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THE RELATIONSHIP BETWEEN HEART RATE VARIABILITY AND CARDIOVASCULAR RISK FACTORS IN HYPERTENSIVE PATIENTS

Yıl 2018, , 303 - 310, 29.06.2018
https://doi.org/10.31832/smj.375106

Öz

Objective:
Although many cardiovascular risk factors are well known at present, additional
number of cardiovascular mortality predictors are needed because of the fact that
cardiovascular diseases are also observed in patients who do not have any well
described risk factors. The aim of current study is to analyse the relationship
between heart rate, heart rate variability and novel cardiovascular risk
factors.


Materials and Methods: A total of 63 consecutive patients were included in this
study. Aortic pulse wave velocity of all patients was calculated with SphygmoCor
(AtCorMedical Instruments) tonometry device. Average heart rate, maximum and
minimum heart rate, average RR period, 24 hours triangle index, the mean of the standard deviations for all
R-R intervals, standard deviation of all R-R intervals in successive
five-minute epochs, and root-mean square differences of successive R-R
intervals were obtained by using time dependent heart rate analyse obtained
from 24 hours ECG records. 


Results: Mean heart rate of the study population was 84.3±9.2 bpm. Mean pulse wave
velocity of the study population was 5.7±0.4 m/sec and mean carotid intima-media
thickness of the study population was 0.87±0.09 mm. Patients were classified into
two groups according to median night heart rate (≤65 bpm vs. >66 bpm). No significant
difference was observed between two groups in terms of age, gender, pulse wave
velocity, and cholesterol levels however, a significant difference was observed
between groups in terms of carotid intima-media thickness. 


Conclusion: We suggest that heart rate and heart rate variability should be
used as a non-invasive method, which can be measured without excessive costs in
daily clinical practice.

Kaynakça

  • 1. Swedberg K, Komajda M, Böhm M, Borer JS, Ford I, Dubost-Brama A, et al. Ivabradine and outcomes in chronic heartfailure (SHIFT): a randomised placebo-controlled study, Lancet. 2010 Sep 11;376(9744):875-85.
  • 2. La Rosa JC, Grundy SM, Waters DD, Shear C, Barter P, Fruchart JC, et al. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med. 2005 Apr 7;352(14):1425-35. Epub2005 Mar 8.
  • 3. Fox K, Ford I, Steg PG, Tendera M, Ferrari R. Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a randomised, double-blind, placebo-controlled trial, Lancet. 2008 Sep 6;372(9641):807-16. Epub 2008 Aug 29.
  • 4. Heart rate variability: standarts of measurement, physiological interpretation and clinical use. Task Force of European Society of Cardiology and North American Society of Pacing and Electrophysiology. Circulation 1996;93:1043-1065.
  • 5. Kleiger RE, Stein PK, Bosner MS, Rottman JN. Time domain measurements of heart rate variability. Cardiol Clin 1992 Aug;10(3):487-98.
  • 6. Chae CU, Pfeffer MA, Glynn RJ, Mitchell GF, Taylor JO, Hennekens CH. Increased pulse pressure and risk of heart failure in the elderly. JAMA 281:634–639;1999.
  • 7. Kostis J, Lawrence-Nelson J, Ranjan R, Wilson A, Kostis W, Lacy C. Association of increased pulse pressure with the development of heart failure in SHEP. Systolic Hypertension in the Elderly (SHEP) Cooperative Research Group. Am J Hypertens 14: 798–803; 2001.
  • 8. Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM. Impact of aorticstiffness on survival in end-stage renal disease. Circulation 99: 2434 –2439; 1999.
  • 9. Forette F, Seux ML, Staessen JA, Thijs L, Birkenhager WH, Babarskiene MR, et al. Prevention of dementia in randomised double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial. Lancet 352:1347–1351; 1998.
  • 10. Benetos A, Gautier S, Ricard S, Topouchian J, Asmar R, Poirier O, et al. Influence of angiotensin-converting enzyme and angiotensin 2 type 1 receptor gene polymorphisms on aortic stiffness in normotensive and hypertensive patients. Circulation 1996;94:698-703.
  • 11. Dart AM, Qi XL. Determinants of arterial stiffness in Chinese migrants to Australia. Atherosclerosis 1995; 117:263-272.
  • 12. Hamazaki T, Urakaze M, Sawazaki S, Yamazaki K, Taki H, Yano S. Comparison of pulse wave velocity of the aorta between in habitants of fishing and farming villages in Japan. Atherosclerosis 1988; 73:157-160.
  • 13. Mutangadura, Gladys B editors. Reducingrisks, promoting healthy life World Health Report 2002: Geneva, World Health Organization, 2002
  • 14. Kannel WB. Range of serum cholesterol values in the poulation developing coronary artery disease. Am J Cardiol 1995;76:69-77.
  • 15. Chait A, Han CY, Oram JF, Heinecke JW. Thematic rewiew series: The immune system andatherogenesis. Lipoprotein-associated inflammatory proteins: Markers or mediators of cardiovascular disease? J LipidRes 2005;46:389- 403
  • 16. Willerson JT, Ridker PM. İnflammation as a cardiovascular risk factor versus risk factor. Circulation 2004:109 (21 Suppl 1):p2-10
  • 17. Schaefer EJ, Lamon-Fava S, Ordovas JM, Chon SD, Shaefer MM, Castelli WP, et al. Factors associated with low and elevated plasma high density lipoprotein cholesterol and apolipoprotein A-I levels in the Framingham Offspring Study. J Lipid Res. 35:871-882, 1994.
  • 18. Mahley RW, Mahley LL, Bersot TP, Pepin GM, Palaoglu KE. The Turkish lipid problem: low levels of high density lipoproteins. Turk J Endocr Metab. 1:1-12, 2002.
  • 19. García-Ortiz L, García-García A, Ramos-Delgado E, Patino-Alonso MC, Recio-Rodríguez JI, Rodríguez-Sánchez E, et al. Relationship of night/day heart rate ratio with carotid intima media thickness and markers of arterial stiffness. Atherosclerosis 2011;53:241-264

Hipertansif Hastalarda Kalp Hızı Değişkenliği ile Kardiyovasküler Risk Faktörlerinin İlişkisi

Yıl 2018, , 303 - 310, 29.06.2018
https://doi.org/10.31832/smj.375106

Öz

Amaç:
Birçok kardiyovasküler risk faktörünün bilinmesine rağmen, risk faktörleri
olmayan hastalarda da kardiyovasküler hastalıkların gözlenmesi nedeniyle yeni
bir takım öngördürücülere ihtiyaç duyulmaktadır. Çalışmamızın amacı kalp hızı
ve kalp hızı değişkenliğinin yeni geliştirilmiş olan kardiyovasküler risk
faktörleri ile ilişkisini değerlendirmektir.


Gereç ve Yöntemler: Çalışmaya toplam 63 ardışık hasta dahil edildi. SphygmoCor
(AtCorMedical Instruments) markalı tonometri cihazı ile tüm hastaların aortik
nabız dalga hızları hesaplandı. Alınan 24 saatlik elektrokardiyografi kayıtlarından
yapılan zaman bağımlı kalp hızı analizlerinde ortalama kalp hızı maksimum ve
minimum kalp hızları, ortalama RR süreleri, 24 saat triangle index, the mean of the standard deviations for all
R-R intervals, standard deviation of all R-R intervals in successive
five-minute epochs ve root-mean square differences of successive R-R
intervals değerleri elde edildi. Kalp hızı ve kalp hızı
değişkenliği ile yeni geliştirilmiş olan kardiyovasküler risk arasındaki ilişki
araştırıldı. 





Bulgular: Çalışma grubunun nabız ortalaması 84.3±9.5 vuru/dk idi. Ortalama
sistolik kan basınçları 141.7±13.5 mmHg, diyastolik kan basınçları 75.3±6.9
mmHg, nabız dalga hızı 5.73 ±0.45 m/sn, ortalama karotis intima-media
kalınlığı 0.87±0.09 mm idi. Median gecelik kalp hızına (65 vuru/dk) göre
2 gruba ayrılan hastaların yaş, cinsiyet, kolesterol düzeyleri ve nabız dalga hızları arasında
anlamlı farklılık saptanmamakla birlikte karotis intima-media kalınlığı ile gecelik kalp hızı arasında
anlamlı ilişki saptandı.


Sonuç: Kardiyovasküler hastalığı öngörmede çeşitli girişimsel olmayan tetkikler
kullanılmaktadır. Bu tetkiklerin basit olması yanında kardiyovasküler hastalığı
tahmin etmede doğruluk oranının da yüksek olması gerekmektedir. Bu açıdan
bakıldığında kalp hızı ve kalp hızı değişkenliği günlük klinik kullanımda
maliyetsiz ölçülebilen, girişimsel olmayan bir yöntem olarak önem kazanmaktadır
ve yakın gelecekte kullanımı umut vadetmektedir.

Kaynakça

  • 1. Swedberg K, Komajda M, Böhm M, Borer JS, Ford I, Dubost-Brama A, et al. Ivabradine and outcomes in chronic heartfailure (SHIFT): a randomised placebo-controlled study, Lancet. 2010 Sep 11;376(9744):875-85.
  • 2. La Rosa JC, Grundy SM, Waters DD, Shear C, Barter P, Fruchart JC, et al. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med. 2005 Apr 7;352(14):1425-35. Epub2005 Mar 8.
  • 3. Fox K, Ford I, Steg PG, Tendera M, Ferrari R. Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a randomised, double-blind, placebo-controlled trial, Lancet. 2008 Sep 6;372(9641):807-16. Epub 2008 Aug 29.
  • 4. Heart rate variability: standarts of measurement, physiological interpretation and clinical use. Task Force of European Society of Cardiology and North American Society of Pacing and Electrophysiology. Circulation 1996;93:1043-1065.
  • 5. Kleiger RE, Stein PK, Bosner MS, Rottman JN. Time domain measurements of heart rate variability. Cardiol Clin 1992 Aug;10(3):487-98.
  • 6. Chae CU, Pfeffer MA, Glynn RJ, Mitchell GF, Taylor JO, Hennekens CH. Increased pulse pressure and risk of heart failure in the elderly. JAMA 281:634–639;1999.
  • 7. Kostis J, Lawrence-Nelson J, Ranjan R, Wilson A, Kostis W, Lacy C. Association of increased pulse pressure with the development of heart failure in SHEP. Systolic Hypertension in the Elderly (SHEP) Cooperative Research Group. Am J Hypertens 14: 798–803; 2001.
  • 8. Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM. Impact of aorticstiffness on survival in end-stage renal disease. Circulation 99: 2434 –2439; 1999.
  • 9. Forette F, Seux ML, Staessen JA, Thijs L, Birkenhager WH, Babarskiene MR, et al. Prevention of dementia in randomised double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial. Lancet 352:1347–1351; 1998.
  • 10. Benetos A, Gautier S, Ricard S, Topouchian J, Asmar R, Poirier O, et al. Influence of angiotensin-converting enzyme and angiotensin 2 type 1 receptor gene polymorphisms on aortic stiffness in normotensive and hypertensive patients. Circulation 1996;94:698-703.
  • 11. Dart AM, Qi XL. Determinants of arterial stiffness in Chinese migrants to Australia. Atherosclerosis 1995; 117:263-272.
  • 12. Hamazaki T, Urakaze M, Sawazaki S, Yamazaki K, Taki H, Yano S. Comparison of pulse wave velocity of the aorta between in habitants of fishing and farming villages in Japan. Atherosclerosis 1988; 73:157-160.
  • 13. Mutangadura, Gladys B editors. Reducingrisks, promoting healthy life World Health Report 2002: Geneva, World Health Organization, 2002
  • 14. Kannel WB. Range of serum cholesterol values in the poulation developing coronary artery disease. Am J Cardiol 1995;76:69-77.
  • 15. Chait A, Han CY, Oram JF, Heinecke JW. Thematic rewiew series: The immune system andatherogenesis. Lipoprotein-associated inflammatory proteins: Markers or mediators of cardiovascular disease? J LipidRes 2005;46:389- 403
  • 16. Willerson JT, Ridker PM. İnflammation as a cardiovascular risk factor versus risk factor. Circulation 2004:109 (21 Suppl 1):p2-10
  • 17. Schaefer EJ, Lamon-Fava S, Ordovas JM, Chon SD, Shaefer MM, Castelli WP, et al. Factors associated with low and elevated plasma high density lipoprotein cholesterol and apolipoprotein A-I levels in the Framingham Offspring Study. J Lipid Res. 35:871-882, 1994.
  • 18. Mahley RW, Mahley LL, Bersot TP, Pepin GM, Palaoglu KE. The Turkish lipid problem: low levels of high density lipoproteins. Turk J Endocr Metab. 1:1-12, 2002.
  • 19. García-Ortiz L, García-García A, Ramos-Delgado E, Patino-Alonso MC, Recio-Rodríguez JI, Rodríguez-Sánchez E, et al. Relationship of night/day heart rate ratio with carotid intima media thickness and markers of arterial stiffness. Atherosclerosis 2011;53:241-264
Toplam 19 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Makaleler
Yazarlar

Alper Çil Bu kişi benim 0000-0002-0074-6326

Efe Edem 0000-0002-5042-4077

Özhan Göldeli 0000-0003-1061-5589

Yayımlanma Tarihi 29 Haziran 2018
Gönderilme Tarihi 4 Ocak 2018
Yayımlandığı Sayı Yıl 2018

Kaynak Göster

AMA Çil A, Edem E, Göldeli Ö. Hipertansif Hastalarda Kalp Hızı Değişkenliği ile Kardiyovasküler Risk Faktörlerinin İlişkisi. Sakarya Tıp Dergisi. Haziran 2018;8(2):303-310. doi:10.31832/smj.375106

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