Siche J P, Herpin D, Asmar R G, Poncelet P, Chamontin B, Comparat V, Gressin V, Boutelant S, Mallion J M
French Society of Hypertension, Grenoble, France.
J Hypertens. 1995 Dec;13(12 Pt 2):1654-9.
The objective of this study was to evaluate the relationship between non-invasive ambulatory blood pressure variability and cardiac baroreflex sensitivity in hypertensive patients.
Ambulatory blood pressure measurements (15-min intervals for 24 h) and continuous blood pressure measurements (Finapres, 20 min at rest after a 10-min resting period) were performed in 123 untreated hypertensives (resting diastolic blood pressure > or = 90 mmHg; 80 males, 43 females; mean +/- SD age 49 +/- 12 years, range 19-73). Fourier series were used to model 24-h blood pressure profiles (four harmonics). Ambulatory blood pressure variability was assessed by determination of the residuals in each 24-h blood pressure profile (measured minus predicted pressures). Resting blood pressure variability was defined as the SD of the mean Finapres value. Baroreflex sensitivity was evaluated by automatic detection of blood pressure and pulse interval sequences of > or = 3 beats when systolic blood pressure and pulse interval sequences changed in the same direction (increase or decrease: 1 mmHg for systolic blood pressure and 4 ms for RR interval), and was assessed as the slope of the regression line for each sequence.
Ambulatory systolic blood pressure variability increased with age (r = 0.28*) and systolic pressure (r = 0.44**). Baroreflex sensitivity (increasing systolic pressure/pulse interval) decreased significantly with age (r = -0.48**) and systolic pressure (r = -0.23**), and was significantly related to increased ambulatory blood pressure variability (r = -0.33**). In a multivariate stepwise analysis the relationship between ambulatory blood pressure variability and baroreflex sensitivity (increasing systolic pressure/pulse interval) was statistically independent of age and systolic pressure (R = 0.55, P<0.001); this relationship was not observed with the corresponding decreasing sequence.
This study shows that in uncomplicated hypertension, ambulatory blood pressure variability is related to baroreflex sensitivity independently of the blood pressure level. This finding has prognostic implications for this non-invasive measurement, which needs to be confirmed by large longitudinal studies.
本研究旨在评估高血压患者非侵入性动态血压变异性与心脏压力反射敏感性之间的关系。
对123例未经治疗的高血压患者（静息舒张压≥90 mmHg；男性80例，女性43例；平均±标准差年龄49±12岁，范围19 - 73岁）进行动态血压测量（每15分钟测量一次，共24小时）和连续血压测量（采用Finapres，在10分钟休息期后静息20分钟）。采用傅里叶级数对24小时血压曲线（四个谐波）进行建模。通过测定每个24小时血压曲线中的残差（测量血压减去预测血压）来评估动态血压变异性。静息血压变异性定义为Finapres平均值的标准差。当收缩压和脉搏间期序列同向变化（升高或降低：收缩压变化1 mmHg，RR间期变化4 ms）时，通过自动检测≥3次搏动的血压和脉搏间期序列来评估压力反射敏感性，并将其评估为每个序列回归线的斜率。
动态收缩压变异性随年龄（r = 0.28*）和收缩压（r = 0.44**）升高。压力反射敏感性（升高的收缩压/脉搏间期）随年龄（r = -0.48**）和收缩压（r = -0.23**）显著降低，且与动态血压变异性增加显著相关（r = -0.33**）。在多变量逐步分析中，动态血压变异性与压力反射敏感性（升高的收缩压/脉搏间期）之间的关系在统计学上独立于年龄和收缩压（R = 0.55，P<0.001）；在相应的降低序列中未观察到这种关系。
本研究表明，在单纯性高血压中，动态血压变异性与压力反射敏感性相关，且独立于血压水平。这一发现对这种非侵入性测量方法具有预后意义，需要通过大型纵向研究加以证实。
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