Institute of Cardiology and Center of Excellence on Aging, 'G. d'Annunzio' University, Chieti.
J Hypertens. 2013 Aug;31(8):1653-61. doi: 10.1097/HJH.0b013e328361e4a6.
Twenty-four-hour blood pressure (BP) variability, by ambulatory BP monitoring (ABPM), has been related to left ventricular hypertrophy, independent of mean BP values. We tested the hypothesis that short-term BP variability (BPV) is also related to subclinical left ventricular systolic dysfunction.
We assessed 24-h SBP and DBP variabilities, quantified as standard deviation (SD) of daytime (awake) BP values and as weighted SD of 24-h BP (24-h-weighted BPV), in 309 recently (<6 months) diagnosed, prospectively recruited, and untreated hypertensive patients. Patients were included only if with normal (≥55%) left ventricular ejection fraction (LVEF). Left ventricular systolic function was assessed by echocardiography measuring midwall fractional shortening (MFS), circumferential end-systolic stress (cESS), MFS/cESS, peak systolic wall stress, left ventricular fractional shortening (LVFS), and LVEF.
At multivariate analysis, awake and 24-h-weighted SBP variabilities (directly, P = 0.038 and P = 0.002, respectively) as well as relative wall thickness (RWT) (inversely, P = 0.001) were significantly related to cESS. Awake and 24-h SBP average values (inversely, P = 0.011 and P = 0.002, respectively), awake and 24-h-weighted SBP variabilities (inversely, P = 0.017 and P = 0.024, respectively), and RWT (directly, P = 0.001) were all significantly related to MFS/cESS. Finally, awake and 24-h average SBP (directly, P = 0.01 for both), awake and 24-h-weighted SBP variability (directly, P = 0.001 and P = 0.032, respectively), and RWT (inversely, P = 0.001) were all significantly and independently related to peak systolic wall stress.
In newly diagnosed never-treated hypertensive patients, in the absence of LVEF changes and independent of left ventricular mass index, higher awake, or 24-h-weighted short-term SBP variabilities are associated with early depressed left ventricular systolic function.
通过动态血压监测（ABPM）评估 24 小时血压变异性（BPV）与左心室肥厚相关，且独立于平均血压值。我们检验了短期 BPV 也与亚临床左心室收缩功能障碍相关的假设。
我们评估了 309 例近期（<6 个月）诊断、前瞻性招募且未接受治疗的高血压患者的 24 小时收缩压和舒张压变异性，分别用日间（清醒时）血压值的标准差（SD）和 24 小时 BP 的加权 SD（24 小时加权 BPV）来量化。所有患者均需左心室射血分数（LVEF）正常（≥55%）。通过超声心动图测量中层壁段缩短率（MFS）、圆周末收缩期压力（cESS）、MFS/cESS、收缩期壁峰值压力、左心室缩短率（LVFS）和 LVEF 评估左心室收缩功能。
多元分析显示，清醒时和 24 小时加权 SBP 变异性（直接，P=0.038 和 P=0.002）以及相对壁厚度（RWT）（间接，P=0.001）与 cESS 显著相关。清醒时和 24 小时 SBP 平均值（间接，P=0.011 和 P=0.002）、清醒时和 24 小时加权 SBP 变异性（间接，P=0.017 和 P=0.024）以及 RWT（直接，P=0.001）均与 MFS/cESS 显著相关。此外，清醒时和 24 小时 SBP 平均值（直接，P=0.01）、清醒时和 24 小时加权 SBP 变异性（直接，P=0.001 和 P=0.032）以及 RWT（间接，P=0.001）与收缩期壁峰值压力均显著相关。
在新诊断且未治疗的高血压患者中，在不改变左心室射血分数和不依赖左心室质量指数的情况下，较高的清醒时或 24 小时加权短期 SBP 变异性与早期左心室收缩功能障碍相关。
