Ikeda Toshio, Gomi Tomoko, Shibuya Yuko, Matsuo Kiyoko, Kosugi Takeshi, Oku Nami, Uetake Yuzaburo, Kinugasa Satoshi, Furutera Rie
Department of Nephrology, Nippon Telegraph and Telephone Corporation (NTT) Kanto Medical Center, Higashigotanda, Tokyo, Japan.
Hypertens Res. 2004 Dec;27(12):939-46. doi: 10.1291/hypres.27.939.
To assess the relationship between home blood pressure and left ventricular mass, we evaluated cardiac echocardiography in 297 hypertensive subjects (188 men and 109 women; mean age, 62.8+/-10.3 years) who were treated with amlodipine monotherapy over 1 year (mean dose, 5.5+/-2.3 mg/day). The morning hypertension group (n=57; 19.2%), who had a morning home systolic blood pressure (HSBP) > or =135 mmHg and an evening HSBP <135 mmHg, had a significantly greater left ventricular mass index (LVMI) concomitant with an increase in the homeostasis model assessment insulin resistance index (HOMA-IR) compared to the good control group (n=174; 58.6%), whose morning and evening HSBP were both <135 mmHg, and had a LVMI roughly equivalent to that of the poor control group (n=63; 21.2%), whose morning and evening HSBP were both > or =135 mmHg. By grouping of subjects according to the difference between morning and evening HSBP (delta HSBP), subjects with a delta HSBP> or =10 mmHg had a significantly greater LVMI than subjects with a delta HSBP <10 mmHg. Increases in LVMI in these patients were still significant after adjustment for age, gender, dose of amlodipine, alcohol consumption, body mass index, office systolic blood pressure, and morning and evening HSBP. In a stepwise multivariate regression analysis, delta HSBP (r2=36.2%, p <0.001), morning HSBP (r2=5.5%, p <0.001), HOMA-IR (r2=1.4%, p=0.016) and age (r2=1.0%, p=0.026) were determined to be significant contributing factors for LVMI. This regression model could explain 44.1% of LVMI variability. These results suggest that morning rise in blood pressure is a dominant predictor of left ventricular hypertrophy.
为评估家庭血压与左心室质量之间的关系，我们对297例高血压患者（188例男性和109例女性；平均年龄62.8±10.3岁）进行了心脏超声心动图评估，这些患者接受氨氯地平单药治疗超过1年（平均剂量5.5±2.3mg/天）。与良好控制组（n = 174；58.6%）相比，早晨高血压组（n = 57；19.2%）早晨家庭收缩压（HSBP）≥135mmHg且晚上HSBP<135mmHg，其左心室质量指数（LVMI）显著更高，同时稳态模型评估胰岛素抵抗指数（HOMA-IR）增加，良好控制组早晚HSBP均<135mmHg，其LVMI大致等同于差控制组（n = 63；21.2%），差控制组早晚HSBP均≥135mmHg。根据早晚HSBP差值（ΔHSBP）对受试者进行分组，ΔHSBP≥10mmHg的受试者LVMI显著高于ΔHSBP<10mmHg的受试者。在对年龄、性别、氨氯地平剂量、饮酒量、体重指数、诊室收缩压以及早晚HSBP进行校正后，这些患者的LVMI增加仍然显著。在逐步多变量回归分析中，ΔHSBP（r2 = 36.2%，p<0.001）、早晨HSBP（r2 = 5.5%，p<0.001）、HOMA-IR（r2 = 1.4%，p = 0.016）和年龄（r2 = 1.0%，p = 0.026）被确定为LVMI的显著影响因素。该回归模型可以解释LVMI变异性的44.1%。这些结果表明，血压的早晨升高是左心室肥厚的主要预测因素。
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