老年高血压患者血压昼夜节律紊乱与心律失常的关系

The correlation between blood pressure arrhythmia and turbulence of circadian rhythm in elderly hypertensive patients

目的探讨老年高血压患者血压昼夜节律紊乱与心律失常的关系。方法选择306例老年单纯收缩期高血压患者,根据动态血压检查结果,分为勺型组100例,非勺型组126例,反勺型组80例,选择健康者52例为对照组。全部患者进行24h动态心电图检查,比较各组与对照组发生总心律失常、并存心律失常、房性心律失常、室性心律失常例数和心率变异性。结果总心律失常例数在非勺型组>勺型组(P<0.01),反勺型组>勺型组(P<0.05),高血压各组>对照组(P<0.01)。并存心律失常例数在非勺型组、反勺型组均>勺型组(P<0.01),高血压各组>对照组(P<0.01)。短阵房速例数在反勺型组>勺型组(P<0.01)、反勺型组>非勺型组(P<0.05);心房颤动或心房扑动例数在反勺型组>勺型组(P<0.05)。频发室性期前收缩例数在反勺型组和非勺型组均>勺型组(P<0.05)。SDANN、r MSSD、PNN50在反勺型组<对照组(P<0.05、P<0.01);<勺型组(P<0.05、P<0.01));r MSSD在反勺型组<非勺型组(P<0.05);PNN50在非勺型组<对照组(P<0.05)、<勺型组(P<0.05)。结论血压昼夜节律紊乱可增加心律失常的发生,反勺型或非勺型高血压患者更易发生心律失常,以房性心律失常更多,并可使心率变异性下降。

Objective To investigate the correlation between blood pressure（BP）arrhythmia and turbulence of circadian rhythm in elderly hypertensive patients.Methods Three hundreds and six elderly patients with isolated systolic hypertension were selected and divided into three subgroups according to their 24h ambulatory blood pressure, 1 00 patients with dippers,1 26 patients with non-dippers,80 patients with reverse-dippers.Fifty-two healthy people were chosen as a control group.All people were monitored with 24h electrocardiograms.Results Patients with gener-al arrhythmia in non-dippers were more than those in dippers（P 〈0.01 ）,those in reverse-dippers were more than those in dippers（P 〈0.05）,those in three subgroups with hypertension were more than those in control group（P 〈0.01 ）.Patients with coexist arrhythmia in non-dippers and reverse-dippers were more than those in dippers（P 〈0.01 ）,those in three subgroups with hypertension were more than those in control group （P 〈0.01 ）.Patients with at-rial tachycardia in reverse-dippers were more than those in dippers（P 〈0.01 ）,those in reverse-dippers were more than those in non-dippers（P 〈0.05）.Patients with fibrillation or atrial flutter in reverse-dippers were more than those in dippers（P 〈0.05 ）.Patients with frequent premature ventricular beats in reverse-dippers and non-dippers were more than those in dippers（P 〈0.05）.SDANN、rMSSD、PNN50 in reverse-dippers were significantly lower than those in control group （P 〈0.05,P 〈0.01 ）,and dippers（P 〈0.05,P 〈0.01 ）;rMSSD in reverse-dippers was lower than that in nondippers（P 〈0.05）;PNN50 in non-dippers was lower than that in control group（P 〈0.05）and dippers（P〈0.05）.Conclusion The turbulence of BP circadian rhythm could cause cardiac arrhythmia.Cardiac arrhymia eas-ily happen in hypertensive patients with reverse-dippers and non-dippers,and more easily happen in those with atrial arrhythmia followed with decline of heart rate variability.