颈动脉窦压力感受性反射功能低下时的 Mayer 波活动。

Department of Medical Physics and Bioengineering, St James's Hospital, Dublin 8, Ireland.

Europace. 2010 Feb;12(2):247-53. doi: 10.1093/europace/eup385.

AIMS

Mayer waves are low frequency blood pressure waves, whose modulation involves central/peripheral baroreflex pathways. Although vasodepressor carotid sinus hypersensitivity (VDCSH) is a common hypotensive disorder in ageing, the mechanism of VDCSH is unknown. We hypothesize that VDCSH is due to impaired baroreflex function and that Mayer wave amplitude and oscillation frequency are therefore altered.

METHODS AND RESULTS

Ten minutes ECG and continuous beat-to-beat blood pressure (TNO Finapres(c)) recordings were taken in supine position. Blood pressure variance, spectral power (0.04-0.15 Hz) and centre of frequency was examined across a number of frequency bands. Vasodepressor carotid sinus hypersensitivity was defined as 50 mmHg drop in systolic blood pressure (SBP) during carotid sinus massage. Syncope facility was used in this study. Twelve patients with VDCSH median age 72 range (50-92) were compared with 36 case-controls median age 78 range (48-88). Diastolic blood pressure variability (median SD) was significantly higher in the VDCSH 6.6 (1.9-12.9) mmHg compared with controls 4.0 (1.7-9.5) mmHg; P < 0.05. Mean arterial blood pressure (MAP) variability (median SD) was significantly higher in the VDCSH 6.6 (2.9-10.1) mmHg compared with controls 4.6 (2.5-9.1) mmHg; P < 0.05. Low frequency Mayer wave activity in MAP in VDCSH compared with controls was increased at 0.06 Hz [controls -21.7 mmHg(2)/Hz (IQR: 30.8); VDCSH -31.5 mmHg(2)/Hz (IQR: 72.0) P < 0.05] and at 0.1 Hz [controls -4.9 mmHg(2)/Hz (IQR: 9.4); VDCSH -11.5 mmHg(2)/Hz (IQR: 12.9) P < 0.1]. High frequency blood pressure fluctuations were significantly increased at 0.3 Hz in VDCSH group in SBP [controls -4.1 mmHg(2)/Hz (IQR: 10.4); VDCSH -17.4 mmHg(2)/Hz (IQR: 47.9) P < 0.05] and MAP records [controls -32.5 mmHg(2)/Hz (IQR: 76.9); VDCSH -64.6 mmHg(2)/Hz (IQR: 59.8) P < 0.01].

CONCLUSION

Blood pressure variability in particular activity at Mayer wave frequencies was higher in VDCSH. Future work will investigate this approach as a basis for diagnosis of VDCSH, with implications for syncope and falls management.

目的

Mayer 波是低频血压波，其调制涉及中枢/外周压力反射途径。尽管颈动脉窦减压性高血压（CSDH）是衰老中常见的低血压障碍，但 CSDH 的机制尚不清楚。我们假设 CSDH 是由于压力反射功能受损，因此 Mayer 波幅度和振荡频率发生改变。

方法和结果

10 分钟仰卧位心电图和连续逐拍血压（TNO Finapres(c)）记录。在多个频带中检查血压方差、频谱功率（0.04-0.15 Hz）和中心频率。定义颈动脉窦按摩时收缩压（SBP）下降 50mmHg 为 CSDH。本研究使用晕厥设施。将 12 名 CSDH 患者（中位年龄 72 岁，范围 50-92 岁）与 36 名病例对照（中位年龄 78 岁，范围 48-88 岁）进行比较。CSDH 患者的舒张压变异性（中位数 SD）明显高于对照组 6.6（1.9-12.9）mmHg 比 4.0（1.7-9.5）mmHg；P < 0.05。CSDH 患者的平均动脉血压变异性（中位数 SD）明显高于对照组 6.6（2.9-10.1）mmHg 比 4.6（2.5-9.1）mmHg；P < 0.05。与对照组相比，CSDH 患者的 MAP 中的低频 Mayer 波活动在 0.06Hz 时增加[对照组-21.7mmHg(2)/Hz（IQR：30.8）；CSDH-31.5mmHg(2)/Hz（IQR：72.0）P < 0.05]和 0.1Hz 时增加[对照组-4.9mmHg(2)/Hz（IQR：9.4）；CSDH-11.5mmHg(2)/Hz（IQR：12.9）P < 0.1]。CSDH 患者的高频血压波动在 SBP 中在 0.3Hz 时明显增加[对照组-4.1mmHg(2)/Hz（IQR：10.4）；CSDH-17.4mmHg(2)/Hz（IQR：47.9）P < 0.05]和 MAP 记录[对照组-32.5mmHg(2)/Hz（IQR：76.9）；CSDH-64.6mmHg(2)/Hz（IQR：59.8）P < 0.01]。