Research On The Cardiac Autonomic Nerve Activity Of The Patients With Orthostatic Hypotension

Backgroud and Objective：Vertebrobasilar insufficiency is a syndromecaused by many reasons and Orthostatic hypotension may be one of thereasons which lead to cerebrum hypoperfusion. Orthostatic hypotension hasbeen formally defined as a fall in systolic blood pressuer (SBP)of at least20mmHg and/or diastolic blood pressue (DBP) of at least10mmHg.Theclassical symptoms are dizziness、fatigue、syncope、even fracture、myocardial infarction.It also has a relation with mortality of heart andcerebral vessels disease. At prensent,it has not drawn much attention on theproblem and the affecting factors.The reseach on cardiac autonomic nerveactivity is not futher studied.The aim of the study was to analysis theincidence of OH in Vertebrobasilar insufficiency、the fall of the bloodpressure during the active standing test、risk factors and to investigate thechanges on HRV. It can be help for the the dignosis、treatment andprognosis. for the patients with Orthostatic hypotension.Method: The patients of vertebrobasilar insufficiency came from theDepartment of Neurology of Chongqing Medical Hospital from novermber 2010to novermber2011.We chose the patients by the adoption andexclusion standards. The patients chosen must undertook the activestanding test at6:00-7：00after the next morning,continuing for3days.Thedignosis of OH is made by ESC、EHRA、HFA、HRS，which announcedguidelines for the diagnosis and management of syncope. At the sametime,we collected the24hours HRV from the patients.During the activestanding test,we analyzed the incidence of OH、the fall of the bloodpressure、the changes of the HRV and influencing factors.We could dividiethe patients into two groups as OH group and non-OH group.Results：100patients accorded standards were enrolled in the study,duringthe investigation,18patients were absencent, the incidence of theOrthostatic hypotension (18patients) was21.95%.We might find thesystolic blood pressure of77%of OH patients drop obviously at3min;About10%of OH patients occurred tardive OH at5min. During thetest, both the systolic and distatolic blood pressue of A group were higherthan B group when decubitus position; the systolic blood pressure wasstatisticaly lower than B group.and not sufficient compensation afterstanding3min;the blood pressure of A group had no changes and thediastolic blood pressure was lower than B group. The parameters of HRV(SDNN、SDNNIndex、SDANNIndex、PNN50、rMSSD、TP、HF、LF)ofA group were lower than B group.（p＜0.05）Comparing A and Bgroups,there were obviously different at age、glycosylated hemoglobin、 triglyceride、 HDL-C、 LDL-C、 creatinnine、 IMT、 diabetes、 alcoholdrinking..while there were little differences at body weight、gender、smoking、 hypertation、 antihypertensive treatment. By the logsticanalysis,we also found that SDNNIndex、TP、HDL-C were the independentOH determinants.Conclusions: Orthostatic hypotension is common reason for dizzeniessin elderly, we should routinely measure the standing blood pressure forVertebrobasilar insufficient patinents,especially combined diabetes、abnormal blood fat、carotid atherosclerosis、alcohol drinking.Sometimes weshould take automatic nerve test in order to diminish the diagnostic errorsand treat patients better.