Association between persistent pressure overload and ventricular arrhythmias in essential hypertension
Association between persistent pressure overload and ventricular arrhythmias in essential hypertension
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DOI：
10.1161/01.hyp.28.2.284
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发表时间：
1996-08-01
期刊：
影响因子：
8.3
通讯作者：
Porcellati, C
中科院分区：
文献类型：
--
作者：
Schillaci, G;Verdecchia, P;Porcellati, C
高血压是心源性猝死的危险因素，一些数据表明，频繁和复杂的室性心律失常可能是高血压患者的额外风险标志物。我们研究了原发性高血压患者室性心律失常与持续24小时以上血压水平升高之间的关系。我们研究了126名从未接受过治疗的原发性高血压患者（83名男性），他们接受了24小时心电图监测、24小时动态血压监测和超声心动图检查。在71%的受试者中检测到室性早搏。与Lown分级0-1的受试者相比，频繁或复杂室性心律失常（Lown分级大于或等于2）的受试者年龄较大（54岁vs 45岁），高血压持续时间较长（5.4年vs 2.8年），左心室质量较大（147 g vs 127 g）。m（-2）），夜间动态血压下降不明显（7%/12% vs 12%/16%）。24小时内室性早搏的次数与年龄（r = 0.25）、左心室质量（r = 0.24）和脉压（r = 0.18）相关，与血压从白天到晚上的下降百分比（收缩压r =-0.29，舒张压r =-0.25）呈负相关。在多元逻辑回归分析中，频繁或复杂的室性心律失常（Lown分类大于或等于2）通过年龄大于或等于60岁预测（比值比，10.4; 95%置信区间，2.4-44.8），超声心动图显示左心室肥大（比值比，4.2; 95%置信区间，1.5-11.6），并且血压从白天到晚上降低< 10%（“非下降”模式：比值比，2.9; 95%置信区间，1.2-7.0）。我们的结论是，除了年龄和超声心动图左心室肥厚的强烈影响外，24小时内持续高血压水平（“非下降”模式）是从未接受过治疗的原发性高血压患者室性心律失常频率和复杂性的独立预测因素。
Hypertension is a risk factor for sudden cardiac death, and some data indicate that frequent and complex ventricular arrhythmias may be additional risk markers in hypertensive individuals. We investigated the relation between ventricular arrhythmias and the persistence of increased blood pressure levels over 24 hours in subjects with essential hypertension. We studied 126 never-treated subjects with essential hypertension (83 men) who underwent 24-hour electrocardiographic monitoring, 24-hour ambulatory blood pressure monitoring, and echocardiography. Premature ventricular beats were detected in 71% of the subjects. Compared with subjects in Lown class 0-1, subjects with frequent or complex ventricular arrhythmias (Lown class greater than or equal to 2) were older (54 versus 45 years) and had a longer duration of hypertension (5.4 versus 2.8 years), a greater left ventricular mass (147 versus 127 g . m(-2)), and a blunted nocturnal reduction in ambulatory blood pressure (7%/12% versus 12%/16%). The number of premature ventricular beats over 24 hours was associated with age (r = .25), left ventricular mass (r = .24), and pulse pressure (r = .18) and inversely associated with the percent reduction in blood pressure from day to night (r = -.29 for systolic and -.25 for diastolic pressures). In a multiple logistic regression analysis, frequent or complex ventricular arrhythmias (Lown class greater than or equal to 2) were predicted by an age greater than or equal to 60 years (odds ratio, 10.4; 95% confidence interval, 2.4-44.8), left ventricular hypertrophy at echocardiography (odds ratio, 4.2; 95% confidence interval, 1.5-11.6), and a < 10% reduction in blood pressure from day to night (''nondipping'' pattern: odds ratio, 2.9; 95% confidence interval, 1.2-7.0). We conclude that in addition to the strong effect of age and left ventricular hypertrophy at echocardiography, the persistence of high blood pressure levels over the 24 hours (''nondipping'' pattern) is an independent predictor of the frequency and complexity of ventricular arrhythmias in never-treated subjects with essential hypertension.