老年原发性高血压患者血压变异性对新发心房颤动的影响

Effect of blood pressure variability on new-onset atrial fibrillation in elderly patients with essential hypertension

目的探讨老年原发性高血压患者血压变异性对新发心房颤动(房颤)的影响。方法回顾性研究2010年1月~2011年12月在我院住院治疗不伴房颤的老年原发性高血压患者683例,根据随访期间是否新发房颤分为房颤组69例及非房颤组614例。记录基线特征、超声心动图参数。进行动态血压监测,按收缩压变异性中位数9.89mm Hg(1mm Hg=0.133kPa)将入选患者分为高变异性342例和低变异性341例。应用Cox回归方程分析血压变异性对新发房颤的影响。结果房颤组24h收缩压变异性明显高于非房颤组[(11.13±3.50)mm Hg vs(10.21±3.41)mm Hg,P=0.034],24h舒张压明显低于非房颤组[(67.19±8.16)mm Hg vs(69.33±8.39)mm Hg,P=0.045]。多因素Cox回归分析显示,24h收缩压变异性、脑出血及心脏永久性起搏器置入是老年原发性高血压患者新发房颤的独立危险因素(HR=1.949,95%CI:1.175~3.233,P=0.010;HR=2.983,95%CI:1.075~8.277,P=0.036;HR=2.567,95%CI:1.370~4.810,P=0.003)。结论收缩压变异性升高是老年原发性高血压患者新发房颤的独立危险因素。

Objective To study the effect of blood pressure variability on new-onset atrial fibrillation（AF）in elderly patients with essential hypertension.Methods Six hundred and eighty-three elderly patients with essential hypertension admitted to our hospital from January 2010 to December 2011 were divided into AF group（n=69）and AF-free group（n=614）.Their baseline characteristics,echocardiographic parameters and ambulatory blood pressure were recorded.The patients were further divided into high variability group（n=342）and low variability group（n=341）according to their median SBP variability（9.89 mm Hg）.The effect of blood pressure variability on new-onset AF was analyzed by multivariate Cox regression analysis.Results The 24 hSBP variability was significantly higher whereas the 24 hDBP was significantly lower in AF group than in AF-free group（11.13±3.50 mm Hg vs 10.21±3.41 mm Hg,P=0.034;67.19±8.16 mm Hg vs69.33±8.39 mm Hg,P=0.045）.Multivariate Cox regression analysis showed that the 24 hSBP variability,cerebral hemorrhage,and cardiac pacemaker implantation were independent risk factors for new-onset AF（P〈0.05,P〈0.01）.Conclusion The 24 hSBP variability is an independent risk factor for new-onset AF in elderly patients with essential hypertension.