非杓型高血压患者运动时的心血管反应

Response of cardiovascular system to exercise in the Non-dipper patients with essential hypertension

目的探讨非杓型高血压患者运动时的心血管反应。方法根据动态血压监测95例原发性高血压(EH)患者有无昼夜节律分为:A组为非杓型组52例和B组为杓型组43例,进行活动平板运动试验,比较分析两组患者运动中心率、血压、运动耐量及运动时间变化。计算分析心率变时性反应指数(CRI2),最大心率收缩压双乘积(RPP);心肌耗氧量(MVO2)等参数。结果 A组峰值心率[(150.27±13.81)次/min比(162.34±9.63)次/min]、心率上升幅度[(71.76±13.14)次/min比(81.46±14.02)次/min]及CIR2(0.86±0.25比0.98±0.17)低于B组,(P<0.05,0.01,0.001);发生变时性不良(CI)的人数及CIR2<0.8的人数A组[27例(51.92%),23例(44.42%)]明显多于B组[12例(27.91%),10例(23.26%)],(P<0.05);表明A组在运动中存在心率反应迟钝,有CI的改变;且运动耐量降低,运动时间缩短,(P<0.05,0.01)。A组峰值收缩压(SBP)(175.54±16.83)明显高于B组(166.18±7.74),(P<0.05);RPP、MVO2较B组增加,(P<0.05)。结论由于非杓型EH患者运动时可能出现CI,SBP及心肌耗氧量明显增加等心血管反应,康复治疗时应个体化。

Objective To investigate the response of cardiovascular system of the non-dipper patients with essential hypertension （EH） during exercising. Methods Ninty five EH patients were taken ambulatory blood pressure （BP） monitoring and treadmill exercise test. According to different nocturnal BP reduction rate, these patients were divided into two groups ： group A ： non-dipper （ n = 52）, group B ： dipper （n = 43 ）. Heart rate , BP response, time and mets were recorded and analyzed. Chronotropic response index （CRI） , maximum double rate-pressure product （RPP） and myocardial oxygen consumption （MVO2 ） were calculated and compared. Results The group A had heart rate blunted response（ 150.27 ± 13.81 vs 162.34 ±9.63 ;71.76 ± 13.14 vs 81.46 ± 14.02） ,P 〈0.01,0.001 ;lower CRI than controls （0. 86 ±0. 25 vs 0. 98 ± 0. 17 ）, P 〈 0. 05; and chronotropic incompetence occupied 27 cases （51.92%）were significantly increased, P 〈 0. 05 ; the systolic BP（SBP） of peak exercise, RPP and MVO2 were significantly higher than the group B, P 〈 0.05. Conclusion Non-dipper patients with EH tends to have a higher incidence of exaggerated SBP and MVO2. and Chronotropic incompetence is common, so rehabilitation should be individual.