The Mechanism Of Ventricular Arrhythmia In Patients With Essential Hypertension

Hypertension with arrhythmia specifically refers to this cardiacarrhythmia without coronary heart disease and other cardiac disorders. Atrialfibrillation significantly increase the risk of thromboembolism, and ventriculartachycardia, ventricular fibrillation significantly affect hemodynamic stability,or even cause sudden death, so they are all called malignant arrhythmias. Butthe mechanisms of hypertension and ventricular arrhythmias are not yet clear.the present study is much about the changes of cardiac structure. Vascularinflammation and endothelial dysfunction also plays a very important role inthe development of hypertension, but the research for its role in thedevelopment of ventricular arrhythmia in patients with hypertension is less.C-reactive protein (CRP) as a non-specific markers of inflammation ortissue damage, is one of the most studied inflammatory markers associatedwith cardiovascular disease, and plays a key role in the prevention, treatmentand prognosisrole of cardiovascular disease. In recent years, a growingnumber of studies have shown that CRP is not only a marker of risk factors,but also a powerful pathogenic substances. Its pathogenicity mainly embodiedin the injury of endothelial function, ventricular remodeling, etc. Endothelin(ET), von willebrand factor (vWF) is mainly composed of endothelial cellsynthesis. When endothelial cell damage, its levels in plasma increasedsignificantly. Tt is a marker of impaire of endothelial function.Objective: Through the detection of CRP, ET, vWF, EDD andLVMI,in patients with simple hypertension and merger of ventriculararrhythmia, we try to explore the mechanism of ventricular arrhythmia inpatients with essential hypertension from vascular inflammation, endothelialdysfunction and ventricular remodeling. We further study on the correlationbetween CRP and endothelial function, ventricular reconstruction, discussing possible mechanisms of hs-CRP of participation in occurrence of ventriculararrhythmias. Explore the clinical significance of monitoring hs-CRP andindicators of endothelial function and heart ultrasound atients for simplehypertension and merger of ventricular arrhythmia.Methods:66cases of primary hypertension patients hospitalized inHebei Province People’s Hospital, Department of Cardiology, from October2011to October2012, were choosed. The diagnosis of hypertension are in linewith the "Chinese Hypertension Prevention Guide2010revision". Accordingto the result of dynamic electrocardiogram and classification of Lown, it canbe divided into pure hypertension group (24cases, male: female=12:12,57.46±9.21years old), hypertension with ventricular arrhythmia of group A (Lowngrade I-Ⅱ g rade) and group B (Lown gradeⅢ-Ⅴ grade), in which group A of23patients (male: female=11:12,59.61±10.44years), B group of19patients(male: female=13:6,59.74±14.76years).20healthy people (9male,11females,53.20±7.54years) in our hospital examination center served as thenormal control group. Patients with secondary hypertension and clearstructural heart disease such as coronary heart disease, myocarditis,cardiomyopathy and other nature arrhythmia patients, and patients sufferingfrom acute inflammation, severe liver and kidney disease, immune systemdisorders, malignant tumors, severe anemia, hyperthyroidism, and who usedanticoagulant and thrombolytic therapy can not be selected. Patients takinganti-inflammatory or anti-arrhythmic drugs which did not reach5half-liveswere also ruled out. the height, weight, and calculate body mass index (BMI)for all the selected patients. Record medication situation of each patient.Fasting blood glucose, cholesterol, triglycerides were measured. C-reactiveprotein (hs-CRP), endothelin (ET), and von willebrand factor (vWF) were alsomeasured. Left atrial internal diameter (LA), left ventricular end-diastolicinternal diameter (EDD), interventricular septum thickness (IVS), leftventricular posterior wall thickness (LVPW), E peak, A peak were detecedwith Echocardiography, then formulated left ventricular mass index (LVMI)according to Devercux.24hours dynamic electrocardiogram (ecg), dynamic blood pressure monitoring were detected. Finally carrie on the statisticalanalysis.Results:1.The level hs-CRP, ET, vWF in Pure hypertension group andhypertension complicating ventricular arrhythmia group was significantlyhigher than normal control group. Compared with the pure hypertension group,the level hs-CRP, ET, vWF of hypertension complicating ventriculararrhythmia group obviously increased, and it increased with the severity ofventricular arrhythmias.2.There were statistical significance OF EDD, LVMI between simplehypertension group, hypertension complicating ventricular arrhythmia groupA and group B. Statistical difference of LA, E/A between groups was notexist.3.The constitute ratio of blood pressure circadian rhythm disappearancesin hypertension complicating ventricular arrhythmia group significantly ishigher than the pure hypertension group, while no statistical differencebetween group A and group B.4.Hs-CRP and ET (r=0.554, P<0.01), vWF (r=0.488, P<0.05), EDD (r=0.496, P<0.05), LVMI (r=0.519, P<0.01) were positively correlated in purehypertension group; hs CRP and ET (r=0.494, P<0.05), vWF (r=0.434,P<0.05), EDD (r=0.456, P<0.05), LVMI (r=0.713, P<0.01) were positivelycorrelated in hypertension complicating ventricular arrhythmia group A;hs-CRP and ET (r=0.567, P<0.05), vWF (r=0.531, P<0.05), EDD (r=0.487, P<0.05), LVMI (r=0.542, P<0.05) were positively correlated in hypertensioncomplicating ventricular arrhythmia group B.Conclusions:1.Vascular inflammation, endothelial dysfunction, ventricular remodelingmay be related to the occurrence and development of ventricular arrhythmia inpatients with essential hypertension.2.Compared with the normal circadian rhythm of blood pressure ofprimary hypertension, circadian rhythm disappearence is prone to ventricular arrhythmias.3.High-sensitivity C-reactive protein associated with endothelial functionand ventricular remodeling, may participate in the occurrence anddevelopment of ventricular arrhythmia through exacerbating endothelialdysfunction and ventricular remodeling. Clinical monitoring of three indexescan to some extent to predict the occurrence and development of ventriculararrhythmia.4.For the treatment of patients with primary hypertension complicatingventricular arrhythmia, except application of anti-arrhythmic drugs andlowering blood pressure, at the same time, we also should pay attention toinhibit vascular inflammation, improve endothelial function and ventricularremodeling, and restore blood pressure circadian rhythm.