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摘要
In patients with chronic kidney disease (CKD), hypertension (HP) is associated with the development of left ventricular (LV) diastolic dysfunction. However, the impact of antihypertensive treatment on LV diastolic function has not been well studied in CKD patients. Recently, two-dimensional speckle-tracking echocardiography (2DSTE) has emerged as a sensitive and quantitative assessment of LV diastolic function. The present study used 2DSTE to investigate the effects of antihypertensive treatment on LV diastolic function in patients with CKD and untreated HP. The study comprised 134 patients with CKD and untreated HP. The patients received blood pressure (BP)-lowering therapy for six months. The patients were clinically and echocardiographically evaluated at baseline and after 6 months of therapy. It was found that the mean systolic BP (SBP) and diastolic BP (DBP) at baseline were 154.0 +/- 7.0 and 92.6 +/- 10.2 mmHg, respectively, decreasing to 121.2 +/- 7.3 and 74.6 +/- 10.4 mmHg, respectively (P<0.05 for both) after the 6-month treatment period. Moreover, the mean peak LV strain rate during the isovolumetric relaxation period (SRIvR) and early diastole (SR) improved following treatment (from 0.23 +/- 0.10 to 0.42 +/- 0.10 sec(-1) and from 0.58 +/- 0.25 to 1.07 +/- 0.24 see, respectively; P<0.05 for both). Notably, the patients with CKD stage >= 3 were more likely to demonstrate an improvement in diastolic speckle-tracking parameters than those with CKD stage 1 or 2. For the entire population, the change (Delta) in B-type natriuretic peptide (BNP) level correlated with changes in echocardiographic parameters between baseline and follow-up, among which Delta SRIVR presented the highest correlation coefficient (r=-0.73, P<0.01). On multivariate analysis, the independent predictors of Delta SRIVR were found to include baseline CKD stage, SBP and Delta SRIVR. This study demonstrated that LV diastolic function was improved in CKD patients following antihypertensive treatment, particularly in patients with CKD stage >= 3, higher baseline SBP and worse LV diastolic function. These results highlight the importance of BP reduction in the treatment of CKD.
