心率变异对原发性高血压患者预后的影响

Impact of Heart Rate Variability on the Prognosis of Patients with Essential Hypertension

目的探讨心率变异(HRV)对原发性高血压患者预后的影响。方法选择2004年8月—2006年4月来我院就诊的原发性高血压患者130例,随访3年。所有患者随访前后行动态心电图(Holter)、动态血压监测和颈动脉内膜中膜厚度检测检查。按照HRV的全部R-R间期的标准差(SDNN)≥100ms和<100ms,分为正常组和异常组,异常组随机分为两组,其中一组接受美托洛尔治疗,称为美托洛尔组,而另一组仍称为异常组。3组患者均给予常规药物治疗。观察3年心脑血管事件发生率。结果用药3年后,美托洛尔组SNDD较异常组好转(P<0.01);MBPS发生率也明显减少(P<0.05),但仍高于正常组(P<0.01);异常组的IMT较正常组和美托洛尔组明显增厚(P<0.05);HR则美托洛尔组明显减慢(P<0.05)。异常组心脑血管事件发生明显高于正常组(P<0.05)和美托洛尔组(P<0.05),而正常组和美托洛尔组之间无明显差别。结论 HRV异常的原发性高血压患者可能预示动脉硬化进展加快,HRV成为判断原发性高血压患者预后的指标之一。美托洛尔可干预HRV的异常,改善原发性高血压患者的预后。

Objective To investigate the Impact of Heart Rate Variability on the prognosis of patients with Essential Hypertension. Methods A total of 130 patients with Essential Hypertension between August 2004 and April 2006 were followed up for three years. Dynamic electrocardiographic record and ambulatory blood pressure record and measuring Iintimia-media thickness （ IMT） were carried out in one hundred and thirty patients with EH before or after being followed up. Patients with the SDNN being below 100ms were assigned to the abnormal group （ n = 80） ,others were assigned to the normal group （ n = 50） . the abnormal group was randomly assigned to receive conventional therapy （ abnormal group,n = 40） or metoprolol （ metopolol＇s group,n = 40） . Three groups＇ patients were investigated to the morbidity of the cerebrovascular and cardiovascular events during the 3 years follow-up. Results At the end of the 3 years follow-up,metoprolol＇s group has the more evident improvement in the SNDD （ P〈 0. 01） ,the slower HR （ P〈 0. 05） ,the more decreased morbility of MBPS （ P〈 0. 05） ,less increase in IMT （ P 〈0. 05） than abnormal group. The morbility of the cerebrovascular and cardiovascular events in abnormal group is higher than others （ P 〈0. 05） . Conclusion The abnormal HRV prevents that arteriosclerosis has been accelerating in patients with EH,HRV become one of the predictor of prognosis in patients with EH. Metoprolol can intervene the abnormal HRV and impove the prognosis in patients with EH.