Polónia Jorge, Amaral Cristina, Bertoquini Susana, Martins Luis
Centro Clínico MOSS do Porto, Faculdade Ciências da Saude, Universidade Fernando Pessoa, Porto, Portugal..
Int J Cardiol. 2006 Jan 13;106(2):238-43. doi: 10.1016/j.ijcard.2005.02.006.
To evaluate whether hypertensive patients with attenuation of nighttime blood pressure (BP) fall exhibit a delay of the recovery of heart rate (HR) after exercise as an index of a general decrease in the vagal tone.
Mild-moderate hypertensive patients (n = 219, age 55 +/- 3, 77% men) underwent a maximal exercise test (Bruce > 85% heart rate limited) in whom we calculated the recovery of HR as the percent decrease of HR from peak to 1 min after stopping exercise (%HR fall-1 min), a 24-h ambulatory BP monitoring, calculating the percent decrease of nighttime vs. daytime BP (% night SBP fall). Left ventricular mass index (LVMI) was measured by echo and aortic stiffness by pulse wave velocity (PWV). Sixty percent were on antihypertensive drugs (not on beta-blockers nor on non-dihydropiridine calcium blockers); 12 subjects were type 2 diabetics.
The "% night SBP fall" ranged from - 6.3% to 38.9% and the "%HR fall-1 min" ranged from 3.3% to 43.7%. There was a significant positive correlation between these two variables (r = 0.594, p < 0.001). Population was divided into five groups according to quintiles of values for the "% night SBP fall". For similar daytime BP and age, the lowest quintile for % night SBP fall (- 6.3% to 7.2%) showed the lower "%HR fall-1 min" (3.1 +/- 0.5%), and the higher LVMI (92 +/- 3 g/m(2)) and PWV (12.1 +/- 0.4 m/s) values comparing to the other quintiles (p < 0.02).
In hypertensives, blunting of the nocturnal fall of BP is associated with a delayed recovery in heart rate after graded maximal exercise and with greater aortic stiffness and ventricular mass. This may indicate that in non-dipper subjects a relative general decrease of parasympathetic reactivation after exercise is linked to the failure of nighttime fall of BP, both of which might contribute to target-organs deterioration.
评估夜间血压（BP）下降减弱的高血压患者运动后心率（HR）恢复延迟是否可作为迷走神经张力普遍降低的指标。
轻度至中度高血压患者（n = 219，年龄55±3岁，77%为男性）接受了最大运动试验（Bruce方案，心率限制>85%），我们计算HR恢复情况，即运动停止后1分钟HR从峰值下降的百分比（%HR下降-1分钟），进行24小时动态血压监测，计算夜间与白天血压下降的百分比（%夜间收缩压下降）。通过超声心动图测量左心室质量指数（LVMI），通过脉搏波速度（PWV）测量主动脉僵硬度。60%的患者服用降压药（未服用β受体阻滞剂和非二氢吡啶类钙通道阻滞剂）；12名受试者为2型糖尿病患者。
“%夜间收缩压下降”范围为-6.3%至38.9%，“%HR下降-1分钟”范围为3.3%至43.7%。这两个变量之间存在显著正相关（r = 0.594，p < 0.001）。根据“%夜间收缩压下降”值的五分位数将人群分为五组。对于相似的白天血压和年龄，%夜间收缩压下降最低的五分位数（-6.3%至7.2%）显示“%HR下降-1分钟”较低（3.1±0.5%），与其他五分位数相比，LVMI较高（92±3 g/m²）和PWV较高（12.1±0.4 m/s）（p < 0.02）。
在高血压患者中，夜间血压下降减弱与分级最大运动后心率恢复延迟以及更大的主动脉僵硬度和心室质量有关。这可能表明，在非勺型受试者中，运动后副交感神经再激活的相对普遍降低与夜间血压下降失败有关，这两者都可能导致靶器官恶化。
