高血压患者非杓型心率与冠心病发病率的关系

摘要

Objective:To observe the relationship between non -dipper heart rate and morbidity of coronary heart disease (CHD) in patients with hypertension .Methods :According to Holter monitored results ,a total of 130 pa‐tients with essential hypertension were divided into dipper heart rate group (n= 77 ) and non -dipper heart rate group (n=53) .Ambulatory blood pressure and dynamic ECG were monitored in two groups ,and CHD was diag‐nosed according to coronary angiography results .Ambulatory blood pressure ,ambulatory heart rate and incidence rate of CHD were compared and analyzed between two groups .Results:Compared with dipper heart rate group , there was significant reduction in daytime mean heart rate [ (73.45 ± 9.57) beats/min vs .(68.77 ± 12.61) beats/min] ,but significant rise in nighttime mean heart rate [ (61.30 ± 7.62) beats/min vs .(65.49 ± 12.97) beats/min] , P<0.05 both ;there were significant reductions in 24h mean diastolic blood pressure (DBP) [ (75.77 ± 10.91) mm‐Hg vs .(71.92 ± 9.30) mmHg] and daytime mean DBP [ (77.16 ± 11.11) mmHg vs .(72.81 ± 9.61) mmHg] , P<0.05 both in non -dipper heart rate group ,there were no significant difference in other blood pressure indexes be‐tween two groups (P>0.05);.Morbidity rate of CHD in non -dipper heart rate group was significantly higher than that of dipper heart rate group (71.70% vs .29.87% ,P=0.001) .Conclusion:Compared with dipper heart rate pa‐tients ,morbidity rate of CHD significantly rises in patients with hypertension and non -dipper heart rate .It may help to reduce occurrence of CHD by monitoring circadian changes of heart rate and recover circadian heart rate rhythm while treating hypertension .%目的：观察高血压患者非杓型心率与冠心病发病率的关系。方法：根据Holter监测结果，130例原发性高血压患者被分为杓型心率组（77例）和非杓型心率组（53例）。监测两组动态血压和动态心电图，根据冠脉造影结果诊断冠心病。比较分析两组患者动态血压、动态心率以及冠心病的发生率。结果：与杓型心率组比较，非杓型心率组白天平均心率[（73.45±9.57）次／min比（68.77±12.61）次／min ]显著降低，而夜间平均心率[（61.30±7.62）次／min比（65.49±12.97）次／min]显著升高（P均＜0.05）；24h平均舒张压[（75.77±10.91） mmHg比（71.92±9.30） mmHg]和白天平均舒张压[（77.16±11.11） mmHg比（72.81±9.61） mmHg]显著降低（P均＜0.05），其余血压指标两组间无显著差异（P＞0.05）。非杓型心率组冠心病发病率显著高于杓型心率组（71.70％比29.87％， P＝0.001）。结论：与杓型心率者比较，非杓型心率高血压患者的冠心病发生率显著升高。治疗高血压的同时，监测心率的昼夜变化，并恢复患者的昼夜心率节律可能有助减少冠心病的发生。