高血压伴脑小血管病患者的日间血压和心率变异性：一项病例对照研究。
Diurnal Blood Pressure and Heart Rate Variability in Hypertensive Patients with Cerebral Small Vessel Disease: A Case-Control Study.
机构信息
Department of Neurology, Donguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, 523000 Guangdong Province, China.
Department of Neurology, Donguan People's Hospital (Affiliated Dongguan Hospital, South Medical University), Dongguan, 523000 Guangdong Province, China.
出版信息
J Stroke Cerebrovasc Dis. 2021 May;30(5):105673. doi: 10.1016/j.jstrokecerebrovasdis.2021.105673. Epub 2021 Feb 22.
BACKGROUND
Whether autonomic dysfunction contributes to cerebral small vessel disease (CSVD) remains unclear. This study aimed to explore the relationship between CSVD and blood pressure variability (BPV) and heart rate variability (HRV).
METHODS
This case-control study recruited 50 patients with CSVD and 50 non-CSVD hypertensive age- and gender-matched controls. All participants completed a 24-h ambulatory electrocardiogram recording and ambulatory BP monitoring (ABPM). Differences in HRV and BPV between the two groups were examined. BPV indices assessed by ABPM included mean systolic BP (SBP), mean diastolic BP (DBP), coefficient of variation and weighted standard deviation of SBP and DBP.
RESULTS
CSVD patients had significant higher 24-h mean systolic BP (SBP), 24-h mean diastolic BP (DBP), daytime mean SBP, nocturnal mean SBP, and nocturnal mean DBP (P < .05 for all). CSVD patients had a significant lower nocturnal SBP fall rate compared with controls (median: 1.0 versus 6.2, respectively; P < .001) and were more likely to be non-dippers and reverse dippers. There were no differences in HRV variables between the two groups. Five logistic models were built to explore the correlations between BPV indices and CSVD. BPV indices were separately entered into the logistic regression models, together with hyperlipidemia, ischemic stroke history, current use of anti-hypertensive agents, and serum blood urea nitrogen. In models 1-3, 24-h mean SBP and nocturnal mean SBP and DBP were significantly correlated with CSVD (r = 0.308-0.340). In model 4, the nocturnal SBP fall rate was negatively correlated with CSVD (odds ratio [OR] = 0.871, 95% confidence interval [CI] = 0.804-0.943; P = .001), with r = 0.415 fitting the model. In model 5, the pattern of SBP dipping was significantly associated with CSVD, with non-dipper (OR = 8.389, 95%CI = 1.489-47.254; P = .016) and reverse dipper (OR = 27.008, 95%CI = 3.709-196.660; P = .001) having the highest risks of CSVD (r = 0.413).
CONCLUSIONS
Lower nocturnal SBP fall rate is associated with CSVD. Non-dipper and reverse dipper hypertensive patients have a higher risk of CSVD.
背景
自主神经功能障碍是否会导致脑小血管病（CSVD）仍不清楚。本研究旨在探讨 CSVD 与血压变异性（BPV）和心率变异性（HRV）之间的关系。
方法
本病例对照研究纳入了 50 例 CSVD 患者和 50 例非 CSVD 的高血压年龄和性别匹配对照。所有参与者均完成了 24 小时动态心电图记录和动态血压监测（ABPM）。比较两组之间的 HRV 和 BPV 差异。ABPM 评估的 BPV 指标包括 24 小时平均收缩压（SBP）、24 小时平均舒张压（DBP）、SBP 和 DBP 的变异系数和加权标准差。
结果
CSVD 患者的 24 小时平均 SBP、24 小时平均 DBP、日间平均 SBP、夜间平均 SBP 和夜间平均 DBP 显著升高（均 P<.05）。CSVD 患者的夜间 SBP 下降率明显低于对照组（中位数：1.0 对 6.2，P<.001），且更可能是非杓型和反杓型血压。两组间 HRV 变量无差异。建立了五个逻辑模型来探讨 BPV 指标与 CSVD 的相关性。将 BPV 指标分别纳入逻辑回归模型中，同时纳入血脂异常、缺血性脑卒中史、当前使用降压药物和血清血尿素氮。在模型 1-3 中，24 小时平均 SBP 和夜间平均 SBP 和 DBP 与 CSVD 显著相关（r=0.308-0.340）。在模型 4 中，夜间 SBP 下降率与 CSVD 呈负相关（比值比[OR] = 0.871，95%置信区间[CI] = 0.804-0.943；P=.001），模型拟合 r 值为 0.415。在模型 5 中，SBP 勺型与 CSVD 显著相关，非杓型（OR=8.389，95%CI=1.489-47.254；P=.016）和反杓型（OR=27.008，95%CI=3.709-196.660；P=.001）的 CSVD 风险最高（r=0.413）。
结论
夜间 SBP 下降率较低与 CSVD 相关。非杓型和反杓型高血压患者 CSVD 风险更高。
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