Association between 24-h ambulatory blood pressure variability and cardiac structure and function

doi:10.16150/j.1671-2870.2019.02.014

Abstract

Abstract:

Objective: To investigate the association between 24-h ambulatory blood pressure variability and cardiac structure and function in untreated patients. Methods: The association between 24-hour ambulatory blood pressure (BP) recordings and echocardiography in 80 untreated patients referred to a hypertension clinic was assessed. BP variability indices were standard deviation (SD), coefficient of variation (CV), variability independent of the mean (VIM), maximum-minimum difference (MMD), and average real variability (ARV). Effect sizes (standardized β)and partial coefficient of determination were computed using multivariable regression models. Results: Left ventricular mass index(LVMI) (systolic BP: β=6.8—8.0, P<0.01; diastolic BP: β=6.7—7.8, P<0.01), longitudinal strain(LS) (systolic BP: β=-0.76—-0.71, P<0.05; diastolic BP: β=-0.81—-0.71, P<0.05) and septal E/e' (systolic BP: β=0.44—0.57, P<0.05) were associated independently with BP, whereas the association with BP variability was not significant except for those of LVMI with systolic BP CV and VIM ( β=3.3, P=0.048, β=3.4, P=0.049), and of septal E/e' with diastolic BP MMD ( β=0.46, P=0.034). Conclusion: Short-term 24-h blood pressure variability is associated with cardiac structure and function, but blood pressure might be a major factor affecting these cardiac indices.

Key words: Blood pressure monitoring, Blood pressure variability, Echocardiography

CLC Number:

R446.5

XU Tingyan, YANG Yan, LI Jingjing, ZHANG Dongyan, WANG Ying, WANG Jiguang, LI Yan. Association between 24-h ambulatory blood pressure variability and cardiac structure and function[J]. Journal of Diagnostics Concepts & Practice, 2019, 18(2): 193-198.

Figures/Tables 4

References 23

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参数	24 h动态收缩压VIM		P值
参数	VIM低组（n=41）	VIM高组（n=39）	P值
女性	20（48.8）	19（48.7）	0.740
吸烟者	9（22.0）	7（17.9）	0.540
饮酒者	6（14.6）	9（23.1）	0.420
高血压	33(80.4)	33(84.6)	0.820
糖尿病	1(2.43)	4(10.3)	0.160
年龄(岁)	46.7±11.2	50.2±10.3	0.150
体质量指数（kg/m²）	25.1±3.2	24.4±2.9	0.320
24 h平均收缩压(mmHg)	131.6±14.0	133.3±11.0	0.580
24 h平均舒张压(mmHg)	86.1±10.1	82.4±7.1	0.070
心率（次/分）	73.4±13.4	74.5±12.5	0.820
空腹血糖（mmol/L）	5.12±0.43	5.23±0.84	0.470
总胆固醇（ mmol/L）	5.27±0.97	5.36±1.16	0.700
SD（mmHg）	12.0±1.8	17.9±3.2	<0.001
CV（%）	9.1±1.5	14.0±2.1	<0.001
MMD（mmHg）	54.8±11.1	74.2±17.3	<0.001
ARV（mmHg）	8.9±1.5	10.4±2.2	0.001
左心室质量指数（g/m²）	88.7±17.1	94.5±15.2	0.100
左心室纵向应变(%)	20.3±2.3	21.0±2.8	0.240
室间隔E/e’	9.1±2.1	9.4±2.4	0.430

血压相关变量( SD)	模型	LVMI（g/m²）	左心室LS (%)	室间隔E/e’比值
24 h收缩压（+15 mmHg）	1	7.1（3.8~10.4）^a)	-0.75（-1.35~-0.15）^b)	0.49（0.08~0.90）^b)
	2:SD	6.9（3.6~10.2）^a)	-0.76（-1.37~-0.15）^b)	0.47（0.06~0.88）^b)
	3:CV	8.0（4.6~11.4）^a)	-0.71（-1.33~-0.09）^b)	0.57（0.14~1.00）^b)
	4:VIM	7.6（4.3~10.9）^a)	-0.73（-1.34~-0.12）^b)	0.54（0.13~0.95）^b)
	5:MMD	6.8（3.5~10.1）^a)	-0.75（-1.36~-0.14）^b)	0.44（0.03~0.85）^b)
	6:ARV	6.8（3.3~10.3）^a)	-0.75（-1.36~-0.14）^b)	0.42（-0.01~0.85）
SD（+4 mmHg）	1	3.5（0.1~7.1）	0.11（-0.20~0.42）	0.35（-0.06~0.76）
	2	3.2（0.1~6.3）	0.15（-0.46~0.76）	0.32（-0.09~0.73）
CV(+3 mmHg)	1	1.3（-2.2~4.8）	0.34（-0.25~0.93）	0.17（-0.24~0.58）
	3	3.3（0.1~6.5）^b)	0.17（-0.42~0.76）	0.31（-0.10~0.72）
VIM(+4 U)	1	2.2（-1.5~5.9）	0.28（-0.33~0.89）	0.24（-0.19~0.67）
	4	3.4（0.1~6.7）^b)	0.17（-0.44~0.78）	0.32（-0.09~0.73）
MMD(+18 mmHg)	1	3.0（0.7~6.7）	-0.11（-0.73~0.51）	0.37（-0.06~0.80）
	5	2.1（-1.2~5.4）	-0.01（-0.62~0.60）	0.30（-0.11~0.71）
ARV(+2 mmHg)	1	2.6（-1.1~6.3）	-0.20（-0.84~0.44）	0.43（-0.01~0.86）
	6	1.1（-2.4~4.6）	-0.04（-0.68~0.60）	0.33（-0.11~0.77）

血压相关变量( SD)	模型	LVMI（g/m2）	左心室纵向应变(%)	室间隔E/e’比值
24 h收缩压（+9 mmHg）	1	6.8（3.2~10.4）^a)	-0.79（-1.44~-0.14）^b)	0.31（0.08~0.54）
	2:SD	7.0（3.4~10.6）^a)	-0.77（-1.41~-0.13）^b)	0.10（0.01~0.19）
	3:CV	7.8（3.7~11.9）^a)	-0.71（-1.44~0.02）	0.10（0.06~0.26）
	4:VIM	7.3（3.6~11.0）^a)	-0.75（-0.98~-0.52）^b)	0.11（0.07~0.29）
	5:MMD	6.9（3.2~10.6）^a)	-0.81（-1.46~-0.16）^b)	0.05（0.01~0.09）
	6:ARV	6.7（3.0~10.4）^a)	-0.77（-1.40~-0.14）^b)	0.18（0.09~0.47）
SD（+4 mmHg）	1	1.0 （-1.9~3.9）	0.17（-0.09~-0.43）	0.18（-0.17~0.53）
	2	1.5（-1.2~4.2）	0.12（-0.13~-0.37）	0.04（-0.02~0.10）
CV（+3 mmHg）	1	-1.1（-4.6~2.4）	0.44（-0.13~1.0）	0.11（-0.28~0.50）
	3	2.0（-1.5~5.5）	0.16（-0.46~-0.78）	0.05（-0.01~0.11）
VIM(+2 U)	1	0.18（-2.8~3.2）	0.27（-0.22~0.76）	0.15（-0.20~0.50）
	4	1.5（-1.3~4.2）	0.13（-0.36~0.62）	0.04（-0.01~0.07）
MMD(+10 mmHg)	1	-0.3（-4.0~3.4）	-0.10（-0.73~0.53）	0.42（0.01~0.83）
	5	0.5（0.3~0.7）	-0.19（-0.80~0.42）	0.46（0.06~0.87）^b)
ARV(+1 mmHg)	1	0.9（-1.7~3.5）	-0.34（-0.77~0.09）	0.18（-0.09~0.47）
	6	0.8（-1.6~3.2）	-0.32（-0.73~0.09）	0.18（-0.09~0.47）