damage in patients with chronic kidney disease than a nondipping pattern[J].J Clin Hypertens(Greenwich),2015,17:792-801.
[22]CUSPIDI C,SALA C,TADIC M,et al.Nondipping pattern and carotid atherosclerosis:a systematic review and meta-analysis[J].JHypertens,2016,34:385-392.
[23]PICKERING T G.What is the true blood pressure?Smirk revisited[J].J Clin Hypertens,2005,7:421-424.
[2]CHOW C K,TEO K K,RANGARAJAN S,et al.PURE(Prospective Urban Rural Epidemiology)Study investigators.Prevalence,awareness,treatment,and control of hypertension in rural and urban communities in high-,middle-,and low-income countries[J].JAMA,2013,310:959-968.
[3]ROTH G A,NGUYEN G,FOROUZANFAR M H,et al.Estimates of global and regional premature cardiovascular mortality in 2025[J].Circulation,2015,132:1270-1282.
[4]DOLAN E,STANTON A,THIJS L,et al.Superiority of ambulatory over clinic blood pressure measurement in predicting mortality:the Dublin outcome study[J].Hypertension,2005,46:156-161.
[5]CLEMENT D L,DE BUYZERE M L,DE BACQUER D A,et al.Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension[J].N Engl J Med,2003,348:2407-2415.
[6]HANSEN T W,LI Y,BOGGIA J,et al.Predictive role of the night-time blood pressure[J].Hypertension,2011,57:3-10.
[7]HERMIDA R C,AYALA D E,MOJN A,et al.Decreasing sleep-time blood pressure determined by ambulatory monitoring reduces cardiovascular risk[J].J Am Coll Cardiol,2011,58:1165-1173.
[8]HERMIDA R C,AYALA D E,MOJN A,et al.Bedtime dosing of antihypertensive medications reduces cardiovascular risk in CKD[J].J Am Soc Nephrol,2011,22:2313-2321.
[9]CUSPIDI C,SALA C,VALERIO C,et al.Nocturnal blood pressure in untreated essential hypertensives[J].Blood Press,2011,20:335-341.
[10]PEREZ-LLORET S,TOBLLI J E,CARDINALI D P,et al.Nocturnal hypertension defined by fixed cut-off limits is a better predictor of left ventricular hypertrophy than non-dipping[J].Int J Cardiol,2008,127:387-389.
[11]DZAU V J,ANTMAN E M,BLACK H R,et al.The cardiovascular disease continuum validated:clinical evidence of improved patient outcomes:partⅠ:pathophysiology and clinical trial evidence(risk factors through stable coronary artery disease)[J].Circulation,2006,114:2850-2870.
[12]MANCIA G,FAGARD R,NARKIEWICZ K,et al.2013 ESH/ESC guidelines for the management of arterial hypertension:the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension(ESH)and of the European Society of Cardiology(ESC)[J].Eur Heart J,2013,34:2159-2219.
[13]HOLLAND D J,MARWICK T H,HALUSKA B A,et al.Subclinical LV dysfunction and 10-year outcomes in type 2 diabetes mellitus[J].Heart,2015,101:1061-1066.
[14]KALAYCIOGLU E,GOKDENIZ T,AYKAN A C,et al.The influence of dipper/nondipper blood pressure patterns on global left ventricular systolic function in hypertensive diabetic patients:a speckle tracking study[J].Blood Press Monit,2014,19:263-270.
[15]TADIC M,CUSPIDI C,MAJSTOROVIC A,et al.Does a nondipping pattern influence left ventricular and left atrial mechanics in hypertensive patients?[J].J Hypertens,2013,31:2438-2446.
[16]O′LEARY D H,POLAK J F,KRONMAL R A,et al.Carotidartery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults.Cardiovascular Health Study Collaborative Research Group[J].N Engl J Med,1999,340:14-22.
[17]IWAKIRI T,YANO Y,SATO Y,et al.Usefulness of carotid intima-media thickness measurement as an indicator of atherosclerosis:findings from autopsy analysis[J].Atherosclerosis,2012,225:359-362.
[18]SERA F,JIN Z,RUSSO C,et al.Ambulatory blood pressure control and subclinical left ventricular dysfunction in treated hypertensive subjects[J].J Am Coll Cardiol,2015,66:1408-1409.
[19]DEN RUIJTER H M,PETERS S A,ANDERSON T J,et al.Common carotid intima-media thickness measurements in cardiovascular risk prediction:a meta-analysis[J].JAMA,2012,308:796-803.
[20]INABA Y,CHEN J A,BERGMANN S R.Carotid plaque,compared with carotid intima-media thickness,more accurately predicts coronary artery disease events:a meta-analysis[J].Atherosclerosis,2012,220:128-133.
[21]WANG C,DENG W J,GONG W Y,et al.Nocturnal hypertension correlates better with target organ damage in patients with chronic kidney disease than a nondipping pattern[J].J Clin Hypertens(Greenwich),2015,17:792-801.
[22]CUSPIDI C,SALA C,TADIC M,et al.Nondipping pattern and carotid atherosclerosis:a systematic review and meta-analysis[J].JHypertens,2016,34:385-392.
[23]PICKERING T G.What is the true blood pressure?Smirk revisited[J].J Clin Hypertens,2005,7:421-424.