The Application Of Holter And Ambulatory Blood Pressure In Patients With Primary Hypertension

Objective:To explore the relationship between incidence of cardiac arrhythmias and heart rate variability/ambulatory blood pressure in hypertensive patients with different types/grading arrhythmias.24-hour ambulatory blood pressure include the mean blood pressure in24-hour, the average systolic and diastolic blood pressure within different time periods.Materials:Hypertension Group:We enrolled266cases into this research. The patients with hypertension were admitted to cardiovascular department of our hospital from January2012to January2014, mean age (66.41±2.89) years old, including136males. All patients were in line with the " Revised Edition of Guidance of Hypertension Prevention in china2010". All patients were given ambulatory blood pressure and Holter test. We defined103hypertensive patients with atrial arrhythmia as group A,80hypertensive patients with ventricular arrhythmia as group B, the rest83hypertensive patients as group C according to Holter results. We divided the patients in group A into5group as A1to A5according to KLeiger classification. We divided patients in group B into4groups as B1to B4according to Lown grading standards. The control group:We selected62normal cases who received physical examination in our hospital as control group, including32males and30females, mean age (65.85±2.34) years old.Methods:We recorded relevant indicators of HRV of patients in each group, including HRV SDNN, SDANN, PNN50, RMSSD and24h-SBP,24h-DBP, d-SBP, n-SBP, n-DBP and other indicators. And we explored the relationship between above indicators and the incidence of different arrhythmia.Results:1. The incidence of arrhythmia of hypertensive group was68.79%, and the incidence of arrhythmia of control group was5.0%, and the difference of these2group was significantly. The index of HRV in hypertension group were significantly lower than control group (P<0.01).2. The indexes of HRV in group C were lower compared with group A and Group B. HRV indexes decreased with increasing grade of arrhythmia. And the difference between group C and Group A was significantly (P<0.01), the difference between group C and Group B was significantly (P<0.05). There was no significantly difference between Group A and Group B with indexes of HRV(P>0.05).3. The relevant indexes of24-hour ambulatory blood pressure (including4h-SBP, d-SBP, n-SBP and so on) in group C were higher compared with group A and Group B. The indexes increased with increasing grade of arrhythmia. And the difference between group C and Group A was significantly (P<0.01), the difference between group C and Group B was significantly (P<0.05). There was no significantly difference between Group A and Group B with indexes of24-hour ambulatory blood pressure (P>0.05).Conclusions:1The incidence of arrhythmias in hypertension Group was higher than control group. And the indexes of HRV in hypertension group were significantly lower than control group.2The relevant indexes of HRV and24-hour ambulatory blood pressure could used as predictors of the incidence of arrhythmias in patients with essential hypertension.