高血压病左室肥厚患者心率变异及动态血压分析

Analysis of heart rate variability and ambulatory blood pressure in hypertensive left ventricular hypertrophy

观察高血压左室肥厚（ＬＶＨ）患者的心率变异（ＨＲＶ）及血压昼夜节律变化，以期了解三者之间的关系。选择伴有左心室肥厚的高血压病患者２１例，不伴有左心室肥厚的高血压患者２８例，选择年龄与患者可比的健康人２５例作为正常对照组，进行动态心电图及动态血压监测，分析２４ｈＨＲＶ时域指标及血压昼夜节律。结果：高血压伴左室肥厚患者ＨＲＶ各指标均显著低于对照组（Ｐ＜０．０５），也比不伴左室肥厚患者进一步降低。ＰＮＮ５０昼夜节律明显减弱。动态血压结果显示：不伴左室肥厚组与左室肥厚组血压昼夜节律消失者分别占各组总数的１７．９％及４７．６％，组间比较差异显著（Ｐ＜０．０５）。结论：副交感神经调节功能减弱可能与以上变化相关。高血压治疗应注意改善ＨＲＶ。

Objective: To investigate the relationship between heart rate variability(HRV) and ambulatory blood pressure in hypertensive left ventricular hypertrophy(LVH). Methods: 28 hypertensive patients without LVH and 21 with LVH, and 25 controls were recorded by Holter ECG and the 24 hour ambulatory blood pressure, HRV time domain were analysed. Results: Each parameter of HRV time domain in hypertensive patients with LVH were markedly lower than that in controls, the diurnal changes of PNN 50 were blunted. The disappearance rate of circadian changes of blood pressure in hypertensive patients with and without LVH was 17.9% and 47.6%( P <0.05), respectively. Conclusion: Decreased parasympathetic activity may be associated with these changes mentioned above, we should pay attention to improving HRV and recovering circadian of blood pressure in the treatment for hypertension.