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학술저널
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대한고혈압학회 Clinical Hypertension Clinical Hypertension 제21권 제22호
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2015.1
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1 - 10 (10page)

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Abstract Background: Epicardial fat tissue is known to have an unique endocrine function which affect the cardiac autonomic system. Heart rate recovery (HRR) is a simple non-invasive measurement that assesses autonomic nervous system dysfunction. We aimed to investigate the association among epicardial fat thickness (EFT), HRR and circadian blood pressure (BP) variation in patients with hypertension. Methods: A total of 358 consecutive patients who underwent both 24-hour ambulatory BP monitoring (ABPM) and a treadmill test were enrolled. Echocardiographic EFT and HRR, defined as peak heart rate minus heart rate after a 1-min recovery time, were measured. Patients were classified according to the ABPM; 147 patients with hypertension with a dipping pattern at night (dippers), 140 patients with hypertension with a non-dipping pattern at night (non-dippers) and 71 normotensive controls. Results: EFT was significantly higher in hypertensive patients, especially in the non-dipper group, compared to the controls (non-dippers, 7.5 ± 2.9 mm; dippers, 6.6 ± 1.6 mm; controls, 5.5 ± 2.1 mm; p < 0.001). HRR was significantly lower in both hypertensive groups as compared to the control group and was the lowest in the non-dipper group (non-dipper, 26.6 ± 18.6; dipper, 29.5 ± 21.5; control, 71.4 ± 19.8; p < 0.001). EFT was significantly correlated with age, body mass index, 24-hour mean systolic BP and 24 h mean BP variability, whereas exercise duration, metabolic equivalents (METs) and HRR were inversely correlated with EFT. Furthermore, EFT > 6.7 mm was associated with a blunted HRR with 76 % sensitivity and 61 % specificity (ROC area under curve: 0.71, 95 % confidence interval, CI = 0.65–0.76, p < 0.001). In a multivariate analysis, EFT (odds ratio, OR = 3.53, 95 % CI = 1.20–10.37, p = 0.022) and 24-hour mean BP variability (OR = 1.09, 95 % CI = 1.03–1.16, p = 0.005) were independent predictors of a blunted HRR defined as HRR ≤ 12 beats (n = 63) in patients with hypertension. Conclusion: EFT and HRR were significantly correlated with circadian BP variability in patients with hypertension. EFT and circadian BP variability were independent predictors of blunted HRR, which suggests a link between epicardial fat and autonomic dysregulation in hypertension.
#Epicardial fat #Cardiac autonomic function #Heart rate recovery #Hypertension

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참고문헌 (20)

참고문헌 신청
Bakirci EM. / 2015 / New inflammatory markers for prediction of non-dipper blood pressure pattern in patients with essential hypertension : Serum YKL-40/Chitinase 3-like pro google schola Best SA. / 2014 / Heart rate recovery after maximal exercise is blunted in hypertensive seniors / J Appl Physiol(1985) 117 (11) : 1302 ~ 1307 google schola Cavalcante JL. / 2012 / Association of epicardial fat, hypertension, subclinical coronary artery disease, and metabolic syndrome with left ventricular diastolic dysfunction google schola Cole CR. / 1999 / Heart-rate recovery immediately after exercise as a predictor of mortality / N Engl J Med 341 (18) : 1351 ~ 1357 google schola Cuspidi C. / 2001 / Target organ damage and non-dipping pattern defined by two sessions of ambulatory blood pressure monitoring in recently diagnosed essential hypertensive p google schola

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