Yugar Louise Buonalumi Tacito, Yugar-Toledo Juan Carlos, Dinamarco Nelson, Sedenho-Prado Luis Gustavo, Moreno Beatriz Vaz Domingues, Rubio Tatiane de Azevedo, Fattori Andre, Rodrigues Bruno, Vilela-Martin Jose Fernando, Moreno Heitor
School of Medical Sciences, State University of Campinas (UNICAMP), Campinas 13083-887, SP, Brazil.
Post-Graduate Course in Medical Science, Faculty of Medicine of São José do Rio Preto (FAMERP), São José do Rio Preto 15090-000, SP, Brazil.
Diagnostics (Basel). 2023 Feb 19;13(4):785. doi: 10.3390/diagnostics13040785.
Cardiac innervation by the parasympathetic nervous system (PNS) and the sympathetic nervous system (SNS) modulates the heart rate (HR) (chronotropic activity) and the contraction of the cardiac muscle (inotropic activity). The peripheral vasculature is controlled only by the SNS, which is responsible for peripheral vascular resistance. This also mediates the baroreceptor reflex (BR), which in turn mediates blood pressure (BP). Hypertension (HTN) and the autonomic nervous system (ANS) are closely related, such that derangements can lead to vasomotor impairments and several comorbidities, including obesity, hypertension, resistant hypertension, and chronic kidney disease. Autonomic dysfunction is also associated with functional and structural changes in target organs (heart, brain, kidneys, and blood vessels), increasing cardiovascular risk. Heart rate variability (HRV) is a method of assessing cardiac autonomic modulation. This tool has been used for clinical evaluation and to address the effect of therapeutic interventions. The present review aims (a) to approach the heart rate (HR) as a CV risk factor in hypertensive patients; (b) to analyze the heart rate variability (HRV) as a "tool" to estimate the individual risk stratum for Pre-HTN (P-HTN), Controlled-HTN (C-HTN), Resistant and Refractory HTN (R-HTN and Rf-HTN, respectively), and hypertensive patients with chronic renal disease (HTN+CKD).
副交感神经系统（PNS）和交感神经系统（SNS）对心脏的神经支配可调节心率（HR）（变时性活动）和心肌收缩（变力性活动）。外周血管系统仅受交感神经系统控制，交感神经系统负责外周血管阻力。它还介导压力感受器反射（BR），进而调节血压（BP）。高血压（HTN）与自主神经系统（ANS）密切相关，功能紊乱可导致血管舒缩功能障碍和多种合并症，包括肥胖、高血压、顽固性高血压和慢性肾病。自主神经功能障碍还与靶器官（心脏、脑、肾和血管）的功能及结构改变相关，增加心血管疾病风险。心率变异性（HRV）是评估心脏自主神经调节的一种方法。该工具已用于临床评估及探讨治疗干预的效果。本综述旨在：（a）将心率（HR）作为高血压患者的心血管危险因素进行探讨；（b）分析心率变异性（HRV）作为一种“工具”，以评估高血压前期（P-HTN）、血压控制良好的高血压（C-HTN）、顽固性高血压和难治性高血压（分别为R-HTN和Rf-HTN）以及慢性肾病高血压患者（HTN+CKD）个体的风险分层。
