aBrigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA bNational University Health System, Singapore cNovartis, East Hanover, New Jersey dState University of New York at Buffalo, Buffalo, New York eUniversity of Alabama, Birmingham, Alabama fUniversity of Michigan, Ann Arbor, Michigan, USA.
J Hypertens. 2014 Jan;32(1):174-80. doi: 10.1097/HJH.0b013e32836586da.
Diastolic dysfunction is associated with adverse outcomes and is highly prevalent among older adults with hypertension. Lowering SBP with antihypertensive therapy has been shown to improve diastolic function, but whether or not age influences this effect is unknown.
In the Exforge Intensive Control of Hypertension to Evaluate Efficacy in Diastolic Dysfunction trial, 189 patients (age range 45-93 years) with hypertension and diastolic dysfunction underwent echocardiography before and after 24 weeks of intensive versus standard antihypertensive therapy titrated to a goal SBP below 135 versus below 140 mmHg. We performed linear regression analyses to examine the association between age and improvement in diastolic function achieved with SBP reduction.
Antihypertensive therapy reduced SBP by 28 ± 19 mmHg overall, and this was not significantly different across age strata. However, percentage improvement in diastolic relaxation velocity (lateral E' peak velocity) for every 10 mmHg reduction in SBP was lower in older compared to younger patients. In analyses adjusting for age stratum, sex, treatment arm, baseline relaxation velocity, and baseline blood pressure, older age was associated with reduced improvement in diastolic relaxation velocity per 10 mmHg of SBP reduction (β -1.64, P = 0.009). In contrast, the degree of change in left ventricular mass index per 10 mmHg reduction in SBP was not influenced by age (P = 0.89).
In our sample of individuals with hypertension and diastolic dysfunction, older compared to younger adults experienced less improvement in diastolic function in response to similar reductions in SBP.
舒张功能障碍与不良结局相关，在高血压老年患者中非常普遍。用降压治疗降低收缩压已被证明可以改善舒张功能，但年龄是否影响这种效果尚不清楚。
在依福地平强化降压以评估舒张功能障碍疗效试验中，189 名（年龄 45-93 岁）患有高血压和舒张功能障碍的患者在接受 24 周强化或标准降压治疗后进行了超声心动图检查，目标收缩压分别低于 135 毫米汞柱和低于 140 毫米汞柱。我们进行线性回归分析，以检查年龄与收缩压降低所带来的舒张功能改善之间的关系。
降压治疗总体上降低了 28 ± 19 毫米汞柱的收缩压，而且在不同年龄组之间没有显著差异。然而，与年轻患者相比，每降低 10 毫米汞柱收缩压，舒张松弛速度（侧壁 E'峰值速度）的百分比改善在老年患者中较低。在调整年龄组、性别、治疗组、基线松弛速度和基线血压后，年龄较大与舒张松弛速度每降低 10 毫米汞柱的收缩压改善减少相关（β -1.64，P = 0.009）。相比之下，每降低 10 毫米汞柱收缩压，左心室质量指数的变化程度不受年龄影响（P = 0.89）。
在我们的高血压和舒张功能障碍患者样本中，与年轻患者相比，老年患者在对相似收缩压降低的反应中，舒张功能的改善程度较低。
