| Objective:Application of the pressure-strain loop(PSL)to evaluate myocardial work done at different levels of blood pressure control in patients with essential elderly hypertension,and to investigate the changes in myocardial work before and after antihypertensive treatment in elderly patients with hypertension,so as to provide a clinical basis for early and accurate assessment of left ventricular systolic function and the efficacy of antihypertensive treatment in elderly patients with hypertension.Methods:189 hypertensive patients attending the Department of Cardiology,Baiqiuen Hospital,Shanxi,from January to June 2017 were retrospectively collected and randomly divided into standard antihypertensive group and intensive antihypertensive group.Their blood pressure was adjusted to the target value of blood pressure lowering for elderly hypertensive patients by pharmacological antihypertensive treatment during a period of 3 consecutive months,namely 130～150/90 mm Hg in the standard antihypertensive group and 110 ～ 130/80 mm Hg in the intensive antihypertensive group,and the treatment was continuously maintained.After 12 and24 months of antihypertensive treatment,31 cases who failed to achieve blood pressure control during the period,lost visits and those whose image quality did not meet the conditions for analysis were excluded,and a total of 158 cases were included,including 75 cases in the standard antihypertensive group and 83 cases in the intensive antihypertensive group.Another 48 cases of sex-and age-matched elderly people without cardiovascular disease or other systemic diseases affecting cardiac function were collected during the same period as the control group.All elderly hypertensive patients underwent conventional echocardiography at baseline and at 12 and 24 months of antihypertensive treatment.Conventional echocardiographic parameters were measured and recorded,and two-dimensional speckle-tracking echocardiography(2D-STE)myocardial imaging was applied to obtain overall longitudinal strain(GLS)of the left ventricular myocardium,and left ventricular pressure-strain loop(LVPSL)was applied to obtain myocardial work parameters,including global constructive work(GCW),global wasted work(GWW),global work index(GWI)and global work efficiency(GWE)were obtained.To compare the differences in conventional echocardiographic parameters,GLS and myocardial work parameters between the groups at baseline,and to compare the changes in conventional echocardiographic parameters,GLS and myocardial work parameters within and between the groups at 12 and 24 months of antihypertensive treatment in the standard and intensive antihypertensive groups,and the amount of change.Results:(1)At baseline,end-diastolic left ventricular posterior wall thickness(LVPWD),end-diastolic left ventricular internal diameter(LVEDD),end-diastolic septal thickness(IVSD),relative ventricular wall thickness(RWT),left ventricular mass index(LVMI)in the standard and intensive hypotensive groups,ratio of early diastolic mitral orifice flow velocity to early diastolic mitral annular motion velocity(E/e’)were all greater in the standard and intensive hypotensive groups than in the control group;myocardial work parameters GWI,GCW and GWW were all greater than those of the control group,and GLS was smaller than that of the control group(all P<0.05);the differences in conventional echocardiographic parameters,GLS and myocardial work parameters were not statistically significant when comparing the standard and intensive hypotensive groups(all P > 0.05).(2)After 12 months of antihypertensive treatment,LVMI,RWT and E/e’ in both the standard antihypertensive group and the intensive antihypertensive group were smaller than the baseline levels(all P < 0.05);LVMI and RWT in the intensive antihypertensive group were smaller than those in the standard antihypertensive group(all P < 0.05).(3)After 24 months of antihypertensive treatment,LVEDD,LVMI,E/e’ in the standard antihypertensive group and IVSD,LVPWD,LVEDD,LVMI,RWT,E/e’ in the intensive antihypertensive group were all smaller than the baseline level.IVSD,LVPWD,LVMI and RWT in the intensive antihypertensive group at 24 months of antihypertensive treatment were all smaller than those at 12 months(all P<0.05).(4)After 12 and 24 months of antihypertensive treatment,GWI,GCW and GWW in both the standard and intensive antihypertensive groups continued to decrease(all P < 0.05)and there was no significant change in GWE(all P > 0.05);in the intensive group,GLS increased sequentially at 12 and 24 months of antihypertensive treatment,and GLS at 24 months of antihypertensive treatment in the standard group was greater than that at baseline and 12 months(all P < 0.05).The GWI,GCW and GWW in the intensive antihypertensive group were smaller than those in the standard antihypertensive group at 12 and 24 months,and the GLS was greater than that in the standard antihypertensive group(all P< 0.05),while the GWE did not change significantly(P>0.05).(5)After 12 months of antihypertensive treatment,the reduction in GWI,GCW and GWW was greater in both the standard and intensive antihypertensive groups than between 24 and 12 months of antihypertensive treatment(all P < 0.05).The reduction in GWI,GCW and GWWW was greater in the intensive antihypertensive group than in the standard antihypertensive group between 12 months and baseline and between 24 months and 12 months of antihypertensive treatment(all P < 0.05).Conclusion:(1)At baseline,patients with primary geriatric hypertension have reduced GLS,increased myocardial work parameters GWI,GCW,GWW and impaired myocardial systolic function;(2)After antihypertensive treatment,GLS increased,myocardial work parameters GWI,GCW and GWW decreased and myocardial sysolic function improved in primary elderly hypertensive patients,with a greater degree of improvement in the intensive antihypertensive group;(3)Between 12 months of antihypertensive treatment and baseline,myocardial work parameters GWI,GCW and GWW decreased more in elderly hypertensive patients.Between 12 months and baseline and between 24 months and 12 months of antihypertensive treatment,the reductions in GWI,GCW and GWW were greater in the intensive antihypertensive group than in the standard antihypertensive group. |
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