Predictive value of UHR, FBG and nDBP for autonomic nervous imbalance in essential hypertension

doi:10.11958/20260562

Abstract

Abstract:

Objective To explore the predictive value of the uric acid (UA) to high-density lipoprotein cholesterol (HDL-C) ratio (UHR), fasting blood glucose (FBG) and nighttime mean diastolic blood pressure (nDBP) for autonomic nervous imbalance in patients with essential hypertension (EH). Methods A total of 176 EH patients were divided into the EH normal autonomic nervous function group (normal group, 98 cases) and the EH combined with reduced autonomic nervous function regulation group (reduced group, 78 cases) according to the standard deviation of all sinus RR intervals (SDNN) in dynamic electrocardiography. General clinical data of the patients [age, gender, body mass index (BMI), history of hypertension, history of antihypertensive drug use, smoking history and drinking history] were collected. Laboratory indicators [creatinine (Cr), UA, FBG, glycated hemoglobin (HbA1c) and blood lipids] were detected. Ambulatory blood pressure parameters [daytime mean systolic blood pressure (dSBP), daytime mean diastolic blood pressure (dDBP), nighttime mean systolic blood pressure (nSBP) and nDBP] were recorded. UHR was then calculated. Binary Logistic regression analysis was used to identify independent risk factors for autonomic nervous imbalance, and receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of UHR, FBG and nDBP for autonomic nervous imbalance. Results Compared with the normal group, there were higher proportion of males, higher levels of BMI, FBG, UA, triglyceride (TG), UHR, dDBP, nSBP and nDBP in the reduced group, while the level of HDL-C was lower (all P<0.05). Binary Logistic regression analysis showed that elevated UHR, FBG and nDBP were independent risk factors for autonomic nervous imbalance (all P<0.05). ROC curve analysis indicated that the predictive value of UHR alone detection for autonomic nervous imbalance was superior to that of FBG or nDBP alone detection, and was equivalent to that of the combined detection of UHR, FBG and nDBP. Conclusion UHR, FBG and nDBP are all independent influencing factors for autonomic nervous imbalance in EH patients. Among them, UHR has higher predictive value and can be used as a reference indicator for early identification of high-risk patients.

Key words: essential hypertension, uric acid, cholesterol, HDL, fasting blood glucose, diastolic pressure, UHR, SDNN

CLC Number:

R544.1

Figures/Tables 4

References 18

[1]	Solanki J D, Hirani C N, Vohra A S, et al. A comparative cross-sectional study of cardiac autonomic status by five minute heart rate variability among type 2 diabetics,hypertensives and normotensive-nondiabetics[J]. Niger Med J, 2023, 64(3):373-381.
[2]	Zaboli M D, Joukar S, Nouzari M, et al. Heart rate variability and blood pressure response to low-intensity endurance exercise training plus blood flow restriction in individuals with mild hypertension:a randomized controlled clinical trial[J]. Iran J Med Sci, 2025, 50(11):775-787. doi:10.30476/ijms.2025.105405.3916.
[3]	李霖, 李丹阳, 崔岩. 糖尿病肾病合并心脏自主神经病变随机森林模型的构建及验证[J]. 天津医药, 2026, 54(1):41-45.
	Li L, Li D Y, Cui Y. Development and validation of a random forest model for diabetic nephropathy with cardiac autonomic neuropathy[J]. Tianjin Med J, 2026, 54(1):41-45. doi:10.11958/20252563.
[4]	Soomra H, Mukhtar A, Asif F, et al. Autonomic nervous system dysregulation in metabolic syndrome:an association with hypertension and cardiovascular risk[J]. Cureus, 2025, 17(12):e98932. doi:10.7759/cureus.98932.
[5]	Zhu L, Zhang X, Fang Z, et al. Association between serum uric acid and pre-hypertension and hypertension among Chinese adults[J]. Arq Bras Cardiol, 2021, 116(6):1072-1078. doi:10.36660/abc.20200098.
[6]	Yi Y, Luo Q, Chen J, et al. Association between the uric acid-to-HDL-cholesterol ratio (UHR) and the risk of cardiovascular disease and dyslipidemia:a population-based study[J]. Lipids Health Dis, 2025, 24(1):143. doi:10.1186/s12944-025-02551-4.
[7]	Li S, Liu Z, Lu C. Association of uric acid to high-density lipoprotein cholesterol ratio with the presence or absence of hypertensive kidney function:results from the China Health and Retirement Longitudinal Study (CHARLS)[J]. BMC Nephrol, 2025, 26(1):123. doi:10.1186/s12882-024-03939-7.
[8]	Huang X, Hu L, Tao S, et al. Relationship between uric acid to high-density cholesterol ratio (UHR) and circulating α-klotho:evidence from NHANES 2007-2016[J]. Lipids Health Dis, 2024, 23(1):244. doi:10.1186/s12944-024-02234-6.
[9]	Steinberg J S, Varma N, Cygankiewicz I, 等. 2017 ISHNE/HRS动态心电图和体外心电监测/远程监测专家共识(1):动态心电监测方法[J]. 实用心电学杂志, 2019, 28(3):153-160.
	Steinberg J S, Varma N, Cygankiewicz I, et al. 2017 ISHNE/HRS expert consensus on ambulatory electrocardiography and external electrocardiographic monitoring/telemonitoring (part 1):methods of ambulatory electrocardiographic monitoring[J]. Journal of Practical Electrocardiology, 2019, 28(3):153-160. doi:10.13308/j.issn.2095-9354.2019.03.001.
[10]	徐君, 张劼. 2型糖尿病患者心率变异性与脑梗死的相关性研究[J]. 中国全科医学, 2025, 28(35):4409-4413.
	Xu J, Zhang J. Correlation study between heart rate variability and cerebral infarction in patients with type 2 diabetes mellitus[J]. Chinese General Practice, 2025, 28(35):4409-4413. doi:10.12114/j.issn.1007-9572.2025.0091.
[11]	Sehgal D, Bonifanti L, Tran J, et al. The effects of hypertension treatment on heart rate variability:a scoping review[J]. Cureus, 2025, 17(9):e91659. doi:10.7759/cureus.91659.
[12]	Wulsin L R, Horn P S, Perry J L, et al. Autonomic imbalance as a predictor of metabolic risks,cardiovascular disease,diabetes,and mortality[J]. J Clin Endocrinol Metab, 2015, 100(6):2443-2448. doi:10.1210/jc.2015-1748.
[13]	Lombardi C, Pengo M F, Parati G. Obstructive sleep apnea syndrome and autonomic dysfunction[J]. Auton Neurosci, 2019, 221:102563. doi:10.1016/j.autneu.2019.102563.
[14]	Guo T, Zheng S, Chen T, et al. The association of long-term trajectories of BMI,its variability,and metabolic syndrome:a 30-year prospective cohort study[J]. eClinicalMedicine, 2024, 69:102486. doi:10.1016/j.eclinm.2024.102486.
[15]	Lutfi M F, Elhakeem R F. Effect of fasting blood glucose level on heart rate variability of healthy young adults[J]. PLoS One, 2016, 11(7):e0159820. doi:10.1371/journal.pone.0159820.
[16]	Tian X, Chen S, Zhang Y, et al. Serum uric acid variation and the risk of cardiovascular disease:A prospective cohort study[J]. Eur J Intern Med, 2023, 112:37-44. doi:10.1016/j.ejim.2023.02.001.
[17]	Xu Y, Dong H, Zhang B, et al. Association between dyslipidaemia and the risk of hyperuricaemia:a six-year longitudinal cohort study of elderly individuals in China[J]. Ann Med, 2022, 54(1):2401-2409. doi:10.1080/07853890.2022.2118368.
[18]	Kurajoh M, Fukumoto S, Emoto M, et al. Independent association of plasma xanthine oxidoreductase activity with serum uric acid level based on stable isotope-labeled xanthine and liquid chromatography/triple quadrupole mass spectrometry:MedCity21 health examination registry[J]. Clin Chem Lab Med, 2020, 58:780-786. doi:10.1515/cclm-2019-0199.

组别	n			年龄/岁	男性			吸烟史	饮酒史			高血压病程				服用降压药史		BMI/（kg/m²）			FBG/（mmol/L）
组别	n			年龄/岁	男性			吸烟史	饮酒史			<5年	≥5年			服用降压药史		BMI/（kg/m²）			FBG/（mmol/L）
正常组	98			49.01±9.94	37（37.8）			14（14.3）	10（10.2）			70（71.4）	28（28.6）			32（32.7）		25.01（22.58，28.44）			5.07（4.65，5.44）
降低组	78			47.99±10.67	52（66.7）			15（19.2）	12（15.4）			63（80.8）	15（19.2）			32（41.0）		27.30（24.97，29.82）			5.38（4.94，5.97）
t、χ²或Z				0.657	14.523^＊			0.772	1.066			2.052				1.316		3.456^＊			3.054^＊
组别			HbA1c/%			UA/（μmol/L）				Cr/（mmol/L）				TG/（mmol/L）			TC/（mmol/L）			HDL-C/（mmol/L）
正常组			5.50（5.30，5.74）			272.24±52.56				58.50（51.00，71.00）				1.34（1.04，1.81）			4.60（3.88，5.34）			1.26（1.11，1.56）
降低组			5.62（5.36，5.90）			356.56±86.27				65.00（52.00，75.00）				1.74（1.29，2.51）			4.54（3.99，5.16）			1.09（0.96，1.27）
t、χ²或Z			1.387			7.548^＊				1.928				3.805^＊			0.363			3.556^＊
组别		LDL-C/（mmol/L）					UHR/%				dSBP/mmHg				dDBP/mmHg				nSBP/mmHg			nDBP/mmHg
正常组		2.87（2.35，3.33）					20.82（16.24，25.26）				135.00（128.00，144.25）				83.84±9.18				126.24±13.10			76.65±10.31
降低组		2.91（2.45，3.47）					31.06（24.36，38.86）				137.50（128.00，146.00）				88.27±11.70				131.23±15.31			82.33±11.90
t、χ²或Z		0.524					6.475^＊				1.426				2.817^＊				2.327^＊			3.390^＊

组别	n			年龄/岁	男性			吸烟史	饮酒史			高血压病程				服用降压药史		BMI/（kg/m²）			FBG/（mmol/L）
组别	n			年龄/岁	男性			吸烟史	饮酒史			<5年	≥5年			服用降压药史		BMI/（kg/m²）			FBG/（mmol/L）
正常组	98			49.01±9.94	37（37.8）			14（14.3）	10（10.2）			70（71.4）	28（28.6）			32（32.7）		25.01（22.58，28.44）			5.07（4.65，5.44）
降低组	78			47.99±10.67	52（66.7）			15（19.2）	12（15.4）			63（80.8）	15（19.2）			32（41.0）		27.30（24.97，29.82）			5.38（4.94，5.97）
t、χ²或Z				0.657	14.523^＊			0.772	1.066			2.052				1.316		3.456^＊			3.054^＊
组别			HbA1c/%			UA/（μmol/L）				Cr/（mmol/L）				TG/（mmol/L）			TC/（mmol/L）			HDL-C/（mmol/L）
正常组			5.50（5.30，5.74）			272.24±52.56				58.50（51.00，71.00）				1.34（1.04，1.81）			4.60（3.88，5.34）			1.26（1.11，1.56）
降低组			5.62（5.36，5.90）			356.56±86.27				65.00（52.00，75.00）				1.74（1.29，2.51）			4.54（3.99，5.16）			1.09（0.96，1.27）
t、χ²或Z			1.387			7.548^＊				1.928				3.805^＊			0.363			3.556^＊
组别		LDL-C/（mmol/L）					UHR/%				dSBP/mmHg				dDBP/mmHg				nSBP/mmHg			nDBP/mmHg
正常组		2.87（2.35，3.33）					20.82（16.24，25.26）				135.00（128.00，144.25）				83.84±9.18				126.24±13.10			76.65±10.31
降低组		2.91（2.45，3.47）					31.06（24.36，38.86）				137.50（128.00，146.00）				88.27±11.70				131.23±15.31			82.33±11.90
t、χ²或Z		0.524					6.475^＊				1.426				2.817^＊				2.327^＊			3.390^＊

变量	β	SE	Wald χ²	P	OR	95%CI
UHR	0.013	0.003	18.595	<0.001	1.013	1.007~1.020
FBG	0.692	0.289	5.743	0.017	1.997	1.134~3.516
nDBP	0.054	0.025	4.601	0.032	1.055	1.005~1.108
常数项	-7.400	3.834	3.725	0.054	0.001

变量	β	SE	Wald χ²	P	OR	95%CI
UHR	0.013	0.003	18.595	<0.001	1.013	1.007~1.020
FBG	0.692	0.289	5.743	0.017	1.997	1.134~3.516
nDBP	0.054	0.025	4.601	0.032	1.055	1.005~1.108
常数项	-7.400	3.834	3.725	0.054	0.001

变量	AUC	95%CI	截断值	敏感度/%	特异度/%	约登指数
UHR	0.784	0.717~0.851	25.47%	71.8	76.5	0.483
FBG	0.634	0.551~0.717	5.52 mmol/L	44.9	81.6	0.265
nDBP	0.637	0.553~0.721	83.5 mmHg	47.4	81.6	0.290
联合指标	0.817	0.754~0.880	-	82.1	71.4	0.535