The Application Of Holter And Ambulatory Blood Pressure In Young And Middle-aged Patients With Primary Hypertension

Objective:To explore the relationship between the level of blood pressure,heart rate variability and the type and frequency of arrhythmias in young and middle-aged essential hypertension patients with different types of arrhythmias.To provide reference for prevention and treatment of arrhythmias in young and middle-aged patients with essential hypertension.Subjects:From December 2017 to October 2018,160 young and middle-aged patients with essential hypertension,including 99 males and 61 females,aged from 19 to 59 years(mean48.48 ±7.15 years),were selected from Taian Central Hospital.All the subjects in the study met the diagnostic criteria for hypertension in the 2010 revision of the China guidelines for the Prevention and treatment of Hypertension.First,to exclude continuous hypertension,and not to take three measurements on the same day without the use of antihypertensive drugs.The systolic blood pressure(SBP)≥140mmHg and/or diastolic blood pressure(DBP)≥90mmHg.All research All subjects were given 24-hour am bulatory blood pressure and 24-hour ambulatory electrocardiogram.According to the results of arrhythmias analyzed by dynamic electrocardiogram,all patients were divided into two groups according to KLeiger grade and Lown grade.Group 1: 20 cases of hypertension with frequent arrhythmias;Group 2: hypertension with occasional or no arrhythmias(n =40).The patients in group 1 were divided into three groups according to the origin of preperiod contraction,including group A(n = 40),group B(n = 40),group C(n = 40).In group A,there are 40 hypertension with frequent atrial arrhythmias,including single atrial premature beat(ASPC)and paired atrial premature beat(AF).Biphasic and triplet laws of atrial premature beats Group B consisted of hypertension with frequent ventricular arrhythmias,including single ventricular premature beats,paired ventricular premature beats,biventricular premature beats and triplets of ventricular arrhythmias,and group B consisted of hypertensives with frequent ventricular arrhythmias,including single ventricular premature beats,paired ventricular premature beats,biphasic ventricular beats and triplet ventricular arrhythmias.Group C: hypertension with fequent mixed arrhythmias,including frequent atrial arrhythmias and frequent ventricular arrhythmias.Research methods:Personal information such as age,sex,height,weight,family history of hypertension,smoking history and drinking history were collected,and body mass index(BMI),was calculated.Using 24-hour ambulatory electrocardiogram monitoring instrument and DM software analysis system,24-hour ambulatory blood pressure monitoring instrument and DM software analysis system,the total standard deviation of time domain indexes of heart rate variability in each group was recorded by(SDNN).The difference between square root(R MSSD),and adjacent NN was greater than that of 50 ms as a percentage of total heartbeat times(PNN50),as well as 24-hour mean systolic blood pressure(24h-SBP),24-hour mean diastolic blood pressure(24h-DBP),and 24-hour mean systolic blood pressure(24h-SBP)and 24-hour diastolic pressure(24h-DBP).Daytime mean systolic blood pressure(d-SBP),daytime mean diastolic blood pressure(d-DBP),nocturnal mean systolic blood pressure(n-SBP),nocturnal mean diastolic blood pressure(n-DBP)and so on.The statistical software SPSS 25.0 was used to compare the differences of each index among the groups.Results:1.There was no significant difference in statistics between the general clinical basic data of all the subjects,including sex,age,body mass index,smoking history,drinking history and family history of Hypertension(P>0.05).2.Compared with 2 and 1 groups of patients and 2 groups of patients,the index of heart rate variability(SDNN,PNN50,SDANN,RMSSD)in 1 groups of patients decreased in different degrees,and there were significant differences in statistics,P<0.05.3.Group A,group B compared with group C,the Indicators of group C(24h-SBP,24h-DBP,dSBP,dDBP,nSBP,nDBP)were higher than group A and group B,statistically,there were significant differences,P<0.05.It shows that with the increase of hypertension level,the more types of arrhythmia occur.Conclusion:1.In young and middle-aged patients with essential hypertension,heart rate variability was correlated with the type and frequency of arrhythmia.The indexes of heart rate variability in patients with frequent arrhythmias were significantly lower than those in patients with sporadic or non-arrhythmias.It is suggested that the patients with impaired autonomic nervous function are hypertensive patients with frequent arrhythmias.2.In young and middle-aged patients with essential hypertension,the level of blood pressure was correlated with the type and frequency of arrhythmias.As hypertension levels rise,the more frequent arrhythmias occur,the more types of arrhythmias occur.3.Ambulatory electrocardiogram and ambulatory blood pressure play an important role in the prevention and treatment of primary hypertension in middle-aged and young people,and heart rate variability(HRV)can predict the type and grade of arrhythmias.