Toba Ayumi, Kariya Taro, Aoyama Rie, Ishiyama Taizo, Tsuboko Yusuke, Takeda Kazuhiro, Fujimoto Hajime, Shimokado Kentaro, Harada Kazumasa
a Division of Cardiology , Tokyo Metropolitan Geriatric Hospital , Tokyo , Japan.
b Division of Geriatrics and Vascular Medicine , Tokyo Medical and Dental University Hospital , Tokyo , Japan.
Blood Press. 2017 Oct;26(5):264-271. doi: 10.1080/08037051.2017.1306422. Epub 2017 Mar 22.
Left ventricular (LV) remodelling is observed in numerous patients with hypertension and is a principal cause of heart failure in elderly patients. The aim of this study was to determine the relationships between age and structural/functional LV remodelling observed in elderly hypertensive patients.
A total of 557 elderly hypertensive patients (mean age: 74.0 ± 8.6 years) with preserved LV systolic function underwent echocardiography and 24-hour blood pressure (BP) measurement.
Overall, 41.1% of patients had LV hypertrophy, 77.9% had increased relative wall thickness (RWT) defined as RWT >0.42, and 31.8% had both. Logistic analysis of the entire study population showed that increased RWT was associated with both 24-hour systolic BP (odds ratio (OR) 1.38, 95% confidence interval (CI) 1.12 to 1.70) and age (OR 1.32, 95%CI 1.08 to 1.61), whereas increased RWT was associated only with age (OR 1.61, 95%CI 1.23 to 2.11) after excluding patients with LV hypertrophy. Univariate and multivariate linear regression analyses of all patients showed that LV diastolic echocardiographic parameters were consistently associated with age (p ≤ .001) alone, even considering LV structural changes.
Age was independently correlated with LV concentric/functional changes regardless of LV hypertrophy, suggesting that ageing is independently involved in the progression of LV remodelling.
众多高血压患者存在左心室(LV)重构,这是老年患者心力衰竭的主要原因。本研究旨在确定老年高血压患者年龄与观察到的左心室结构/功能重构之间的关系。
总共557例左心室收缩功能保留的老年高血压患者(平均年龄:74.0±8.6岁)接受了超声心动图检查和24小时血压(BP)测量。
总体而言,41.1%的患者有左心室肥厚,77.9%的患者相对室壁厚度(RWT)增加(定义为RWT>0.42),31.8%的患者两者都有。对整个研究人群的逻辑分析表明,RWT增加与24小时收缩压(优势比(OR)1.38,95%置信区间(CI)1.12至1.70)和年龄(OR 1.32,95%CI 1.08至1.61)均相关,而在排除左心室肥厚患者后,RWT增加仅与年龄相关(OR 1.61,95%CI 1.23至2.11)。对所有患者的单因素和多因素线性回归分析表明,即使考虑左心室结构变化,左心室舒张期超声心动图参数仅与年龄一致相关(p≤0.001)。
无论左心室肥厚情况如何,年龄均与左心室向心性/功能性变化独立相关,提示衰老独立参与左心室重构的进展。