Study Of The Relationship Between Blood Pressure Variability And Plasma Angiotensin Ⅱ And Inflammatory Factors In Hypertensive Patients With Obstructive Sleep Apnea Hyponea Syndrome

Objectives This study observed the level of serum angiotensin II (Ang II) and blood pressure variability (BPV) of hypertension patients and hypertension patients with obstructive sleep apnea hypopnea syndrome (Obstructive Sleep Apnea Hyponea Syndrome, OSAHS) before and after treatment.To explore①the relationship between hypertension and OSAHS;②The relationship between Ang II and hypertension and hypertension with OSAHS;③The relevance between Ang II and blood pressure variability,sleep disorder and intermittent hypoxemia;④The relationship between OSAHS severity and blood pressure variability and the level of Ang II.⑤The changes of Ang II level and blood pressure variability before and after continuos positive air way pressure (CPAP) or surgery treatment.Methods A case-control study was adopted, The data of 225 patients with hypertension were analysed retrospectively,who hospitalized continuously to the department of Otolaryngology Head and Neck Surgery and Department of Cardiology from January 2006 to June 2010. According to polysomnography(PSG),These patients were divided into three groups:simple hypertension, hypertension with mild OSAHS, hypertension with moderate-severe OSAHS.Concentration of serum Ang II was tested and ambulatory blood pressure monitoring (ABPM) was finished within the first week. Sleep apnea-hypopnea index (AHI), the lowest oxygen saturation (SaO2 min), the average oxygen saturation (MSa02),24h mean blood pressure (24hEBP), daytime average blood pressure (dEBP), nighttime mean blood pressure (nEBP) were selected as research indexes. According to the patients'condition, continuous positive airway pressure (CPAP) or surgery were selected as treatment methods, the indicators were reexamined 3 months later.Results①The concentration of Ang II were higher in hypertension with OSAHS than those in simple hypertension, Ang II concentration increased with severity of OSAHS, the difference was statistically significant (P<0.05).②Non-dipper circadian blood pressure in hypertension patients,hypertension combined with mild and moderate to severe obstructive sleep apnea syndrome was 31.8%,57.1% and 83.7%, respectively. Non-dipper blood pressure,BPV in hypertension with OSAHS group was significantly higher than those with simple hypertension. The proportion of non-dipper in hypertension with OSAHS group increased with AHI, the difference was statistically significant (P<0.05).③After treatment, the concentration of Ang II in OSAHS groups declined, the proportion of non-dipper blood pressure decreased, the difference was statistically significant (P<0.05).④Correlation analysis showed that Ang II concentration was positively correlated with AHI, was negatively correlated with lowest SaO2, mean SaO2, blood pressure decline rate. Multiple stepwise regression analysis showed that Ang II concentration was decreased after treatment, mainly related with AHI, followed by systolic blood pressure decline rate.Conclusions①The Ang II level of hypertension with OSAHS group was higher than that of hypertension without OSAHS group, indicating that hypertension with OSAHS may contribute to the secretion of Ang II, which led to a strong contraction of blood vessels, leading to blood pressure higher. OSAHS severity and the relationship with Ang II shows the longer the duration of hypoxemia, the more significant reaction became.②The correlation analysis between AngⅡand BPV shows that the changes of blood pressure circadian rhythm (BPCR) of hypertension patients with OSAHS was associated with Ang II.③The changes of BPCR was related to OSAHS severity.④Ang II might play a role in BPV in hypertension patients with OSAHS. CPAP or surgical treatment can improve blood pressure disorder and decrease plasma Ang II level in those patients. Objectives By observing the changes of serum Neopterin (Npt) and High Sensitivity C-reactive Protein (hsCRP) levels in Obstructive Sleep Apnea Hyponea Syndrome (OSAHS) Patients without hypertension (HP) and in those associated HP(OSAHS+HP), To explore①the relationship between inflammation and OSAHS or OSAHS+HP.②the association between Npt,hsCRP,and the circadian variation of blood pressure (BPCV),sleep disorder,intermittent hypoxaemia.③the relationship between OSAHS severity and BPCV in OSAHS patients.④the changes of inflammatory factors and BPCV before and after multi-dimensions surgey.Methods A case-controlled study was adopted,382 OSAHS patients who were hospitalized continuously in our hospital Otolaryngology-Head and Neck department from January 2005 to June 2010 were retrospectively analyzed,who were divided into three groups bases on polysomnography (PSG):mild OSAHS group(n=206),86 cases with HP(41.75%);moderate OSAHS(n=108),45 cases with HP(41.67%)and severe OSAHS(n=68),28 cases with HP(41.18%). Plasma Npt and hsCRP,24-hour ambulatory blood pressure monitoring (ABPM),PSG were measured in all patients before and 3 months after surgery.Apnea hypopnea index(AHI), Minimum oxygen saturation(SaO2 min),Mean oxygen saturation(MSa02),24-hour average blood pressure (24hEBP),day average blood pressure (dEBP),night average blood pressure (nEBP) were choosed as study indexes.Results①Npt and hsCPR level were higher in OSAHS+HP than OSAHS without HP, it's concentration increased with OSAHS severity, the difference was statistically significant (P< 0.05). Inflammatory factors were positively correlated with basic blood pressure.②Serum Npt and hsCRP concentration were negatively correlated with the drop rate of nocturnal and diurnal blood pressure, SaO2 min and MSa02,which were positively correlated with AHI.③Non-dipper blood pressure curve constitute ratio incresed with OSAHS severity, statistically significant difference (P< 0.05).④Plasma Npt in mild, moderate and severe OSAHS patients before surgery were21.76 nmol/L,30.42nmol/L and 38.42 nmol/L, respectively. whereas the values significantly decreased to 13.32nmol/L,19.57 nmol/L,21.89 nmol/L after surgery;Plasma hsCRP in three group were 3.76mg/L,6.65mg/L,9.58mg/L before surgery, whereas the values significantly decreased to 1.88mg/L, 4.59mg/L,6.84mg/L after surgery, respectively;The incidence of non-dipper curve in three groups patients were 34.8%,58.1% and 76.2% before surgery, The values decreased to 19.7%,33.6% and 48.4%,the difference were all statistically significant(P< 0.05). Relevance analysis indicate that the drop rate of nocturnal and diurnal blood pressure has negatively correlated with plasma Npt and hsCRP.Conclusions①The inflammatory factors of HP were higher than that of normal blood pressure,which indicates that hypertension was correlated with inflammation. Plasma Npt and hsCRP was a independent risk factor of hypertension. OSAHS seriousness associated with inflammation,which may indicate the longer of hypoxemia duration, the more notable of reaction.②The relation analysis of the Npt and hsCRP level and BPCVin this paper shows that BPCV of OSAHS was related with inflammation.③The change of BPCV was related with the seriousness of OSAHS.④Npt and hsCPR may be play some role in mechanism of blood pressure variability of OSAHS. Surgical treatment can improve the blood pressure variability and relieve inflammatory reaction.