| Background and ObjectiveHypertension is seriously harmful to human health, because the early mild symptoms and the slow progress seldom make many patients feel uncomfortable. Human have so strong compensatory ability that many morphological and laboratory examinations are normal in the early stage. With the developing of hypertension, it can cause damage in different degree of heart, brain, kidney and other target organs,which is often the main reason patients appearing in hospital.However, the disease has become complicated, or dangerously, even more the body organ function may change irreversibly, which bring tremendous economic and psychological pressure to society, patients and their families. Therefore, early detection, early diagnosis, early intervention is the key to the prevention and treatment of hypertension, which will not only improve the hypertension patients quality of life,but also prolong living of patients. Hypertension has a variety of types, such as the true hypertension, the masked hypertension,high power type hypertension, high impedance type hypertension, high output type hypertension, high capacity type hypertension or other types according to different classification methods. However, the definite diagnosis need to rely on clinic blood pressure, ambulatory blood pressure, heart function diagnosis instrument, dynamic electrocardiogram.The latter three are special inspection,which have not yet widespread popularization and application in most hospitals at present,so it is difficult to discovery, diagnosis and cure for the hypertension patients in early stage.ECG technique(acquisition convenient, fast, non-invasive, good repeatability. At present, it has become routine inspection project for healthy, outpatient and hospitalized patients to understand their heart condition) has been used in clinical for 113 years, which is important,especially in the diagnosis of cardiovascular disease. Compared with morphological examination(ultrasound, X-ray, CT, MRI), ECG is electrical inspection, which has obvious advantages in the hypertension early stage on cardiac damage. Due to different patients have different hypertension types,different severity, different complications, different lengths, which will lead to different performances reflected in morphological examination and cardiac electricity examination.Especially in the early stage of hypertension, the heart has not yet appeared morphological changes, while might have appeared cardiac electrical changing, so we can base on electrocardiogram changes to early detection the effect of hypertension on the heart. But the world did not attach importance to the role of ECG in the diagnosis of hypertension, or is still in a state of separation between theory and practice, perhaps many also know that hypertension can cause the ECG changes, but really encountered in hypertensive patients, there are few people let patients do electrocardiogram examination(no more use ambulatory blood pressure, dynamic electrocardiogram, heart function)to evaluate the effects of hypertension on cardiac. Since the last century, many scholars have made X-ray, ultrasound or CT, magnetic resonance and ECG contrast, got the conclusion that the accuracy of the former is better than latter in the diagnosis of atrioventricular hypertrophy caused by the hypertension.From the previous studies of this topic, we found that different stages of hypertension(early, middle and late stage) would have varying degrees of impact on the heart, ECG can be as follows: atrial and ventricular hypertrophy, all kinds of conduction block, ST-T changes. However, in the early stage of hypertension, ECG can be performance as atrial depolarization- P wave duration, morphological abnormalities(at a time when morphological examination has no positive findings), document retrieval has not been reported. Therefore, we think it is necessary to carry out the study of the change of atrial depolarization in patients with essential hypertension ". Materials and methods1 research object:108 essential hypertension cases were selected from out-patient and in-patient, all patients met the following criteria:(1)The history of hypertension is clear, whether or not get regular medication;(2)The history of hypertension was unclear, but the ambulatory blood pressure with clinical blood pressure met "Chinese hypertension Prevention Guide 2010" diagnostic criteria.Clinical data were collected including gender, age, history of hypertension and diabetes, fasting blood glucose, glycosylated hemoglobin, cholesterol, triglyceride, low density lipoprotein, high density lipoprotein, creatinine, urea, dynamic blood pressure,dynamic electrocardiogram( arrhythmia) and the conventional 12( 15 ? 18) lead electrocardiogram(paper speed 25mm/s, gain 10mm/mV, frequency range 0.05~ 150Hz), all the results are verified and corrected by professional doctors.2 grouping methods:(1) All patients were divided into three groups according to the hypertension history:(1)0- 5 years group;(2)5-10 years group;(3)above 10 years group, compared the ECG abnormal rate;(2) All patients were divided into 4 groups according to ECG P wave duration and Ptfv1 :(1)normal P wave duration +normal Ptfv1 group;(2)normal P wave duration+abnormal Ptfv1 group;(3)prolonging P wave duration +normal Ptfv1 group;(4)prolonging P wave duration+abnormal Ptfv1 group, summed up hypertension and other types of features between the different groups, drew the electrocardiogram P wave duration and Ptfv1 distribution in the development of hypertension, and analysed the significance in the diagnosis of essentioal hypertension with the prolonging P wave duration;(3)All patients were divided into 2 groups according to ECG P wave form:(1)regular shape group;(2)irregular shape group; analysed the related factors on morphological changes of ECG P wave, drew arrhythmia distribution map.3 statistical methods:All the data were collected by Excel form, the statistical analysis was performed using SPSS 16.0 statistical software, measurement data used the mean and standard deviation( x + S), count data used percentage(%).When two groups' measurement data were compared, t test or t' test were used. When two groups' count data were compared, x2 test was used.When three groups' measurement data were compared,variance analysis was used. When two groups between the three were compared, Bonferroni analysis non parametric test were used.the test level alpha =0.05 Results1 In the progression of essential hypertension, abnormal rate of ECG was elevated, and prolonging P wave duration in each stage was the most common(59.6%, 66.7%, 90.0%), especially in the early stage of essential hypertension was more obvious(59.6% vs 7.7% vs 7.7% vs 5.8% vs. 19.2%).2 Multiple linear regression analysis shows that the duration of ECG P wave duration was correlated with the essential hypertension history, the regression coefficient was 0.704, P = 0.005, and other parameters were not statistically significant. Person correlation analysis showed that the length of ECG P wave duration and the duration of hypertension related coefficient r = 0.35( positive correlation).3 The sensitivity of essential hypertension diagnosis using prolonging ECG P wave duration was 67.6%(73/108). The "dipper" rhythm of blood pressure in 80.8%(59/73) hypertension patients disappeared, 57.5%(42/73) showed "non dipper" changing, 23.3%(17/73) showed "anti dipper" changing; 19.2%(14/73) patients denied with hypertension history. 6.8%(5/73) hypertension patients performanced increasing night blood pressure alone.4 In the progression of essential hypertension, atrial depolarization wave- ECG P wave could chang as follows:(1)normal P wave duration : a short hypertension history, blood pressure can be briefly increased;(2)Ptfv1 abnormalities: a slightly longer hypertension history,the day and night systolic blood pressure increased;(3)prolonging P duration: hypertension history ranged different lengths. When the blood pressure was controled better, there was normal Ptfv1, when the blood pressure was not controled or poor controled, there could be abnormal Ptfv1.5 When combined with longer diabetes history(6.31±7.64 years), ECG P wave morphology showed irregular changing, mostly in male;Conversely, ECG P wave morphology showed regular changing; In the all irregular changing, the notch(descending notch)was the largest proportion {39.7%(29/73)}, the change was highly correlated with the diabetes history, fasting blood glucose, glycated protein level; When the P wave showed flat changing, the older patients was most;When the P wave showed ascending notch changing,diabetes history(0.14 + 0.05years), P wave duration(105.60 + 15.42ms) were the shortest, if prolonging P duration + ascending notch changing, the sensitivity of hypertension diagnosis can be increased from 67.6% to 73.1%; When the P wave showed bimodal changing,P wave duration was longest.6 the incidence of atrial arrhythmias in patients with essential hypertension is greater than that of ventricular arrhythmias, and P wave morphology irregular was more likely to occur atrial arrhythmias. Conclusions1 The sensitivity in diagnostic of essential hypertension with prolonging ECG P wave duration is higher.It may be the early cardiac electrical changes in essential hypertension, and P wave duration was related with hypertension history;2 Essential hypertension patients combined with diabetes, ECG P wave mostly appear descending notch changing;3 Essential hypertension patients with irregular ECG P wave morphology are easy to occur atrial arrhythmias. |
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