The Mechanism Of Atrial Arrhythmia In Patients With Essential Hypertension

Hypertension is the most common diseases of the cardiovascular system.atrial arrhythmia, especially the occurrence of AF significantly increased therisk of thromboembolism, Atrial fibrillation is the most common clinicalarrhythmia, can lead to stroke and heart failure, as the main causes ofdisability and death.Hypertension with arrhythmia specifically refers to thiscardiac arrhythmia without coronary heart disease and other cardiac disorders.But the mechanism of hypertension complicating atrial arrhythmia is not clear,the present study is much about the changes of cardiac structure. Many studieshave confirmed the endothelial dysfunction plays an important role in thedevelopment of hypertension, But endothelial dysfunction in patients withessential hypertension leads to atrial arrhythmia is short of enough research.Synthesis of endothelin (ET) is mainly composed of endothelial cells, asimportant vessels endothelial dependent shrinkage factor, is very important tomaintain normal cardiovascular function. False von willebrand factor (vWF) isthe synthesis and secretion of endothelial cells and megakaryocyte.Undernormal circumstances, the body reached dynamic balance mechanism ofcoagulation and anticoagulation, plays a important role in the cardiovascularand cerebrovascular function.Blood pressure circadian change is the circadianrhythm of blood pressure, blood pressure circadian rhythm in normalcircumstances the characteristics of the curve presents a "twin peaks valley",namely "scoop" blood pressure fluctuations, this has to do with the body’snormal physiological activity, cardiovascular function.Objective: through to the ET, vWF, EDD and LA heart structure index,blood pressure circadian rhythm and high blood pressure progression inpatients with primary hypertension and merging atrial arrhythmia in the levelof observation, explore the possibility of mechanism of atrial arrhythmia in patients with primary hypertension from endothelial dysfunction, cardiacremodeling, course of blood pressure circadian rhythm and high bloodpressure. at the same time, research relationship between hypertension courseand atrial arrhythmia occurred, explore the clinical significance of monitoringendothelial function and blood pressure circadian rhythm for primaryhypertension patients and patients with hypertension combined atrialarrhythmia.Methods: main choice in October2012to October2013(3cases inNovember2011,1case on December2011,1case in February2012,1case inMarch2012,1case in May2012) in hebei province people’s hospital ofcardiology hospital treatment of64patients with primary hypertension,thediagnosis is in line with the "2010China hypertension prevention andtreatment guidelines revision" diagnostic criteria of hypertension. Accordingto the result of dynamic electrocardiogram and Kleiger classification, it can bedivided into primary hypertension group (20cases, male: female=8:12,55.35±10.94years old), hypertension with atrial arrhythmia of group A (Kleigerclass1-2grade，namely mild atrial arrhythmia) and group B (Kleiger class3-6grade，namely complex atrial arrhythmia).in which group A of20patients(male: female=9:11,60.45±10.23years old), B group of24patients (14:10,62.75±13.26years old). 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 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),medication situation, fasting blood glucose, cholesterol, triglycerides,Endothelin (ET), von willebrand factor (vWF), left atrial internal diameter(LA), left ventricular end-diastolic internal diameter (EDD), interventricularseptum thickness (IVS), left ventricular posterior wall thickness (LVPW), E peak, A peak were deteced with Echocardiography, then formulated leftventricular mass index (LVMI)(according to Devercux),24hours dynamicelectrocardiogram, ambulatory blood pressure monitoring for all the selectedpatients. Finally the statistical analysis.Results:1Hypertension combined atrial arrhythmia group ET, vWF weresignificantly higher than that of pure hypertension group, and increases withthe severity of atrial arrhythmia; High blood pressure progression of hypert-ension with atrial arrhythmia group (group A and group B) were significantlyhigher than the pure hypertension group, but between group A and group Bwas no statistical difference.2EDD, LVMI, LA and E/A of pure hypertension group and hyper-tension complicating atrial arrhythmia between group A and group B was nostatistical difference.3Blood pressure circadian rhythm disappearances constitute ratio ofhypertension complicating atrial arrhythmia group (group A and group B)were significantly higher than the pure hypertension group, but no statisticaldifference between group A and group B.4In44cases of hypertension with atrial arrhythmia group of patients, theLogistic regression equation to predict42cases had atrial arrhythmia, accuraterate95.5%(42/44), in20patients with hypertension group, using logisticregression equation to predict with10cases without atrial arrhythmia, accuraterate50%(10/10), the total accuracy was81.3%. Enter the regression equationof the independent variables are the two factors, blood pressure circadianrhythm and vWF, chi-square=35.357, P=.000, Logistic regression equationwas statistically significant. Logistic regression equation for: logitP=7.999+1.959X(circadian)+4.247(vWF).This study used two risk factors (blood pressure circadian rhythm,vWF) Logistic regression coefficient to reflect the two risk factors on p/(1-p)(atrial arrhythmia occurrence probability of the occurrence probability of notscore the OR). Abnormal blood pressure circadian rhythm of blood pressure circadian rhythm abnormalities atrial arrhythmia occurrence ratio is39.11,thescore of vWF than average below average of vWF ratrial arrhythmia occur-rence score rate of702.22Conclusions:1Endothelial dysfunction and high blood pressure progression may berelated to occurrence and development of atrial arrhythmia in patients withessential hypertension.2Compared with blood pressure circadian rhythm to scoop type inpatients with primary hypertension, circadian rhythm non dipper type inpatients is prone to atrial arrhythmia.3The results of single factor analysis meaningful indicators into thebinary classification Logistic regression equation model in blood pressurecircadian rhythm, vWF for atrial fibrillation independent risk factors forhypertension in room.4Through the observation of the level of the endothelial function, highblood pressure progression, and blood pressure circadian rhythm in clinical,predict the occurrence and development of atrial fibrillation in patients withhypertension.