Absence of Nocturnal Fall in Blood Pressure Detected by Ambulatory Blood Pressure Monitoring in Acute Chagas Disease Patients with Oral Infection

Abstract Background The involvement of the autonomic nervous system is one of the mechanisms proposed to explain the progression of myocardial lesion in Chagas disease. Evidences have shown changes in sympathetic and parasympathetic nervous system since the acute phase of the disease, and studies to clarify the pathophysiological and prognostic value of these changes are needed. Objetives To assess blood pressure profile by ambulatory blood pressure monitoring (ABPM) in normotensive patients with acute Chagas disease (ACD) without apparent cardiac damage, and the influence of the infection on nocturnal blood pressure fall. Methods ABPM was performed with 54 patients with ACD and a control group composed of 54 age- and sex-matched normotensive individuals. The alpha level of significance (type I error rate) was set at 5%. Results In the total of 54 patients, 74.0% did not show nocturnal fall in systolic blood pressure, 53.7% did not show nocturnal fall in diastolic blood pressure, and lack of both nocturnal fall in SBP and DBP was observed in 51.8% (*p<0.05). In 12.9% of patients, there was an increase in SBP and in 18.5% increase in DBP (p<0.05). Conclusions In patients with acute Chagas disease, a significant absence of the physiological fall in both systolic and diastolic blood pressure was observed during sleep, and some of the patients showed nocturnal increase in these parameters. These findings suggest autonomic changes in the acute phase of Chagas disease. (Arq Bras Cardiol. 2020; 114(4):711-715)

【摘要】
背景：自主神经系统受累是目前阐释恰加斯病（Chagas disease）心肌病变进展的潜在机制之一。已有研究证实，该病急性期即可出现交感与副交感神经系统的功能异常，目前仍需开展相关研究以阐明此类改变的病理生理意义与预后价值。
研究目的：通过动态血压监测（ambulatory blood pressure monitoring，ABPM）评估无明显心脏损伤的急性恰加斯病（acute Chagas disease，ACD）血压正常患者的血压谱，并明确该感染状态对夜间血压下降的影响。
研究方法：本研究纳入54例急性恰加斯病患者，以及54例年龄、性别匹配的血压正常对照个体，均接受动态血压监测。本研究设定检验水准α（Ⅰ类错误率）为5%。
研究结果：54例患者中，74.0%未出现收缩压夜间下降，53.7%未出现舒张压夜间下降，同时存在收缩压与舒张压夜间下降缺失的患者占比为51.8%（*p<0.05）。另有12.9%的患者出现收缩压升高，18.5%的患者出现舒张压升高（p<0.05）。
研究结论：急性恰加斯病患者睡眠期间，收缩压与舒张压均出现显著的生理性夜间下降缺失，部分患者的此类血压参数甚至出现夜间升高。上述结果提示恰加斯病急性期存在自主神经系统功能改变。（发表于《巴西心脏病学档案》[Arq Bras Cardiol]; 2020; 114(4):711-715）