Uen Sakir, Baulmann Johannes, Düsing Rainer, Glänzer Kilian, Vetter Hans, Mengden Thomas
Department of Internal Medicine, University Clinic, Bonn, Germany.
J Hypertens. 2003 May;21(5):977-83. doi: 10.1097/00004872-200305000-00023.
Various statements are made concerning peaks of heart rate (HR), blood pressure (BP) and double product (product of HR and systolic BP) as triggers for ST-segment depression. The aim of the present study was to identify determinants of ST-segment depression with a new ambulatory device for simultaneous 24-h electrocardiogram (ECG) and BP monitoring.
A total of 63 treated patients (63 +/- 9 years, 33 women and 30 men) with arterial hypertension and ischemic heart disease were studied with a new ambulatory 24-h BP measurement (ABPM) device evaluated according to the BHS protocol (Cardiotens, Meditech, Hungary). This device allows simultaneous ST-segment analysis with extra BP recordings triggered by episodes of ST-segment depression.
ST-segment (Holter ECG) depression (> 1 mm and > 60 s) was demonstrated in 26 patients with a mean duration of 4.95 +/- 2.6 min and a peak in the early morning hours. All ST-segment depressions were silent and occurred during a significant increase of BP (15 +/- 11 mmHg systolic and 10 +/- 5 mmHg diastolic, compared with the mean ABPM values) and a significant increase of the double product from 10 921 +/- 2 395 (24-h mean) to 14 515 +/- 2329 (during ST-depression). The recorded systolic and diastolic BP (SBP, DBP) values from the pre ST-event were significant higher compared with 24-h values (153 +/- 19 versus 145 +/- 22 mmHg systolic, 83 +/- 12 versus 78 +/- 14 diastolic). The mean pulse pressure (PP) value in the group with ST-depression was significantly higher than in the group without ST changes (69 +/- 16 versus 58 +/- 10 mmHg; P < 0.005). A total of 73% of patients with ST-events compared with 35% without ST-events showed a PP >or= 60 mmHg (P = 0.025).
Simultaneous ABPM and ST-segment analysis identifies episodes of silent myocardial ischemia during increases of BP and HR. Hypertensive patients with ischemic heart disease and ST events show higher mean pulse pressure values than are observed in patients without events. A PP of >or= 60 mmHg is linked to an increased risk of silent myocardial ischemias.
关于心率（HR）、血压（BP）峰值以及双乘积（心率与收缩压的乘积）作为ST段压低触发因素的说法众多。本研究的目的是使用一种新型动态设备同时进行24小时心电图（ECG）和血压监测，以确定ST段压低的决定因素。
共有63例接受治疗的患者（年龄63±9岁，女性33例，男性30例），患有动脉高血压和缺血性心脏病，使用一种根据BHS协议评估的新型动态24小时血压测量（ABPM）设备（Cardiotens，Meditech，匈牙利）进行研究。该设备允许在ST段压低发作触发额外血压记录的同时进行ST段分析。
26例患者出现ST段（动态心电图）压低（>1mm且>60秒），平均持续时间为4.95±2.6分钟，且在清晨时段达到峰值。所有ST段压低均为无症状性，且发生在血压显著升高时（收缩压升高15±11mmHg，舒张压升高10±5mmHg，与平均ABPM值相比），双乘积从10921±2395（24小时平均值）显著升高至14515±2329（ST段压低期间）。ST段事件前记录的收缩压和舒张压（SBP，DBP）值显著高于24小时平均值（收缩压153±19对145±22mmHg，舒张压83±12对78±14mmHg）。ST段压低组的平均脉压（PP）值显著高于无ST段变化组（69±16对58±10mmHg；P<0.005）。与无ST段事件的患者相比，有ST段事件的患者中共有73%的患者PP≥60mmHg，而无ST段事件的患者中这一比例为35%（P=0.025）。
同步ABPM和ST段分析可识别血压和心率升高期间的无症状性心肌缺血发作。患有缺血性心脏病且有ST段事件的高血压患者的平均脉压值高于无事件患者。PP≥60mmHg与无症状性心肌缺血风险增加有关。
