Davies Simon J C, Jackson Peter R, Lewis Glyn, Hood Sean D, Nutt David J, Potokar John P
Psychopharmacology Unit, University of Bristol, Dorothy Hodgkin Building, Whitson Street, BRISTOL BS1 3NY, United Kingdom.
J Affect Disord. 2008 Dec;111(2-3):344-50. doi: 10.1016/j.jad.2008.03.003. Epub 2008 Apr 29.
Autonomic nervous system dysfunction may be implicated in the association of hypertension with panic attacks and panic disorder. We hypothesised that panic symptoms of autonomic origin are more common in attacks experienced by hypertensive than normotensive patients, that autonomic panic symptoms cluster together as a distinct factor, and that this factor is more prevalent in hypertensive patients with panic than in normotensives.
We analysed all 346 structured questionnaires completed by primary care and hospital clinic patients who had reported experiencing full (n=287) or limited symptom panic attacks (n=59) (268 with hypertension, and 78 never having had hypertension). Frequency of sweating, flushes, and racing heart, symptoms selected prospectively as being most likely of autonomic origin, were compared between hypertensive and normotensive patients. Principal component analysis was performed with varimax orthogonal rotation. Using logistic regression, odds ratios were calculated for association of factor scores with hypertension.
Sweating and flushes were significantly more common among hypertensive patients than normotensives (sweating; 65% v 46%, p=0.003, flushes; 55% v 40%, p=0.019). There was no significant difference between groups for frequency of racing heart nor any of the remaining panic symptoms analysed as secondary endpoints. Principal component analysis yielded four factors with eigenvalues >1.0. Factor 1 was dominated by autonomic symptoms, notably sweating and flushes, which had loadings of 0.68 and 0.61. On regression only this autonomic factor showed a significant association with hypertension, the odds ratio being 1.37 (95% C.I. 1.05 to 1.77, p=0.018).
These findings support the possibility that autonomic dysfunction contributes to the association of hypertension with panic.
自主神经系统功能障碍可能与高血压合并惊恐发作及惊恐障碍有关。我们假设，高血压患者比血压正常者在发作时出现源于自主神经的惊恐症状更为常见，自主神经惊恐症状会聚集形成一个独特因素，且该因素在伴有惊恐的高血压患者中比血压正常者更为普遍。
我们分析了基层医疗和医院门诊患者填写的所有346份结构化问卷，这些患者报告经历过完全（n = 287）或有限症状的惊恐发作（n = 59）（268例患有高血压，78例从未患过高血压）。比较了高血压患者和血压正常者出汗、脸红和心跳加速的频率，这些症状是前瞻性选择的最可能源于自主神经的症状。进行了主成分分析并采用方差最大化正交旋转。使用逻辑回归计算因素得分与高血压关联的比值比。
高血压患者出汗和脸红的发生率显著高于血压正常者（出汗：65%对46%，p = 0.003；脸红：55%对40%，p = 0.019）。两组间心跳加速的频率以及作为次要终点分析的其余任何惊恐症状均无显著差异。主成分分析产生了四个特征值>1.0的因素。因素1主要由自主神经症状主导，尤其是出汗和脸红，其载荷分别为0.68和0.61。回归分析显示只有这个自主神经因素与高血压有显著关联，比值比为1.37（95%可信区间1.05至1.77，p = 0.018）。
这些发现支持自主神经功能障碍导致高血压与惊恐相关的可能性。
