高血压病合并糖尿病的动态脉压与心率变异性

A STUDY OF AMBULATORY PULSE PRESSURE AND HEART RATE VARIABILITY IN PATIENTS WITH ESSENTIAL HYPERTENSION AND DIABETES MELLITUS

目的 :探讨高血压病合并糖尿病患者的动态脉压 (APP)与心率变异性 (HRV)分析的临床意义。方法 :对 43例健康者、64例原发性高血压 (EH)患者、2 6例糖尿病 (DM )和 30例EH +DM患者的APP和HRV进行对比研究。结果 :①EH +DM组APP≥ 5 0mmHg者 ,例数多 ,年龄偏大 ,LVH、心电图异常、CVD发生率高 ,与EH组、对照组相比差异显著 (P <0 0 1) ;②EH +DM组APP≥ 5 0mmHg组与 <5 0mmHg组之间 2 4h平均SBP、DBP比较无差异 ,但前者LVH、心电图异常 ,CVD增高明显 (P<0 0 5 ) ;③ 2 4h平均脉压较偶测脉压更能反映患者平时真正脉压水平 ;④EH与DM的HRV均低于正常人 ,以EH +DM患者减低最明显 ;⑤在EH、EH +DM患者中 ,APP≥ 5 0mmHg组较 <5 0mmHg组HRV明显减低。 结论 :①动态脉压是心脑血管疾病的发生和死亡的独立危险因子 ;②APP比偶测脉压更适宜用于临床研究 ;③高血压病、糖尿病的自主神经活动受损 ,EH+DM患者更加明显 ;④APP与HRV参数密切相关 ,组合指标测定 ,有助于识别高危人群。

Objective:To study the clinical significance of ambulatory pulse pressure (APP) and heart rate variability (HRV) in patients with essential hypertension (EH) and diabetes mellitus(DM).Methods:The APP and HRV of patients with EH(n=64),DM(n=26),EH+DM(n=30) and 43 mormal controls were compared.Results:①Compared with EH group and normal control group,the EH+DM group with APP≥50mmHg had higher percentages of patient?high age? LVH?abnormal ECG?CVD(P<0 01).②Incidence rate of LVH?abnormal ECG and CVD in EH+DM group with APP≥50mmHg significantly increased than that in the group with APP<50mmHg(P<0 05).However no siginficant differences were found between the two groups in systolie pressure.diastolic pressure of 24h.③The real level of pulse pressure has a closer correlation with 24h mean pulse pressure than happening pulse pressure with it.④The HRV of EH and DM patients was lower than that of the normal controls,and that of EH+DM patients was the lowest.⑤The HRV im EH group and EH+DM group with APP≥50mmHg significantly decreased than that in the two groups with APP<50mmHg.Conclusion:①Ambulatory pulse pressure is independent factors in predicting cardiac events of cardiovascular patients.②APP is more suitable for clinical study than happening pulse pressure.③The autonomic never system function of EH and DM patients are damaged,its damaged of EH+DM patients is the most.④APP is related to HRV.it can be useful to identify patients with high cardiovascular disease risk.