Department of Cardiology, Manisa Merkezefendi State Hospital, Manisa, Turkey.
Department of Cardiology, Manisa City Hospital, Manisa, Turkey.
Turk J Med Sci. 2022 Dec;52(6):1906-1916. doi: 10.55730/1300-0144.5538. Epub 2022 Dec 21.
Hypertension is a known risk factor for developing atrial fibrillation. However, there is limited data to investigate the association between morning blood pressure surge (MBPS) and paroxysmal atrial fibrillation (PAF). We conducted the present study to determine whether there is a relationship between asymptomatic PAF and MBPS and whether MBPS may be a predictor of asymptomatic PAF episodes.
This prospective study comprised 264 adult patients who were newly diagnosed with essential hypertension or were previously diagnosed but not receiving regular antihypertensive therapy. We evaluated the patients in 2 groups according to their 24-h electrocardiography monitoring results: group 1 included patients who exhibited PAF (n = 32, 23 females/9 males; mean age 60.2 ± 7.4 years) and group 2 included patients with no signs of PAF as a control group (n = 232, 134 females/98 males; mean age 56.9 ± 9.4 years). We calculated the MBPS as the difference between mean systolic blood pressure (SBP) in the 2 h after getting up and the minimum nocturnal SBP.
: MBPS values were significantly higher in group 1 than in group 2 (35.3 ± 7.0 vs. 22.0 ± 6.7, p < 0.001). MBPS was positively associated with left atrial diameter (LAD) (r = 0.441, p < 0.001), left ventricle mass index (LVMI) (r = 0.235, p < 0.001), the ratio of early (E) peak of mitral inflow velocity to early (Em) diastolic mitral annular velocity (E / Em) (r = 0.239, p < 0.001), 24-h mean (r = 0.270, p < 0.001) and daytime SBP (r = 0.291, p < 0.001). We determined a cut-off value for MBPS as 28.6 for predicting PAF episodes development and identified LAD and MBPS as independent risk factors for PAF.
Patients who had larger MBPS were observed to have higher PAF incidence. MBPS values may be sensitive in predicting asymptomatic episodes of paroxysmal atrial fibrillation.
高血压是心房颤动的已知危险因素。然而，目前的数据有限，无法研究清晨血压飙升（MBPS）与阵发性心房颤动（PAF）之间的关系。我们进行了本研究，以确定无症状性 PAF 与 MBPS 是否存在关系，以及 MBPS 是否可作为无症状性 PAF 发作的预测指标。
这项前瞻性研究纳入了 264 名新诊断为原发性高血压或之前诊断但未接受常规降压治疗的成年患者。根据 24 小时心电图监测结果，我们将患者分为 2 组：组 1 为 PAF 患者（n = 32，23 名女性/9 名男性；平均年龄 60.2 ± 7.4 岁），组 2 为无 PAF 迹象的对照组患者（n = 232，134 名女性/98 名男性；平均年龄 56.9 ± 9.4 岁）。我们将 MBPS 定义为起床后 2 小时平均收缩压（SBP）与夜间最低 SBP 之间的差值。
组 1 的 MBPS 值明显高于组 2（35.3 ± 7.0 与 22.0 ± 6.7，p < 0.001）。MBPS 与左心房直径（LAD）（r = 0.441，p < 0.001）、左心室质量指数（LVMI）（r = 0.235，p < 0.001）、二尖瓣血流速度 E 峰与早期舒张期二尖瓣环速度 E / Em 的比值（r = 0.239，p < 0.001）、24 小时平均 SBP（r = 0.270，p < 0.001）和日间 SBP（r = 0.291，p < 0.001）呈正相关。我们确定 MBPS 的截断值为 28.6，以预测 PAF 发作的发展，并确定 LAD 和 MBPS 是 PAF 的独立危险因素。
MBPS 较大的患者观察到 PAF 发生率较高。MBPS 值可能对预测无症状阵发性心房颤动敏感。
