心率加速力及心率减速力与高血压患者24 h动态血压昼夜节律变化的关系
Heart rate acceleration and deceleration capacities associated with 24-hour circadian blood pressure variation in hypertensive patients
王吉静 1徐金义 1张恒源 1邱妍妍 1张娜 1闫菲 2王文涛 2姬艳芳3
作者信息
- 1. 郑州大学人民医院(河南省人民医院)心肺功能科,河南郑州 450003
- 2. 阜外华中心血管病医院心肺功能科
- 3. 河南省疾病预防控制中心免疫规划所
- 折叠
摘要
目的 观察高血压患者24 h动态血压昼夜节律与心率加速力(AC)和心率减速力(DC)的关系.方法 选取198例原发性高血压患者,均行24 h动态血压监测,根据夜间收缩压下降率分为两组:勺型组(夜间血压下降率10％～20％,n=58)和非勺型组(夜间血压下降率＜10％,n=140).根据动态心电图数据计算得出DC和AC值.比较两组DC和AC的差异.通过Pearson相关分析高血压患者DC、AC与昼夜血压和血压节律的相关性,多因素logistic回归分析非勺型高血压的影响因素.结果 非勺型组AC高于勺型组,DC、RR间期标准差(SDNN)、相邻RR间期均值＞50 ms心搏百分比(PNN50)低于勺型组(均P＜0.05).Pearson相关性分析发现,AC值与夜间收缩压(r=0.297)、最慢心率(r=0.221)正相关,与 SDNN(r=-0.233)、PNN50(r=-0.238)负相关,DC 值与夜间收缩压(r=-0.300)、最慢心率(r=-0.213)负相关,与 SDNN(r=0.230)、PNN50(r=0.267)正相关(均P＜0.05).多因素 logistic 回归分析发现,在包含 AC 的模型中,AC(OR=1.320,95％CI 1.102～1.580,P=0.003)、年龄(OR=1.029,95％CI 1.001～1.057,P=0.039)、24 h 平均心率(OR=1.062,95％CI 1.010～1.116,P=0.020)是非勺型高血压的影响因素;在包含DC的模型中,DC(OR=0.824,95％CI 0.709～0.956,P=0.011)、年龄(OR=1.027,95％CI 1.001～1.055,P=0.046)、24 h 平均心率(OR=1.058,95％CI 1.007～1.113,P=0.025)为非勺型高血压的影响因素.结论 高血压非勺型组的AC值增高、DC值降低;夜间收缩压与AC值正相关,与DC值负相关;AC和DC均为高血压患者血压昼夜节律异常的独立影响因子.
Abstract
Objective To observe the relationship between 24-hour ambulatory blood pressure circadian rhythm and heart rate acceleration(AC),deceleration capacities(DC)in patients with hypertension.Methods A total of 198 patients with essential hypertension were included and were monitored by 24-hour ambulatory blood pressure.Based on the nocturnal decline rate of systolic blood pressure,patients were divided into two groups:dippers(decline rate 10％-20％,n=58)and non-dippers(decline rate＜10％,n=140).DC and AC values were calculated based on dynamic electrocardiogram data and the differences were compared between two groups.Pearson correlation analysis was used to analyse the correlation between DC,AC and blood pressure and circadian blood pressure variation.Mul-tivariate logistic regression analysis was used to analyse the influencing factors of non-dippers.Results Compared with dippers,AC in non-dippers increased,while DC,standard deviation of normal R-R intervals(SDNN),percent-age of adjacent normal R-R intervals differing by more than 50 ms(PNN50)decreased in non-dippers(P＜0.05).Pearson analysis showed that AC was positively correlated to nighttime systolic blood pressure(r=0.297),slowest heart rate(r=0.221)and negatively correlated to SDNN(r=-0.233)and PNN50(r=-0.238),while DC was negatively correlated to nighttime systolic blood pressure(r=-0.300),slowest heart rate(r=-0.213),and posi-tively correlated to SDNN(r=0.230),PNN50(r=0.267)(all P＜0.05).Multivariate logistic regression analysis showed that in the model included AC,AC(OR=1.320,95％CI 1.102 to 1.580,P=0.003),age(OR=1.029,95％CI 1.001 to 1.057;P=0.039)and 24 h average heart rate(OR=1.062,95％CI 1.010 to 1.116,P=0.02)were independent risk factors for non-dippers,while in the model included DC,DC(OR=0.824,95％CI 0.709 to 0.956,P=0.011),age(OR=1.027,95％CI 1.001 to 1.055,P=0.046)and 24 h average heart rate(OR=1.058,95％CI 1.007 to 1.113,P=0.025)were independent risk factors for non-dippers.Conclusions AC in-creases and DC decreases in patients with non-dipper hypertension.Nighttime systolic blood pressure positively cor-relates with AC and negatively correlates with DC.AC and DC are independent risk factors for abnormal circadian rhythm of blood pressure in hypertensives.
关键词
高血压/24/h动态血压监测/血压昼夜节律/心率加速力/心率减速力Key words
hypertension/ambulatory bood pressure monitoring/circadian blood pressure variation/heart rate acceleration capacity/heart rate deceleration capacity引用本文复制引用
基金项目
河南省医学科技攻关联合共建项目(LHGJ20200089)
出版年
2024
NETL
NSTL
万方数据