Abstract: Background Hypertension is a major chronic disease managed by primary healthcare institutions in China. Cardiac autonomic dysfunction is a key cause of blood pressure regulation imbalance and adverse cardiovascular events. Therefore，in primary healthcare institutions，the use of efficient and portable single lead wearable electrocardiogram（ECG）devices can help explore the relationship between elderly hypertensive patients and the autonomic nervous system，providing a simple，efficient，low-cost，and sustainable suitable method and objective basis for the management and prevention of cardiovascular disease in primary hypertensive patients. Objective To investigate the correlation between the duration of hypertension and autonomic nervous system damage in elderly patients in Primary Care institutions in the Ningxia Hui Autonomous Region using a single lead wearable ECG device. Methods A total of 2 137 elderly hypertension patients aged 65 years or older from 20 primary medical institutions in the Ningxia Hui Autonomous Region were enrolled in this study. ECG data of 72 hours，along with basic information，psychological health，and lifestyle data，were collected and uploaded to the cloud platform using a single-lead wearable ECG device from January 2022 to December 2022. Based on the heart rate variability（HRV）time-domain parameter standard deviation of all sinus rhythm RR intervals（SDNN），subjects were divided into two groups：a normal group（SDNN>100ms，n=470）and an abnormal group（SDNN<100 ms，n=1 667）. propensity score was used to match subjects on a 1 ∶ 1 basis，adjusting for confounding factors with a caliper value of 0.02，and the matching effect was verified using inverse probability weighting. Single-factor and multivariate logistic regression analyses were conducted to investigate the relationship between the onset of hypertension and autonomic nerve damage，and the matching effect was further verified. Subgroup analyses were performed using propensity score matching based on the onset of hypertension and autonomic nerve damage，with sensitivity analyses conducted before and after matching. Additionally，a nonlinear association between the duration of hypertension and autonomic nerve damage was examined using restricted cubic splines（RCS）analysis to test interaction effects.Results Among the patients，479 had grade 1 hypertension，and 1 658 had grade 2 hypertension. Disease duration was categorized as follows：1 203 patients had less than 5 years of disease duration，753 had 5-10 years，110 had 10-15 years，41 had 15-20 years，26 had 20-30 years，and 4 had more than 30 years. The multivariate logistic regression analysis showed that the relationship between autonomic nerve damage and hypertension duration was positive after matching（P<0.001）. Subgroup analysis showed that the relationship between hypertension duration and autonomic nerve damage was stronger in the 80-year-old and younger，lower-educated，no comorbidities of coronary heart disease，female，and those with obstructive sleep apnea（OSA）subgroups before and after matching，with statistically significant differences（P<0.05）and interaction effects（P<0.05）. However， the RCS analysis showed no nonlinear relationship between the course of hypertension and autonomic nerve damage in matched patients. Conclusion There was a positive correlation between the course of hypertension and autonomic nerve damage in elderly hypertension patients from the primary healthcare centers of the Ningxia Hui Autonomous Region. Primary healthcare facilities should strengthen health education for patients to improve their treatment adherence，which can delay autonomic nerve damage in hypertensive patients.

Key words: Hypertension, Elderly, Disease course, Autonomic nerve, Primary health service centers, Singlelead wearable electrocardiogram monitoring

摘要： 背景 高血压是我国基层医疗卫生机构管理的主要慢性病。心脏自主神经功能紊乱是引起血压调控失衡，发生不良心血管事件的主要原因。因此在基层医疗卫生机构借助高效便携的单导联可穿戴心电设备探索老年高血压患者与自主神经之间关系，可为基层高血压患者管理和心血管病防控提供简单、高效、低成本且可持续的适宜方法和客观依据。目的 基于单导联可穿戴心电设备探索宁夏回族自治区基层医疗卫生机构老年高血压患者病程与自主神经功能损害的相关性。方法 选取2022年1月—2022年12月宁夏回族自治区20家基层医疗卫生机构应用单导联可穿戴心电设备采集并上传至云平台的2137例65岁以上高血压患者为研究对象，收集患者的72h心电图资料及云平台收集的患者基本信息、心理健康及生活方式等资料。自主神经损害依据心率变异性（HRV）时域参数全部窦性心搏RR间期的标准差（SDNN）结果分为正常组（SDNN>100ms）470例及异常组（SDNN≤100ms）1667例。通过1∶1比例行倾向评分匹配校正混杂因素，卡钳值为0.02，以逆概率处理加权法作为参考，验证倾向评分匹配的匹配效果，采用单因素和多因素Logistics回归分析高血压病程与自主神经损伤之间的关系，同时进一步验证倾向评分匹配的效果，采用倾向性评分匹配，基于高血压病程和自主神经损伤，行匹配前和匹配后敏感性亚组分析，同时采用限制性三次样条（RCS）分析来检验高血压病程与自主神经损害是否存在非线性关联及反应效应。结果 共收集1级高血压479例，2级高血压1658例；病程<5年者1203例、5~10年者753例、10~15年者110例、15~20年者41例、20~30年者26例、≥30年者4例。多因素Logistics回归分析显示匹配前后高血压患者自主神经损害与病程呈正相关（P<0.001）。亚组分析显示，匹配前后80岁以下、较低的教育程度、无共病冠心病的高血压患者；女性、共病阻塞性呼吸睡眠暂停（OSA）的高血压患者病程与自主神经损害的相关性更大，差异有统计学意义（P<0.05），交互作用有统计学意义（P<0.05）。但RCS分析显示匹配前后高血压患者病程与自主神经损害无非线性关系。结论 宁夏回族自治区基层老年高血压患者病程与自主神经损害呈正相关。基层医疗卫生机构应加强对患者的健康宣教，提高患者治疗的依从性，可延缓高血压患者自主神经损害。

关键词: 高血压, 老年, 病程, 自主神经, 基层医疗卫生机构, 单导联可穿戴心电设备