原发性高血压患者心脏电重构与血压控制效果的关系

摘要：目的　通过分析原发性高血压患者心电图胸前导联T波振幅、动态血压的变化情况以明确心电重构与血压控制的关系。方法　根据24 h动态血压监测结果，将360例血压分级为2级及以上的原发性高血压患者分为血压控制达标组（53例）和血压控制未达标组（307例）。比较2组患者临床资料、24 h动态血压监测、心电图、实验室检查指标差异。采用Logistic回归分析血压控制未达标的影响因素。结果　与血压控制达标组比较，未达标组患者男性多见，心电图V1导联T波振幅增高（P＜0.05），TV1＞TV5、V6和V6 T/R＜1/10比例增加（均P＜0.05）。心电图TV1＞TV5、V6组（90例）患者平均收缩压（mSBP）、夜间平均收缩压（nSBP）、夜间平均舒张压（nDBP）较非TV1＞TV5、V6组（270例）升高，V6 T/R＜1/10组（119例）患者mSBP、日间平均收缩压（dSBP）、nSBP、nDBP较非V6 T/R＜1/10组（241例）升高（均P＜0.05）。Logistic回归分析显示，未校正年龄、性别、高血压分级、高血压病程及降压药物种类混杂因素，V1、V3导联T波振幅升高及TV1＞TV5、V6、V6 T/R＜1/10是高血压患者血压控制未达标的危险因素；校正混杂因素后，仅TV1＞TV5、V6、V6 T/R＜1/10是高血压患者血压控制未达标的独立危险因素（OR分别为3.145、2.632；95%CI分别为1.156~8.556、1.067~6.449；均P＜0.05），V1、V3导联T波振幅升高不是血压控制未达标的危险因素。结论　心电图TV1＞TV5、V6、V6 T/R＜1/10与高血压患者血压控制未达标有关联。

Relationship between cardiac electrical remodeling and blood pressure control in patients with primary hypertension

Abstract: Objective　To analyze the relationship between electrocardiogram (ECG) T wave amplitude in precordial leads and ambulatory blood pressure in patients with essential hypertension, and to investigate the relationship between cardiac electrical remodeling and blood pressure control. Methods　A total of 360 patients with primary hypertension with classified as grade 2 or above were enrolled in the study. Patients were divided into two groups according to the result of 24-hour ambulatory blood pressure monitoring (24 h ABPM): the controlled group (n=53) and the un-controlled group (n=307). The clinical data including baseline data, 24 h ABPM, ECG and laboratory indicators were collected in the two groups. The general data such as baseline data and T wave amplitude of precordial leads were analyzed between the two groups. Logistic regression analysis was used for analyzing factors predicting blood pressure control failure in patients with primary hypertension. Results　Compared with the blood pressure control group, the male patients were more common in the blood pressure uncontrol group (P＜0.05). The amplitude of T wave in lead V1 of ECG was increased (P＜0.05), and the proportion of patients with TV1＞TV5, V6 and V6 T/R＜1/10 increased (P＜0.05). The mSBP, nSBP and nDBP were increased in patients with TV1＞TV5, V6 (n=90) than those of patients without TV1＞TV5, V6 (n=270). The mSBP, dSBP, nSBP and nDBP were significantly increased in patients with V6 T/R＜1/10 (n=119) than those of patients without V6 T/R＜1/10 (n=241, P＜0.05). Logistic regression analysis showed that the increase of T wave amplitude in leads V1 and V3 and the increase in the proportion of patients with TV1＞TV5, V6 and V6 T/R＜1/10 before adjusting for age, gender, hypertension grade, duration of hypertension and types of antihypertensive drugs were the risk factors for substandard blood pressure control in hypertensivepatients. After adjusting for confounding factors, only the increase in the ratio of TV1＞TV5, V6 and V6 T / R＜1/10 was the independent risk factor for the failure of blood pressure control (OR= 3.145, 2.632. 95% CI: 1.156-8.556, 1.067-6.449, all P＜0.05). But the increased T wave amplitude in leads V1 and V3 was not the risk factor for the failure of blood pressure control. Conclusion　The ECG TV1＞TV5, V6 and V6 T/R＜1/10 is related with the failure of blood pressure control in patients with primary hypertension.