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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Diurnal Blood Pressure and Heart Rate Variability in Hypertensive Patients with Cerebral Small Vessel Disease: A Case-Control Study
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Diurnal Blood Pressure and Heart Rate Variability in Hypertensive Patients with Cerebral Small Vessel Disease: A Case-Control Study

机译：高血压患者昼夜血压和心率变异性：案例对照研究

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Background: Whether autonomic dysfunction contributes to cerebral small vessel disease (CSVD) remains unclear. This study aimed to explore the relationship between CSVD and blood pressure variability (BPV) and heart rate variability (HRV). Methods: This case-control study recruited 50 patients with CSVD and 50 non-CSVD hypertensive age- and gender-matched controls. All participants completed a 24-h ambulatory electrocardiogram recording and ambulatory BP monitoring (ABPM). Differences in HRV and BPV between the two groups were examined. BPV indices assessed by ABPM included mean systolic BP (SBP), mean diastolic BP (DBP), coefficient of variation and weighted standard deviation of SBP and DBP. Results: CSVD patients had significant higher 24-h mean systolic BP (SBP), 24-h mean diastolic BP (DBP), daytime mean SBP, nocturnal mean SBP, and nocturnal mean DBP (P < .05 for all). CSVD patients had a significant lower nocturnal SBP fall rate compared with controls (median: 1.0 versus 6.2, respectively; P < .001) and were more likely to be non-dippers and reverse dippers. There were no differences in HRV variables between the two groups. Five logistic models were built to explore the correlations between BPV indices and CSVD. BPV indices were separately entered into the logistic regression models, together with hyperlipidemia, ischemic stroke history, current use of anti-hypertensive agents, and serum blood urea nitrogen. In models 1-3, 24-h mean SBP and nocturnal mean SBP and DBP were significantly correlated with CSVD (r(2) = 0.308-0.340). In model 4, the nocturnal SBP fall rate was negatively correlated with CSVD (odds ratio [OR] = 0.871, 95% confidence interval [CI] = 0.804-0.943; P = .001), with r(2) = 0.415 fitting the model. In model 5, the pattern of SBP dipping was significantly associated with CSVD, with non-dipper (OR = 8.389, 95%CI = 1.489-47.254; P = .016) and reverse dipper (OR = 27.008, 95%CI = 3.709-196.660; P = .001) having the highest risks of CSVD (r(2) = 0.413). Conclusions: Lower nocturnal SBP fall rate is associated with CSVD. Non-dipper and reverse dipper hypertensive patients have a higher risk of CSVD.
机译：背景：自主神经功能障碍是否与脑小血管病（CSVD）有关尚不清楚。本研究旨在探讨CSVD与血压变异性（BPV）和心率变异性（HRV）之间的关系。方法：本病例对照研究招募了50例CSVD患者和50例年龄和性别匹配的非CSVD高血压对照。所有参与者完成24小时动态心电图记录和动态血压监测（ABPM）。研究了两组之间HRV和BPV的差异。ABPM评估的BPV指数包括平均收缩压（SBP）、平均舒张压（DBP）、变异系数以及SBP和DBP的加权标准差。结果：CSVD患者的24小时平均收缩压（SBP）、24小时平均舒张压（DBP）、日间平均收缩压、夜间平均收缩压和夜间平均舒张压显著升高（均P<0.05）。与对照组相比，CSVD患者夜间收缩压下降率显著降低（中位数：分别为1.0和6.2；P<0.001），且更有可能为非杓型和反向杓型。两组之间的HRV变量没有差异。建立五个logistic模型，探讨BPV指数与CSVD的相关性。BPV指数分别与高脂血症、缺血性卒中史、目前使用的抗高血压药物和血清尿素氮一起输入logistic回归模型。在模型1-3中，24小时平均收缩压、夜间平均收缩压和舒张压与CSVD显著相关（r（2）=0.308-0.340）。在模型4中，夜间收缩压下降率与CSVD呈负相关（优势比[OR]=0.871，95%可信区间[CI]=0.804-0.943；P=0.001），r（2）=0.415符合模型。在模型5中，SBP倾斜模式与CSVD显著相关，非杓型（OR=8.389，95%CI=1.489-47.254；P=0.016）和反向杓型（OR=27.008，95%CI=3.709-196.660；P=0.001）的CSVD风险最高（r（2）=0.413）。结论：夜间收缩压下降率较低与CSVD有关。非杓型和反向杓型高血压患者患CSVD的风险较高。

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