Objective To explore the effects of hyperhomocysteinemia(HHCY) on circadian rhythm of blood pressure and heart rate variability in elderly hypertensive patients with ambulatory blood pressure and ambulatory electrocardiogram performed simultaneously. Methods 105 essential hypertensive patients were divided into two groups:with or without hyperhomocysteinemia. All patients were monitored simultaneously by ambulatory blood pressure and ambulatory electrocardiogram. Nocturnal blood pressure decline rate was calculated as circadian rhythm of blood pressure. The relationships between circadian rhythm of blood pressure and Hcy and heart rate variability were analyzed by using multivariate logistic regression. Results Compared with non HHCY hypertension group,the percentage of non dipper blood pressure rhythm was higher in HHCY hypertension group(73.5％ VS 29.1％,P<0.01);SDNN,rMSSD,PNN50 were lower in the HHCY hypertension group(P<0.05). LF,LF/HF were higher in the HHCY hypertension group than in the non HHCY hypertension group (P<0.05).Multivariate logistic regression analysis showed that abnormal Circadian rhythm of blood pressure was associated with SDNN,LF and HCY(OR:1.338;0.562;1.121,95％CI:1.123～1.648;0.335～0.943;0.887～1.989;P<0.05). Conclusion Non dipper blood pressure is common in the people with hypertension and hyperhomocysteinemia. Decreased heart rate variability may be associated with autonomic dysfunction.%目的 同步进行动态血压及动态心电图检测,探讨高同型半胱氨酸血症(HCY)对老年高血压患者血压昼夜节律及心率变异性的影响.方法 选择原发性高血压患者105例,按是否伴有高同型半胱氨酸血症分为两组,高HCY组及非高HCY组.同步行动态血压及动态心电图检测,血压昼夜节律以夜间血压下降率表示,采用多因素Logistic回归分析血压昼夜节律与Hcy及心率变异性的关系.结果 与非高HCY组比较,高HCY组非勺型血压节律占比高(73.5％VS 29.8％,P<0.01);高HCY组SDNN、rMSSD、PNN50均较低(P<0.05);高HCY组LF、LF/HF值较非高HCY组高(P<0.05);以血压昼夜节律是否为非勺型作为因变量,进行Logistic回归分析显示:SDNN、LF、HCY与血压昼夜节律紊乱独立相关(OR:1.338;0.562;1.121,95％CI:1.123～1.648;0.335～0.943;0.887～1.989;P<0.05).结论 高血压合并高HCY者非勺型血压多见,心率变异性减低,可能与自主神经功能紊乱有关.
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