Ciobanu Andrea O, Gherghinescu Carmen Lucia, Dulgheru Raluca, Magda Stefania, Dragoi Galrinho Ruxandra, Florescu Maria, Guberna Suzana, Cinteza Mircea, Vinereanu Dragos
"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania ; Cardiology Department, University Emergency Hospital, Bucharest, Romania.
"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
Maedica (Bucur). 2013 Jun;8(2):129-36.
Blood pressure variability (BPV) was proved as a cardiovascular risk factor. One of its mechanisms is related to arterial stiffness and ventriculo-arterial coupling; however its impact on subclinical cardiovascular dysfunction has not been evaluated yet.
To assess the relationship between BPV on 24 hours, and subclinical left ventricle (LV), renal, and vascular dysfunction in diabetic and hypertensive patients.
We studied 56 patients (57±9 years, 29 men) with mild-to-moderate hypertension and type 2 diabetes, no cardiovascular disease, normal ejection fraction and normal renal function. 24 hours ambulatory blood pressure monitoring (ABPM) was used to assess BPV, daytime (d) and night time (n), by: 1. mean (M); 2. standard deviation of mean (SD); 3. variance (Vr); 4. coefficient of variation (CV); 5. day/night variation: reverse dippers, non-dippers, dippers and extreme dippers; conventional and 2D speckle tracking echo to assess LV function; myocardial deformation was measured as global longitudinal strain (GLS). Endothelial (flow mediated dilation, FMD) and arterial function (intima media-thickness, IMT; pulse wave velocity, PWV), microalbuminuria were tested.
Daytime BPV correlates inversely with subclinical myocardial function evaluated through GLS. Daytime systolic BPV correlates positively with IMT (all rho > 0.30, all p < 0.05). Also, there is a significantly inverse correlation between mean BP and GLS. We found a direct correlation between mean BP, but not BPV, and microalbuminuria (all rho > - 0.30 and all p < 0.05). We found no correlation between BPV and FMD, PWV. There were no differences for GLS, microalbuminuria and FMD between dipper groups.
In diabetic patients with mild-to-moderate hypertension, increased daytime blood pressure variability correlates with subclinical left ventricular dysfunction and arterial function (IMT), while microalbuminuria correlates with elevated blood pressure, but not with blood pressure variability.
血压变异性（BPV）已被证明是一种心血管危险因素。其机制之一与动脉僵硬度和心室 - 动脉耦合有关；然而，其对亚临床心血管功能障碍的影响尚未得到评估。
评估24小时血压变异性与糖尿病和高血压患者亚临床左心室（LV）、肾脏及血管功能障碍之间的关系。
我们研究了56例患者（年龄57±9岁，男性29例），患有轻度至中度高血压和2型糖尿病，无心血管疾病，射血分数正常且肾功能正常。采用24小时动态血压监测（ABPM）评估血压变异性，包括日间（d）和夜间（n），评估指标如下：1. 平均值（M）；2. 平均标准差（SD）；3. 方差（Vr）；4. 变异系数（CV）；5. 日间/夜间变化：反勺型、非勺型、勺型和极端勺型；采用传统及二维斑点追踪超声心动图评估左心室功能；心肌变形以整体纵向应变（GLS）衡量。检测内皮功能（血流介导的血管舒张，FMD）和动脉功能（内膜中层厚度，IMT；脉搏波速度，PWV）、微量白蛋白尿。
日间血压变异性与通过GLS评估的亚临床心肌功能呈负相关。日间收缩压变异性与IMT呈正相关（所有rho>0.30，所有p<0.05）。此外，平均血压与GLS之间存在显著负相关。我们发现平均血压与微量白蛋白尿之间存在直接相关性，但血压变异性与微量白蛋白尿之间无相关性（所有rho>-0.30且所有p<0.05）。我们发现血压变异性与FMD、PWV之间无相关性。勺型组之间在GLS、微量白蛋白尿和FMD方面无差异。
在轻度至中度高血压的糖尿病患者中，日间血压变异性增加与亚临床左心室功能障碍和动脉功能（IMT）相关，而微量白蛋白尿与血压升高相关，但与血压变异性无关。
