| PurposeIn this study,the changes of heart rate variability(HRV)and blood pressure variability(BPV)in patients with essential hypertension complicated with acute myocardial infarction after PCI were analyzed,and the clinical significance of the changes of the two indexes in judging the condition and prognosis of these patients was discussed.MethodAccording to the definition of " National Guidelines for the Prevention and Management of Hypertension at the Grassroots Level 2020 " and the fourth edition of "Global Myocardial Infarction," 112 patients with essential hypertension were screened from 2020.09 to 2023.06 in the Second Affiliated Hospital of Dalian Medical University.According to whether they had acute myocardial infarction,they were divided into essential hypertension group(hypertension group)and essential hypertension with acute myocardial infarction after PCI group(combined group),and 54 hospitalized patients without cardiovascular disease were selected as the control group.Patients with the following diseases were excluded :(1)secondary hypertension;(2)Malignant arrhythmia;non-sinus rhythm,such as atrial fibrillation;II degree and above atrioventricular block;pacing rhythm;(3)suffering from cerebrovascular disease,diabetes,severe liver and kidney dysfunction,severe cardiac insufficiency and sleep apnea syndrome;(4)previous history of myocardial infarction or myocardial revascularization(PCI or coronary artery bypass grafting);(5)suffering from hyperthyroidism,hypothyroidism and other diseases;(6)Hematological diseases and malignant tumors;(7)pregnant or lactating women;(8)Patients with long-term mental illness such as anxiety,depression,or significant mental abnormalities that affect the cardiac autonomic nervous system;(9)with severe infectious diseases,severe electrolyte disorders.The patients in the hypertension group and the control group completed Holter and ABPM examinations within 1 week after admission,and all patients in the combined group completed the above examinations 1 week after PCI.The general data and HRV and BPV indexes of the above patients were collected.The general data included gender,age,smoking history and course of hypertension.Blood test indicators myocardial markers including troponin(c Tn I),CK-MB isoenzyme mass determination(MMB);renal function index serum creatinine(Cr);liver function indexes include alanine aminotransferase(ALT),aspartate aminotransferase(AST)and blood lipid indexes include triglyceride(TG),serum total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),etc.HRV-related indicators included the standard deviation of NN intervals(SDNN),the standard deviation of the mean value of NN intervals every 5 minutes(SDANN),the root mean square value of the difference between adjacent NN intervals(RMSSD),the mean value of the standard deviation of NN intervals in 5 minutes(SDNN Index),and the percentage of the number of heart beats with the difference between adjacent NN intervals > 50 ms in the total number of heart beats(PNN50).BPV related indicators include 24 h systolic blood pressure coefficient of variation(24 h SCV),24 h diastolic blood pressure coefficient of variation(24 h DCV);daytime systolic blood pressure coefficient of variation(d SCV),daytime diastolic blood pressure coefficient of variation(d DCV);night systolic blood pressure coefficient of variation(n SCV)and night diastolic blood pressure coefficient of variation(n DCV).The above indicators were statistically analyzed to clarify the changes of HRV and BPV in patients with primary hypertension and acute myocardial infarction after PCI.Results1.Comparing the general data of the three groups of patients,it was found that there was no significant difference in gender,age and smoking history among the three groups of samples(P > 0.05).There were no significant differences in blood lipids(TC,TG,HDL-C,LDL-C),liver function indexes(ALT,AST)and renal function indexes(Cr)among the three groups(P > 0.05).There was no significant difference in the course of hypertension between the hypertension group and the combined group.The myocardial markers(c Tn I,MMB)in the combined group were significantly higher than those in the hypertension group and the control group(P < 0.05).2.Comparing the time domain indexes of HRV in the three groups,it was found that the time domain indexes SDNN and SDNN Index of HRV in the hypertension group and the combined group were lower than those in the control group,and the differences between the groups were statistically significant(P < 0.05).The RMSSD and PNN50 values of the time domain indexes in the control group were higher than those in the hypertension group and the combined group,and the difference between the groups was statistically significant(P < 0.05).The SDANN value of the hypertension group was lower than that of the control group(P < 0.05).3.The 24 h SCV and d SCV values of the hypertension group and the combined group were higher than those of the control group,and the above indexes of the combined group were also higher than those of the hypertension group,the difference was statistically significant(P<0.05).Conclusion1.Compared with healthy people and patients with essential hypertension,BPV increased and HRV decreased in patients with essential hypertension complicated with acute myocardial infarction after PCI.2.The impairment of autonomic nerve function in patients with primary hypertension complicated with acute myocardial infarction is further aggravated than that in patients with simple hypertension,which is characterized by sympathetic hypertonia and vagus nerve activity inhibition.3.It is recommended to improve 24-hour ambulatory blood pressure and electrocardiogram monitoring for patients with hypertension and acute myocardial infarction after PCI.Monitoring the changes of BPV and HRV is helpful to evaluate the impairment of autonomic nerve function in patients,and is of great significance for judging the patient ’s condition,guiding individualized rational drug treatment and improving prognosis. |
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