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目的:探讨24 h动态血压监测对治疗老年原发性高血压患者发生心房颤动的预后价值。方法:回顾性分析2015年3月至2016年7月河南大学淮河医院收治的老年原发性高血压患者125例,并根据是否并发房颤分为并发房颤组36例和单纯高血压组89例,进行动态血压监测,并根据白昼舒张压(DBP)监测结果分为低舒张压组(DBP<85 mm Hg,n=70)、中舒张压组(85 mm Hg≤DBP≤95 mm Hg,n=39)和高舒张压组(DBP>95 mm Hg,n=16),分析血压与房颤发生的相关性。结果:并发房颤组白昼和夜间DBP和SBP均明显较单纯高血压组高,差异具有统计学意义(P<0.05),而24 h内平均脉压变化差异均无统计学意义(P>0.05);低、中、高舒张压组中房颤发生率随着舒张压的升高而增高,然低舒张压组和中舒张压组间房颤发生率,差异均无统计学意义(P>0.05),高舒张压组房颤发生率较低、中舒张压组高,差异具有统计学意义(P<0.05)。结论:老年原发性高血压患者房颤的发作与其脉压高低密切相关,通过密切监测患者血压,有助于对高血压预后的判断,指导临床高血压病的治疗,减少预后不良事件的发生。
Objective: To investigate the prognostic value of 24-h ambulatory blood pressure monitoring for the treatment of atrial fibrillation in elderly patients with essential hypertension. Methods: A retrospective analysis of 125 elderly patients with essential hypertension admitted to Huaihe Hospital of Henan University from March 2015 to July 2016 was performed. According to whether atrial fibrillation was complicated by atrial fibrillation, 36 patients were complicated by atrial fibrillation and 89 patients with hypertension The patients underwent diastolic blood pressure (DBP <85 mm Hg, n = 70), diastolic pressure group (85 mm Hg≤DBP≤95 mm Hg, n = 39) and high diastolic blood pressure (DBP> 95 mm Hg, n = 16). The correlation between blood pressure and the occurrence of atrial fibrillation was analyzed. Results: DBP and SBP were significantly higher in patients with atrial fibrillation than those in patients with hypertension alone (P <0.05), while there was no significant difference in mean pulse pressure within 24 hours (P> 0.05) ). The incidence of atrial fibrillation in low, moderate and high diastolic blood pressure group increased with the increase of diastolic blood pressure. However, there was no significant difference in the incidence of atrial fibrillation between low and medium diastolic pressure group (P> 0.05). The incidence of atrial fibrillation in high diastolic pressure group was lower than that in moderate diastolic pressure group, the difference was statistically significant (P <0.05). Conclusions: The onset of atrial fibrillation in elderly patients with essential hypertension is closely related to the level of its pulse pressure. By closely monitoring the patient’s blood pressure, it is helpful to judge the prognosis of hypertension, to guide the treatment of clinical hypertension and to reduce the occurrence of adverse prognostic events .