老年冠心病患者的动态血压变化与心率变异性的关系

Relation between ambulatory blood pressure variation and heart rate variability in elderly patients with coronary heart disease

目的观察老年冠心病患者的动态血压变化与心率变异性的关系,探讨老年冠心病患者血压变异性的影响因素。方法对179例老年冠心病患者同时行24h动态血压监测和24h动态心电图检查,将患者按照收缩压昼夜节律变化情况分为杓型组30例、非杓型组84例和反杓型组65例,记录冠状动脉造影结果、24h血压变异性参数、心率变异性参数及其他临床变量的基线值。比较各组冠状动脉病变Gensini评分和心率变异性各参数。结果非杓型组和反杓型组的log Gensini评分均高于杓型组(P<0.05);非杓型组和反杓型组的24h内正常R-R间期的标准差、24h内连续每5min平均R-R间期的标准差均低于杓型组(P<0.05);24h血压变异性各参数与心率变异性各参数无明显相关性。结论血压昼夜节律异常的老年冠心病患者比血压昼夜节律正常者冠状动脉病变程度更重;血压昼夜节律与心率变异性相关,随血压昼夜节律减弱,心率变异性降低,而24h动态血压监测所测血压变异性与心率变异性无明显相关性。

Objective To study the influencing factors for blood pressure variability （BPV） in eld- erly patients with coronary heart disease （CHD） by investigating the relation between ambulatory blood pressure variation （ABPV） and heart rate variability （HRV）. Methods One hundred and seventy-nine CHD patients who underwent coronary angiography,24 h ambulatory blood pressure monitoring （ABPM） and 24 h ambulatory electrocardiogram were included in this study. Baseline values of coronary angiograpby,24 h ABPM,24 h ambulatory electrocardiogram and other clinical variables were recorded. The patients were divided into dipping group （n= 30）, non-dipping group （n=84） and anti-dipping group （n=65） according to their circadian rhythym of blood pressure. Their Gensini score and HRV were compared. Results The Gensini score of CHD was higher while the 24 h SDNN and SDNNM were lower in non-dipping group and anti-dipping group than in dipping group （P〈0.05）. The 24 BPV was not significantly related with the HRV. Conclusion CHD is severer in elderly patients with abnormal circadian rhythym of blood pressure than in those with normal circadian rhythym of blood pressure. The circadian rhythym of blood pressure is related with the HRV which reduces with the circadian rhythym of blood pressure. The BPV measured by ABPM is not significantly related with the HRV.