Ragot S, Herpin D, Siché J P, Poncelet P, Mallion J M
Service de cardiologie, centre hospitalo-universitaire de Poitiers.
Arch Mal Coeur Vaiss. 1999 Aug;92(8):1115-9.
Prospective study involving 245 untreated hypertensives (51 +/- 13 years, 146 men, 99 women). All of the patients underwent a 24-hour ambulatory blood pressure measurement (ABPM) as well as an echocardiography for left ventricular mass index determination (LVMI) and a photoplethysmographic recording of blood pressure (BP). Nondippers were defined as those whose nocturnal decrease in systolic BP (SBP) and/or diastolic BP (DBP) was < 10% of daytime BP. Spectral powers were obtained from the photoplethysmographic recording using a fast Fourier transform over the low frequency band (LF) and the high frequency band (HF). Baroreflex sensitivity (BRS) was evaluated by the sequences method.
Of the 245 patients, 159 were dippers (98 men, 61 women) and 86 were non dippers (48 men and 38 women). Clinic BP was significantly higher in non dippers than in dippers (168/101 vs 161/98 mmHg; p < 0.01 for SBP and p < 0.05 for DBP) whereas daytime ABPM and LVMI were not different, whatever the gender. LF spectral powers were significantly lower in non dippers than in dippers for SBP (respectively 25 +/- 11% vs 30 +/- 13%; p < 0.01) for DBP (respectively 35 +/- 14% vs 41 +/- 15%; p < 0.01) and for HR (respectively 34 +/- 15% vs 38 +/- 15%; p = 0.03). They showed a positive correlation with the nocturnal SBP fall (r = 0.21, p < 0.001 for SBP and DBP spectral powers, r = 0.19; p < 0.005 for HR spectral power) and with the nocturnal DBP fall, too (r = 0.19; p < 0.005 for SBP spectral power, r = 0.20; p < 0.002 for DBP spectral power, r = 0.19; p < 0.005 for HR spectral power). HF spectral powers tended to be higher in non dippers than in dippers but in a non significative way. BRS was roughly the same in dippers and non dippers (7.5 +/- 2.7 vs 7.0 +/- 3.1 ms/mmHg, NS). The interaction between non dipper/dipper status and sex was non significant whatever the LF spectral power.
1）比较勺型和非勺型高血压患者通过光电容积脉搏波记录获得的自主神经系统活动参数。2）探寻勺型/非勺型状态与性别之间的相互作用。
前瞻性研究纳入245例未经治疗的高血压患者（年龄51±13岁，男性146例，女性99例）。所有患者均接受24小时动态血压监测（ABPM）以及超声心动图检查以测定左心室质量指数（LVMI），并进行光电容积脉搏波血压（BP）记录。非勺型患者定义为夜间收缩压（SBP）和/或舒张压（DBP）下降幅度小于日间血压10%的患者。使用快速傅里叶变换从光电容积脉搏波记录中获取低频带（LF）和高频带（HF）的频谱功率。通过序列法评估压力反射敏感性（BRS）。
245例患者中，159例为勺型（男性98例，女性61例），86例为非勺型（男性48例，女性38例）。非勺型患者的诊室血压显著高于勺型患者（168/101 mmHg对161/98 mmHg；SBP p<0.01，DBP p<0.05），而无论性别如何，日间ABPM和LVMI并无差异。非勺型患者的SBP低频频谱功率显著低于勺型患者（分别为25±11%对30±13%；p<0.01），DBP低频频谱功率也显著低于勺型患者（分别为35±14%对41±15%；p<0.01），心率（HR）低频频谱功率同样显著低于勺型患者（分别为34±15%对38±15%；p = 0.03）。它们与夜间SBP下降呈正相关（SBP和DBP频谱功率r = 0.21，p<0.001；HR频谱功率r = 0.19；p<0.005），与夜间DBP下降也呈正相关（SBP频谱功率r = 0.19；p<0.005，DBP频谱功率r = 0.20；p<0.002，HR频谱功率r = 0.19；p<0.005）。非勺型患者的HF频谱功率倾向于高于勺型患者，但差异无统计学意义。勺型和非勺型患者的BRS大致相同（7.5±2.7对7.0±3.1 ms/mmHg，无显著性差异）。无论LF频谱功率如何，非勺型/勺型状态与性别之间的相互作用均无显著性差异。
1）夜间血压下降幅度越大，交感神经活动指数越高。2）这种关系在男性和女性中均存在。
