血压负荷,血压昼夜节律及心率变异性与左室肥厚的关系

目的：观察高血压左心室肥厚患者血压负荷，血压昼节律和心率变异性及其相关性。方法：选择伴有左室肥厚的高血压患者31例（I组），不伴左心室肥厚的高血压患者33例（Ⅱ组），选择年龄与患者可比的健康人30例作为对照组（Ⅲ组），进行动态血压与动态心电图同步监测，分析24小时血压负荷，血压昼夜节律及24小时心率变异性时域指标。结果：（1）血压负荷，血压昼节律：I、Ⅱ组24小时血压负荷，日间血压及夜间血压显著高于Ⅲ组，I组与Ⅱ组间血压负荷有显著差异；I与Ⅱ组非构型血压显著高于Ⅲ组，I与Ⅱ组二者间的非构型高血压出现率有显著差异。（2）心率变异性：I、Ⅱ组心率变异性各参数显著低于Ⅲ组，I与Ⅱ组间心率变异性也有显著差异。（3）四个指标的相关性：I组HRV与24小时血压负荷，非构型出现率及左室肥厚呈负相关。结论：高血压左室肥厚患者昼夜节律消失，血压负荷增加，心率变异性降低。副交感神经调节功能减弱可能与上述变化有关。高血压治疗中应注意改变心率变异性，恢复血压昼夜节律，减少血压负荷。

THE RELATIONSHIP AMONG BLOOD PRESSURE LOAD,CIRCADIAN RHYTHM OF BLOOD PRESSURE ,HEART RATE VARIABILITY AND LEFT VENTRICULAR HYPERTROPHY IN ESSENTIAL HYPERTENSION

Objective: To investigate the relationship among blood pressure load (BPL),the circadian rhythm of blood pressure,heart rate variability(HRV)and left ventricular hypertrophy (LVH) in esstential variability (EH). Methods; 31 hypertensive patients with LVH and 33 without LVH and 30 controls were recoded by Holter ECG and 24 hour ambulatory blood pressure. Result: (1)Each paramter of BPL in hypertensive patients with LVH and without LVH were markedly lower than that in controls. (2)Each paramter of HRV in hypertensive patients with LVH and withoout LVH were markedly lower than that in controls. (3)In EH with LVH and without LVH there were positive realation a-mong HRV BpL and LVH.Conclusion:In EH patients,HRV were reduced and the circadian rhythm of blood pressure were disappeared. Decreased parasympathetic acivity may be associated with these change metioned above. We should pay attention to impoving HRV and recovering circadian rhythm of blood pressure in the treatment for hypertension.