难治性高血压患者心率变异性与临床特征分析

Analysis of the heart rate variability and clinical characteristics in patients with resistant hypertension

目的探讨难治性高血压患者的心率变异性和靶器官损害情况。方法前瞻性收集难治性高血压患者(难治性高血压组)30例,非难治性高血压患者(非难治性高血压组)32例及健康体检者36例作为对照组,通过24 h动态心电图监测,比较3组患者心率变异性指标及靶器官损害情况的差异。结果难治性高血压组和非难治性高血压组心率变异性各时域及频域分析指标与对照组比较,差异均有统计学意义(P均<0.05),提示其心率变异性降低;与非难治性高血压组比较,难治性高血压组rMSSD、pNN50显著降低(P<0.05),其余心率变异性指标亦有所降低,但差异无统计学意义(P>0.05)。与非难治性高血压组比较,难治性高血压组患者估算肾小球滤过率显著下降,室间隔厚度显著增加(P<0.05);颈动脉斑块亦有所增多,但差异无统计学意义(P>0.05)。结论难治性高血压患者心率变异性显著降低,靶器官损害更严重。

Objective To investigate heart rate variability and target organ damage in patients with resistant hypertension.Methods Patients with resistant hypertension(n=30)and non-resistant hypertension(n=32)were prospectively collected when a control group composed of 36 healthy subjects were also used.The heart rate variability index and target organ damages were compared among 3 groups by 24hour dynamic electrocardiogram(ECG)monitoring.Results Compared with the control group,the indexes of heart rate variability in time domain and frequency domain of the resistant hypertension group and the nonresistant hypertension group were statistically significant(P<0.05),indicating that the heart rate variability was decreased.Compared with the nonresistant hypertension group,rMSSD and pNN50 in the resistant hypertension group were significantly decreased(P<0.05),and other indexes of heart rate variability were also decreased,but the difference was not statistically significant(P>0.05).Compared with the nonresistant hypertension group,the estimated glomerular filtration rate of patients in the resistant hypertension group was decreased significantly,and the thickness of ventricular septum was increased significantly(P<0.05);carotid plaque was also increased,but the difference was not statistically significant(P>0.05).Conclusion Heart rate variability is significantly decreased in patients with resistant hypertension,and the target organ damages is more serious.