静息心率对中心脉压的影响具有年龄依赖性。

The Influence of Resting Heart Rate on Central Pulse Pressure is Age-Dependent.

机构信息

Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina.

出版信息

High Blood Press Cardiovasc Prev. 2021 Jan;28(1):27-34. doi: 10.1007/s40292-020-00432-8. Epub 2021 Jan 16.

DOI:10.1007/s40292-020-00432-8

PMID:33453049

Abstract

INTRODUCTION

Low resting heart rate (RHR) increases augmentation pressure (AP) and central pulse pressure (central PP) and decreases peripheral pressure wave amplification. Given that the contribution of AP to central PP increases with age we hypothesized that the influence of RHR on AP, central PP and peripheral amplification varies with age.

AIM

To evaluate the interaction between age and RHR on the forward and backward components of central PP.

METHODS

A cohort of 1249 ambulatory hypertensive patients with good quality radial wave recordings was stratified into age groups and quartiles of RHR (< 61, 61-68, 69-76 and > 76 bpm). Central aortic pressure was estimated from radial applanation tonometry.

RESULTS

Forward wave (FW) and AP showed opposite changes until midlife, mutually canceling their effect on central PP, whereas both components of central PP increased in parallel after the fifth decade. The initial fall in FW was expressed in the brachial artery as a corresponding decrease in PP and in peripheral amplification. After midlife there was a further decrease in peripheral amplification at the expense of the rise in central PP. A lower RHR exaggerated the age-related increase in left ventricular ejection time (LVET), AP, central PP, and the decrease in peripheral amplification (P < 0.001, for all the interactions between decades and quartiles of RHR). Multivariable regression analyses (n = 1249) confirmed a significant interaction between age and RHR on central PP (P < 0.001), AP (P < 0.001), LVET (P < 0.001), AIx (P < 0.035), and peripheral amplification (P < 0.001). Multivariable regression analyses stratified by age groups (< 30, 30-59 and ≥ 60 years) showed an increasing strength in the relationship of RHR with AP, independently of sex, mean arterial pressure, pulse wave velocity and beta-blockers use. The average increase in AP for a decrease in 10 bpm was 1.4 mmHg before age < 30 years; 2.5 mmHg between age 30-59 years; and 5.4 mmHg at 60 years and older.

CONCLUSIONS

A lower heart rate exaggerated AP and central PP in an age dependent fashion, being the effect particularly relevant in older patients.

摘要

简介

静息心率（RHR）降低会增加增强压（AP）和中心脉搏压（central PP），并降低外周压力波放大。鉴于 AP 对 central PP 的贡献随年龄增长而增加，我们假设 RHR 对 AP、central PP 和外周放大的影响随年龄而变化。

目的

评估年龄和 RHR 对 central PP 前向和后向分量的相互作用。

方法

对 1249 例具有高质量桡动脉波记录的动态高血压患者进行分层，分为年龄组和 RHR 四分位数（<61、61-68、69-76 和 >76 bpm）。从桡动脉平板测压法估计中心主动脉压。

结果

前向波（FW）和 AP 在中年之前呈现相反的变化，相互抵消了它们对 central PP 的影响，而 central PP 的两个分量在 50 岁后平行增加。FW 的初始下降在肱动脉中表现为相应的 PP 和外周放大的下降。中年后，由于 central PP 的上升，外周放大进一步下降。较低的 RHR 夸大了与年龄相关的左心室射血时间（LVET）、AP、central PP 和外周放大的降低（所有与 RHR 十年和四分位数的相互作用 P<0.001）。多变量回归分析（n=1249）证实了年龄和 RHR 对 central PP（P<0.001）、AP（P<0.001）、LVET（P<0.001）、AIx（P<0.035）和外周放大（P<0.001）的交互作用有显著影响。按年龄组（<30、30-59 和≥60 岁）分层的多变量回归分析显示，RHR 与 AP 的关系强度随着年龄的增长而增加，独立于性别、平均动脉压、脉搏波速度和β受体阻滞剂的使用。静息心率每降低 10 bpm，AP 平均增加 1.4mmHg，年龄<30 岁；年龄 30-59 岁时增加 2.5mmHg；60 岁及以上时增加 5.4mmHg。