高血压的盐敏感性与交感神经活动及血管损伤的相关性

Study of synchronic heart rate variability and blood pressure variability and carotid-femoral pulse wave velocity in hypertensive patients with varying salt sensitivy

目的探讨原发性高血压盐敏感性与交感神经兴奋性及血管损伤的关系。方法选取原发性高血压患者315例。根据临床检测的24 h平均心率和血压昼夜节律将盐敏感性(salt sensitivity)分为低危组(n=123)、中危组(n=110)和高危组(n=82)。对受试者病史采集并进行生化检查,应用全自动动脉硬化检测仪测定颈-股脉搏波传导速度(PWV),并且对受试者行同步24小时动态心电图(Holter)及24小时动态血压监测(ABPM)。进行统计学分析(单因素分析、多因素分析和相关性分析)。结果 3组患者同步动态血压、动态心电图及PWV指标的比较,发现3组间随着盐敏感性升高每5 min总心搏数R-R间期均值的标准差(SDANN)依次降低(P<0.05),低频(LF)、LF/高频(HF)、夜/白心率比(n HR/d HR)、24 h收缩压标准差(24h SSD)及PWV依次升高(均P<0.05)。高频功率(HF)、夜间收缩压标准差(d SSD)、白天收缩压标准差(n SSD)高危组较低危组升高(P<0.05)。进行非参数的Spearman秩相关分析,发现血压控制良好的高血压患者的盐敏感性高低与LF、LF/HF、n HR/d HR、24h SSD及PWV正相关(r=0.228,r=0.146,r=0.129,r=0.125,r=0.102,均P<0.05)。在对影响PWV的指标进行多元Logistic逐步回归分析,发现PWV、24h SSD、LF、LF/HF及n HR/d HR是影响盐敏感性的的独立相关因素。结论盐敏感性增高是交感神经兴奋性增强(LF)、自主神经功能紊乱(LF/HF)及早期动脉硬化(PWV)的独立相关因素。

AIM To investigate the association between cardiac autonomic function and arterial stiffness in patients with hypertension with different salt sensitivity. METHODS From 2011 to 2014, 315 patients with EH whose blood pressure had been controlled to a nomal level and admitted to a cardiovascular ward were enrolled in the study. Synchronic 24 hour ambulatory blood pressure monitoring （ABPM） and dynamic electrocardiogram （Hoher）, carotid-femoral pulse wave velocity （PWV）, were performed for all participants. The 315 patients were divided into 3 groups according to the 24 hour heart rate and blood pressure circadian rhythm as low, medium, and high risk group of salt sensitivity. RESULTS There were increased 24-hour systolic blood pressure standard deviation （24hSSD） （ P 〈 0. 05 ） and decreased standard deviation of the average of all normal-to-normal intervals in all 5-minute intervals （SDANN） （P 〈 0. 05 ） in the riskergroup of salt sensitivity. The HRV analysis revealed that SDANN significantly decreased and LF, LF/HF increased in risker group of salt sensitivity （ P 〈 0. 05 ）. Analyzing the data of ABPM showed that 24hSSD, dSSD, nSSD are significantly higher than in the low risk group （P 〈 0. 05 ）. Night/day heart rate ratio were significantly higher in risker group of salt sensitivity （ P 〈 0. 05 ）. Spearman analysis revealed that salt sensitivity is correlated with PWV, 24hSSD, LF, LF/HF and Night/day heart rate ratio. Multiple regression analysis showed that the risk of salt sensitivity is independently correlated withPWV, 24hSSD, LF, LF/HF and Night/day heart rate ratio. CONCLUSION The salt sensitivity is an independent factors of Sympathetic nervous system activity （LF）, autonomic nervous system dysfunction （LF/HF） and arterial stiffness in patients with EH.