老年高血压患者心律失常特点及其与左室肥厚的关系

Prevalence of Arrhythmias and Their Relations with Left Ventricular Hypertrophy in Senile Hypertensive Patients

分析老年前期与老年期高血压患者２０６例（老年前期组８２例、老年组１２４例）和健康老年人６３例的２４ｈ动态心电图心律失常特点。结果显示老年高血压组总房性心律失常和总室性心律失常发生率为９８％和７５％，老年前期高血压组分别是９０％和６０％，老年健康对照组为８７％和５２％。其中短阵房性心动过速、房颤和Ｌｏｗｎ＇ｓ分级≥３级的室性心律失常发生率在老年高血压组分别为５５％和２６％，老年前期高血压组为２１％和１１％，老年对照组为２４％和６％（Ｐ＜０．０１～０．００１）。老年高血压组中伴左室肥厚者６６例，其总室性心律失常和Ｌｏｗｎ＇ｓ分级≥３级室性心律失常发生率分别是８５％和３６％，均高于不伴左室肥厚用者的６４％和１４％（Ｐ＜０．０１），提示室性心律失常的发生与左室肥厚密切相关。

Twenty-four-hour ambulatory electrocardiographic examination was performed in 206 hypertensive patients(presenile hypertensive group:82 cases,age 45～59 years;senile hypertensive group:124 cases,age≥60 years)and 63 healthy normotensive senile subjects.The incidences of total atrial and ventricular arrhythmias were 98% and 75% in senile hypertensive group,90% and 60% in presenile hypertensive group.87% and 52% in senile control group;transient atrial tachycardia and atrial fibrillation and Lown's grade≥3 ventricular arrhythmias were 55% and 26% in senile hypertensive group,21% and 11% in presenile hypertensive group(P<0.01～0.001,respectively).In senile hypertensive patients,66 cases with left ventricular hypertrophy(LVH)and 58 cases without LVH,the incidences of total ventricular arrhythmias and Lown's grade≥3 ventricular arrhythmias were 85% and 36% vs 64%and 14% respectively(P<0.01,respectively).The results suggest that arrhythmias often occur in hypertensive patients and have a increased tendency in the senile;in particular,ventricular arrhythmia seems closely to relate to LVH.