不同昼夜节律高血压患者心率减速力检测的临床意义

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Abstract Objective To investigate the clinical significance of the changes of deceleration capacity of rate (DC) in patients with primary hypertension of different circadian rhythm. Methods One hundred and eighty-four patients with primary hypertension treated in the Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University (“our hospital” for short) from January 2014 to December 2016 were selected and given ambulatory blood pressure monitoring. According to the descent rate of nighttime blood pressure, they were divided into two groups: the patients with descent rate of ＜10% were taken as non-dipper pattern hypertension group (NDPH group, 118 cases), the patients with descent rate of ≥10% were taken as dipper pattern hypertension group (DPH group, 66 cases). 50 healthy subjects taken physical examination in our hospital at the same time were taken as control group. 24 h Holter was used to detect and compare the levels of DC, acceleration capacity of rate (AC), heart rate variability (HRV) among the three groups, and their relevance was analyzed. Results The DC and standard deviation of normal sinus RR intervals (SDNN) in NDPH group and DPH group were significantly lower than that of control group, and AC was significantly higher than that of control group (all P ＜ 0.01); the root mean square of standard deviations of differences between adjacent normal RR intervals (RMSSD) and the proportion derived by dividing NN50 by the total number of NN intervals (PNN50) in NDPH group were significantly lower than that of control group (P ＜ 0.05). DC and SDNN in NDPH group were significantly lower than that of DPH group, and AC was significantly higher than that of DPH group (P ＜ 0.05). In NDPH group, DC was significantly positively correlated with SDNN, RMSSD (P ＜ 0.01, P ＜ 0.05) and negatively correlated with AC (P ＜ 0.01). Conclusion The patients with primary hypertension of different circadian rhythm have impaired autonomic nerve function, and its imbalance in NDPH group is more obvious than that in DPH group. In clinical practice, physicians should not only care for the blood pressure control, but also pay attention to the changes of autonomic function and circadian blood pressure rhythm in the diagnosis and treatment of hypertension.

Key words： Autonomic nervous system Circadian rhythm Hypertension Deceleration capacity of rate

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	ZHOU Li WANG Xingde SHEN Shurong CHENG Pei CHEN Bin CHEN Zhong

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ZHOU Li WANG Xingde SHEN Shurong CHENG Pei CHEN Bin CHEN Zhong. Clinical significance of detection of deceleration capacity of rate in patients with primary hypertension of different circadian rhythm[J]. 中国医药导报, 2017, 14(29): 61-64.

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http://www.yiyaodaobao.com.cn/EN/ OR http://www.yiyaodaobao.com.cn/EN/Y2017/V14/I29/61

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