| Background and ObjectiveHypertension is one of the most common chronic diseases in the world.It is a kind of "cardiovascular syndrome" characterized by the continuous elevation of arterial blood pressure.According to the survey,the prevalence of hypertension in adults is about 18.8%,about 95% of which is primary hypertension,even its pathogenesis has not been fully defined.However,the initial stage of primary hypertension,symptoms of it are insidious,slowly progress,be ignored easliy,failed to get timely diagnosis and treatment,then the late diagnosis and treatment is often happened in advanced stage.With the gradual progress course of hypertension,blood pressure rising,in this time the body has been lost to the compensatory ability of hypertension and the target organs such as brain,kidney etc can been hurt.The heart which to maintain blood pressure and transport body bloods,is the first target organ to be damaged.Long-term overload of blood pressure can cause heart electrical and morphological changes,and cardiac power and morphology can interact with each other,mutual cause and effect,the formation of a vicious cycle,causing a series of serious consequences of the heart.Through the conventional electrocardiogram,dynamic electrocardiogram and other cardiac electrical examination,we can be found in hypertensive patients with atrioventricular hypertrophy,myocardial ischemia,arrhythmia and other heart electrical changes,and arrhythmia is one of the main manifestations of changes in cardiac power.In many of arrhythmia,ventricular arrhythmia is a common arrhythmia in essential hypertension.Ventricular arrhythmia refers to the initiative and passive arrhythmia occurring below the bifurcation bifurcation,which includes premature beats,escape,ventricular rhythm,tachycardia,ventricular tachycardia,and ventricular fibrillation.The risk of ventricular arrhythmia is closely related to the factors such as interdecadal period,quantity and occurrence pattern.The premature ventricular premature rhythm is shorter,that is,ventricular premature beats are more advanced,the greater the changes in hemodynamics.The mechanism of which is premature rhythm shortened,ventricular filling time is shortened,ventricular end diastolic volume decreased,cardiac output decreased,the hemodynamic changes more obvious.Frequent,bursts,short interphalangeal ventricular arrhythmia,can cause patients with fatigue,dizziness,palpitations,syncope symptoms,have serious consequences.Multi-form,recurrent ventricular arrhythmias more harmful,and even can cause severe changes in hemodynamics,causing sudden cardiac death.In view of the essential hypertension with high incidence,hidden symptoms,multiple complications,serious harm and other reasons,we think its prevention,diagnosis and treatment are important in clinical work.At the same time,the incidence of ventricular arrhythmia in patients with essential hypertension is also high,if not timely detection and treatment will have serious consequences.Traditionally,the mechanism of ventricular arrhythmia mainly includes three kinds of classical theory: exhumation mechanism,triggered electrical activities and increased ventricular automaticity.but the researches on the relevant factors on the occurrence of hypertension in patients with ventricular arrhythmia are rare.and they are scattered,small sample,single research reports.Therefore,we collected the clinical data of 229 cases of primary hypertension patients in many aspects in this study,then we analysised causing the ventricular arrhythmia related factors of patients with essential hypertension,to provide the basis for clinical treatment and prevention of complications in patients with essential hypertension.Materials and Methods1 Subjects: the study subjects were 229 cases which were diagnosed as essential hypertension in the Department of Cardiology,The Second Affiliated Hospital of Zhengzhou University.There were 132 males and 97 females with an average age of(59 ± 17)years.The 229 patients were in line with the "Chinese Hypertension Prevention Guide 2010" in the diagnosis of essential hypertension.2 Methods: the detailed relevant clinical data of all patients were recorded,including gender,age,duration of hypertension,blood glucose,triglyceride(TG),glycosylated hemoglobin(HbA1c),total cholesterol(TC),low density lipoprotein cholesterol(HDL-C),high density lipoprotein cholesterol(LDL-C)and N terminal pro brain natriuretic peptide(NT-proBNP),Conventional electrocardiogram,dynamic blood pressure,dynamic electrocardiogram,echocardiography.3 Grouping methods:according to 24 h dynamic ECG results,to 24 hours of dynamic ECG ventricular premature beats> 100 times as the standard,the patients were divided into ventricular arrhythmia and non-ventricular arrhythmia group.At the same time,the ventricular arrhythmia group was divided into different subgroups according to the following methods: 1)According to the course of primary hypertension,divided into:(1)the course of hypertension for 0-5 years,(2)5 ~ 10 years of hypertension,Hypertension Course> 10 years group.2)According to the Lown classification method,divided into 5: ?,?,?,?,?grade,this study no RonT type phenomenon,it is only four.3)According to circadian rhythm of blood pressure,divided into three groups: normal group(including dipper type and super(1)dipper type),(2)non-scoop group,(3)anti-diarrhea blood pressure group.4)According to the ventricular premature beats load(ie,ventricular premature beats accounted for the proportion of total heart rate of 24 hours)is divided into: low load group,medium load group,high load group.4 Statistical methods: SPSS 18.0 data processing software to deal with the relevant data,measurement data to(x ± s),the comparison between groups using t test or correction t test;count data to the relative number of said,between the two groups compared ?2 The Kruskal-Wallis H test was used to compare the data of the two groups.SNY(Student-Newman-Keuls)method was used to compare the data.The statistically significant parameters were further analyzed by Logistic regression analysis.Person correlation analysis,test level ? = 0.05.Results1 The incidence of ventricular arrhythmias was 54.59%(125/229)in 229 patients with primary hypertension,and the incidence of ventricular arrhythmias in the left ventricle origin was 60.8%(76/125),Higher than the right ventricle origin 31.2%(39/125).2 Compared with patients with essential hypertension without ventricular arrhythmia,the patients with essential hypertension with ventricular arrhythmia of the ventricular septal thickness,abnormal blood pressure rhythm,hypertension course,NT-proBNP,SBP / DBP in day,SBP / DBP in night and so on were increased,while SBP decline rate,and DBP decline rate were decreased,the difference was statistically significant(P <0.05).There were no significant differences in the other parameters between the two groups.3 Logistics regression analysis,the results show that: The results showed that the course of hypertension,ventricular septal thickness,blood pressure circadian rhythm were related with ventricular arrhythmia,the greatest impact is the course of hypertension.4 With the prolongation of primary hypertension,ventricular premature beats increased,the Lown grades were all more common in all stages,and the Lown grades grading of early ventricular arrhythmia in primary hypertension gradually decreased.5 Ventricular arrhythmias in different ventricular arrhythmias in patients with primary hypertension in the distribution of ventricular septal thickness increased first and then decreased.6 In the ventricular arrhythmia group,the circadian rhythm of blood pressure was 81.6%(102/125),58 cases were "anti-dipper" blood pressure,44 cases were "non-dipper" blood pressure,ventricular arrhythmia has such characteristics: Blood pressure circadian rhythm disappeared,ventricular premature beats load higher,ventricular arrhythmia Lown graded heavier(mainly to ?,level).?7 Ventricular arrhythmias in patients with essential hypertension:?Comparing the results of primary hypertension patients with different ventricular load indexes showed that low,LVEDD and LVESD,beats load,LVEF,NT-proBNP in medium and high load group were different,the differences were statistically significant.?The Person correlation analysis showed that the primary hypertension patients with ventricular premature beat load has significant negative correlation with LVEF values(r=-0.724,P < 0.001),was positively correlated with LVEDD,LVESD and NT-proBNP(correlation coefficients were 0.345,0.271,0.160,P were 0.003,0.001,0.002).Conclusions1 The incidence of ventricular arrhythmia was higher in patients with essential hypertension,and the incidence of premature ventricular burst was higher than that of right ventricle.2 The incidence of ventricular arrhythmia in patients with essential hypertension is related with hypertension course,ventricular septal thickness,blood pressure circadian rhythm,and they have a coherent relationship3 The course of hypertension is a major risk factor for ventricular arrhythmias in patients with essential hypertension.The circadian rhythm of blood pressure and the thickness of interventricular septum are secondary risk factors.4 The occurrence of ventricular arrhythmias in patients with essential hypertension can affect the structure and function of the heart: with ventricular premature beats load increases,the left ventricular structure remodeling,its function also will change. |
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