心血管高反应对男性高血压患者血压昼夜节律及心率变异的影响

Effects of hyper-cardiovascular reactivity on circadian rhythm of ambulatory blood pressure and heart rate variability in male patients with hypertension

目的研究心血管高反应性（HCVR）对中年男性高血压患者血压昼夜节律与心率变异（HRV）的影响。方法自愿参与本研究的在院疗养男性高血压（1级）患者60例，依照冷加压试验（CPT）将受试者分成高反应组及正常反应组。比较两组相应的临床资料以及动态血压、HRV等。结果（1）与50名正常血压对照者比较，60名高血压患者中HCVR所占比例较高（58．3％vs26．0％，P〈0．01）。（2）与正常反应组比较，高反应组24h平均收缩压（SBP）[（148．9±8．9）vs（143．6±8．5）mmHg，P〈0．05]、24h平均舒张压（DBP）[（94．4±5．7）vs（90．5±6．0）mmHg，P〈0．05]较高；夜间平均SBP[（145．4±9．2）vs（135．2±6．4）mmHg，P〈0．01]、夜间平均DBP[（92．7±5．8）V．g（83．6±5．2）mmHg，P〈0．01]增高更明显；高反应组中血压昼夜节律消失，非勺型高血压者较正常反应组显著增高（74．3％vs28．0％，P〈0．01）。（3）高反应组与正常反应组相比，HRV各项指标均显著降低[SDNN：（85．8±10．7）vs（118．6±13．8）ms；SDANN：（73．1±14．2）vs（106．1±15．2）ms；RMSD：（14．3±5．5）vs（22．3±9．5）ms；PNN50：（4．9±2．1）％vs（7．0±3．0）％，P〈0．01]。（4）logistic逐步回归分析显示，HCVR（OR=4．53；95％CI1．77～11．60）及HRV（OR=10．28，95％CI3．94±26．86）降低可能是血压昼夜节律消失的危险因素（均P〈0．01）。结论HCVR者在高血压患者中的比例较高；高血压合并HCVR者非勺型血压多见，昼夜节律紊乱，心率变异减低，可能与自主神经功能受损有关。

Objective To investigate the effects of hyper-cardiovascular reactivity （HCVR） on circadian rhythm of ambulatory blood pressure and heart rate variability（HRV） in middle-aged male patients with essential hypertension （EH）. Methods A total of 60 voluntary male EH patients were divided into EH＋HCVR group （n=35） and EH＋normal cardiovascular reactivity group （NCVR group, n=25） according to cold pressor test （CPT）. Related clinic information, ambulatory blood pressure monitoring and HRV between the two groups were compared and analyzed. Results （1）The proportion of HCVR in 60 EH patients was higher than that in 50 normotensive controls （58.3% vs 26.0%; P 〈 0.01）. （2）Compared with EH＋NCVR group, the 24h average systolic blood pressure （SBP） [（148.9 ± 8.9） vs （143.6 ± 8.5）mmHg; P 〈 0.05] and 24h diastolic blood pressure （DBP） [（94.4± 5.7） vs （90.5 ± 6.0）mmHg; P 〈 0.05], the average SBP [（145.4 ± 9.2） vs （135.2 ＋ 6.4）mmHg; P 〈 0.01] and DBP [（92.7± 5.8） vs （83.6 ± 5.2）mmHg; P 〈 0.01] of night in EH＋HCVR group were higher, and the latter was more obviously increased; the circadian rhythm of ambulatory blood pressure lost, circadian rhythm of non-dipper in EH＋HCVR group was higher than that in EH＋NCVR group （74.3% vs 28.0%; P 〈 0.01）. （3）The HRV index was lower in EH＋HCVR group than in EH＋NCVR group [SDNN： （85.8 ± 10.7） vs （118.6± 13.8）ms; SDANN： （73.1 ± 14.2） vs （106.1 ± 15.2）ms; RMSD： （14.3± 5.5） vs （22.3 ± 9.5）ms; PNNS0：（4.9 ± 2.1）% vs （7.0 ± 3.0）%; P〈 0.01]. （4）The logistic regression analysis indicated that HCVR （OR=4.53; 95%CI 1.77±11.60） and HRV （OR=10.28; 95%CI 3.94±26.86） decreasing were the risk factors of the loss of circadian rhythm in EH patients （P 〈 0.01）. Conclusion The proportion of HCVR is higher in EH patients. Circadian rhythm of non-dipper, loss of circadian rhythm and HRV decrease are common in EH patients with HCVR and may be related with the autonomic nerve damage.