高血压病合并焦虑、抑郁的临床特点及其与心率变异性的关系探讨  

Clinical Characteristics of Anxiety and Depression and the Relationship between Heart Rate Variability in Patients with Hypertension

作　　者：杨波[1] 吴增颖[1] 张钲[1] 

机构地区：[1]兰州大学第一医院,兰州730000

出　　处：《中西医结合心脑血管病杂志》2015年第2期171-174,共4页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：甘肃省自然科学研究基金计划项目(No.1208RJZA138)

摘　　要：目的探讨高血压病合并焦虑、抑郁患者的临床特点及其与心率变异性的关系。方法收集我院心血管内科病房和门诊收治的高血压病患者200例,根据是否合并有焦虑和抑郁,将所有患者分为焦虑抑郁组和非焦虑抑郁组,再根据是否抗焦虑抑郁治疗,将焦虑抑郁组患者分为试验组和对照组,对所有患者24h动态血压和心率变异性进行分析。结果 200例高血压病患者中存在焦虑70例(35.0%),抑郁65例(32.5%),焦虑抑郁组的焦虑自评量表(SAS)评分及抑郁自评量表(SDS)评分、24h平均血压、白昼平均血压和夜间平均血压明显高于非焦虑抑郁组(P<0.05),而NN间期标准差(SDNN)、NN间期平均值的标准差(SDANN)、相邻NN间期差值的均方根(RMSSD)明显低于非焦虑抑郁组(P<0.05)。多变量Logistic回归分析发现,SDNN和RMSSD减小是高血压患者合并焦虑抑郁的独立危险因素(P<0.05);与对照组比较,试验组治疗前后SAS评分、SDS评分、24h平均血压、白昼平均血压和夜间平均血压、SDNN、SDANN和RMSSD的差值明显增大(P<0.05)。结论与单纯高血压病患者比较,合并有焦虑和抑郁的高血压病患者有血压升高幅度大和心率变异性小的临床特点,心率变异性减低是导致焦虑和抑郁的危险因素,积极进行抗焦虑抑郁治疗可能更有利于降压效果和改善心率变异性异常。Objective To determine the clinical characteristics of hypertensive patients with anxiety and depression,and the correlation between heart rate variability（HRV）.Methods Two hundreds hypertensive patients with anxiety and depression were divided into two groups according to SAS and SDS scores,and then randomly divided into two subgroup according to whether treatment with anx-iety and depression.Ambulatory blood pressure and HRV were compared between two groups.Results 35% of patients was accom-panied with anxiety and 32.5% with depression in 200 hypertensive patients.The indexes for ambulatory blood pressure,SAS scores and SDS scores of anxiety and depression group were significantly higher than that in no anxiety and depression group（P〈0.05）. And the HAV index（SDNN,SDANN and RMSSD）of anxiety and depression group were significantly lower than that in no anxiety and depression group（P〈0.05）.The difference of SAS scores,SDS scores and ambulatory blood pressure before and after treat-ment were significantly increased（P〈0.05）.Conclusion Hypertensive patients with anxiety and depression,whose blood pressure are higher than other hypertensive patients,and the HRV are lower than others.Low HRVs are the risk factors of anxiety and depres-sion for hypertensive patients.Anti anxiety and depression treatment may be beneficial to the hypotensive effect and improve the HRV.

关 键 词：高血压 焦虑 抑郁 心率变异性 

分 类 号：R544.1[医药卫生—心血管疾病] R255.3[医药卫生—内科学]