International Journal of Cardiology: Hypertension最新文献_第5页

Telemedicine can revolutionize the treatment of chronic disease 远程医疗可以彻底改变慢性病的治疗

Q4 Medicine

International Journal of Cardiology: Hypertension

Pub Date : 2020-12-01 DOI: 10.1016/j.ijchy.2020.100051

Jeffrey A. Corbett , Janice M. Opladen , John D. Bisognano

引用次数: 26

Potential benefits and harms of various arterial hypertension guidelines 各种动脉高血压指南的潜在益处和危害

Q4 Medicine

International Journal of Cardiology: Hypertension

Pub Date : 2020-12-01 DOI: 10.1016/j.ijchy.2020.100047

Maria Dorobantu, Nicoleta-Monica Popa-Fotea

引用次数: 0

Prevalence of hypertension and controlled hypertension among United States adults: Evidence from NHANES 2017-18 survey 美国成年人高血压和控制高血压的患病率:来自NHANES 2017-18调查的证据

Q4 Medicine

International Journal of Cardiology: Hypertension

Pub Date : 2020-12-01 DOI: 10.1016/j.ijchy.2020.100061

Juwel Rana , John Oldroyd , Md. Momin Islam , Carla E. Tarazona-Meza , Rakibul M. Islam

Background

This study aims to compare the prevalence of hypertension (HTN) and controlled hypertension (CHTN) in US adults and determine the absolute difference in the prevalence of HTN and CHTN between the JNC7 and ACC/AHA 2017 guidelines.

Methods

Data for this study were derived from the most recent cycle of the National Health and Nutrition Examination Survey (NHANES) 2017–2018. After excluding participants with missing systolic blood pressure (BP) or diastolic BP and aged <18 years, 4730 participants were included in the final analyses. BP was defined as the average of the first three measurements. The prevalence of HTN and CHTN, including absolute differences of these prevalences, were estimated using both JNC7 and ACC/AHA 2017 guidelines.

Results

The overall weighted prevalence of HTN was 31.7% (95% CI: 28.7–34.8) based on JNC7, while the corresponding prevalence was 45.6% (95% CI: 43.0–48.3) when new guideline of ACC/AHA was used. Of the people who had HTN according to the JNC7 and ACC/AHA 2017 guidelines, 48.2% (95% CI: 44.4–52.0) and 21.0% (95% CI: 18.1–24.2) had a controlled blood pressure level, respectively. When blood pressure was assessed using both guidelines, the greatest absolute increase in rates of HTN and CHTN was 17.4% and 30.0% in people aged 40–59 years, respectively.

Conclusion

Given the high burden of disease due to complications arising from untreated HTN, as well as the higher costs of untreated disease, new guidelines have important public health implications to early detection of patients at risk and prevent complications across different populations.

本研究旨在比较美国成人高血压(HTN)和控制性高血压(CHTN)的患病率，并确定JNC7和ACC/AHA 2017指南中HTN和CHTN患病率的绝对差异。方法本研究的数据来自2017-2018年国家健康与营养检查调查(NHANES)的最新周期。在排除收缩压(BP)或舒张压(舒张压)缺失和年龄18岁的参与者后，4730名参与者被纳入最终分析。BP被定义为前三次测量的平均值。根据JNC7和ACC/AHA 2017指南估计HTN和CHTN的患病率，包括这些患病率的绝对差异。结果以JNC7为标准HTN的总加权患病率为31.7% (95% CI: 28.7 ~ 34.8)，而采用ACC/AHA新指南时HTN的总加权患病率为45.6% (95% CI: 43.0 ~ 48.3)。根据JNC7和ACC/AHA 2017指南，患有HTN的人中，分别有48.2% (95% CI: 44.4-52.0)和21.0% (95% CI: 18.1-24.2)的血压水平得到控制。当使用两种指南评估血压时，40-59岁人群中HTN和CHTN的绝对增加率分别为17.4%和30.0%。鉴于未经治疗的HTN引起的并发症造成的高疾病负担，以及未经治疗的疾病成本较高，新指南对不同人群中高危患者的早期发现和并发症预防具有重要的公共卫生意义。

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引用次数: 15

10-Year community prevalence and trends of severe asymptomatic hypertension among patients with hypertension in the USA: 2007–2016 2007-2016年美国高血压患者严重无症状高血压的10年社区患病率和趋势

Q4 Medicine

International Journal of Cardiology: Hypertension

Pub Date : 2020-12-01 DOI: 10.1016/j.ijchy.2020.100066

Muchi Ditah Chobufo , Ebad Ur Rahman , Fatima Farah , Mohamed Suliman , Kanaan Mansoor , Adee Elhamdani , Mehiar El-Hamdani , Sudarshan Balla

Background

Severe asymptomatic hypertension (SAH) is associated with significant health cost, morbidity and mortality.

Aim

Establish the nationwide prevalence, trends and associated sociodemographic characteristics of SAH among patients with hypertension in the USA.

Methods

We utilized the National Health and Nutrition Examination data collected over five survey cycles (2007–2016). Included were participants aged 20–80 years with self-reported diagnosis of hypertension. SAH was defined as having a mean systolic blood pressure (SBP) ≥180 mmHg and/or mean diastolic blood pressure (DBP) ≥120 mmHg at the time of examination. The Chi square test was used to compare prevalence across different categories. Associations between sociodemographic variables and SAH were assessed using multivariate binary logistic regression.

Results

The prevalence of SAH among patients with hypertension is 2.15% (95% CI 1.80–2.56), mainly explained by isolated mean SBP≥180 mmHg (86% of all cases), with no statistically significant change between 2007: 2.66% (95% CI 2.10–3.36) and 2016:2.61% [95% CI 1.73–3.94), p-trend = 0.17. Increasing age (OR 1.07, 95% CI 1.04–1.09), NH Blacks (OR 2.20, 95% CI 1.37–3.54), BMI< 25 (OR 2.52, 95% CI 1.48–4.28), lack of health insurance OR 4.92% (95% CI 2.53–9.54) and never married individuals (OR = 2.59%, 95% CI 1.20–5.60) were more likely to have SAH, comparatively. There was no significant association between duration of hypertension and SAH.

Conclusion

The prevalence of SAH in the USA is 2.15% and has been stable over the past decade. Our study underscores the importance of identifying barriers to screening and treatment of hypertension which is a major treatable risk factor for cardiovascular disease.

背景:严重无症状高血压(SAH)与显著的健康成本、发病率和死亡率相关。目的了解美国高血压患者中SAH的全国患病率、趋势和相关的社会人口学特征。方法利用2007-2016年5个调查周期收集的国家健康与营养检查数据。参与者年龄在20-80岁之间，自我报告诊断为高血压。SAH被定义为在检查时平均收缩压(SBP)≥180 mmHg和/或平均舒张压(DBP)≥120 mmHg。卡方检验用于比较不同类别的患病率。社会人口学变量与SAH之间的关系采用多元二元逻辑回归进行评估。结果高血压患者中SAH的患病率为2.15% (95% CI 1.80 ~ 2.56)，主要原因是孤立的平均收压≥180 mmHg(占所有病例的86%)，2007年为2.66% (95% CI 2.10 ~ 3.36)， 2016年为2.61% (95% CI 1.73 ~ 3.94)， p趋势= 0.17。增加年龄(OR 1.07, 95% CI 1.04-1.09)， NH黑人(OR 2.20, 95% CI 1.37-3.54)， BMI<相比之下，25 (OR 2.52, 95% CI 1.48-4.28)、缺乏健康保险OR 4.92% (95% CI 2.53-9.54)和从未结婚的个体(OR = 2.59%， 95% CI 1.20-5.60)更容易患SAH。高血压持续时间与SAH之间无显著关联。结论美国SAH的患病率为2.15%，在过去的十年中一直保持稳定。我们的研究强调了确定筛查和治疗高血压障碍的重要性，高血压是心血管疾病的主要可治疗危险因素。

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引用次数: 2

Body weight variability is not associated with changes in risk factors for cardiometabolic disease 体重变异性与心脏代谢疾病危险因素的变化无关

Q4 Medicine

International Journal of Cardiology: Hypertension

Pub Date : 2020-09-01 DOI: 10.1016/j.ijchy.2020.100045

Jake Turicchi , Ruairi O'Driscoll , Graham Horgan , Cristiana Duarte , Inês Santos , Jorge Encantado , Antonio L. Palmeira , Sofus C. Larsen , Jack K. Olsen , Berit L. Heitmann , R. James Stubbs

Context

Weight loss is known to improve health, however the influence of variability in body weight around the overall trajectory on these outcomes is unknown. Few studies have measured body weight frequently enough to accurately estimate the variability component.

Objective

To investigate the association of 12-month weight variability and concurrent weight change with changes in health markers and body composition.

Methods

This study was a secondary analysis of the NoHoW trial, a 2 × 2 factorial randomised controlled trial promoting evidence-based behaviour change for weight loss maintenance. Outcome measurements related to cardiometabolic health and body composition were taken at 0, 6 and 12 months. Participants were provided with Wi-Fi connected smart scales (Fitbit Aria 2) and asked to self-weigh regularly over this period. Associations of weight variability and weight change with change in outcomes were investigated using multiple linear regression with multiple levels of adjustment in 955 participants.

Results

Twelve models were generated for each health marker. Associations between weight variability and changes in health markers were inconsistent between models and showed no evidence of a consistent relationship, with all effects explaining <1% of the outcome, and most 0%. Weight loss was consistently associated with improvements in health and body composition, with the greatest effects seen in percent body fat (R² = 10.4–11.1%) followed by changes in diastolic (4.2–4.7%) and systolic (3–4%) blood pressure.

Conclusion

Over 12-months, weight variability was not consistently associated with any measure of cardiometabolic health or body composition, however weight loss consistently improved all outcomes.

Trial registration number

ISRCTN88405328.

众所周知，减肥可以改善健康状况，但总体轨迹周围体重变化对这些结果的影响尚不清楚。很少有研究频繁地测量体重，以准确地估计可变性成分。目的探讨12个月体重变异性和同期体重变化与健康指标和体成分变化的关系。方法本研究是对NoHoW试验的二次分析，NoHoW试验是一项2 × 2因子随机对照试验，旨在促进循证行为改变以维持体重。在第0、6和12个月时测量与心脏代谢健康和身体组成相关的结果。研究人员为参与者提供了连接Wi-Fi的智能秤(Fitbit Aria 2)，并要求他们在此期间定期称重。在955名参与者中，采用多水平调整的多元线性回归研究了体重变异性和体重变化与结果变化的关系。结果每个健康标志物生成12个模型。体重变异性和健康指标变化之间的关联在不同的模型之间不一致，没有证据表明两者之间存在一致的关系，所有的影响都只能解释1%的结果，大多数只能解释0%的结果。体重减轻始终与健康和身体组成的改善有关，体脂百分比(R2 = 10.4-11.1%)的影响最大，其次是舒张压(4.2-4.7%)和收缩压(3-4%)的变化。结论:在12个月的时间里，体重变异性与心脏代谢健康或身体组成的任何指标都没有一致的相关性，但体重减轻始终改善了所有结果。试验注册号为isrctn88405328。

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引用次数: 7

Prevalence and control rates of hypertension in the USA: 2017–2018 美国高血压患病率和控制率:2017-2018

Q4 Medicine

International Journal of Cardiology: Hypertension

Pub Date : 2020-09-01 DOI: 10.1016/j.ijchy.2020.100044

Muchi Ditah Chobufo , Vijay Gayam , Jean Soluny , Ebad U. Rahman , Sostanie Enoru , Joyce Bei Foryoung , Valirie N. Agbor , Alix Dufresne , Tonga Nfor

Background

Recent review of hypertension guidelines requires fresh updates of prevalence and control rates. Though retrospective analysis provided burden estimates, control rates were grossly misleading. We set out to update the prevalence and control rates of hypertension in the USA using contemporary NHANES data.

Methods

Persons with mean systolic blood pressure (mSBP) ≥130 mmHg or mean diastolic blood pressure (mDBP) ≥80 mmHg or self-reported current use of antihypertensive medications were classified as hypertensives. Hypertensives on medications with mSBP <130 mmHg and mDBP <80 mmHg were classified as having well-controlled hypertension. Subgroup comparisons of hypertension prevalence were computed using Chi-square test. Predictors of hypertension and well-controlled BP were assessed using multivariable logistic regressions. Two tailed p-values <0.05 were considered statistically significant.

Results

The prevalence of hypertension in the USA in 2017–2018 was 49.64% (95% CI 46.67–52.61) corresponding to 115(95% CI 104–128) million persons. NH Blacks: 58.53% (95% CI 55.39–61.60); Men: 54.46% (95% CI 51.01–57.87); older persons and obese individuals: 61.03% (95% CI 57.31–64.63) as well as persons with diabetes and CKD, comparatively. The overall rate of well-controlled hypertension was 39.64% (95% CI 36.20–42.81). Persons with at least a college degree: OR 2.20(95% CI 1.02–5.04, p=0.049) and persons with incomes ≥3 times the poverty threshold; OR 1.88(95% CI 1.1.8–2.99, p=0.011) had higher rates of well-controlled hypertension when compared to lowest categories.

Conclusion

One in every two persons ≥20 years in the USA has hypertension with only 39.64% on medications having well-controlled hypertension. Significant discrepancies exist in the burden and control rates in different subpopulation categories. Targeted interventions could help improve the prevalence and hypertension control rates in the USA.

背景:最近对高血压指南的审查需要更新患病率和控制率。虽然回顾性分析提供了负担估计，但控制率严重误导。我们开始使用最新的NHANES数据更新美国高血压患病率和控制率。方法将平均收缩压(mSBP)≥130 mmHg或平均舒张压(mDBP)≥80 mmHg或自我报告当前使用降压药的患者归为高血压患者。降压血压130 mmHg和降压血压80 mmHg的高血压患者被归为控制良好的高血压患者。采用卡方检验计算高血压患病率的亚组比较。使用多变量logistic回归评估高血压和控制良好的血压的预测因子。两个尾部p值<0.05认为有统计学意义。结果2017-2018年美国高血压患病率为49.64% (95% CI 46.67-52.61)，相当于115亿人(95% CI 1.04 - 1.28)。NH黑人:58.53% (95% CI 55.39-61.60);男性:54.46% (95% CI 51.01-57.87);老年人和肥胖者:61.03% (95% CI 57.31-64.63)，糖尿病和CKD患者相对较少。高血压控制良好的总比率为39.64% (95% CI 36.20-42.81)。至少有大学学历的人:OR为2.20(95% CI 1.02-5.04, p=0.049)，收入≥贫困线3倍的人;OR为1.88(95% CI 1.1.8-2.99, p=0.011)的患者与控制良好的高血压患者相比，高血压发病率较高。结论美国≥20岁人群中每2人中就有1人患有高血压，仅39.64%的患者服药后高血压得到良好控制。不同亚人群类别的负担率和控制率存在显著差异。有针对性的干预措施可以帮助改善美国的高血压患病率和控制率。

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引用次数: 28

Position statement of the Interamerican Society of Cardiology (IASC) on the current guidelines for the prevention, diagnosis and treatment of arterial hypertension 2017–2020 美洲心脏病学会(IASC)关于2017-2020年动脉高血压预防、诊断和治疗指南的立场声明

Q4 Medicine

International Journal of Cardiology: Hypertension

Pub Date : 2020-09-01 DOI: 10.1016/j.ijchy.2020.100041

Fernando Wyss , Antonio Coca , Patricio Lopez-Jaramillo , Carlos Ponte-Negretti

Objectives

As an Inter-American Society we are convinced of the need to standardize the steps in which we diagnose, evaluate, treat and control hypertension, establishing guidelines and rules that should be adopted in all countries of Latin America, aimed at standardizing management and control of CV risk in order to achieve a substantial decrease in CV events.

Methods

In the last four years important international guidelines for the diagnosis, management, treatment and control of arterial hypertension have been published. In America, mostly in mid- and low-income countries, hypertension is a major problem of public health, being the most important cardiovascular risk factor due to its great population impact. Therefore, it is crucial to dedicate all the possible efforts to increase substantially the number of hypertensive patients diagnosed in a given area, and to improve the percentage of controlled patients. This is a major necessity in order to reduce the morbidity and mortality for CVD in the Latin American region, although no guidelines takes the Latin American populations into account, and much less standardizes their diagnosis and management.

Conclusions

The Inter-American Society of Cardiology suggest the use of the blood pressure classification of the Latin American Society of Hypertension (LASH) and recommends the use of the SCORE System to stratify the global CV risk because this system has the capability to adapt the global risk by means of a correcting factor based on the ethnicity of the different native populations in America.

目的:作为一个美洲协会，我们确信有必要标准化我们诊断、评估、治疗和控制高血压的步骤，建立拉丁美洲所有国家都应采用的指南和规则，旨在标准化心血管风险的管理和控制，以实现心血管事件的大幅减少。方法近4年来发表了有关高血压诊断、管理、治疗和控制的重要国际指南。在美国，主要是中低收入国家，高血压是一个重大的公共卫生问题，由于其人口影响很大，是最重要的心血管危险因素。因此，至关重要的是要尽一切可能的努力，在给定地区大幅增加诊断出的高血压患者的数量，并提高控制患者的百分比。这对于降低拉丁美洲地区心血管疾病的发病率和死亡率是非常必要的，尽管没有指南考虑到拉丁美洲的人群，更没有将其诊断和管理标准化。结论美洲心脏病学会建议使用拉丁美洲高血压学会(LASH)的血压分类，并建议使用SCORE系统对全球心血管风险进行分层，因为该系统有能力通过基于美洲不同土著人口种族的校正因子来适应全球风险。

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引用次数: 18

The effect of feedback on cardiovascular risk factors on optimization of primary prevention: The PharmLines initiative 心血管危险因素反馈对一级预防优化的影响:PharmLines倡议

Q4 Medicine

International Journal of Cardiology: Hypertension

Pub Date : 2020-09-01 DOI: 10.1016/j.ijchy.2020.100042

M. Yldau van der Ende , Ingmar E. Waardenburg , E. Lipsic , Jens H.J. Bos , Eelko Hak , H. Snieder , Pim van der Harst

Background

It is unknown whether population based single assessment of cardiovascular disease (CVD) risk and feedback to individuals and general practitioners results in initiation of preventive cardiovascular pharmacotherapy in those at risk.

Methods

The population based cohort study Lifelines was linked to the IADB.nl pharmacy database to assess information on the initiation of preventive medication (N = 48,770). At the baseline visit, information on cardiovascular risk factors was collected and reported to the participants and their general practitioners. An interrupted-time-series-analysis was plotted, in which the start year of blood pressure and lipid lowering medication was displayed in years before or after the baseline visit. Subsequently, predictors of the initiation of pharmacotherapy were determined and possible reduction in cardiovascular events that could be achieved by optimal treatment of individuals at risk.

Results

Before the Lifelines baseline visit, 34% (out of 1,527, 95% Confidence interval (CI) 32%–36%) and 30% (out of 1,991, 95%CI 28%–32%) of the individuals at risk had a blood pressure or lipid lowering drug prescription, respectively. In those at risk, the use of blood pressure lowering medication, increased substantially during the year of the baseline visit. Treating individuals at increased risk (≥5% 10-year risk) with lipid or blood pressure lowering medication (N = 8515 and N = 6899) would have prevented 162 and 183 CVD events, respectively, in the upcoming five years.

Conclusion

Primary prevention of CVD in the general population appears suboptimal. Feedback of cardiovascular risk factors resulted in a substantial increase of blood pressure lowering medication and extrapolated health benefits.

背景目前尚不清楚基于人群的心血管疾病(CVD)风险评估和对个人和全科医生的反馈是否会导致高危人群开始预防性心血管药物治疗。方法基于人群的队列研究“生命线”与IADB相关联。nl药房数据库评估开始预防性用药的信息(N = 48,770)。在基线访问时，收集心血管危险因素的信息并向参与者及其全科医生报告。绘制了一个中断的时间序列分析，其中血压和降脂药物的开始年份显示在基线访问之前或之后的年份。随后，确定了药物治疗开始的预测因素，并通过对高危个体的最佳治疗来实现心血管事件的可能减少。结果在生命线基线访问之前，34%(1,527人，95%置信区间(CI) 32%-36%)和30%(1,991人，95%CI 28%-32%)的高危个体分别有降压药或降脂药处方。在那些有风险的人群中，使用降血压药物的人数在基线访问期间大幅增加。使用降脂或降血压药物(N = 8515和N = 6899)治疗风险增加的个体(10年风险≥5%)将在未来5年内分别预防162和183例CVD事件。结论普通人群对心血管疾病的一级预防并不理想。心血管危险因素的反馈导致降压药的大量增加和推断的健康益处。

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引用次数: 2

Self-employment and cardiovascular risk in the US general population 美国普通人群的自雇与心血管风险

Q4 Medicine

International Journal of Cardiology: Hypertension

Pub Date : 2020-09-01 DOI: 10.1016/j.ijchy.2020.100035

Chayakrit Krittanawong , Anirudh Kumar , Zhen Wang , Usman Baber , Deepak L. Bhatt

Background

Studies on self-employment and cardiovascular risk are very limited. We examined the relationship between self-employment and cardiovascular risk among the general population in the United States from 1999 to 2016.

Methods

Using the National Health and Nutrition Examination Survey (NHANES), we identified all patients with hypertension (HTN), hyperlipidemia (HLD), diabetes mellitus (DM), stroke, heart failure (HF), and coronary artery disease (CAD) between 1999 and 2016. Type of job was defined based on the participant's response to the survey question as “an employee of a private company, business, or individual for wages, salary, or commission” or “self-employed in own business, professional practice or farm”. Multivariable logistic regression analyses were performed to adjust for confounders.

Results

Of 30,103 patients, 2835 (9.4%) were self-employed in their own business, professional practice, or farm and 27,268 (90.6%) were employed by a private company, business, or government. After adjusting for age, race, sex, BMI, marital status, educational level, health insurance status, smoking status, sleep duration and lipid profiles, self-employed individuals had a higher prevalence of HTN (OR: 1.12; 95% confidence interval [CI] 1.05–1.20), HLD (OR: 1.10; 95% CI 1.07–1.31), stroke (OR: 1.45; 95% CI 1.27–1.67), HF (OR: 1.17; 95% CI 1.03–1.32), and CAD (OR: 1.26; 95% CI 1.13–1.35) (all P v< 0.05).

Conclusions

Self-employment may be associated with greater cardiovascular risk in the US general population. Further prospective studies are urgently needed to establish the optimal preventive strategy to reduce cardiovascular risk in self-employed individuals.

背景:关于个体经营与心血管风险的研究非常有限。我们研究了1999年至2016年美国普通人群中自营职业与心血管风险之间的关系。方法采用全国健康与营养调查(NHANES)，对1999年至2016年间所有患有高血压(HTN)、高脂血症(HLD)、糖尿病(DM)、中风、心力衰竭(HF)和冠状动脉疾病(CAD)的患者进行分析。工作类别是根据受访者对调查问题的回答界定为“受雇于私营公司、企业或个人领取工资、薪金或佣金”或“自雇经营自己的业务、专业执业或农场”。进行多变量逻辑回归分析以调整混杂因素。结果30103例患者中，2835例(9.4%)在自己的企业、专业诊所或农场中自雇，27268例(90.6%)受雇于私营公司、企业或政府。在调整年龄、种族、性别、身体质量指数、婚姻状况、教育程度、健康保险状况、吸烟状况、睡眠时间和血脂等因素后，个体经营者HTN患病率较高(OR: 1.12;95%置信区间[CI] 1.05-1.20)， HLD (OR: 1.10;95% CI 1.07-1.31)，卒中(OR: 1.45;95% ci 1.27-1.67)， hf (or: 1.17;95% CI 1.03-1.32)和CAD (OR: 1.26;95% CI 1.13-1.35)(均为P v<0.05)。结论在美国普通人群中，自营职业可能与较高的心血管风险相关。迫切需要进一步的前瞻性研究来建立最佳的预防策略，以降低个体户的心血管风险。

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引用次数: 4

Arterial stiffening is a crucial factor for left ventricular diastolic dysfunction in a community-based normotensive population 动脉硬化是社区正常血压人群左室舒张功能障碍的关键因素

Q4 Medicine

International Journal of Cardiology: Hypertension

Pub Date : 2020-09-01 DOI: 10.1016/j.ijchy.2020.100038

Maeda Mika , Hideaki Kanzaki , Takuya Hasegawa , Hiroki Fukuda , Makoto Amaki , Jiyoong Kim , Masanori Asakura , Hiroshi Asanuma , Motonobu Nishimura , Masafumi Kitakaze

Background

Left ventricular (LV) diastolic dysfunction is an important underlying hemodynamic mechanism for heart failure. Hypertension reportedly increases aortic stiffness with histological changes in the aorta assessed using aortic pulse wave velocity (PWV) that is associated with LV diastolic dysfunction. The role of hypertension per se in the relationship between aortic stiffness and LV diastolic dysfunction has not been clarified; therefore, we investigated whether this relation works for normotensive subjects.

Methods

Of the 502 subjects who underwent both echocardiography and PWV measurement in a medical check-up conducted in Arita, Japan, we enrolled 262 consecutive normotensive subjects (age 52 ± 13 years). LV diastolic dysfunction was defined as abnormal relaxation and pseudonormal or restrictive patterns determined with both transmitral flow velocity and mitral annular velocity. Aortic stiffness was assessed via non-invasive brachial-ankle PWV measurement.

Results

LV diastolic dysfunction was detected in 67 of the 262 (26%) normotensive subjects, and PWV was higher in subjects with LV diastolic dysfunction (15.4 ± 3.6 vs. 13.0 ± 2.7 m/s, p < 0.01). Multivariate logistic regression analyses revealed that PWV was independently associated with LV diastolic dysfunction (p = 0.02) after the adjustment for age; body mass index; blood pressure; eGFR; blood levels of BNP, glucose, and HDL cholesterol; LV mass index; and LA dimension.

Conclusions

Both aortic stiffness and LV diastolic function are mutually related even in normotensive subjects, independent of the potential confounding factors. The increase in aortic stiffness may be a risk factor for LV diastolic dysfunction, irrespective of blood pressure.

背景:左室舒张功能障碍是心衰的重要潜在血流动力学机制。根据与左室舒张功能障碍相关的主动脉脉波速度(PWV)评估，高血压会增加主动脉硬度，并伴有主动脉组织学改变。高血压本身在主动脉僵硬和左室舒张功能障碍之间的关系中的作用尚未明确;因此，我们研究了这种关系是否适用于血压正常的受试者。方法在日本有田市接受超声心动图检查和PWV测量的502例患者中，选取262例连续血压正常的患者(年龄52±13岁)。左室舒张功能障碍被定义为异常舒张和伪异常或限制性模式，这两种模式都是由二尖瓣血流速度和二尖瓣环速度确定的。通过无创肱-踝关节PWV测量评估主动脉僵硬度。结果262例正常血压组中67例(26%)存在左室舒张功能不全，左室舒张功能不全组PWV较高(15.4±3.6 vs 13.0±2.7 m/s, p <0.01)。多因素logistic回归分析显示，年龄调整后PWV与左室舒张功能不全独立相关(p = 0.02);身体质量指数;血压;表皮生长因子受体;血液中BNP、葡萄糖和高密度脂蛋白胆固醇的水平;LV质量指数;和LA维度。结论即使在血压正常的受试者中，主动脉僵硬度和左室舒张功能也是相互相关的，独立于潜在的混杂因素。主动脉僵硬度增加可能是左室舒张功能障碍的危险因素，与血压无关。

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引用次数: 5