血压晨峰与原发性高血压患者心律失常及心肌缺血的关系

The Relationship between Morning Peak Blood Pressure and Arrhythmia and Myocardial Ischemia in Patients with Essential Hypertension

目的:探讨血压晨峰与原发性高血压患者心律失常及心肌缺血的相关关系及其临床意义。方法:选取2011年1月至2013年1月原发性高血压患者168例,根据动态血压结果,将血压晨峰≥23.6mmHg或<23.6mmHg分成A组(晨峰组)79例与B组(非晨峰组)89例,所有患者均同步进行24 h动态心电图和动态血压监测,比较两组心律失常与心肌缺血发生情况。结果:两组患者的一般临床情况具有可比性。与B组比较,A组的高血压患者更易发生频发房性早搏、房速、频发室性早搏和室速等心律失常情况,差异有统计学意义(P<0.05)。A组患者发生心律失常总数明显高于B组(=52.19,r=0.552,P<0.001)。与B组比较,A组的高血压患者容易发生ST段改变,差异有统计学意义(P<0.05);ST-T改变和T波改变两组之间差异无统计学意义(P>0.05)。A组患者发生心肌缺血的情况明显高于B组(=10.05,r=0.213,p=0.0015)。结论:原发性高血压患者若出现血压晨峰提示心律失常和心肌缺血的发生率增加,尤其是房性早搏的发生率明显升高。血压晨峰与患者的心律失常和心肌缺血关系密切,具有临床指导意义。

Objective： To explore the correlation between morning peak blood pressure and arrhythmia and myocardial ischemia in patients with essential hypertension and its clinical significance. Methods： 168 cases of patients with essential hypertension between January 2011 and January 2013 were chosen. According to the results of the dynamic blood pressure （morning blood pressure surge≥ 23.6 mmHg or 〈 23.6 mmHg） patients were divided into group A （79 cases for morning peak group） and group B （89 cases for Non morning peak group）, synchronous dynamic ECG and ambulatory blood pressure were monitored for 24 h in all patients, the rates of arrhythmia and myocardial ischemia were compared between two groups. Results： The general clinical data of two groups＇ of patients was comparable. Compared with group B, frequent atrial premature beat, atrial tachycardia, frequent ventricular premature beat and ventricular tachycardia were more likely to happen in patients in group A, the differences were statistically significant P〈 0.05）. The total number of patients undergoing arrhythmias in group A was significantly larger than in group B （= 52.19, r=0.552, P 〈 0.001）. Compared with group B, group A was more likely to undergo the ST segment changes, and the difference was statistically significant （P〈 0.05）. There was no significant difference in ST -t change and T wave change between two groups （P〉 0.05）. The occurrence of myocardial ischemia in group A was significantly higher than that in group B （=10.05, r =0.213, P= 0.0015）. Conclusion： Morning blood pressure peak in patients with essential hypertension suggested an increased incidence of arrhythmia and myocardial ischemia, and a significantly higher incidence of atrial premature beats. The relationship between morning blood pressure peak and arrhythmia and myocardial ischemia was close and had a clinical significance.