Fujimoto Naoki, Okada Yoshiyuki, Shibata Shigeki, Best Stuart A, Bivens Tiffany B, Levine Benjamin D, Fu Qi
aThe University of Texas Southwestern Medical Center bInstitute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA.
J Hypertens. 2013 Nov;31(11):2282-9; discussion 2289. doi: 10.1097/HJH.0b013e3283649730.
Hypertension is associated with cardiovascular stiffening and left ventricular diastolic dysfunction, leading to comorbidities such as heart failure with preserved ejection fraction (HFpEF). It is unknown whether sex and hypertension subtype affect haemodynamics and left ventricular function in older individuals.
Ninety-five older patients with Stage 1 hypertension (ambulatory awake SBP135-159 mmHg) and 56 normotensive controls were enrolled. Patients were stratified prospectively into isolated systolic hypertension (ISH, DBP <85 mmHg) or systolic-diastolic hypertension (SDH, DBP ≥85 mmHg). Haemodynamics and Doppler variables including early filling (E) and averaged mitral annular (E'mean) velocities were measured during supine rest.
Ambulatory awake blood pressures (BPs) were the highest in SDH, whereas supine SBP was similar in both hypertensive groups. No sex difference was observed in supine or ambulatory awake BPs in all groups. Stroke volume was similar among groups within the same sex, but smaller in women. Women exhibited faster E, slower E'mean and greater E/E'mean, whereas no group difference was observed in E within the same sex. In women, E'mean was significantly slower in SDH (5.9 ± 1.6 vs. 7.4 ± 1.1 cm/s, P < 0.01) and ISH (6.6 ± 1.6 cm/s, P = 0.07) than controls, resulting in the highest E/E'mean in SDH. In men, E'mean and E/E'mean were similar among the three groups.
These results suggest that elderly hypertensive women may have left ventricular early diastolic dysfunction and higher estimated filling pressure, consistent with their susceptibility to HFpEF. Women with SDH seemed to have more left ventricular diastolic dysfunction, which might be explained by the greater cumulative afterload when ambulatory.
高血压与心血管僵硬和左心室舒张功能障碍相关，可导致诸如射血分数保留的心力衰竭（HFpEF）等合并症。尚不清楚性别和高血压亚型是否会影响老年人的血流动力学和左心室功能。
纳入95例1期高血压老年患者（动态清醒收缩压135 - 159mmHg）和56例血压正常的对照者。患者被前瞻性地分为单纯收缩期高血压（ISH，舒张压<85mmHg）或收缩期 - 舒张期高血压（SDH，舒张压≥85mmHg）。在仰卧休息时测量血流动力学和多普勒变量，包括早期充盈（E）和平均二尖瓣环（E'平均）速度。
动态清醒血压在SDH组中最高，而仰卧位收缩压在两个高血压组中相似。所有组在仰卧位或动态清醒血压方面均未观察到性别差异。同性别组间每搏输出量相似，但女性的每搏输出量较小。女性表现出更快的E、更慢的E'平均和更高的E/E'平均，而同性别的E组内未观察到差异。在女性中，SDH组（5.9±1.6 vs. 7.4±1.1cm/s，P<0.01）和ISH组（6.6±1.6cm/s，P = 0.07）的E'平均明显慢于对照组，导致SDH组的E/E'平均最高。在男性中，三组间的E'平均和E/E'平均相似。
这些结果表明，老年高血压女性可能存在左心室早期舒张功能障碍和更高的估计充盈压，这与其对HFpEF的易感性一致。SDH女性似乎有更多的左心室舒张功能障碍，这可能是由于动态时更大的累积后负荷所致。
