| Objective: to investigate the relationship between heart rate variability and carotid intima media thickness(IMT)and uric microalbumin in patients with hypertension and diabetes mellitus.Methods:Collected in October 2014 to August 2018 in the first affiliated hospital of guangxi medical university hospital confirmed 491 hypertension patients and 318 patients with hypertension and diabetes,all patients were performed for 24 hours ambulatory blood pressure and dynamic electrocardiogram monitoring,blood and urine biochemical indicator detection,a comparative analysis of two groups of patients with high blood pressure and high blood pressure and diabetes about age,sex,blood biochemical indexes,dynamic parameters of blood pressure,heart rate variability index,carotid intima-media thickness(IMT),the difference of the index such as urine trace albumin,To investigate the correlation between heart rate variation and carotid intima media thickness(IMT)and urinary protein.Results:(1)compared with hypertension patients,high blood pressure and diabetes patient’s age,BMI(body mass index),duration of hypertension and TG(triglyceride),fasting glucose,glycosylated hemoglobin,BUN(blood urea nitrogen),UA(uric acid)and Ccr(endogenous creatinine clearance)weresignificantly increased(P<0.05),HDL-C(high density lipoprotein cholesterol)reduced(P<0.05),both of the patient’s gender,TC),total cholesterol,LDL-C(low density lipoprotein cholesterol),Cr(creatinine)had no significant difference(P>0.05).(2)comparison of dynamic blood pressure and ecg monitoring indexes:Compared with hypertension,high blood pressure and diabetes all day,day and night,on average,systolic blood pressure were significantly increased(P<0.05),and index of heart rate variability SDNN all sinus cardiac within 24h(R-R between the standard deviation),RMSSD(all within 24 h of the phase difference between adjacent RR root mean square),PNN50(within 24 h period between adjacent two normal sinus RR number difference of 50 ms or the percentage of the total sinus cardiac)were significantly lower(P<0.05),However,there were no significant differences in the mean diastolic blood pressure,nocturnal blood pressure drop,AASI(dynamic arteriosclerosis index),24 hour mean heart rate,and SDANN(standard deviation of the mean value of sinus r-r interval every 5 minutes within 24h)between the two groups(P>0.05).(3)compared with patients with hypertension,patients with hypertension and diabetes had significantly higher positive proportion of 24 hour urinary protein,24 hour urinary microalbumin,urinary protein/creatinine ratio and carotid atherosclerosis(IMT>0.9mm or carotid artery plaque formation).(4)to the 24 hour urine trace as the dependent variable,age,sex,body mass index(BMI)and hypertension duration,smoking history,blood lipid,SDNN as independent variables,such as binary Logistic regression analysis found that hypertension course length,LDL-C level was positively correlated with 24 hour urine trace albumin(P<0.05),SDNN and negatively correlated with 24 hour urine trace albumin(P<0.05);Whether carotid atherosclerosis as dependent variable,with age,sex and BMI,hypertensionduration,blood pressure decline,dynamic parameters,blood lipid,glycosylated hemoglobin,blood pressure,heart rate variability index as independent variables,such as binary Logistic regression analysis,the author found out that age,BMI,LDL-C,24 hour average systolic blood pressure,nighttime blood pressure drop was positively correlated with carotid atherosclerosis(P<0.05),HDL-C and negatively correlated with carotid atherosclerosis(P<0.05);(5)with SDNN as the dependent variable,age,gender,BMI,hypertension duration,smoking history,blood lipid,fasting glucose,and glycosylated hemoglobin,dynamic blood pressure parameters as independent variables,such as multiple linear regression analysis found that age,glycosylated hemoglobin,all-day average diastolic blood pressure and negatively correlation with SDNN(P<0.05),nighttime blood pressure drop was positively related with SDNN(P<0.05).Conclusions: the blood pressure level of patients with hypertension and diabetes is significantly higher than that of patients with simple hypertension,and they are more prone to abnormal urine protein and carotid atherosclerosis.Age,BMI,ldl-c,24 hour mean systolic blood pressure and nocturnal blood pressure were positively correlated with carotid atherosclerosis,while hdl-c was negatively correlated with carotid atherosclerosis.The duration of hypertension and ldl-c were positively correlated with 24 hour urinary microalbumin,while SDNN was negatively correlated with 24 hour microalbumin.SDNN,RMSSD and PNN50 were significantly decreased in patients with hypertension and diabetes mellitus,while age,hba1 c and mean diastolic blood pressure were negatively correlated with SDNN,and the decrease of blood pressure at night was positively correlated with SDNN.The above results show that hypertension and diabetic cardiac autonomic nerve disorder and is closely related to nocturnal blood pressure drop,both influenceeach other may be promote in patients with hypertension and diabetes mellitus is one of the mechanisms of proteinuria and the neck atherosclerosis,prompt adjustment nighttime blood pressure drop and cardiac autonomic nervous function might be protect patients with hypertension and diabetes mellitus to avoid damage of the important measures of kidney and neck artery. |
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