M N Murat AKSOY, İbrahim KOCAYİĞİT, Yusuf CAN, Mustafa Tarık AĞAÇ

Hipertansiyon Hastalarında Sistolik Kan Basıncı Değişkenliği ve Kardiyovasküler Riskin Vekil Belirteçleri Arasındaki İlişki

Amaç: Sistolik kan basıncı değişkenliği (SKBD) 24 saatlik kan basıncı takiplerinde sistolik kan basıncının gösterdiği yükselme ve düşme hareketinin bir ölçüsüdür. SKBD ile kardiyovasküler (KV) hastalıklar arasındaki ilişkiyi gösteren çelişkili bilgiler mevcuttur. Bu çalışmada, hipertansif bir kohortta SKBD ile KV hasarı gösteren vekil belirteçler arasındaki ilişkiyi araştırdık Metod: Esansiyel hipertansiyon hastalarının dahil edildiği çalışmada; belgelenmiş KV hastalık, diabetes mellitus ve sekonder hipertansiyon öyküsü olan bireyler dışlandı. 24 saat ambulatuar kan basıncı ölçümü (AKBÖ), ekokardiyografi, elektrokardiyografi ve kalp-ayak bileği vaskuler indeks (KAVİ) ölçümleri yapıldı. SKBD, AKBÖ kayıtlarında ortalama sistolik kan basıncı değerinin standart sapması olarak tanımlandı. SKBD ile EKG’de QTc mesafesi, QT dispersiyonu, fragmante QRS varlığı ve KAVİ sonuçları karşılaştırıldı. Bulgular: 64 hasta çalışmaya dahil edildi ortalama yaş 508, 24(%37) erkek. SKBD (ortalama 15.124.6) ile KAVİ ölçümü, QTc mesafesi, fragmante QRS varlığı arasında bir korelasyon bulunamadı ancak QT dispersiyonu ile pozitif bir korelasyon izlendi. Hastalar ortanca SKBD değerine göre ikiye bölünüp yüksek ve düşük SKBD olarak ikiye bölündüğünde QT dispersiyonu yüksek SKBD grubunda tutarlı ve anlamlı olarak daha yüksekti (p=0.006) Sonuç: Belgelenmiş KV hastalıkları ve hipertansif KC değişim belirteçleri görülmeyen hipertansiyon hastalarında SKBD değerleri, QT dispersiyonu ile pozitif korelasyon gösterirken, bir aort sertlik indeksi olan KAVİ ile ilişki görülmedi. Bu bulgular SKBD’si yüksek olan hipertansif hasta grubunda gizli sol ventrikül fibrozis varlığını ve buna bağlı artmış aritmi riskini gösteriyor olabilir.

Anahtar Kelimeler:

sistolik kan basıncı değişkenliği, hipertansiyon, kardiyovasküler risk

Systolic Blood Pressure Variability and Its Relationship with Surrogate Markers of Cardiovascular Risk in Hypertensive Patients

Objective: Systolic blood pressure variability (SBPV) is a measure of oscillations in SBP for 24 hours. There are conflicting data about the relationship between SBPV and cardiovascular (CV) diseases. In this study, we aim to document a relationship between SBPV and surrogate markers of CV damage in a hypertensive patient cohort. Methods: Previously documented hypertension patients were enrolled. Patients with previously documented CV disease, diabetes mellitus and secondary hypertension were excluded. 24-hour ambulatory blood pressure monitoring (ABPM), echocardiography, electrocardiography and cardio-ankle vascular index (CAVI) measurements were performed. SBPV is defined as the standard deviation of mean systolic blood pressure readings from ABMP records. The relationship between SBPV and QTc distance, QT dispersion, presence of fragmented QRS, CAVI results were examined. Results: 64 patients were enrolled mean age 508, 24(37%) were male]. Mean SBPV was 15.124.6 and there was not a significant correlation between SBPV CAVI, QTc measurements of the study patients but there was a significant positive correlation with QT dispersion values (28.615.2, p=0.004, p=0.354). When patients were divided into two categories as high SBPV and low SBPV, QT dispersion was consistently longer in high SBPV group (p=0.006). Conclusion: In hypertensive patients without documented CV disease and signs of hypertensive CV changes on clinical evaluation, SBPV is positively correlated with QT dispersion but high SBPV is not related with aortic stiffness according to CAVI results. These findings might be a sign of occult left ventricular fibrosis and high risk of arrhythmia in hypertensive patients with high SBPV.

Keywords:

systolic blood pressure variability, hypertension, cardiovascular risk,

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ISSN: 1309-3878
Yayın Aralığı: 3
Başlangıç: 2009
Yayıncı: Düzce Üniversitesi Tıp Fakültesi Aile Hekimliği AD adına Yrd.Doç.Dr.Cemil Işık Sönmez