Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Section Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research institute, Amsterdam, The Netherlands.
Blood Press. 2023 Dec;32(1):2270070. doi: 10.1080/08037051.2023.2270070. Epub 2023 Oct 20.
Hypertension can be classified into different phenotypes based on systolic and diastolic blood pressure (BP) that carry a different prognosis and may therefore be differently associated with sympathetic activity. We assessed the association between cardiac autonomic function determined from continuous finger BP recordings and hypertensive phenotypes. We included 10,221 individuals aged between 18-70 years from the multi-ethnic HELIUS study. Finger BP was recorded continuously for 3-5 minutes from which cross-correlation baroreflex sensitivity (xBRS) and heart rate variability (HRV) were determined. Hypertension was classified into isolated systolic (ISH; ≥140/<90), diastolic (IDH; <140/≥90) and combined systolic and diastolic hypertension (SDH; ≥140/≥90). Differences were assessed after stratification by age (younger: ≤40, older: >40 years) and sex, using regression with correction for relevant covariates. For xBRS, values were log-transformed. In younger adults with ISH, xBRS was comparable to normotensive individuals in men (ratio 0.92; 95%CI 0.84-1.01) and women (1.00; 95%CI 0.84-1.20), while xBRS was significantly lower in IDH and SDH (ratios between 0.67 and 0.80). In older adults, all hypertensive phenotypes had significantly lower xBRS compared to normotensives. We found a similar pattern for HRV in men, while in women HRV did not differ between phenotypes. In younger men and women ISH is not associated with a shift towards increased sympathetic control, while IDH and SDH in younger and all hypertensive phenotypes in older participants were associated with increased sympathetic control. This suggests that alterations in autonomic regulation could be a contributing factor to known prognostic disparities between hypertensive phenotypes.
高血压可以根据收缩压和舒张压（BP）分为不同的表型，这些表型具有不同的预后，因此可能与交感神经活动的相关性不同。我们评估了连续手指 BP 记录确定的心脏自主功能与高血压表型之间的关联。我们纳入了来自多民族 HELIUS 研究的 10221 名年龄在 18-70 岁之间的个体。连续记录手指 BP 3-5 分钟，从中确定交叉相关压力反射敏感性（xBRS）和心率变异性（HRV）。高血压分为单纯收缩期高血压（ISH；≥140/<90）、单纯舒张期高血压（IDH；<140/≥90）和收缩期和舒张期高血压（SDH；≥140/≥90）。使用相关协变量校正后的回归，按年龄（年轻：≤40 岁，年长：>40 岁）和性别进行分层，评估差异。对于 xBRS，值进行对数转换。在年轻的 ISH 患者中，xBRS 与男性（比值 0.92；95%CI 0.84-1.01）和女性（1.00；95%CI 0.84-1.20）的正常血压个体相当，而 IDH 和 SDH 的 xBRS 显著降低（比值在 0.67 到 0.80 之间）。在年长的成年人中，所有高血压表型的 xBRS 均显著低于正常血压者。我们在男性中发现了 HRV 的类似模式，而在女性中，各表型之间的 HRV 没有差异。在年轻男性和女性中，ISH 与交感神经控制的增加无关，而 IDH 和 SDH 在年轻人群中以及所有高血压表型在年长参与者中均与交感神经控制的增加有关。这表明自主神经调节的改变可能是高血压表型之间已知预后差异的一个促成因素。
