Mamontov Oleg V, Kozlenok Andrey V, Kamshilin Alexei A, Shlyakhto Evgeny V
Dept. of Circulation Physiology, Almazov National Medical Research Centre, St. Petersburg 197341, Russia.
Dept. of Departmental Therapy, Pavlov First Saint Petersburg State Medical University, St. Petersburg 197022, Russia.
Cardiol Res Pract. 2019 Dec 30;2019:8391924. doi: 10.1155/2019/8391924. eCollection 2019.
Comprehensive study of autonomic regulation assessed during follow-up could provide new detailed information about the risks stratification for hypertensive patients. Therefore, we investigated the associations of these indices with death, stroke, and revascularization during the follow-up observation of 55 patients.
All patients were with target organ damage, and 27 of them had associated clinical conditions (ACC). Mean age of patients with and without ACC was 62.6 ± 4.2 and 51.9 ± 9.9 (mean ± SD) years, respectively. Follow-up was from 66 to 95 months. At entry, autonomic regulation was assessed by the tilt test, Valsalva maneuver, hand-grip test, and cold-stress vasoconstriction. Hemodynamic parameters were measured by continuous blood pressure monitoring, occlusion plethysmography, and electrocardiography. Re-examination of patients was carried out by questioning and physical and laboratory examination.
We found that fatal outcomes were associated with a lower Valsalva index (1.34 ± 0.16 vs. 1.69 ± 0.37, < 0.05) and depressed cold vasoconstriction (0.20 ± 0.02 vs. 0.39 ± 0.16%, < 0.05) and depressed cold vasoconstriction (0.20 ± 0.02 vs. 0.39 ± 0.16%, < 0.05) and depressed cold vasoconstriction (0.20 ± 0.02 vs. 0.39 ± 0.16%, < 0.05) and depressed cold vasoconstriction (0.20 ± 0.02 vs. 0.39 ± 0.16%, < 0.05) and depressed cold vasoconstriction (0.20 ± 0.02 vs. 0.39 ± 0.16%, < 0.05) and depressed cold vasoconstriction (0.20 ± 0.02 vs. 0.39 ± 0.16%, < 0.05) and depressed cold vasoconstriction (0.20 ± 0.02 vs. 0.39 ± 0.16%.
This study shows that such autonomic regulation indices as Valsalva index, blood pressure dynamics in the tilt test, cold-stress vasomotor reactivity, and BPV are important for prognosis of hypertension course.
在随访期间对自主神经调节进行全面研究可为高血压患者的风险分层提供新的详细信息。因此，我们在对55例患者的随访观察中调查了这些指标与死亡、中风和血运重建的关联。
所有患者均有靶器官损害，其中27例伴有相关临床情况（ACC）。有ACC和无ACC患者的平均年龄分别为62.6±4.2岁和51.9±9.9岁（均值±标准差）。随访时间为66至95个月。入院时，通过倾斜试验、瓦尔萨尔瓦动作、握力试验和冷应激血管收缩来评估自主神经调节。通过连续血压监测、肢体容积描记法和心电图测量血流动力学参数。通过询问、体格检查和实验室检查对患者进行复查。
我们发现致命结局与较低的瓦尔萨尔瓦指数（1.34±0.16对1.69±0.37，<0.05）、冷血管收缩功能减退（0.20±0.02对0.39±0.16%，<0.05）以及冷血管收缩功能减退（0.20±0.02对0.39±0.16%，<0.05）、冷血管收缩功能减退（0.20±0.02对0.39±0.16%，<0.05）、冷血管收缩功能减退（0.20±0.02对0.39±0.16%，<0.05）、冷血管收缩功能减退（0.20±0.02对0.39±0.16%，<0.05）、冷血管收缩功能减退（0.20±0.02对0.39±0.16%，<0.05）以及冷血管收缩功能减退（0.20±0.02对0.39±0.16%，<0.05）相关。
本研究表明，诸如瓦尔萨尔瓦指数、倾斜试验中的血压动态变化、冷应激血管运动反应性和血压变异性等自主神经调节指标对高血压病程的预后很重要。
