Objectives: To determine the association between glycosylated hemoglobin (HbA1c) and ambulatory blood pressure or heart rate in hypertensive patients.
Methods: A total of 585 patients, who performed ambulatory blood pressure monitoring (ABPM) from September 2018 to April 2019 in Xiangya Hospital, Central South University, were enrolled and assigned into 2 groups (470 in a hypertensive group and 115 in a normal group). HbA1c levels were compared. According to the HbA1c level, the hypertensive group was divided into 2 subgroups: A high HbA1c group (HbA1c≥6.1%, n=142) and a normal HbA1c group (HbA1c<6.1%, n=328). Whole basic data and ABPM parameter were compared among the groups. Pearson/Spearman correlation analysis was applied to study the association between HbA1c and BPV. Multivariate logistic regression was used to explore the influential factors for HbA1c (≥6.1%) and continuous increase of HbA1c in different hypertensive populations, respectively.
Results: The hypertensive group had higher HbA1c level than the normal group [(6.1±1.3)% vs (5.1±1.7)%, P<0.05]. In hypertensive patients, nocturnal systolic blood pressure [(131.1±19.2) mmHg vs (122.5±19.2) mmHg], nocturnal systolic blood pressure load [62.5% (15.5%-100%) vs 28.6% (0-75%)], and daytime heart rate [(74.3±11.6) min-1 vs (71.2±11.4) min-1] of the high HbA1c group were higher than those in the normal HbA1c group (all P<0.05). Pearson/Spearman correlation analysis showed that HbA1c was positively correlated with systolic blood pressure and blood pressure load (both P<0.05). Logistic regression analysis showed that nocturnal systolic pressure load was the risk factor for the increase of HbA1c level (OR=1.025, 95% CI 1.003 to 1.048, P<0.05). Multiple linear regression showed that nocturnal systolic pressure load was still positively correlated with HbA1c in total, tertiary, and hypertensive patients without treatment (β=0.155, β=0.171, β=0.384, respectively, all P<0.05).
Conclusions: In hypertensive patients, HbA1c is positively correlated with ambulate blood pressure, blood pressure load, and heart rate, and it has no correlation with blood pressure variability, heart rate variability, or morning blood pressure.
目的: 探讨高血压患者糖化血红蛋白(glycosylated hemoglobin，HbA1c)与动态血压及心率的关系。方法: 纳入2018年9月至2019年4月在中南大学湘雅医院行24 h动态血压监测的患者585例，其中高血压患者470例(高血压组)，健康体检者115名(对照组)。比较两组的HbA1c水平。根据HbA1c水平再将高血压组分为两个亚组：高HbA1c组(HbA1c≥6.1%，n=142)和正常HbA1c组(<6.1%，n=328)。比较各组间基本资料和动态血压及心率参数。HbA1c与动态血压及心率的相关性采用Pearson/Spearman相关分析；HbA1c≥6.1%的危险因素采用多因素logistic回归分析，不同高血压人群HbA1c升高的影响因素采用多元线性逐步回归分析。结果: 高血压组的HbA1c水平较对照组高[(6.1±1.3)% vs (5.1±1.7)%，P<0.05)。在高血压患者中，与正常HbA1c组相比，高HbA1c组的夜间收缩压[(131.1±19.2) mmHg vs (122.5±19.2) mmHg]、夜间收缩压负荷[62.5%(15.5%~100%) vs 28.6%(0~75%)]及白昼平均心率[(74.3±11.6) min-1 vs (71.2±11.4) min-1]更高(均P<0.05)。Pearson/Spearman相关分析示HbA1c与收缩压和收缩压负荷呈正相关(均P<0.05)。Logistic回归分析示夜间收缩压负荷是HbA1c≥6.1%的危险因素(OR=1.025，95% CI：1.003~1.048，P<0.05)；多元线性回归分析示在高血压患者、3级高血压患者、未降压治疗的高血压患者中，夜间收缩压负荷仍与HbA1c呈正相关(分别β=0.155、β=0.171、β=0.384，均P<0.05)。结论: 在高血压患者中，HbA1c与血压水平、血压负荷及心率呈正相关，与血压变异性、心率变异性及清晨血压无关。.
Keywords: blood pressure load; blood pressure variability; glycated hemoglobin; heart rate variability; morning blood pressure.