心率变异性与平滑指数对高血压左室肥厚逆转的影响
심솔변이성여평활지수대고혈압좌실비후역전적영향
Effects of heart rate variability and smoothness index on the reversal of hypertensive left ventricular hypertrophy
  • 万方数据
    中华医学杂志 중화의학잡지
    National Medical Journal of China
    2011年 12期 832-835 ,共4页

    王宏保%施青%张超

    왕굉보%시청%장초

    左心室肥厚%心率变异性%平滑指数%血管紧张素Ⅱ受体阻滞剂 左心室肥厚%心率變異性%平滑指數%血管緊張素Ⅱ受體阻滯劑
    좌심실비후%심솔변이성%평활지수%혈관긴장소Ⅱ수체조체제
    Left ventricular hypertrophy%Heart rate variability%Smoothness index%Angiotensin Ⅱ receptor blocker
    目的 探讨心率变异性(HRV)与平滑指数(SI)对高血压左室肥厚(LVH)逆转的影响.方法 选择未经治疗的高血压病LVH患者127例,给予口服海捷亚1片/d+美托洛尔(12.5～50 mg/次,2次/d).观察治疗20周前后坐位血压、超声心动图[主要检测舒张期左室后壁厚度(PWT)、室间隔厚度(IVST)、左室舒张末期内径(LVDd)与左室收缩末期内径(LVDs)等并计算左室质量指数(LVMI)]、24 h动态血压监测(ABPM)[主要包括24 h平均压、白昼平均压与夜间平均压等,并计算谷峰比值(T/P)与SI]、24 h动态心电图[主要测定时域指标中的SDNN(全部正常窦性心搏间期的标准差)、RMSSD(全部窦性心搏间期差的均方根)、PNN50(相邻正常窦性心搏问期差＞50ms的心搏数占全部心搏数的百分比)和频域指标中的低频(LF)、高频(HF)及LF/HF]等相关指标的变化.结果 20周后患者坐位血压明显下降Sbp(158.7±12.1)mm Hg与(132.2±14.0)mm Hg(1 mm Hg=0.133 kPa);Dbp(97.2±7.7)与(86.4±6.5)mm Hg,P＜0.001;超声心动图相关参数及LVMI明显下降[LVMI(128.9±32.4)g/m2与(118.4±31.1)g/m2,P＜0.01];24 h动态血压监测相关指标明显下降[24 h平均收缩压(146.2±10.1)mm Hg与(129.7±6.1)mm Hg,P＜0.001;24 h平均舒张压(93.5±5.5)mm Hg与(81.8±6.7)mm Hg,P＜0.01;白昼平均收缩压(149.5±8.7)mm Hg与(133.6±6.3)mm Hg,P＜0.001;白昼平均舒张压(94.7±5.0)mm Hg与(83.6±7.0)mm Hg,P＜0.001;夜间平均收缩压(137.2±8.7)mm Hg与(122.7±7.6)mm Hg,P＜0.001;夜间平均舒张压(86.7±6.2)mm Hg与(72.8±5.5)mm Hg,P＜0.001].治疗后收缩压与舒张压的T/P值分别为0.79和0.71,治疗后收缩压与舒张压的SI值分别为1.4±0.5和1.2±0.6.而反映HRV变化的指标中SDNN、RMSSD、PNN50与HF明显增加[SDNN(97.3±16.7)ms与(152.3±34.2)ms,P＜0.01;RMSSD(21.3±8.7)ms与(41.9±10.4)ms,P＜0.001;PNN50(3.2±1.2)与5.9±2.2;P＜0.01;HF(239.8±98.3)ms2/Hz与(367.3±188.4)ms2/Hz,P＜0.01],LF和LF/HF明显下降[LF(485.2±217.3)ms2/Hz与(287.9±128.6)ms2/Hz,P＜0.01;LF/HF(2.03±0.56)与(0.79±0.38),P＜0.001].结论 血管紧张素Ⅱ受体阻滞剂+利尿剂+β1受体阻滞剂可平稳降低高血压LVH患者的血压、改善其心率变异性、逆转LVH.
    목적 탐토심솔변이성(HRV)여평활지수(SI)대고혈압좌실비후(LVH)역전적영향.방법 선택미경치료적고혈압병LVH환자127례,급여구복해첩아1편/d+미탁락이(12.5～50 mg/차,2차/d).관찰치료20주전후좌위혈압、초성심동도[주요검측서장기좌실후벽후도(PWT)、실간격후도(IVST)、좌실서장말기내경(LVDd)여좌실수축말기내경(LVDs)등병계산좌실질량지수(LVMI)]、24 h동태혈압감측(ABPM)[주요포괄24 h평균압、백주평균압여야간평균압등,병계산곡봉비치(T/P)여SI]、24 h동태심전도[주요측정시역지표중적SDNN(전부정상두성심박간기적표준차)、RMSSD(전부두성심박간기차적균방근)、PNN50(상린정상두성심박문기차＞50ms적심박수점전부심박수적백분비)화빈역지표중적저빈(LF)、고빈(HF)급LF/HF]등상관지표적변화.결과 20주후환자좌위혈압명현하강Sbp(158.7±12.1)mm Hg여(132.2±14.0)mm Hg(1 mm Hg=0.133 kPa);Dbp(97.2±7.7)여(86.4±6.5)mm Hg,P＜0.001;초성심동도상관삼수급LVMI명현하강[LVMI(128.9±32.4)g/m2여(118.4±31.1)g/m2,P＜0.01];24 h동태혈압감측상관지표명현하강[24 h평균수축압(146.2±10.1)mm Hg여(129.7±6.1)mm Hg,P＜0.001;24 h평균서장압(93.5±5.5)mm Hg여(81.8±6.7)mm Hg,P＜0.01;백주평균수축압(149.5±8.7)mm Hg여(133.6±6.3)mm Hg,P＜0.001;백주평균서장압(94.7±5.0)mm Hg여(83.6±7.0)mm Hg,P＜0.001;야간평균수축압(137.2±8.7)mm Hg여(122.7±7.6)mm Hg,P＜0.001;야간평균서장압(86.7±6.2)mm Hg여(72.8±5.5)mm Hg,P＜0.001].치료후수축압여서장압적T/P치분별위0.79화0.71,치료후수축압여서장압적SI치분별위1.4±0.5화1.2±0.6.이반영HRV변화적지표중SDNN、RMSSD、PNN50여HF명현증가[SDNN(97.3±16.7)ms여(152.3±34.2)ms,P＜0.01;RMSSD(21.3±8.7)ms여(41.9±10.4)ms,P＜0.001;PNN50(3.2±1.2)여5.9±2.2;P＜0.01;HF(239.8±98.3)ms2/Hz여(367.3±188.4)ms2/Hz,P＜0.01],LF화LF/HF명현하강[LF(485.2±217.3)ms2/Hz여(287.9±128.6)ms2/Hz,P＜0.01;LF/HF(2.03±0.56)여(0.79±0.38),P＜0.001].결론 혈관긴장소Ⅱ수체조체제+이뇨제+β1수체조체제가평은강저고혈압LVH환자적혈압、개선기심솔변이성、역전LVH.
    Objective To investigate the relationship of reversal of hypertensive left ventricular hypertrophy (LVH) with heart rate variability (HRV) and smoothness index (SI).Methods A total of 127 patients with untreated essential hypertension associated with LVH were enrolled to receive a 20-week treatment.The drugs included losartan potassium & hydrochlorothiazide (1 tablet/day ) and metoprolol (12.5 mg- 50 mg twice daily).The sitting systolic and diastolic blood pressures (SBP & DBP),M-mode and pulsed Doppler echocardiography,24-hour ambulatory blood pressure monitoring (ABPM) and 24-hour ambulatory ECG (Holter) were performed at pre- and post-treatment.The changes in various parameters such as echocardiography left ventricular end-systolic dimension (LVDs),left ventricular end-diastolic dimension (LVDd) and the thickness of interventricular septum (IVST) and posterior wall (PWT) were measured.And left ventricular mass index (LVMI) and smoothness index (SI) were also examined.The evaluated parameters of ABPM were average 24-hour,daytime and nighttime SBP & DBP.As to 24-hour ambulatory ECG (Holter),the parameters were standard deviation of normal to normal intervals (SDNN),rate mean square of the differences of successive RR intervals ( RMSSD ) ,percentage of RR intervals differing ＞50 ms (PNN50),high frequency (HF) and low frequency (LF).Results After a 20-week treatment,the levels of sitting blood pressure(SBP 158.72 ± 12.11 mm Hg vs 132.21 ± 14.03 mm Hg;DBP 97.20 ± 7.71 vs 86.36 ± 6.48 mm Hg,P ＜ 0.001 ),parameters of 24-hour ABPM (24-hour mean SBP146.20 ±10.11 mm Hg vs 129.68 ±6.12 mm Hg,P＜0.001;24-hour mean DBP93.45 ±5.46mm Hg vs 81.77 ±6.71 mm Hg,P ＜0.01;daytime mean SBP 149.53 ±8.67 mm Hg vs 133.60 ±6.27mm Hg,P＜0.001;daytime mean DBP 94.68 ±4.96 mm Hg vs 83.55 ±7.03 mm Hg,P＜0.001;nighttime mean SBP 137.21 ± 8.73 mm Hg vs 122.74 ± 7.58 mm Hg,P ＜ 0.001;nighttime mean DBP 86.75 ±6.22 mm Hg vs 72.81 ±5.47 mm Hg,P ＜0.001 ) and LVMI significantly decreased ( 128.90 ±32.35 g/m2 vs 118.39 ± 31.10 g/m2,P ＜ 0.01 ) while the indicators of HRV changes such as SDNN,RMSSD,PNN50 and HF significantly increased( SDNN 97.28 ± 16.67 ms vs 152.27 ± 34.23 ms,P ＜0.01;RMSSD 21.32±8.70 ms vs 41.91 ±10.38 ms,P ＜0.001;PNN50 3.17 ±1.23 vs 5.89 ±2.18,P ＜ 0.01;HF 239.82 ± 98.26 ms2/Hz vs 367.32 ± 188.37 ms2/Hz,P ＜ 0.01 ) accompanied by the decreases in LF and LF/HF( LF 485.22 ±217.34 ms2/Hz vs 287.94 ± 128.61 ms2/Hz,P ＜0.01;LF/HF 2.03 ±0.56 vs 0.79 ± 0.38,P ＜ 0.001 ).The post-treatment SIs of SBP and DBP were 1.35 and 1.2 respectively.Conclusion The combination treatment of angiotensin Ⅱ receptor blocker ( ARB ),diuretics and β1-receptor blockers can lower the blood pressures stably,improve heart rate variability and lead to a reversal of hypertensive LVH.
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