| BackgroundHypertension is one of the most widespread cardiovascular and cerebrovascular diseases in the world.It is a chronic disease with a high incidence in China.Most of the people with hypertension are primary hypertension.The etiology and pathogenesis are still unclear,but it is mostly due to the interaction of multiple factors such as genetics and environment.Hypertension seriously harms human life and health.Similarly,hypertension plays a very important role in its course which can also accelerate the atherosclerosis process of coronary atherosclerotic heart disease.Ambulatory blood pressure monitoring?ABPM?and heart rate variability analysis?HRV?play an important role in the prevention and treatment of diseases which have been widely used in clinical diagnosis and disease evaluation to guide clinicians to formulate a reasonable antihypertensive program.ObjectiveBy observing the relevant indicators of ambulatory blood pressure and heart rate variability in patients with primary hypertension and coronary heart disease,this study analyzed and discussed the characteristics of ambulatory blood pressure and heart rate variability in these patients,and provided reference for clinical treatment.Methods1.General information:Randomly selected 169 patients who were admitted to the outpatient,inpatient and health check-ups of the People's Hospital of Xinxiang Medical College from June 01,2018 to January 31,2019,with an average age of 63.63±11.51years,including 40 people with normal blood pressure and 129 patients with different were all patients with different degrees of hypertension.2.Inclusion criteria:newly diagnosed hypertension:on the premise of without taking antihypertensive drugs,the blood pressure is measured three times in the clinic on different days,systolic blood pressure?SBP??140mmHg and/or diastolic blood pressure?DBP??90mmHg?1mmHg=0.1333kPa?;Diagnosed hypertension:after detailed inquiry of the patient's medical history,if the previous diagnosis of hypertension is clearly diagnosed,even if the blood pressure level is<140/90mmHg,it is also diagnosed as hypertension.These hypertensive patients have not taken any antihypertensive drugs for at least the past 5 days.Coronary heart disease?CHD?:after detailed inquiry of medical history and comprehensive physical examination,founding evidence of ischemia or clear coronary stenosis by the relevant examination and inspection,such as electrocardiogram,echocardiography,coronary CT angiography,coronary angiography,etc.,heart disease caused by coronary atherosclerosis that narrows or occludes the lumen to cause myocardial ischemia,hypoxia,or necrosis can be included in the patients with chronic stable coronary heart disease.3.Exclusion criteria:Hypertensive patients with systolic blood pressure?180mmHg and/or diastolic blood pressure?110mmHg in the blood pressure of the clinic;have a clear history of secondary hypertension or highly suspects that certain secondary factors caused an increase in blood pressure by renal function,renal color Doppler ultrasound,adrenal CT or renal arteriography examination;basic rhythm is non-sinus rhythm,such as atrial flutter,atrial fibrillation,etc.;medical history combined with diabetes,cerebrovascular disease,renal insufficiency and severe cardiac insufficiency;medical history with previous cardiac pacemaker implantation,cardiac stent implantation and other heart-related surgical treatment;medical history such as thyroid or pituitary affecting heart rate;medical history with clear malignant tumors of the blood system or malignant solid tumors;pregnant women or previous pregnancy with hypertension;long-term suffering from mental illnesses such as anxiety and depression,and recent poor night sleep quality,insomnia,etc.;significant fever?body temperature?37.3??and severe infection in the past 3 days;taking digitalis preparations,B vitamins and other drugs may affect HRV in the past week;having cardiac events such as acute myocardial infarction in the past month.4.Diagnostic criteria:The diagnostic criteria for hypertension are in accordance with the National Guidelines for the Prevention and Control of Primary Hypertension?2017Edition?[1];the diagnostic and classification criteria for coronary heart disease are in compliance with the Guidelines for the Rational Use of Coronary Heart Disease?2nd Edition?[2].5.Grouping:According to the above criteria,the selected patients were divided into normal blood pressure group,simple primary hypertension group and primary hypertension combined with CHD group;the normal blood pressure group was recorded as group A?a total of 40 people?,simple primary hypertension group was recorded as group B?a total of 67 people?,and primary hypertension combined with CHD group was recorded as group C?a total of 62 people?.6.Observation content:The selected patients were all improved 24-hour ambulatory electrocardiogram and ambulatory blood pressure monitoring,collected the average blood pressure during the day?07:00-22:00?,the average blood pressure at night?22:00-07:00the next day?,the whole day 24-hour average blood pressure,and night-time blood pressure drop rate data,observed the shape of 24-hour blood pressure,and collected the time domain indicators SDNN,SDANN,SDNN-Index,RMSSD values of HRV.Result1.There is no statistically significant difference between the general data such as gender and age of each sample?P>0.05?.2.The day-time mean systolic blood pressure?dmSBP?,day-time mean diastolic blood pressure?dmDBP?,night-time mean systolic blood pressure?nmSBP?,night-time mean diastolic blood pressure?nmDBP?,24-hour mean systolic blood pressure?24hmSBP?,24-hour mean diastolic blood pressure?24hmDBP?of patients in group B and group C were higher than that in group A,and the difference was statistically significant compared with group A?P<0.05?.The blood pressure level in group C was only dmDBP,nmSBP,nmDBP,24hmDBP higher than group B,and the difference between the two groups was statistically significant?P<0.05?.However the difference of dmSBP and24hmSBP between the two groups was not statistically significant?P>0.05?.3.The difference between the three types of blood pressure in group B and group C was statistically significant?P<0.05?.The proportion of reverse dipper blood pressure in group C was significantly increased,so the difference was statistically significant compared with group B?P<0.05?.4.The HRV time domain indexes of SDNN,SDANN,SDNN-Index,and RMSSD in group B and group C were lower than those in group A,and the differences between the groups were statistically significant?P<0.05?.The observed value of the index is the lowest in group C,and the difference is also statistically significant compared with group B?P<0.05?.Conclusion1.24-hour ambulatory electrocardiogram and ambulatory blood pressure monitoring can noninvasively and effectively monitor the diurnal blood pressure fluctuations and heart rate variability in patients with primary hypertension and CHD.2.Nocturnal blood pressure of patients with primary hypertension and CHD is significantly higher than that patients with simple primary hypertension,and the proportion of reverse dipper blood pressure patterns is increased.At the same time,the circadian rhythm of blood pressure changes more significantly.3.All patients with primary hypertension have autonomic dysfunction,which is mainly characterized by increased sympathetic excitability and decreased parasympathetic excitability,but when CHD is merged,the autonomic nerve function damage is more significant. |
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