社区高血压患者自主神经功能检测及其价值研究

背景　高血压严重威胁人类健康，高血压的发生与交感神经过度激活及自主神经功能失调相关，而目前对社区人群自主神经功能检测的研究较少。目的　探讨社区人群自主神经功能受损与高血压发病与血压控制的关系。方法　随机选取2017年6月-2019年6月在社区卫生服务中心完成24 h动态心电图检查的120例高血压患者和100例非高血压人群为研究对象。高血压患者根据血压达标情况分为血压控制组（n=67）和血压未控制组（n=53）。分析高血压患者与非高血压人群、血压控制组和血压未控制组患者心率变异性参数，包括全部窦性RR间期的标准差（SDNN）、每5分钟窦性RR间期均值标准差（SDANN）、全程相邻RR间期差值的均方根（rMSSD）、全部相邻的RR间期差值大于50 ms的百分数（pNN50）、极低频（VLF）、低频（LF）、高频（HF）、LF/HF及非特异性ST-T改变情况。采用多因素Logistic回归分析高血压及血压控制的危险因素。结果　高血压组rMSSD、VLF、LF、HF值低于非高血压组，差异有统计学意义（P<0.05）。校正性别、年龄、体质指数、吸烟及冠心病病史后，多因素Logistic回归分析结果显示rMSSD、VLF值降低是高血压的危险因素（P<0.05）。血压未控制组联合用药占比高于血压控制组，rMSSD、pNN50、HF、VLF、LF值低于控制组，差异有统计学意义（P<0.05）。校正性别、年龄、体质指数、吸烟及冠心病病史后，多因素Logistic回归分析结果显示rMSSD、PNN50、VLF降低和非特异性ST-T改变是高血压控制不达标的危险因素（P<0.05）。结论　自主神经功能受损是社区高血压及血压控制的危险因素，用动态心电图评估自主神经功能状态具有一定预测价值。

Value of Autonomic Nerve Function Assessment in Community-dwelling Patients with Hypertension

Background Hypertension is a serious threat to human health.The occurrence of hypertension is related to excessive sympathetic activation and autonomic dysfunction.At present,there are few studies on autonomic nerve function detection in community-dwelling population.Objective To explore the association of impaired autonomic function with hypertension incidence and blood pressure control rate in community-dwelling population.Methods A retrospective study was conducted.Participants with complete data of 24-hour ambulatory ECG were recruited from a community health center during June 2017 to June 2019,including 120 hypertensive cases(including 67 with controlled hypertension and 53 with uncontrolled hypertension)and 100 non-hypertensive cases.The parameters of heart rate variabilit〔y standard deviation of RR interval(s SDNN),standard deviation of the 5-minute mean RR intervals(SDANN),square root of the mean squared differences of successive RR intervals(rMSSD),number of successive RR intervals differing by>50 ms divided by the total number of successive RR intervals(pNN50),very low frequency(VLF),low frequency(LF),high frequency(HF),LF/HF〕,and nonspecific ST-T wave changes were compared between hypertensive and non-hypertensive cases,and between hypertensive cases with controlled and uncontrolled hypertension.Multivariate Logistic regression model was used to analyze the risk factors of hypertension and hypertension control.Results The mean values of rMSSD,VLF,LF and HF were significantly lower in the hypertensive group than those in the non-hypertensive group(P<0.05).Multivariate Logistic regression analysis showed that reduced rMSSD,and VLF were risk factors of hypertension after adjusting for gender,age,body mass index,smoking and coronary heart disease(P<0.05).Hypertensive cases with controlled hypertension had higher prevalence of combination drug treatment,and lower mean values of rMSSD,pNN50,HF,VLF and LF than those with uncontrolled hypertension(P<0.05).Multivariate Logistic regression analysis showed that reduced rMSSD,pNN50 and VLF value and non-specific ST-T wave changes were risk factors for uncontrolled hypertension after adjusting for gender,age,body mass index,smoking and coronary heart disease(P<0.05).Conclusion Our study shows that impaired autonomic function may be a risk factor for hypertension and uncontrolled hypertension in community-dwelling population.The autonomic nerve function evaluated by 24-hour ambulatory ECG has predictive value for hypertension in this group.