心率变异性的降低对难治性高血压患者夜间血压下降幅度减弱的影响  

Influence of reduction of heart rate variability on attenuated descend range of nighttime blood pressure in patients with refractory hypertension

作　　者：方子美[1] 周明敏[1] Fang Zimei;Zhou Mingmin(Department of Cardiovascular Medicine,Central Hospital of Huangshi City,Hubei Province,Huangshi 435000,China;不详)

机构地区：[1]黄石市中心医院心血管内科,黄石435000

出　　处：《中国循证心血管医学杂志》2020年第3期356-360,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨心率变异性(HRV)的降低对难治性高血压患者夜间血压下降幅度减弱的影响。方法本研究是一项横断面研究,共212例难治性高血压患者纳入研究。所有患者接受包括全面临床检查、实验室评估、2D超声心动图、24 h动态血压监测,24 h动态心电图监测和颈动脉-股动脉脉搏波速度测量。110例患者(52%)进行了多导睡眠描记。采用多元线性回归和Logistic回归评估夜间血压下降与HRV参数之间的关系。结果非杓型患者年龄较大,亚临床靶器官损害(左心室肥厚和主动脉僵硬度增加)的发生率高于杓型患者,并且临床心血管疾病和血清肌酐水平高于杓型患者。非杓型患者的呼吸暂停低通气指数(AHI)和严重阻塞性睡眠呼吸暂停综合征(OSAS,AHI>30)的患病率显著高于杓型患者。在HRV参数方面,非杓型患者比杓型患者有较低的SDANN。多变量分析结果显示,SDNN(P=0.007、0.004)、SDANN(P=0.008、0.003)均与夜间血压下降独立相关。SDNN的降低(<70 ms,P=0.027、0.013)和SDANN的降低(<50 ms,P=0.006、0.010)可作为非杓型的独立危险因素。结论两个主要反映交感神经过度活跃的HRV参数(SDNN和SDANN)降低与难治性高血压患者夜间血压下降幅度减弱独立相关。Objective To investigate the influence of reduction of heart rate variability(HRV)on attenuated descend range of nighttime blood pressure in patients with refractory hypertension.Methods This study was a cross-section study,and there were totally 212 patients included in the study.All patients were received thorough clinical examinations,laboratory evaluations,2D-echocardiography,24-h ambulatory monitoring of blood pressure(BP),24-h Holter monitoring and measurement of carotid-femoral pulse wave velocity(cfPWV).There were 110 patients(52%)received polysomnography.The relationship between nighttime BP reduction and HRV parameters was reviewed by using multivariate linear regression analysis and Logistic regression analysis.Results The patients were older,and the incidence rate of subclinical target-organ damage(left ventricular hypertrophy and higher aortic stiffness)and clinical cardiovascular diseases,and level of serum creatinine(SCr)were higher in nondipper hypertension group than those in dipper hypertension group.The level of apnea hypopnea index(AHI)and prevalence of obstructive sleep apnea syndrome(OSAS,AHI>30)were significantly higher in non-dipper hypertension group than those in dipper hypertension group.In terms of HRV parameters,SDANN was lower in non-dipper hypertension group than that in dipper hypertension group.The results of multivariate analysis showed that SDNN(P=0.007,0.004)and SDANN(P=0.008,0.003)were independently correlated to the reduction of nighttime BP.The decrease of SDNN(<70 ms,P=0.027,P=0.013)and decrease of SDANN(<50 ms,P=0.006,P=0.010)were independent risk factors of non-dipper hypertension.Conclusion The reduction of 2 HRV parameters(SDNN and SDANN),which mainly reflect sympathetic hyperactivity,are independently correlated to attenuated descend range of nighttime BP in patients with refractory hypertension.

关 键 词：心率变异性 难治性高血压 夜间血压 阻塞性睡眠呼吸暂停综合征 交感神经系统 

分 类 号：R544.1[医药卫生—心血管疾病]