性别及高血压家族史对心率自主控制、舒张功能和脑钠肽的影响

Influence of gender and family history of hypertension on autonomic control of heart rate, diastolic function and brain natriuretic peptide.

作者信息

Pitzalis M V, Iacoviello M, Massari F, Guida P, Romito R, Forleo C, Vulpis V, Rizzon P

机构信息

Institute of Cardiology, University of Bari, Italy.

出版信息

J Hypertens. 2001 Jan;19(1):143-8. doi: 10.1097/00004872-200101000-00019.

DOI:10.1097/00004872-200101000-00019

PMID:11204295

Abstract

OBJECTIVE

To verify in a unitary view whether autonomic control of heart rate and cardiac structure and function are modified early in offspring of hypertensive families.

METHODS AND RESULTS

We selected 87 age- and sex-matched young normotensive subjects with (n = 45) and without (n = 42) a family history of hypertension who underwent evaluations of arterial pressure, time-domain parameters of autonomic heart rate control (24-h ECG monitoring), spectral baroreflex sensitivity, left ventricular geometry and function (echo-Doppler) and plasma brain natriuretic peptide levels (BNP). The group with a family history of hypertension significantly differed from their counterparts for systolic pressure (119 +/- 11 versus 114 +/- 9 mmHg, P< 0.05), heart rate (RR interval, 766 +/- 64 versus 810 +/- 93 ms, P< 0.05), heart rate variability [the standard deviation of normal RR intervals (SDNN), 147 +/- 29 versus 171 +/- 33 ms, P < 0.051, diastolic function (isovolumetric relaxation time, 65 +/- 9 versus 60 +/- 8 ms, P< 0.05) and BNP (23 +/- 13 versus 37 +/- 10 pg/ml, P< 0.05). Baroreflex sensitivity values did not differ between the two groups. When gender was considered, all the above-mentioned measures, as well as baroreflex sensitivity, were significantly different between males with and without a family history of hypertension but not between females, except for BNP, which was lower in males and females with a history of hypertension (males, 24 +/- 11 versus 38 +/- 8 pg/ml, P< 0.01; females 21 +/- 14 versus 36 +/- 13 pg/ml, P < 0.05).

CONCLUSIONS

Male, but not female, hypertensive offspring have modified diastolic function and autonomic control of heart rate; BNP is the only parameter able to characterize hypertensive offspring independently from the influence of gender. This provides the hypothesis that the impaired production of this hormone could play a primary role in the pre-hypertensive state.

摘要

目的

从整体角度验证高血压家族后代的心率自主控制以及心脏结构和功能是否在早期就发生改变。

方法与结果

我们选取了87名年龄和性别匹配的血压正常的年轻人，其中45名有高血压家族史，42名无高血压家族史。这些受试者接受了动脉压评估、自主心率控制的时域参数（24小时心电图监测）、压力反射敏感性频谱分析、左心室几何结构和功能（超声多普勒）以及血浆脑钠肽水平（BNP）的检测。有高血压家族史的组与无家族史的组相比，收缩压（119±11对114±9 mmHg，P<0.05）、心率（RR间期，766±64对810±93 ms，P<0.05）、心率变异性[正常RR间期的标准差（SDNN），147±29对171±33 ms，P<0.05]、舒张功能（等容舒张时间，65±9对60±8 ms，P<0.05）和BNP（23±13对37±10 pg/ml，P<0.05）存在显著差异。两组间压力反射敏感性值无差异。考虑性别因素时，除BNP外，上述所有指标以及压力反射敏感性在有和无高血压家族史的男性之间存在显著差异，而在女性之间无显著差异。有高血压家族史的男性和女性的BNP水平均较低（男性，24±11对38±8 pg/ml，P<0.01；女性，21±14对36±13 pg/ml，P<0.05）。