The Korean Journal of Medicine

  • 제85권1호
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  • Pages.50-57
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  • 2013
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  • 1738-9364(pISSN)
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  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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고혈압 환자에서 혈압변동성 및 심장박동수와 hsCRP와의 연관성

Relationship of Blood Pressure Variability and Heart Rate with Plasma hsCRP in Patients with Recently Diagnosed Hypertension

  • 김동민 (단국대학교 의과대학 심장혈관내과학교실) ;
  • 임성훈 (단국대학교 의과대학 심장혈관내과학교실) ;
  • 이명용 (단국대학교 의과대학 심장혈관내과학교실)
  • Kim, Dongmin (Division of Cardiology, Department of Internal Medicine, Dankook University College of Medicine) ;
  • Lim, Seong-Hoon (Division of Cardiology, Department of Internal Medicine, Dankook University College of Medicine) ;
  • Lee, Myung-Yong (Division of Cardiology, Department of Internal Medicine, Dankook University College of Medicine)
  • 투고 : 2012.06.04
  • 심사 : 2013.01.11
  • 발행 : 2013.07.01
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 혈압의 변동성과 심장박동수는 표적 장기 손상과 심장 혈관 합병증과 관련이 있다. 하지만 그 정확한 기전은 밝혀져 있지 않다. 이에 저자들은 혈압의 변동성 및 심장박동수와 염증 인자가 관계가 있는지 확인하고자 본 연구를 시행하였다. 방법: 최근 진단되거나 새로이 진단된 151명의 고혈압 환자의 24시간 활동성 혈압을 분석하였다. 혈압의 변동성은 측정된 혈압의 표준편차로 표시하였다. 24시간 활동성 혈압 검사 중 동시에 측정된 평균 심장박동수 및 표준편차를 측정하였다. 혈중 high-sensitivity C-reactive protein (hsCRP)를 염증 인자로 사용하였다. 결과: 대상 환자의 평균나이는 44 ${\pm}$ 11.3세로 이 중 남자는 74.2%이었다. hsCRP는 남자 환자(0.131 ${\pm}$ 0.014 vs. 0.06 ${\pm}$ 0.023, p = 0.001) 및 흡연력이 있는 환자(0.136 ${\pm}$ 0.017 vs. 0.101 ${\pm}$ 0.017, p = 0.003)에서 높게 나타났다. 상관 분석에서 24시간 동안의 이완기 혈압의 변동성은 hsCRP와 양의 상관관계를 보였다(p = 0.002, r = 0.258). 또한 24시간 동안(p = 0.004, r = 0.236), 활동시간 동안(p = 0.003, r = 0.239), 수면시간 동안의 (p = 0.020, r = 0.190) 평균 심장박동수 그리고 24시간 동안의 심장박동수의 변동성은(p = 0.025, r = 0.182) hsCRP와 양의 상관관계를 보였다. 다중선형회귀분석에서 24시간 동안의 이완기 혈압의 변동성과(${\beta}$ = 0.286, p = 0.011) 활동시간 동안의 평균 심장박동수가(${\beta}$ = 0.169, p = 0.049) hsCRP와 유의한 관계가 있었다. 결론: 24시간 활동성 혈압을 통하여 측정된 이완기 혈압의 변동성 및 심장박동수는 염증 인자인 hsCRP와 연관성이 있었다. 혈압의 변동성과 심장박동수는 염증반응과 연관하여 심장혈관 합병증에 영향을 주는 것으로 생각한다.

Background/Aims: Blood pressure (BP) variability and heart rate (HR) are associated with target organ damage and cardiovascular complications; however, the exact mechanisms are uncertain. In this study, we examined the association of an inflammatory marker with BP variability and HR. Methods: A total of 151 patients diagnosed recently with hypertension were subjected to 24-h ambulatory BP monitoring. BP variability was assessed as the standard deviation of the BP recordings. The average HR and HR variability were calculated from concomitantly recorded HR values. Plasma high-sensitivity C-reactive protein (hsCRP) was used as a marker of inflammation. Results: The mean age of the study population was 44 ${\pm}$ 11.3 years, and 74.2% of the patients were male. The plasma hsCRP level was higher in male patients (0.131 ${\pm}$ 0.014 vs. 0.06 ${\pm}$ 0.023, p = 0.001) and patients with a history of smoking (0.136 ${\pm}$ 0.017 vs. 0.101 ${\pm}$ 0.017, p = 0.003). A correlation analysis showed that the variability in diastolic BP during 24-h monitoring was associated with hsCRP (p = 0.002, r = 0.258). The 24-h (p = 0.004, r = 0.236), daytime (p = 0.003, r = 0.239), and nighttime (p = 0.020, r = 0.190) average HRs were related to the hsCRP level. The 24-h HR variability (p = 0.025, r = 0.182) was also associated with hsCRP. After adjusting for the effect of related variables, the 24-h diastolic BP variability (${\beta}$ = 0.286, p = 0.011) and daytime average HR (${\beta}$ = 0.169, p = 0.049) were positively related to hsCRP. Conclusions: Plasma hsCRP is related to diastolic BP variability in recently diagnosed hypertensive patients. Moreover, HR measured with BP is associated with hsCRP. These findings suggest that inflammation mediates adverse cardiovascular outcomes of BP variability and an elevated HR.

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참고문헌

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