背景:根据收缩压和舒张压(BP),可以将高血压分为不同的表型,这些表型具有不同的预后,因此可能与交感神经活动相关。我们评估了通过连续手指BP记录确定的心脏自主神经功能与高血压表型之间的关联。方法:我们纳入了多种族HELIUS研究中的10,221名年龄在18-70岁之间的个体。连续记录手指BP3-5分钟,从中确定互相关压力反射敏感性(xBRS)和心率变异性(HRV)。高血压分为单纯收缩期(ISH;≥140/<90),舒张压(IDH;<140/≥90)和收缩期和舒张期合并高血压(SDH;≥140/≥90)。根据年龄(年龄:≤40岁,年龄:>40岁)和性别进行分层后评估差异,对相关协变量使用带校正的回归。对于xBRS,值进行了对数转换。结果:在患有ISH的年轻成年人中,xBRS与男性(比率0.92;95CI0.84-1.01)和女性(1.00;95CI0.84-1.20)的正常血压个体相当,而IDH和SDH的xBRS显著较低(比值介于0.67和0.80之间)。在老年人中,与正常高血压患者相比,所有高血压表型的xBRS均显著降低.我们在男性中发现了类似的HRV模式,而在女性中,HRV在表型之间没有差异。结论:在年轻男性和女性中,ISH与交感神经控制增加的转变无关。而年轻和所有老年高血压表型参与者的IDH和SDH与交感神经控制增加相关.这表明自主神经调节的改变可能是导致高血压表型之间已知预后差异的因素。
根据具有不同预后的收缩压和舒张压(BP),高血压可以分为不同的表型。自主神经调节受损在高血压的发病机制中很重要,并且与不良心血管结局独立相关。我们分析了参与HELIUS队列研究的10.000多名患者的3-5分钟连续非侵入性手指血压记录。从这些测量中,使用自动算法确定短期心率变异性(HRV)和互相关压力反射敏感度(xBRS).在我们的分析中,我们观察到自主神经调节与高血压表型之间的关系存在明显差异,这取决于年龄和性别。年轻男性和女性(年龄18-40岁)的单纯收缩期高血压与正常血压相比,xBRS和HRV值相似,而孤立的舒张期高血压与交感神经控制的增加有关。与我们在年轻人身上的发现相反,在老年参与者(年龄40~70岁)中,所有高血压表型均与交感神经控制增强相关.这支持了早期显示预后差异的研究,并表明交感迷走神经平衡的改变可能是表型之间差异的促成因素。
Background: Hypertension can be classified into different phenotypes based on systolic and diastolic blood pressure (BP) that carry a different prognosis and may therefore be differently associated with sympathetic activity. We assessed the association between cardiac autonomic function determined from continuous finger BP recordings and hypertensive phenotypes. Methods: We included 10,221 individuals aged between 18-70 years from the multi-ethnic HELIUS study. Finger BP was recorded continuously for 3-5 minutes from which cross-correlation baroreflex sensitivity (xBRS) and heart rate variability (HRV) were determined. Hypertension was classified into isolated systolic (
ISH; ≥140/<90), diastolic (IDH; <140/≥90) and combined systolic and diastolic hypertension (SDH; ≥140/≥90). Differences were assessed after stratification by age (younger: ≤40, older: >40 years) and sex, using regression with correction for relevant covariates. For xBRS, values were log-transformed. Results: In younger adults with
ISH, xBRS was comparable to normotensive individuals in men (ratio 0.92; 95%CI 0.84-1.01) and women (1.00; 95%CI 0.84-1.20), while xBRS was significantly lower in IDH and SDH (ratios between 0.67 and 0.80). In older adults, all hypertensive phenotypes had significantly lower xBRS compared to normotensives. We found a similar pattern for HRV in men, while in women HRV did not differ between phenotypes. Conclusions: In younger men and women
ISH is not associated with a shift towards increased sympathetic control, while IDH and SDH in younger and all hypertensive phenotypes in older participants were associated with increased sympathetic control. This suggests that alterations in autonomic regulation could be a contributing factor to known prognostic disparities between hypertensive phenotypes.
Hypertension can be classified into different phenotypes based on systolic and diastolic blood pressure (BP) that carry a different prognosis. Impaired autonomic regulation is important in the pathogenesis of hypertension and independently associated with adverse cardiovascular outcomes.We analyzed 3-5 minutes continuous non-invasive finger blood pressure recordings performed in over 10.000 individuals participating in the HELIUS cohort study. From these measurements, short term heart rate variability (HRV) and cross correlation baroreflex sensitivity (xBRS) were determined using an automatic algorithm.In our analysis we observed pronounced differences in the relation between autonomic regulation and hypertensive phenotypes that depend on age and sex.Younger men and women (age 18-40 years) with isolated systolic hypertension had similar values for xBRS and HRV compared to normotensives, while isolated diastolic hypertension was associated with a shift towards increased sympathetic control. In contrast to our findings in younger individuals, all hypertensive phenotypes were associated with increased sympathetic control in older participants (age 40-70 years).This supports earlier studies showing prognostic differences and suggests that alterations in sympathovagal balance could be a contributing factor to the disparities between phenotypes.