隐性高血压及白大衣性高血压患者的窦性心率震荡变化及临床意义

目的:探讨隐性高血压(MH)及白大衣性高血压(WCH)患者的窦性心率震荡(HRT)变化及临床意义。方法:将120例高血压患者的临床资料进行回顾性分析,其中MH患者58例,WCH患者62例。另外选择同期收治的原发性高血压(EH)患者60例,健康体检者(NT组)60例,对上述四组进行24h动态血压、24h动态心电图进行监测,从而计算出HRT的参数--初始震荡TO(%)、震荡斜率TS(ms/RR)、SDNN(ms)、SDANN(ms)及RMSSD(ms),并对各组进行比较、分析。结果:(1)高血压组(EH组、MH组及WCH组)血压(24hSBP、24hDBP、dSBP、dDBP、平均收缩压及平均舒张压)较NT组差异具有统计学意义(P<0.05),但高血压组内血压无统计学差异(P>0.05);(2)高血压组较NT组TO明显增大、TS明显减小,差异具有统计学意义(P<0.01),但高血压组内TO、TS值无统计学差异(P>0.05);(3)高血压组SDNN、SDANN、RMSSD及PNN50(%)较NT组的差异具有统计学意义(P<0.05),但高血压组内SDNN、SDANN、RMSSD及PNN50(%)差异无统计学意义(P>0.05)。结论:MH与WCH患者同原发性高血压一样,HRT均发生显著性变化,应对HRT各参数值进行动态监测。

Changes and clinical significance of masked hypertension and white coat hypertension in patients with sinus heart rate turbulence

Objective: To investigate the masked hypertension(MH) and white coat hypertension(WCH) in patients with sinus heart rate turbulence(HRT) changes and clinical significance.Methods: The clinical data of 120 hypertensive patients admitted during 2007.07-2012.07 was retrospectively analyzed,including 58 cases of MH patients and 62 cases of WCH patients.In addition,60 cases of essential hypertension(EH),and 60 cases of healthy subjects(NT group) were selected in the same period.24 h ambulatory blood pressure and 24 h ambulatory electrocardiogram of 4 groups were monitored,and then the parameters of the HRT-initial shock TO(%),the shock slope of the TS(ms / RR),SDNN(ms) SDANN(ms) and RMSSD(ms) were calculated,and compared.Results: There was a significant difference in blood pressure(24 h SBP,24 h DBP,dSBP,dDBP,average systolic and mean diastolic blood pressure) between hypertension group(EH group,MH Group and WCH group) and the NT group(P<0.05),but difference in blood pressure was no significant among EH group,MH Group and WCH group(P>0.05).TO value in the hypertension group increased significantly in hypertension group compared with NT group,and TS value in the hypertension group decreased significantly(P<0.01),but TO and TS value showed no significant difference among EH group,MH Group and WCH group(P>0.05);There were a statistical differences in SDNN,SDANN,RMSSD and PNN50(%) in the hypertension group compared with NT group(P<0.05),but no significant difference among EH group,MH Group and WCH group(P>0.05).Conclusions: HRT has changed significantly in MH and WCH patients,which is the same as patients of essential hypertension,and HRT parameter values should be monitored dynamically.