The Correlation Between Hypertension Management And Senile Degenerative Valvular Heart Disease

Background The incidence of valvular heart disease is second only to coronary heart disease and hypertension,and it is the subject of increasing attention in the field of cardiovascular medicine.Since the 1950 s,the main cause of valvular disease has shifted from rheumatism to degenerative disease.The early stage of senile degenerated heart valvular disease(SDHVD)is characterized by progressive dystrophy calcification of valve tip,which is similar to the active inflammatory process of atherosclerosis.In the early stage,there may be no clinical symptoms.With the aggravation of valve injury,a series of clinical symptoms such as heart failure,arrhythmia,syncope and sudden death may occur,which seriously affects the quality of life of elderly patients.Objective The aim of this study was to retrospectively analyze the incidence,clinical symptoms and ultrasonic manifestations of senile degenerated heart valvular disease(SDHVD)in elderly patients with hypertension under different blood pressure control states to explore the early prevention strategy of SDHVD.Methods This study was a single-center,observational,retrospective epidemiological investigation,all data came from outpatient and inpatient medical records of Yichang Central People’s Hospital.Subjects of this study were hypertensive patients aged ≥60 years old who underwent echocardiography in our hospital from January 2019 to December 2019,The basic clinical data of the patients were collected,including the history of hypertension,clinical symptoms,ECG results,MNA-SF test,MMSE test,etc.The incidence of SDHVD and the characteristics of valvular disease in different groups were analyzed according to the blood pressure standard,the time of hypertension and the time of blood pressure standard.The incidence of SDHVD in the hypertension control group and the uncontrolled group in different hypertension duration groups was used χ~2text,For different time between groups of hypertension incidence of SDHVD and valve damage contrast using trend χ~2text,the differences of clinical symptoms of arrhythmia in hypertension patients complicated with SDHVD were used χ~2 text,Rank-sum test was used for the difference between hypertension control and cardiac dysfunction in patients with hypertension complicated with SDHVD.Variance test was used to evaluate the differences of nutritional status and cognitive function in hypertension patients complicated with SDHVD,P < 0.05 indicated that the difference was statistically significant.Results(1)The incidence of SDHVD in hypertension patients(duration < 5 years,5-10 years,10-15 years,15-20 years,≥20 years)was 33.72%,37.44%,45.23%,54.33%,64.03%,respectively,P < 0.01,showing statistical difference.(2)With the prolongation of hypertension time,the proportion of simple valve calcification gradually decreased,but the proportion of valve calcification combined with functional impairment gradually increased,p < 0.01,showing statistical difference.Valvular insufficiency was the main cause of valvular function impairment regardless of the duration of hypertension,P >0.05,no statistical difference.(3)With the prolongation of hypertension time,the proportion of mixed valve damage gradually increased,P < 0.01,show statistical difference.No matter the length of time of hypertension,the valve damage was mainly mixed valve damage,single aortic valve damage and single mitral valve damage,single tricuspid valve damage and single pulmonary valve damage were less,P > 0.05,there was no statistical difference.(4)The incidence of SDHVD in the hypertension control group was significantly lower than that in the hypertension control group,P < 0.01,show statistical difference.(5)With the prolonging of hypertension duration,the incidence rate of SDHVD in the hypertension control group decreased gradually,while the incidence rate of SDHVD in the uncontrolled hypertension group increased gradually,P < 0.01,show statistical difference.(6)The most common clinical manifestations of hypertension complicated with SDHVD were cardiac dysfunction(1358 cases)(67.46%),followed by arrhythmia(1287 cases)(63.94%).SDHVD with clinical symptoms was more common in the uncontrolled hypertension group,P < 0.05,show statistical difference.(7)There were 1358 patients with hypertension complicated with SDHVD cardiac dysfunction,including 1033 patients(76.07%)in NYHA Ⅱ、Ⅲgrade.The hypertension control group was more common below NYHA Ⅱ grade,while the hypertension uncontrolled group was more common above NYHA Ⅲgrade,P <0.05,showing statistical difference.(8)A total of 1287 patients with hypertension complicated with SDHVD had arrhythmias,accounting for 63.94%,and atrial arrhythmia was the dominant one,in which atrial fibrillation ranked first,accounting for 21.71%,followed by atrial premature beats and atrioventricular block,accounting for 16.94% and 9.55%,respectively.The incidence of arrhythmias of all kinds in the hypertension control group was lower than that in the hypertension uncontrol group,P <0.05,showing statistical difference.(9)146 patients with hypertension complicated with SDHVD were at risk of malnutrition(43.58%),and 91 patients were at risk of malnutrition(27.16%).The mean score of the hypertension control group was 10.17±2.77,and the mean score of the hypertension uncontrolled group was 9.03±2.18.The nutritional status of the hypertension control group was better than that of the hypertension uncontrolled group(P < 0.01),showing statistical difference.(10)A total of 145 patients with hypertension complicated with SDHVD had cognitive dysfunction.The mean score of the hypertension control group was 24.13±4.85,and the mean score of the hypertension uncontrol group was 18.32±7.74.The cognitive function of the hypertension control group was higher than that of the hypertension uncontrol group,P <0.01,showing statistical difference.Conclusion 1.The incidence of senile degenerative valvular heart disease in hypertension patients increases gradually with the prolonging of hypertension duration.The incidence of SDHVD can be significantly reduced by the hypertension control reaching the target,and the earlier the control reaching the target,the greater the benefit;2.The hypertension control can reduce the occurrence of clinical symptoms of SDHVD;3.Patients with hypertension complicated with SDHVD are prone to malnutrition and cognitive decline,and the standard control of hypertension can improve the nutritional status and cognitive function of patients with hypertension complicated with SDHVD.