Metabolik sendromlu hastalarda nondipper kan basıncı seyrinin hedef organ hasarı üzerine etkisi
Küçük Resim Yok
Tarih
2009
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Hem metabolik sendromun (MetS) hem de nondipper durumun (gece kan basıncı düşüşündeki yetersizlik) hedef organ hasarı ile ilişkili olduğu gösterilmiştir.Bu çalışmada MetS’li kişilerde nondipper durumun hedef organ hasarına etkisi araştırıldı. Ça lış ma pla nı: Metabolik sendrom tanısı konan 82 hasta, 24 saatlik ambulatuvar kan basıncı izleme sonuçlarına göre dipper (n35, 19 kadın, 16 erkek; ort. yaş 48.46.4) ve nondipper (n47, 35 kadın, 12 erkek; ort. yaş 50.44.7) olarak iki gruba ayrıldı. Tüm çalışma grubunda kardiyak hasar konvansiyonel ve doku Doppler ekokardiyografi ile, böbrek hasarı ise 24 saatlik idrarda albümin atılımı ile değerlendirildi. Bul gu lar: İki grup, yaş, beden kütle indeksi, diyabet varlığı, klinik ve 24 saatlik kan basıncı, gece ve gündüz kan basın- cı değerleri, plazma lipit düzeyleri, sigara kullanımı, MetS ölçütlerinin dağılımı ve toplam MetS ölçütü sayısı bakımından benzer özellikteydi. Sol ventrikül tepe diyastolik erken miyokardiyal hız (Em)/tepe diyastolik geç miyokardiyal hız (Am) oranı nondipper grupta anlamlı derecede daha düşük bulundu (p0.016). Sol ventrikül kütle indeksi, miyokart performans indeksi ve 24 saatlik idrar albümin atılımı nondipper grupta daha yüksek olmakla birlikte, fark anlamlı değildi (sırasıyla p0.110, p0.099 ve p0.093). Çokdeğişkenli regresyon analizi sonucunda yaş artışı ve nondipper durumun bağımsız olarak Em/Am oranında azalmaya neden olduğu görüldü (sırasıyla; ?-0.25, p0.020 ve ?-0.22, p0.042). So nuç: Metabolik sendromlu kişilerdeki nondipper durumu diğer MetS bileşenlerinden bağımsız olarak hem kardiyak hem de böbrek hasarı ile ilişkili olabilir. Nondipper gruptaki diyastolik disfonksiyonun albüminüri düzeyindeki artıştan daha belirgin olması, bu kişilerde kardiyak hasarın böbrek hasarından daha ön planda olabileceğini düşündürmektedir.
Objectives: Both metabolic syndrome (MetS) and nondipping status (insufficient reduction in nocturnal blood pressure) have been linked with target organ damage. We evaluated the effect of nondipping status on target organ damage in subjects with MetS. Study design: Eighty-two patients diagnosed as having MetS were divided into two groups according to the findings of 24-hour ambulatory blood pressure monitoring as dipper (n35, 19 women, 16 men; mean age 48.4±6.4 years) and nondipper (n47, 35 women, 12 men; mean age 50.4±4.7 years). Cardiac damage was assessed by conventional and tissue Doppler echocardiography, and renal damage by 24-hour urinary albumin excretion. Results: The two groups were similar with regard to age, body mass index, presence of diabetes, smoking, clinical and 24-hour, daytime and nighttime blood pressures, plasma lipid profile, distribution of and the mean total number of MetS criteria. The ratio of early (Em) to late (Am) left ventricular peak diastolic myocardial velocities (Em/Am) was significantly lower in nondippers (p0.016). Nondippers also had higher values of left ventricular mass index, myocardial performance index, and 24-hour urinary albumin excretion, but these differences did not reach a significant level (p0.110, p0.099, p0.093, respectively). Multivariate regression analysis showed increasing age and nondipping status as independent factors associated with decreased Em/Am ratio (β-0.25, p0.020 and β-0.22, p0.042, respectively). Conclusion: In subjects with MetS, nondipping status may be associated with both cardiac and renal damage independent of other components of MetS. Since the degree of diastolic dysfunction is more marked than that of albuminuria in nondippers, it may be extrapolated that the extent of cardiac damage surpasses renal damage in these subjects.
Objectives: Both metabolic syndrome (MetS) and nondipping status (insufficient reduction in nocturnal blood pressure) have been linked with target organ damage. We evaluated the effect of nondipping status on target organ damage in subjects with MetS. Study design: Eighty-two patients diagnosed as having MetS were divided into two groups according to the findings of 24-hour ambulatory blood pressure monitoring as dipper (n35, 19 women, 16 men; mean age 48.4±6.4 years) and nondipper (n47, 35 women, 12 men; mean age 50.4±4.7 years). Cardiac damage was assessed by conventional and tissue Doppler echocardiography, and renal damage by 24-hour urinary albumin excretion. Results: The two groups were similar with regard to age, body mass index, presence of diabetes, smoking, clinical and 24-hour, daytime and nighttime blood pressures, plasma lipid profile, distribution of and the mean total number of MetS criteria. The ratio of early (Em) to late (Am) left ventricular peak diastolic myocardial velocities (Em/Am) was significantly lower in nondippers (p0.016). Nondippers also had higher values of left ventricular mass index, myocardial performance index, and 24-hour urinary albumin excretion, but these differences did not reach a significant level (p0.110, p0.099, p0.093, respectively). Multivariate regression analysis showed increasing age and nondipping status as independent factors associated with decreased Em/Am ratio (β-0.25, p0.020 and β-0.22, p0.042, respectively). Conclusion: In subjects with MetS, nondipping status may be associated with both cardiac and renal damage independent of other components of MetS. Since the degree of diastolic dysfunction is more marked than that of albuminuria in nondippers, it may be extrapolated that the extent of cardiac damage surpasses renal damage in these subjects.
Açıklama
Anahtar Kelimeler
Kalp ve Kalp Damar Sistemi
Kaynak
Türk Kardiyoloji Derneği Arşivi
WoS Q Değeri
Scopus Q Değeri
Cilt
37
Sayı
7
