清晨高血压与无症状性心肌缺血的关系及雷米普利对其影响

目的:通过24h同步动态血压(ABPM)和动态心电图(DCG)的监测,观察清晨血压(收缩压、舒张压、心率)和ST段压低的变化。探讨清晨高血压与无症状性心肌缺血(SMI)的关系,以及口服长效降血压药物雷米普利治疗后对其影响。方法:对68例高血压合并冠心病患者,于口服雷米普利治疗前、治疗后4周,分别用三导动态心电图血压二合一分析仪,行24h同步动态血压和动态心电图的监测,观察清晨血压(收缩压、舒张压、心率)和ST段压低的变化。结果:清晨高血压(收缩压、舒张压、心率)与无症状缺血性ST段压低呈正相关(P<0.01)。经雷米普利治疗4周后动态血压、动态心电图与治疗前比较,血压(收缩压、舒张压)和ST段压低的变化有显著性差异(P<0.01),心率虽有减少,但无显著性意义(P>0.05)。结论:清晨高血压与无症状性心肌缺血的发生密切相关。雷米普利能有效降低清晨高血压,并能减少无症状性心肌缺血的发作次数,是治疗高血压合并冠心病的一种有效而安全的药物。

The Relationship of Hypertension in Morning and Silent Myocardial Ischemia and the Curative Effect of Ramipril for the Disease

Objective:To observe the change of hypertension in morning(systolic blood pressure,diastolic blood pressure and heart rate) and ST-segment depression and by monitoring 24h synchronous ambulatory blood pressure(ABPM) and dynamic electrocardiogram(DCG),so as to probe the relationship of hypertension in morning and silent myocardial ischemia and the effect of Ramipril for the disease.Methods:24h ABPM and DCG were monitored by use of three-guide analysator of dynamic electrocardiogram and blood pressure,in order to observe the change of hypertension in morning(systolic blood pressure,diastolic blood pressure and heart rate) and ST-segment depression in 68 hypertensive patients with coronary heart disease in 4 weeks before and after treatment with Ramipril.Results: There was positive correlation between hypertension in morning(systolic blood pressure,diastolic blood pressure and heart rate) and ST-Segment depression(P<0.01).After 4 weeks of treatment with Ramipri,there were significant difference in change of blood pressure(systolic blood pressure,diastolic blood pressure)(P<0.01),but no significant difference in change of heart rate(P>0.05),although the heart rate reduced.Conclusion:There are closed correlation between hypertension in morning and silent myocardial ischemic.Because Ramipril can effectively depress hypertension in morning and diminish the attack frequency of silent myocardial ischemia,it is a kind of effective and safe medicine to treat hypertensive patients with coronary heart disease.