心率减速力与心率昼夜节律对高血压患者预后的影响

目的：探讨高血压患者杓型心率、非杓型心率患者心率变异与心率减速力的变化及其预后，为高血压患者的临床治疗及预后提供预警指标。方法随机选原发性高血压患者185例，以心源性死亡为终点，进行0.5～4年的追踪随访。按心率/血压昼间均值-夜间均值/昼间均值≥10%者定为杓型心率/血压，＜10%者定为非杓型心率/血压。分杓型心率组116例，非杓型心率组69例，全部做24 h动态心电和动态血压同步监测，采集静息心率（RHR）、平均心率（AHR）、昼间心率（DHR）、夜间心率（NHR），心率变异的定量指标低频（LF）、高频（HF）和心率减速力（DC）、心率加速力（AC）进行统计分析。结果高血压患者杓型心率者以杓型血压为主（62.93%），非杓型心率者以非杓型血压为主（86.96%），且静息心率和夜间心率显著加快（P＜0.001），非杓型心率者死亡人数是杓型心率的4倍，非杓型心率者较杓型心率者交感神经与迷走神经张力显著减低（P＜0.0001）。结论高血压患者心率和血压昼夜节律同步消失者HRV、DC显著减低，预后差。

Effect of deceleration capacity of heart rate and heart rate circadian rhythm on the prognosis of patients with hypertension

Objective To explore the variation and prognosis of heart rate variability and deceleration capacity of heart rate in hypertensive patients with dipper heart rate and non-dipper heart rate, provide the predictor for the clinical treatment and prognosis. Methods 185 cases of patients with essential hypertension were randomly selected, and ended in cardiac death followed up for 0.5-4 years. According to the numerical value＂the day heart rate （DHR）-the night heart rate （NHR）/the night heart rate （NHR）＂, patients were divided into the dipper heart rate group （〉10%） and the non-dipper heart rate group （〈10%）. And patients were also divided into the dipper BP group （〉10%） and the non-dipper BP group （〈10%） with the same method. 116 cases were in the group of dipper heart rate, 69 cases were in the group of non-dipper heart rate. All patients were synchronously monitored by 24 h Holter and ambulatory blood pressure. Observe resting heart rate （RHR）, average heart rate （AHR）, daytime heart rate （DHR）, night heart rate （NHR）, LF, HF（the quantitative index of heart rate variability）, deceleration capacity of heart rate （DC）, acceleration capacity of heart rate （AC） and analysed by SPSS 15.0 Statistical software. Results Dipper blood pressure predominate in hypertensive patients with dipper heart rate（62.93%）, Non-dipper blood pressure predominate in hypertensive patients with Non-dipper heart rate（86.96%）. And the value of RHR and NHR were significantly increased（P〈0.001）. The mortality in Non-dipper heart rate group is four times higher than in dipper heart rate group, the tension of sympathetic and vagal reduced significantly in Non-dipper heart rate group than in dipper heart rate group（P〈0.001）. Conclusion The circadian rhythm of heart rate and blood pressure in patients with hypertension synchronized disappeared, the value of HRV, DC was decreased significantly and indicate the poor prognosis.