高血压病患者血压变异、心率变异、QT变异及其相关性研究

摘要

Objective: To investigate the changes of ambulatory blood pressure variability(ABPV),heart rate variability(HRV),QT variability(QTv) in essential hypertension(EH),and study their relativity. To evaluate the effect of beta-adrenergic blocker on autonomic nervous system. Methods: 19 controls,38 EH patients without therapy and 30 EH patients with the therapy of beta-adrenergic blocker all received 24h ambulatory blood pressure and 24h Holter eletrocardiogram measurement. Results:(1)ABPV:24h,daytime and nighttime ABPVs of EH without therapy were higher than control, 24h,daytime and nighttime average SBP,DBP of EH without therapy were higher than control and EH with therapy.(2)HRV: 24h,daytime and nighttime SDNN of control were significantly higher than EH without therapy, significant difference was found in daytime SDNN between two EH groups; Daytime and nighttime HFnorm of control were higher than EH without therapy, daytime LFnorm, daytime and nighttime HFnorm had difference between two EH groups. (3)Daytime QTv was significantly higher than nighttime in control and EH with therapy.(4)In EH with LVH and EH without therapy, there were positive relations between daytime ABPVs and SDNN, daytime average SBP and SDNN, nighttime average DBP and SDNN,24h SDNN and QTv; there was negative relations between night average DBP and HFnorm. Conclusion:(1)In EH patients ABPV were increased, HRV were reduced,the rhythm of blood pressure were disappeared, no significant difference was found between daytime and nighttime QTv.(2)There were relations between ABPV and HRV, HRV and QTv.(3) ABPV,HRV and the rhythm of BP can be improved by beta-adrenergic blocker.%目的：研究高血压病(EH)患者血压变异、心率变异、QT变异及其相关性，并探讨β受体阻滞剂对心脏自主神经功能的改善。方法：88例研究对象分为正常对照组（Ⅰ组）、高血压病未治疗组（Ⅱ组）及高血压病β受体阻滞剂治疗组（Ⅲ组）。均同时佩带24h动态血压和动态心电图纪录盒。结果：（1）血压变异指标：Ⅱ组24h、昼间、夜间ABPVs均大于Ⅰ组，Ⅱ组与Ⅲ组间24h及昼间ABPVd有显著差异。Ⅱ组24h、昼间及夜间平均SBP、平均DBP显著高于Ⅰ组及Ⅲ组。（2）心率变异指标：Ⅰ组24h、昼间、夜间SDNN显著高于Ⅱ组；Ⅲ组昼间SDNN显著高于Ⅱ组。Ⅰ组昼间、夜间HFnorm显著高于Ⅱ组；Ⅲ组昼间LFnorm、昼间及夜间HFnorm 高于Ⅱ组。（3）QT变异度：Ⅰ组及Ⅲ组QT变异度昼间大于夜间，Ⅱ组昼、夜间QT变异度无显著差异。（4）三组指标的相关性：Ⅱ组伴LVH者昼间ABPVs与SDNN、昼间平均SBP与SDNN、夜间平均DBP与SDNN以及24hSDNN与QTv均呈正相关,而夜间平均DBP与HFnorm呈负相关。结论：（1）EH患者血压变异增大，昼夜波动节律消失，心率变异性降低，QT变异度昼夜无显著差异。（2）EH伴LVH者血压变异与心率变异、心率变异与QT变异间存在一定程度的相关。（3）β受体阻滞剂可一定程度增加心率变异，降低血压变异，改善血压昼夜节律。