Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP - Brasil.
Universidade Federal de São Paulo, São Paulo, SP - Brasil.
Arq Bras Cardiol. 2023 Oct 9;120(9):e20230050. doi: 10.36660/abc.20230050. eCollection 2023.
Weight gain can trigger mechanisms that increase blood pressure. Nevertheless, obesity causes structural changes in the myocardium, including increased ventricular mass, atrial dilatation, and diastolic and systolic dysfunction. Additionally, blood pressure variations, like morning surge (MS) in obese hypertensive patients may have clinical relevance in cardiovascular events. Although morning blood pressure surge is a physiological phenomenon, excess MS can be considered an independent risk factor for cardiovascular events.
To evaluate MS values and their association with left ventricular hypertrophy (LVH) and nocturnal dipping (ND) in obese and non-obese hypertensive patients.
A cross-sectional study that evaluated BP measurements by ambulatory blood pressure monitoring (ABPM) and the presence of LVH by echocardiography in 203 hypertensive outpatients, divided into two groups: 109 non-obese and 94 obese hypertensives patients. The significance level was set at 0.05 in two-tailed tests.
A MS above 20 mmHg by ABPM was detected in 59.2% of patients in the non-obese group and 40.6% in the obese group. LVH was found in 18.1% and 39.3% of patients in the non-obese and obese groups, respectively, p<0.001. In the "obese group", it was observed that a MS>16 mmHg was associated with LVH, [prevalence ratio: 2.80; 95%CI (1.12-6.98), p=0.03]. For the non-obese group, the cut-off point of MS for this association was >22 mmHg.
High MS was positively associated with LVH, with a particular behavior in the hypertensive obese group.
体重增加会引发导致血压升高的机制。然而，肥胖会导致心肌结构发生变化，包括心室质量增加、心房扩张以及舒张和收缩功能障碍。此外，血压变化，如肥胖高血压患者的清晨血压飙升（MS），可能与心血管事件具有临床相关性。虽然清晨血压飙升是一种生理现象，但过度的 MS 可被视为心血管事件的独立危险因素。
评估 MS 值及其与肥胖和非肥胖高血压患者左心室肥厚（LVH）和夜间血压下降（ND）的关系。
这是一项横断面研究，通过动态血压监测（ABPM）评估血压测量值，并通过超声心动图评估 203 例高血压门诊患者的 LVH 情况，这些患者分为两组：109 例非肥胖和 94 例肥胖高血压患者。双侧检验的显著性水平设定为 0.05。
非肥胖组中通过 ABPM 检测到的 MS 超过 20mmHg 的患者占 59.2%，而肥胖组中的这一比例为 40.6%。非肥胖组和肥胖组中分别有 18.1%和 39.3%的患者存在 LVH，p<0.001。在“肥胖组”中，观察到 MS>16mmHg 与 LVH 相关，[患病率比：2.80；95%CI（1.12-6.98），p=0.03]。对于非肥胖组，MS 与这种相关性的截止值为>22mmHg。
MS 升高与 LVH 呈正相关，在高血压肥胖组中表现出特殊的行为。
