The Study On The Influential Factors Of Left Ventricular Hypertrophy In Obese Postmenopausal Women With Hypertension

Objective:The prevalence of hypertension in postmenopausal women increased successively,hypertension-mediated organ damage(HMOD)and cardiovascular disease(CVD)were higher in recent years.Previous studies have shown that obese postmenopausal women with hypertension are more likely to have HMOD.The purposes of this study are to explore the influential factors of left ventricular hypertrophy(LVH)and left ventricular diastolic dysfunction(LVDD)in obese postmenopausal women with hypertension through the retrospective analysis of the clinical data of postmenopausal hypertensive patients.Methods:This is a retrospective cross sectional study.351 postmenopausal hypertensive patients diagnosed and treated in the Hypertension Department of the Lanzhou University Second Hospital from January 2018 to September 2019 were enrolled.Female hypertensive patients who were naturally postmenopausal were included.Exclusion criteria including patients after ovaries or uterus operations or postmenopausal hormone replacement therapy(HRT);as well as secondary hypertension or refractory hypertension.According to BMI(body mass index),they were divided into normal body weight group(BMI 18.5～<24kg/m~2;n=151),overweight group(BMI24～<28kg/m~2;n=96)and obesity group(BMI≥28kg/m~2;n=104);According to the duration of menopause,they were also divided into early postmenopausal group(the duration of menopause≤8 years;n=122)and late postmenopausal group(the duration of menopause>8 years;n=229).We have collected the general information,biochemical indicators(including sex hormone),ambulatory blood pressure monitoring(ABPM)and Echocardiogram(UCG)parameters through HIS system,statistical analysis of the above data was performed in SPSS 25.0.The above research scheme was approved by the ethics committee of the Lanzhou University Second Hospital(Ethical number:2021A-025).Results:1.Comparing the clinical data of the three groups with different BMI:(1)General clinical and biochemical data:Compared with the normal group,Office systolic blood pressure(SBP)was higher and high density lipoprotein(HDL-C)was lower in the overweight group(all P<0.05).Fasting blood glucose(FBG),uric acid and triglyceride(TG)was higher and HDL-C was lower in the obesity group(all P<0.05).(2)Main structure and function indexes of heart:compared with the normal group,left atrial diameter(LAD)and the thickness of the posterior wall of the left ventricle at the end of diastole(LVPWTd)in the obesity group was larger(all P<0.05).(3)ABPM:BP level:With the increase of BMI,d SBP,n SBP and 24h SBP increased successively,and the difference between the normal group and the obese group was significant(all P<0.05).BPV:A tendency towards higher blood pressure variability(BPV)was seen with the increase of BMI.Some indicators of diastolic BPV,including 24h DSD,24h DCV,w DSD and the nocturnal diastolic blood pressure fall were higher if subjects were more obese,the obesity group and the overweight group were significantly higher than the normal group(all P<0.05).There were no significant statistical differences in blood pressure circadian rhythm among the three groups(P>0.05).2.Comparing the parameters of ABPM of in the two groups with different duration of menopause:(1)BP level:Compared with the early postmenopausal group,daytime DBP(d DBP)、nighttime DBP(n DBP)and 24h DBP were lower in the late postmenopausal group(all P<0.001).(2)BPV:Some indicators of BPV,including the standard deviation of 24h SBP(24h SSD),the coefficient of variation of 24h SBP(24h SCV),the coefficient of variation of 24h DBP(24h DCV)and the weighted standard deviation of 24h SBP(w SSD)were higher and the nocturnal blood pressure fall was lower with the increase of duration of menopause.The proportion of circadian rhythm of anti-dipper blood pressure is higher in the late postmenopausal group(all P<0.05).3.The relationship between obesity,the duration of menopause and LVH,LVDD:(1)Variance analysis of two factors show that the duration of menopause and obesity have an interactive effect on E/e’(F=0.266,P=0.046),and the combination of them will further aggravate LVH and impair left ventricular diastolic function.(2)After correction for unrelated variables,the partial correlation analysis of BMI and left ventricular mass index(LVMI)/E/e’showed that:BMI was positively correlated with E/e’in the late postmenopausal group(r=0.052,P=0.034).Similarly,the duration of menopause were positively correlated with E/e’in normal,overweight and obesity group(r=0.173,P=0.041)(r=0.353,P=0.040)(r=0.081,P=0.001).The duration of menopause was positively correlated with LVMI only in the obesity group(r=0.035,P=0.021).(3)Multivariate stepwise regression analysis using LVMI and E/e’as dependent variables respectively showed that LVMI was positively correlated with 24h SBP and negatively correlated with HDL-C;E/e’was positively correlated with d SBP and the duration of menopause,negatively correlated with HDL-C.Conclusion:Obesity is one of the influencing factors of LVH and LVDD in postmenopausal hypertensive patients.The effects of obesity and the duration of menopause on cardiac hypertension-mediated organ damage(HMOD)are superimposed and interactive.Obesity plays a more important role in the development of LVH and LVDD in female hypertensive patients with longer duration of menopause.