摘要
目的 采用心率变异性(heart rate variability,HRV)、心率减速力(deceleration capacity of heart rate,DC)等监测心脏自主神经功能的方法,研究女性原发性高血压患者夜间血压下降率与心脏自主神经功能的相关性,探讨影响女性原发性高血压患者夜间血压下降率的相关因素.方法 选取2019年1月～2023年8月兰州大学第二医院收治的187例女性原发性高血压患者,收集一般资料、夜间血压下降率、HRV时域参量(SDNN:正常窦性心搏R-R间期的标准差;SDANN:每分钟正常窦性心搏R-R间期平均值的标准差;SDNNI:5 min正常窦性心搏RR间期标准差的平均值;PNN50:相邻正常窦性心搏RR间期相差超过50ms的心搏数占总窦性心搏数的百分比)及DC,按夜间收缩压下降率分为杓型组、非杓型组、反杓型组3组,比较3组患者的一般资料和24h、日间、夜间平均血压及心率、HRV时域参量、DC值的差异,分析夜间血压下降率与HRV时域参量、DC值及其他一般资料的相关性,并采用简单、多重线性回归分析影响女性原发性高血压患者夜间血压下降率的因素.结果 女性原发性高血压患者夜间血压下降率与SDNN、SDANN、SDNNI、DC值呈线性正相关(β分别为0.235、0.016、0.102和0.493,P＜0.05),与绝经呈线性负相关(β=-3.798,P＜0.05).多重线性回归分析结果显示,SDNN、绝经、年龄、糖尿病是夜间血压下降率的影响因素.结论 女性原发性高血压患者心脏自主神经调节失衡、绝经、年龄增长以及合并糖尿病是影响夜间血压下降率的主要危险因素.
Abstract
Objective Using the methods of heart rate variability(HRV)and deceleration capacity of heart rate(DC),which mo-nitor cardiac autonomic nervous function,to study the correlation between the nocturnal blood pressure dropping rate and cardiac autonom-ic nervous function in female patients with essential hypertension,and to explore the related factors affecting the nocturnal blood pressure dropping rate in female patients with essential hypertension.Methods A total of 187 female patients with essential hypertension admitted to the Second Hospital of Lanzhou University from January 2019 to August 2023 were selected.General data,nocturnal blood pressure dropping rate,HRV time domain parameters(SDNN,SDANN,SDNNI,PNN50)and DC were collected.According to the nocturnal sys-tolic blood pressure dropping rate,they were divided into three groups:dipper group,non-dipper group,and reverse dipper group.The differences of general data and 24-hour,daytime and nighttime mean blood pressure and heart rate,HRV time domain parameters and DC values among three groups were compared,and the correlation between the nocturnal blood pressure dropping rate and HRV time do-main parameters,DC values and other general data was analyzed,and the factors affecting the nocturnal blood pressure dropping rate of fe-male patients with essential hypertension were analyzed by simple and multiple linear regression.Results The nocturnal blood pressure dropping rate in female patients with essential hypertension was linearly positive correlated with SDNN,SDANN,SDNNI and DC values(β were 0.235,0.016,0.102,0.493,P＜0.05),and linearly negative correlated with menopause(β=-3.798,P＜0.05).The re-sults of multiple linear regression analysis showed that SDNN,menopause,age,diabetes were the factors affecting the nocturnal blood pressure dropping rate.Conclusion In female patients with essential hypertension,the imbalance of cardiac autonomic nerve regulation,menopause,age and diabetes are the main risk factors affecting the nocturnal blood pressure dropping rate.
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