| Objective:To retrospectively analyze the structural changes of the left atrium and associated risk factors in young and middle-aged hypertensive patients,the baseline and one-year follow-up results of biochemical indexes,echocardiograph,and electrocardiogram were compared between the Essential hypertensive patients with obesity and non-obese participants.Methods:310 of middle-aged and young in-patients diagnosed essential hypertension were divided into two groups obese hypertension group(BMI≥28kg/m~2)(n=157)and non-obese hypertension group(BMI<28kg/m~2).The data including gender,age,height,body weight,blood pressure,heart rate,history of smoking and driking,medical history of DM and NALFD,duration and treatment of hypertension.Laboratory examination included ALT,GGT,Scr,UA,TC,TG,HDL-C,LDL-C and FBG.Echocardiography indexes included left atrial diameter(LAD),left atrial diameter,left atrial left and right diameter,ventricular septal thickness,left ventricular posterior wall thickness,left ventricular end-diastolic inner diameter,and other cardiac ultrasound parameters.Left ventricular mass index(LVMi)and left atrial volume index(ILA)were also calculated,and Ptf V1 was evaluated as well.All the data were analyzed with Version 26 of SPSS.Results:1.Non-obese age(50.10±6.31)years,109/157(69.4%)males;BMI,diastolic blood pressure and heart rate were significantly higher in the obese group than in the non-obese group,they were(30.68±2.41)vs.(25.13±1.88),(97.75±17.44)vs.(92.70±12.66)and(74.73±12.76)vs.(71.65±10.03),respectively,all P value<0.05;The indexes including ALT,UA and TG in obese group were significantly higher than that in the non-obese group,they were(35.62±19.61)vs.(30.14±21.08),(412.49±96.04)vs.(378.41±88.17)and(2.65±2.21)vs.(2.05±1.64),respectively,all P value<0.01,medical history of NALFD,the use of ACEI/ARB/ARNI andβblocker,the proportion of combined medication and hyperuricemia in obese group were significantly higher than that in the non-obese group,they were 130(85.0)vs.93(59.2),112(73.2)vs.93(59.2),64(41.8)vs.44(28),107(69.9)vs.79(50.3)and 76(49.7)vs.52(33.1),respectively,all P value<0.05.HDL-C was significantly lower in the obese group than in the non-obese group,(1.10±0.29)vs.(1.19±0.30),P=0.003.2.Baseline indexes comprised of Echocardiograph and ECG:E/e’,LAD,ILA weresignificantly higher in the obese group than that in the non-obese group,they were(10.51±2.97)vs.(9.87±2.31),(39.79±4.13)vs.(37.31±3.55),(25.14±6.91)vs.(21.37±5.18),respectively,all P value<0.05.3.One-year follow-up biochemical parameter analysis:the prevalence of diabetes mellitus,ALT,FBG and TG were significantly higher in the obese group than that in the non-obese group,they were 67(43.8)vs.47(29.9),(39.24±32.42)vs.(30.45±21.00),(6.66±2.71)vs.(5.89±1.64),(2.72±1.80)vs.(1.92±1.17),respectively,all P value<0.05.4.One-year cardiac ultrasound and ECG results analysis:LVMi,LAD,ILA,and Ptf V1were significantly higher in the obese group than in the non-obese group,they were(96.49±21.59)vs.(91.50±21.44),(40.54±3.74)vs.(37.50±3.66),(26.37±6.91)vs.(21.72±5.99),(-0.022±0.016)vs.(-0.017±0.013),respectively,all P value<0.05.5.Compared with baseline,SBP,DBP,e GFR,TC in non-obese hypertension group were significantly lower after one year,they were(141.18±21.58)vs.(147.05±19.49),(89.84±13.98)vs.(92.70±12.66),(101.16±13.69)vs.(104.29±14.72),(4.74±1.06)vs.(4.90±1.08),respectively,all P value<0.05.Scr and HDL-C were significantly higher after one year,they were(66.19±18.46)vs.(68.38±17.63),(1.24±0.31)vs.(1.19±0.30),respectively,all P value<0.05.6.Compared with baseline,BMI,SBP,DBP,TC,e GFR in obese hypertension group were significantly lower after one year,they were(30.06±2.75)vs.(30.68±2.41),(145.76±11.60)vs.(151.76±23.06),(92.01±11.46)vs.(97.75±17.44),(4.77±1.18)vs.(4.96±1.27),(101.15±16.17)vs.(103.43±14.04),respectively,all P value<0.05.The prevalence of DM was significantly higher after 1 year,67(43.8)vs.56(36.6),P=0.005.The indexes including Scr,LVMi,LAD,ILA and Ptf V1 were significantly higher after one year than the baseline,they were(70.70±19.30)vs.(68.66±17.26),(96.49±21.59)vs.(91.75±21.58),(40.54±3.74)vs.(39.79±4.13),(26.37±6.91)vs.(25.14±6.91),(-0.022±0.016)vs.(-0.019±0.015),respectively,all P value<0.05.7.In the non-obese hypertension group,correlation analysis revealed that the following variables had an impact on△ILA within a year:△e GFR(r=0.267,P=0.001)and△LVMi(r=0.177,P=0.026).The following variables had an impact on△ILA within a year in the obese hypertension group:△BMI(r=0.238,P=0.003),△LVMi(r=0.225,P=0.014),and△E/e’(r=0.169,P=0.036).8.In the non-obese hypertension group,multiple linear regression revealed that△e GFR(=0.212,P=0.008)and△LVMi(=0.209,P=0.009)were independently linked with△ILA.△BMI(=0.243,P=0.002)and△LVMi(=0.231,P=0.003)were independently linked with△ILA in the obese hypertension group.9.According to the change of△BMI,hypertensive patients in the obese group were divided into obesity reduction and recombinant(△BMI≤-5%),and obesity did not reduce recombinant(△BMI>-5%).It can be seen that obesity reduced recombinant ILA at baseline was higher than that of obesity unreduced recombinant[(26.72±8.13)vs.(24.57±6.37),P=0.055]and non-obese group[(26.72±8.13)vs.(21.37±5.18),P<0.001].At 1-year follow-up,the ILA of obesity reduction was higher than that of the non-obese group,[(25.75±6.52)vs.(21.72±5.99),P=0.455]but lower than that of non-obese unreduced recombinant[(25.75±6.52)vs.(26.60±6.23),P<0.001].Conclusions:Obesity accelerates left atrial remodeling and left ventricular hypertrophy in young and middle-aged hypertensive patients with short disease duration.ILA,LAD,Ptf V1,and LVMi are more sensitive biomark of atrial and ventricular remodeling than LVEF and E/e’,while BMI is an independent influencing factor of left atrial changes.e GFR is a distinct influencing factor of left atrial alterations in young and middle-aged hypertension patients who are not fat. |
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