原发性高血压合并2型糖尿病老年患者24小时最小心率的影响因素分析

Influencing factors of 24-hour minimum heart rate in elderly patients with essential hypertension and type 2 diabetes mellitus

目的 探讨原发性高血压(EH)合并2型糖尿病(T2DM)老年患者24小时最小心率(24h MHR)的影响因素。方法 选择2019年8月~2021年8月在郑州大学第二附属医院就诊的行24h动态血压、动态心电图监测的156例EH合并T2DM老年患者,根据24h MHR值将156例患者分为4组:A组39例(24h MHR<43次/min)、B组40例(24h MHR 43~50次/min)、C组39例(24h MHR 51~58次/min)和D组38例(24h MHR>58次/min)。比较4组基线资料、糖化血红蛋白(hemoglobin A1c,HbA1c)、最大迷走神经张力(maximum vagal tone,MVT)、动态血压参数[24h平均收缩压(24-hour mean systolic blood pressure,24h SBP)、日间平均收缩压(daytime mean systolic blood pressure,dSBP)、夜间平均收缩压(nighttime mean systolic blood pressure,nSBP)、24h平均舒张压(24-hour mean diastolic blood pressure,24h DBP)、日间平均舒张压(daytime mean diastolic blood pressure,dDBP)、夜间平均舒张压(nighttime mean diastolic blood pressure,nDBP)]和心率变异性参数(SDANN、SDNN、RMSSD、PNN50、TP、LF、HF)等指标,运用Spearman相关性分析及多元Logistic回归分析24h MHR的影响因素。结果 4组的HbA1c、MVT、部分血压参数(24h SBP、nSBP、24h DBP、dDBP、nDBP)和心率变异性参数差异有统计学意义。Spearman相关性分析显示,24h MHR与HbA1c、各血压参数呈正相关,与年龄、MVT及心率变异性参数呈负相关(均P<0.05)。多元Logistic回归分析显示HbA1c、SDNN和24h DBP是24h MHR的主要影响因素(OR=1.58、0.95、1.07,P=0.007、<0.001、0.001)。结论 HbA1c、SDNN和24h DBP是24h MHR的主要影响因素,在EH合并T2DM老年患者中,除关注HbA1c、SDNN常规指标外,还应该密切监测24h DBP。

Objective To investigate the influencing factors of 24-hour minimum heart rate(24h MHR)in elderly patients with essential hypertension(EH)and type 2 diabetes mellitus(T2DM).Methods A total of 156 elderly patients with EH and T2DM who underwent 24h ambulatory blood pressure and dynamic electrocardiogram monitoring in the Second Affiliated Hospital of Zhengzhou University from Aug 2019 to Aug 2021 were selected and divided into 4 groups according to the level of 24 MHR:group A(24h MHR<43 times/min),group B(24h MHR 43~50 times/min),group C(24h MHR 51~58 times/min)and group D(24h MHR>58 times/min).These indicators were compared with baseline data,hemoglobin A1c(HbA1c),maximum vagal tone(MVT),ambulatory blood pressure parameters[24h mean systolic blood pressure(24h SBP),daytime mean systolic blood pressure(dSBP),nighttime systolic blood pressure(nSBP),24h mean diastolic blood pressure(24h DBP),daytime mean diastolic blood pressure(dDBP),nighttime mean diastolic blood pressure(nDBP)]and heart rate variability parameters(SDANN,SDNN,RMSSD,PNN50,TP,LF,HF).Spearman correlation analysis and multivariate Logistic regression analysis were used to analyze the influencing factors of 24h MHR.Results There were statistically significant differences in HbA1c,MVT,partial blood pressure parameters and heart rate variability parameters among the four groups.Spearman correlation analysis showed that 24h MHR was positively correlated with HbA1c,blood pressure parameters and negatively correlated with age,MVT,heart rate variability parameters(all P<0.05).Logistic regression analysis showed that HbA1c,SDNN and 24h DBP were the main influencing factors of 24h MHR(OR=1.58,0.95,1.07,P=0.007,<0.001,0.001).Conclusion HbA1c,SDNN and 24h DBP are the main influencing factors of 24h MHR.Except paying attention to the routine indicators of HbA1c and SDNN,24h DBP should also be closely monitored in elderly patients with EH and T2DM as well.