Dobrowolski Piotr, Klisiewicz Anna, Prejbisz Aleksander, Florczak Elżbieta, Rybicka Justyna, Bieleń Przemysław, Śliwiński Paweł, Gosk Maria, Januszewicz Andrzej, Hoffman Piotr
Department of Congenital Heart Diseases, Institute of Cardiology, Warsaw, Poland;
Department of Hypertension, Institute of Cardiology, Warsaw, Poland;
Am J Hypertens. 2015 Mar;28(3):307-11. doi: 10.1093/ajh/hpu150. Epub 2014 Aug 26.
Diastolic dysfunction has been shown to be an independent factor of cardiovascular diseases in patients with hypertension. Very often, obstructive sleep apnea (OSA) and metabolic syndrome (MS) coexist with resistant hypertension (RHTN) and may lead to diastolic dysfunction. Thus, the purpose of this study was to investigate whether OSA and MS are associated with diastolic dysfunction in patients with RHTN independently from other factors, including age, left ventricular mass index (LVMI), and blood pressure (BP).
Data from 155 patients (n = 92 men and 63 women) were analyzed. All patients underwent thorough examination, including biochemical evaluations, ambulatory blood pressure monitoring, polysomnography with assessment of apnea/hypopnea index (AHI), and echocardiography. LVMI and diastolic function parameters were obtained.
Patients were divided into 2 groups based on the presence or absence of diastolic dysfunction: group 1 (E' < 10cm/second; n=87) and group 2 (E' > 10cm/second; n = 68). AHI, LVMI, and 24-hour systolic BP/diastolic BP values were higher in group 1. E' correlated with AHI (r = -0.25; P < 0.001), LVMI (r = -0.36; P < 0.0001), 24-h systolic BP/24-h diastolic BP (r = -0.28, P < 0.001; r = -0.30, P < 0.001, respectively), glucose level (r = -0.26; P < 0.01), and abdominal obesity (r = -0.28; P < 0.0001). In multivariable models decreased E' was independently related to the presence of MS or abdominal obesity when separate components of MS were included in the model. Age and 24-hour systolic BP were independently associated with decreased E'. However, the relationship of decreased E' with 24-hour systolic BP was nonsignificant if LVMI was included in the multivariable model.
MS and abdominal obesity were independently associated with diastolic dysfunction in patients with RHTN. OSA was not confirmed to be an independent factor of diastolic dysfunction.
舒张功能障碍已被证明是高血压患者心血管疾病的独立危险因素。阻塞性睡眠呼吸暂停（OSA）和代谢综合征（MS）常常与顽固性高血压（RHTN）并存，并可能导致舒张功能障碍。因此，本研究的目的是调查OSA和MS是否独立于其他因素（包括年龄、左心室质量指数（LVMI）和血压（BP））与RHTN患者的舒张功能障碍相关。
分析了155例患者（92例男性和63例女性）的数据。所有患者均接受了全面检查，包括生化评估、动态血压监测、多导睡眠图检查以评估呼吸暂停/低通气指数（AHI）以及超声心动图检查。获取了LVMI和舒张功能参数。
根据是否存在舒张功能障碍将患者分为两组：第1组（E' < 10cm/秒；n = 87）和第2组（E' > 10cm/秒；n = 68）。第1组的AHI、LVMI和24小时收缩压/舒张压值更高。E'与AHI（r = -0.25；P < 0.001）、LVMI（r = -0.36；P < 0.0001）、24小时收缩压/24小时舒张压（分别为r = -0.28，P < 0.001；r = -0.30，P < 0.001）、血糖水平（r = -0.26；P < 0.01）和腹型肥胖（r = -0.28；P < 0.0001）相关。在多变量模型中，当模型中纳入MS的各个单独成分时，E'降低与MS或腹型肥胖的存在独立相关。年龄和24小时收缩压与E'降低独立相关。然而，如果在多变量模型中纳入LVMI，则E'降低与24小时收缩压之间的关系不显著。
MS和腹型肥胖与RHTN患者的舒张功能障碍独立相关。OSA未被证实是舒张功能障碍的独立因素。
