高血压病患者血压昼夜节律异常与心率变异减低的关系

The Relationship between Abnormal Circadian Variation of Blood Pressure and Heart Rate Variability in Essential Hypertensive Patients

目的：探讨高血压病患者血压昼夜节律异常与心率变异（ＨＲＶ）减低之间的关系。方法：按ＷＨＯ标准选择高血压病患者７０例，同期分别作动态血压监测及动态心电图ＨＲＶ分析。结果：血压昼夜节律消失组（Ａ组）较血压昼夜节律正常组（Ｂ组）夜间收缩压（ＳＢＰ）、夜间舒张压（ＤＢＰ）、２４ｈ平均ＳＢＰ、２４ｈ平均ＤＢＰ分别增高１５ｍｍＨｇ（Ｐ＜０．０１）、６ｍｍＨｇ（Ｐ＜０．０１）、８ｍｍＨｇ（Ｐ＜０．０１）、６ｍｍＨｇ（Ｐ＜０．０５）。Ａ组２４ｈＳＤＮＮ、ＳＤＡＮＮ、ＳＤＮＮｉｎｄｅｘ和ｐＮＮ５０分别减低３．６２ｍｓ（Ｐ＜０．０５）、１０．５５ｍｓ（Ｐ＜０．０５）、４．６７ｍｓ（Ｐ＜０．０５）及１．１３个百分点（Ｐ＜０．０５）。Ａ组患者２４ｈ平均动脉压与２４ｈＨＲＶ呈线性负相关，相关系数－０．５１２，Ｐ＜０．０１。结论：高血压病患者血压昼夜节律异常与ＨＲＶ减低及其昼夜节律消失密切相关，血压昼夜节律消失与自主神经功能严重受损有关。

Objective:To explore the abnormal circadian variation of blood pressure and its association with the decreased heart rate variability(HRV) in hypertensive patients.Methods:24 h ambulatory blood pressure (ABP) and 24 h HRV,day and night HRV were compared between the cases and controls,the cases were 36 essential hypertensive(EH) patients with the missing of circadian rhythm in blood pressure (BP),the controls were EH patients with normal circadian rhythm in BP.Results:Compared with the controls,night systolic BP(SBP),night diastolic BP(DBP),24 h mean SBP and 24 h mean DBP of the cases were increased 15 mmHg( P <0 01),6 mmHg( P <0 01),8 mmHg( P <0 05) and 6 mmHg( P <0 05),respectively.24 h mean arterial pressure(MBP) was negatively correlated with 24 h HRV in patients with the missing of circadian rhythm in BP.Conclusion:The missing of circadian variation in BP may be more serious prognosis than those with normal circadian variation and the decreased HRV is associated with the elevation of BP as well as the missing of circadian rhythm in BP in the EH patients.