NGHIÊN cứu BIẾN THIÊN NHỊP TIM và HIỆN TƯỢNG KHÔNG GIẢM HAY GIẢM HUYẾT áp về đêm TRÊN BỆNH NHÂN TĂNG HUYẾT áp BẰNG HOLTER HUYẾT áp và điện TIM 24 GIỜ

476

NGHIÊN CU BIN THIÊN NHP TIM VÀ HING KHÔNG GIM
HAY GIM HUYT ÁP V T ÁP
BNG HOLTER HUYN TIM 24 GI

Trn Minh Trí
1
, Hu
2

1
Bnh vin Nguyn Trãi,
2



 


p.
 

h giá là nhóm
Non-Dipper.
-
-


2
), LF (ms

2
)

 
-



SUMMARY
Objective: to evaluate the differences in heart rate variability (HRV) in hypertensive patients
according to day-night decreasing of the systolic (SBP) and diastolic (DBP) blood pressure.
Patients and Methods: 60 patients with essential hypertension (EH) were included in this
study. All patients had 24h ambulatory blood pressure monitoring and 24 h electrocardiographic
monitoring. According to daily index (DI) all patients were divided into 2
groups: 1st gr. 23 patients with DI for SBP and DBP 10-20 % ("dippers"); 2nd gr. 37 patients
with DI for both SBP and DBP < 10 % ("non-dippers").
Results: In the non-dipper patients, indexes of time-domain analysis such as the SDNN
(ms), SDANN (ms), RMSSD (ms) were significantly lower than that of the dipper patients.
Additionally, as for spectral analysis, the HF (ms
2
), LF (ms
2
) was lower than that of the dipper
Patients (p<0.05).
Conclusion: Decrease in parasympathetic nervous function and increase in sympathetic
nervous function may contribute to occurrence of non-dipper phenomenon. These data may
partially explain the higher incidence of cardiovascular events reported in non dipper patients.






(THA) [6
                  

-Dipper) hay gi
477
5].




 





- 
- 



version 3.3.2.
- Tiêu c      
-


- 




[2]









HF, ms
2
thn kinh phó giao cm
LF, ms
2
-

VLF, ms
2
-thn kinh giao cmphó giao
cm
ULF, ms
2
--
thn kinh giao cm

TF, ms
2

 0.4Hz.
[1][8]
- - - 

- 
- 





< 125/75
< 130/80
478
Ban ngày
< 130/80
< 135/85

< 115/65
< 120/70





Nam, n=32




17 (28.3%)
15 (25.0%)
15 (25.0%)
13 (21.7%)
HATTh (mmHg)
Ngày
162.38±2.8
162.61±3.6

150.03±2.9
147.64±4.1
HATTr (mmHg)
Ngày
95.78±2.3
98.79±2.4

84.81±1.7
87.86 (2.1
Dipper

15 (25.0%)
8 (13.3%)
Non-Dipper

17 (28.3%)
20 (33.3%)
 
 - 

Dipper, n=23


Non-Dipper, n=37

p
HATTh(mmHg)
Ngày
155.70±1.4
166.70±3.3
<0.05

142.57±2,7
152.86±3.5
<0.05
HATTr (mmHg)
Ngày
93.74±1.0
99.32±2.5
<0.05

82.39±1.6
88.62±1.9
<0.05
ASDNN (ms)
50.06±5.9
42.74±3.0
>0.05
SDANN (ms)
106.41±6.5
88.15±4.2
<0.05

SDNN (ms)
126.54±9.1
101.44±4.9
<0.05
RMSSD (ms)
46.37±10.3
25.17±2.4
<0.05
LnULF (ms
2
)
2.28±0.14
2.21±0.09
>0.05
LnVLF (ms
2
)
4.07±0.23
3.98±0.13
>0.05
LnLF (ms
2
)
4.61±0.25
3.92±0.18
<0.05
LnHF (ms
2
)
4.74±0.36

3.92±0.15
<0.05
LnTF (ms
2
)
6.85±0.29
6.60±0.15
>0.05

1.03±0.05
1.00±0.04
>0.05

- -
ngày - 
- -


     -
5


-dipper [9]. 
-
4
 -
1]
-
s9



479
-
 Radchenko [5], Yukiko Nakan [11].



-


1. Huỳnh Ngọc Cẩn, Nguyễn Đức Công (2009). Nghiên cứu biến đổi huyết áp 24 giờ ở bệnh
nhân tăng huyết áp có hội chứng chuyển hoá. Tp chí ni khoa 1/2009; trang 175-183.
2. Huỳnh Văn Minh (2009).  24 gi trong bnh lý tim mch. Nhà xuất
bản đại học Huế.
3. Cao Thúc Sinh (2009). Nghiên cứu mối tương quan giữa nhịp sinh học huyết áp với phì
đại thất tráỉ ở bệnh nhân tăng huyết áp nguyên phát bằng huyết áp lưu động 24 giờ. Tp
chí ni khoa 1/2009; trang 211-218.
4. Faye S Routledge MN RN, et al (2007). Night-time blood pressure patterns and target
organ damage: A review. Can J Cardiol Vol 23 No 2 February.
5. Ganna D. Radchenko,et al (2003). "Dipper" and "non-dipper" phenomena and heart rate
variability in patients with mild to moderate arterial hypertension. Am J Hypertens 16,
61A–61A; doi:S0895-7061(03)00229-2
6. Julius S (1991). Autonomic nervous system dysregulation in human hypertension. Am J
Cardiol; 67: 3B-7B.
7. O'Brien, et al (2003). European Society of Hypertension recommendations for
conventional, ambulatory, and home blood pressure measurement. Journal of
Hypertension. 21:821–848.
8. Pickering, TG, et al (2005). AHA Scientific Statement: Recommendations for blood
pressure measurement in humans and experimental animals. Hypertens. 45:142–161.
9. Sherwood A, Steffen PR, et al (2002). Nighttime blood pressure dipping: The role of the

sympathetic nervous system. Am J Hypertens; 15:111-8.
10. Verdecchia P, Schillaci G, et al (2001). Original articles prognostic value of combined
echocardiography and ambulatory blood pressure monitoring in hypertensive patients
at low or medium cardiovascular risk. Ital Heart J; 2:287-93.
11. Yukiko Nakano, et al (2001). Non-dipper phenomenon in essential hypertension is
related to blunted nocturnal rise and fall of sympatho-vagal nervous activity and
progress in retinopathy. Autonomic neuroscience: Basic and Clinical;Volume 88, Issue 3,
Pages 181-186.