老年高血压病人血压动态变化与心率变异性关系的研究

The relationship Between Ambulatory Blood Pressure Fluctuation and Heart Rate Variability in Old Hypertensive Patients

目的 研究比较老年高血压病人的血压变化与自主神经关系。对象 研究组高血压病人 1 0 0例 ,男性 93例 ,女性 7例 ,平均年龄 73± 7(60～ 90 )岁。对照组为同期住院的无高血压病人 1 0 0例 ,男性 98例 ,女性 2例 ,平均年龄72± 8(60～ 90 )岁。方法 动态血压测定 2 4h血压 ,动态心电图测定心率变异性反映自主神经功能。结果 研究组的心率变异性指标均低于对照组。以 2 4小时平均血压 (MAP)为自变量 ,2 4h平均R R间期标准差 (SD)为应变量 ,研究组的HRV与血压改变为正相关 ,SD =0 0 9MAP +2 4 .75 ,PNN50 =0 1 0MAP +8.34 ;对照组的HRV与血压改变为负相关 ,SD =- 0 32MAP +68.87,PNN50 =- 0 0 4 7MAP +2 1 .65。结论 老年人中血压正常者其自主神经与血压的关系仍符合正常生理状态。高血压病人的这种自主神经反射机制发生故障 ,所以表现出一种相反的趋势 :血压越高 。

Objective To evaluate the relation between the autonomic nerves and the ambulatory blood pressure fluctuation in the old hypertensive patients.\ Method\ We selected 100 old essential hypertensive patients (research group) and compared them with 100 age and gender matched normotensive controls(control group).\ The blood pressures were measured with ambulatory blood pressure monitoring(ABPM) and the heart rate valiability(HRV) with ambulatory electrocardiography.\ Results\ The HRV is low in the research group than in the control group.\ In patients in the research group the SD was positively correlated with the MAP (SD=0 09 MAP+24.75,PNN50=0 10 MAP+8.34) and the SD was negatively correlated with the MAP (SD=-0 32MAP+68.87,PNN50=-0 047 MAP+21.65) in the control group.\ Conclusion\ In the old normotensive the relationship between the autonomic nerves and the ambulatory blood pressure fluctuation is in a normal physical condition, representing by that higher BP is associated with lower HRV.\ The abnormalifiens of autonomic nervous system in the hypertensive patients were assumed to reverse the relationship between BP and HRV, manifestating by the higher the BP, the higher the HRV.