Yu Yijun, Xu Yanling, Zhang Mingjing, Wang Yuting, Zou Wusong, Gu Ye
Department of Cardiology, Wuhan Fourth Hospital, Puai Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Int J Hypertens. 2018 Oct 14;2018:4067601. doi: 10.1155/2018/4067601. eCollection 2018.
To explore the relationship between blood pressure control and autonomic nervous function assessing by heart rate variability (HRV) and heart rate turbulence (HRT) in hypertensive patients.
A total of 120 consecutive hypertensive patients and 80 nonhypertensive patients (N-HP group) were enrolled in this study. The hypertensive patients were divided into controlled blood pressure and uncontrolled blood pressure groups according to their blood pressure on admission. All subjects underwent 24-hour Holter monitoring. This study compared HRV and HRT in nonhypertensive and hypertensive patients and hypertensive patients with controlled and uncontrolled blood pressure. HRV parameters include square root of mean of the sum of squares of successive NN interval differences (rMSSD), number of successive NN intervals differing by > 50ms divided by the total number of successive NN intervals (pNN50), very low frequency (VLF) at frequency between 0.0033 and 0.04 Hz, low frequency (LF) at frequency between 0.04 and 0.15 Hz, and high frequency (HF) at frequency between 0.15 and 0.4 Hz. Turbulence slope (TS) belongs to HRT parameters.
TS, rMSSD, pNN50, VLF, LF, and HF values were significantly lower in the HP group than in the N-HP group. Multiple logistic regression analysis showed that reduced TS, rMSSD, pNN50, LF, and HF values were risk factors of hypertension. TS, rMSSD, pNN50, VLF, LF, and HF values were significantly lower in hypertensive patients with uncontrolled blood pressure than in hypertensive patients with controlled blood pressure. Multiple logistic regression analysis showed that reduced TS, rMSSD, pNN50, VLF, LF, and HF values were risk factors for uncontrolled blood pressure.
This study indicates impaired autonomic nervous function in hypertensive patients, especially in hypertensive patients with uncontrolled blood pressure despite guideline recommended antihypertensive medications.
探讨高血压患者血压控制与通过心率变异性（HRV）和心率震荡（HRT）评估的自主神经功能之间的关系。
本研究共纳入120例连续的高血压患者和80例非高血压患者（非高血压组）。高血压患者根据入院时的血压分为血压控制组和血压未控制组。所有受试者均接受24小时动态心电图监测。本研究比较了非高血压患者、高血压患者以及血压控制和未控制的高血压患者的HRV和HRT。HRV参数包括连续NN间期差值平方和的均值平方根（rMSSD）、连续NN间期差值大于50ms的次数除以连续NN间期总数（pNN50）、频率在0.0033至0.04Hz之间的极低频（VLF）、频率在0.04至0.15Hz之间的低频（LF）以及频率在0.15至0.4Hz之间的高频（HF）。震荡斜率（TS）属于HRT参数。
高血压组的TS、rMSSD、pNN50、VLF、LF和HF值显著低于非高血压组。多因素logistic回归分析显示，TS、rMSSD、pNN50、LF和HF值降低是高血压的危险因素。血压未控制的高血压患者的TS、rMSSD、pNN50、VLF、LF和HF值显著低于血压控制的高血压患者。多因素logistic回归分析显示，TS、rMSSD、pNN50、VLF、LF和HF值降低是血压未控制的危险因素。
本研究表明高血压患者存在自主神经功能受损，尤其是那些尽管使用了指南推荐的降压药物但血压仍未控制的高血压患者。
