Cipollini Franco, Arcangeli Enrica, Greco Emanuela, Franconi Flavia, Pettinà Giuseppe, Seghieri Giuseppe
Department of Internal Medicine, Spedali Riuniti, Viale Matteotti 9/D, 51100 Pistoia, Italy.
Blood Press. 2012 Aug;21(4):255-64. doi: 10.3109/08037051.2012.676752. Epub 2012 May 1.
Much evidence suggests sexual dimorphism in the relationship linking blood pressure (BP) to both left ventricular mass (LVM) and geometry in hypertension. To better evaluate gender-associated characteristics in the relation BP-LVM among newly diagnosed hypertension (24-h average ambulatory BP monitoring, ABPM, > 125/80 mmHg), we measured indexed LVM and relative wall thickness (RWT) by standardized echographic methods in 209 Caucasian drug-naïve subjects, of whom 162 (100M/62F) were recognized to be hypertensive. Mean office systolic (SBP)/diastolic (DBP), 24-h average and night-time BP values were similar between sexes and significantly related to indexed LVM in both genders. Daytime SBP was significantly related to indexed LVM only in females (r =0.41; p =0.0008 in women; r =0.11; p = NS in males), while LVM was more sensitive to day-to-night SBP change in females. RWT was, on the contrary, significantly related to ABPM values only in males. All these findings were confirmed after adjusting for possible confounders. Percentage of LVM variance explained by 24-h average, daytime or night-time SBP values were higher in females than in males (17% vs 3%; 11% vs 1%; and 17% vs 8%). In conclusion, in early hypertension, LVM was significantly associated with daytime BP and more sensitive to reduced percentage of night BP fall in females. LVM variance explained by ABPM SBP was much higher in females than in males. RWT, expressing concentric LVM remodelling was, conversely, more related to BP increase in males.
大量证据表明，在高血压患者中，血压（BP）与左心室质量（LVM）及几何形态之间的关系存在性别差异。为了更好地评估新诊断高血压患者（24小时平均动态血压监测，ABPM，>125/80 mmHg）中BP-LVM关系的性别相关特征，我们采用标准化超声心动图方法，对209名未服用药物的白种人受试者进行了LVM指数和相对壁厚度（RWT）测量，其中162人（100名男性/62名女性）被确诊为高血压。男女之间的平均诊室收缩压（SBP）/舒张压（DBP）、24小时平均血压和夜间血压值相似，且在两性中均与LVM指数显著相关。仅在女性中，日间SBP与LVM指数显著相关（女性中r = 0.41；p = 0.0008；男性中r = 0.11；p =无显著性差异），而女性的LVM对日间至夜间SBP变化更敏感。相反，RWT仅在男性中与ABPM值显著相关。在对可能的混杂因素进行校正后，所有这些发现均得到证实。24小时平均、日间或夜间SBP值所解释的LVM方差百分比在女性中高于男性（17%对3%；11%对1%；17%对8%）。总之，在早期高血压中，LVM与日间血压显著相关，且对女性夜间血压下降百分比降低更敏感。ABPM SBP所解释的LVM方差在女性中远高于男性。相反，表达向心性LVM重塑的RWT在男性中与血压升高的关系更大。
