静息心率增高对原发高血压患者的预测价值及与血压昼夜节律改变的相关性

Predictive value of increased resting heart rate in patients with primary hypertension and its correlation with changes in circadian rhythm of blood pressure

目的:探讨静息心率增高对原发高血压患者的预测价值,以及其与血压昼夜节律的改变有无相关性。方法:选取在门诊健康体检中首次查出血压增高者138例,另选择同期门诊健康体检血压正常者120例作对比。按静息心率(resting heart rate,RHR)水平将两组对象再分为3组,即甲组为RHR<70次·min-1,乙组为70次·min-1≤RHR<80次·min-1,丙组为RHR≥80次·min-1。对门诊初次查出血压增高的138例患者,继续跟踪检查24 h动态血压(ambulatory blood pressure monitoring,ABPM),根据ABPM结果分为杓型组、非杓型组、反杓型组。结果:(1)初筛血压增高组RHR为(78.24±9.13)次·min-1,较正常对照组RHR的(70.56±10.05)次·min-1显著增高,而且RHR≥80次·min-1的患者在初筛血压增高组所占比例显著高于对照组(P<0.01)。(2)动态血压结果:初筛血压增高组除12例患者总平均血压在正常范围内外,其余患者平均血压均增高;随着静息心率的增加,24 h动态血压昼夜节律正常的比例越来越低,即血压曲线呈杓型的比例在减少,非杓型和反杓型的比例在增加。结论:静息心率增高可作为预测高血压发病的一个独立因子,且与血压昼夜节律的改变密切相关。

Objective： To explore the predictive value of increased resting heart rate（RHR） on primary hypertension patients,and to observe the correlation between RHR and circadian blood pressure rhythm change.Methods： 138 first-time found high blood pressure cases and 120 normal blood pressure cases in the same period physical examinations for comparison were selected. Both first-time found high blood pressure cases and normal blood pressure cases were divided into three groups based on RHR levels. Group 1： RHR： 〈 70 beats·min- 1,Group 2：70 beats·min- 1≤RHR 〈80 beats·min- 1,and Group 3： RHR≥80 beats·min- 1. 24-hour ambulatory blood pressure monitoring（ ABPM） was applied to the 138 first-time found high pressure cases. These 138 cases were divided into three groups based on ABPM results： dipper,non-dipper and anti dipper hypertensions. Results：（1） The RHR（78. 24 ± 9.13） beats·min- 1of the first-time found high blood pressure cases increased significantly compared with the RHR（70. 56 ± 10. 05） beats·min- 1of the normal cases,and the percentage of the cases with RHR≥80 beats·min- 1were much higher in the first-time found high blood pressure cases than in the normal cases（P 〈 0. 01）.（2） In the 138 high blood pressure cases,only 12 cases’ average blood pressures were within the normal level,all other cases’ average blood pressure increased; and with the increase of the RHR,the percentage of the cases with normal 24-hour ambulatory blood pressure rhythm change decreased,ie,in the blood curve line,the percentage of the dipper hypertension were decreasing,while the percentage of the non-dipper and anti-dipper hypertensions were increasing. Conclusion： Increased resting heart rate can be used as an independent factor for the prediction of hypertension; which is closely related to the circadian blood pressure rhythm change.