Ambulatory Blood Pressure Monitoring Are Used To Analyze The Circadian In Hypertensives Whose Blood Pressure Under The Standard In Clinic

Objective:Using the ambulatory blood pressure monitoring to analyze the effect and circadian in patients with conbined antihypertension treatment,whose blood pressure upto standard in clinic.Method:Hospitalized patients with hypertension from January2010to November2011in cardiology of the second Hospital of Tian Jin medical university who treated by conbined antihypertension treatment were enrolled,whose blood pressure upto clinical standard,24hour ambulatory blood pressure monitoring (ABMP) were used for them. All subjects were divided into groups according to drugs, duration of hypertension, according to drugs, the patients were classified into groups:[calcium channel blockers (CCB)and Angiotensin receptor blockers(ARB),group A, n=145],[CCB andβreceptor blockers,group B, n=168],[CCB、ARB and β receptor blocker,group C,n=108], calculate all the blood pressure value of each group and perform the statistic analysis, analysis the blood pressure changes of patients.Results:1. The pattern of blood pressure variation during24hour among all the patients with dippers55cases (13%)、nondippers195cases(47%)、reverse dippers132cases (31%)、extreme dippers39cases (9%). Among all the patients,the amount of morning peak blood pressure is62cases(14.7%),non-morning peak blood pressure is359cases(85.3%).2. According to drugs to classify groups:group A,B,C.2.1compare the baseline patient characteristics in the group A、B、C:The left atrium diameter in group A and group B larger than group C(35.42±3.50vs34.17±2.90,P=0.003;35.22±3.25vs34.17±2.90,P=0.009), the left ventricular in group A and group B larger than group C(44.73±2.86vs43.54±2.31, P=0.001;44.48±2.79vs43.54±2.31, P=0.005), the serum sodium in group C are lower than group B and group C (139±3.12vs140.1±3.4, P=0.008;139±3.12vs140.6±3.4, P=0.000), there was no statistical difference about other factors among the groups.2.2compare the24-hour systolic blood pressure(24hSBP)among the group A、B、C:The24hSBP in group C are lower than Group A and B (120.49±13.1vs137.91±13.27,120.49±13.1vs134.26±13.68, P=0.000), The24hSBP in group B are lower than Group A (134.26±13.68vs137.91±13.27, P=0.017),the difference has a statistically significant.2.3compare the daytime systolic blood pressure(dSBP)among the group A、B、C:The dSBP in group C are lower than Group A and B (121.80±13.19vs140.28±13.53,121.80±13.19vs135.64±13.73, P=0.000), The dSBP in group B are lower than Group A (135.64±13.73vs140.28±13.53, P=0.003), the difference has a statistically significant.2.4compare the nighttime systolic blood pressure(nSBP)among the group A、B、C:The nSBP in group C are lower than Group A and B (117.81±16.47vs135.2±14.60,117.81±16.47vs133.27±15.23, P=0.000), the difference has a statistically significant.compare the nSBP between group A and B(135.2±14.60vs133.27±15.23, P=0.269),the difference has no statistically significant.2.5compare the24-hour diastolic blood pressure(24hDBP)among the group A、B、 C:The24hDBP in group A and group C are lower than group B (75.18±8.72vs78.17±9.84, P=0.005;73.24±9.11vs78.17±9.84, P=0.000), the difference has a statistically significant; compare the24hDBP between group A and C (75.18±8.72vs73.24±9.11, P=0.102), the difference has no statistically significant.2.6compare the daytime diastolic blood pressure(dDBP)among the group A、B、C: The dDBP in group A and group C are lower than group B (76.23±8.51vs79.13±9.57, P=0.004;74.51±8.45vs79.13±9.57, P=0.000), the difference has a statistically significant; compare the dDBP between group A and C (76.23±8.51vs74.51±8.45, P=0.132), the difference has no statistically significant.2.7compare the nighttime diastolic blood pressure(nDBP)among the group A、B、C:The nDBP in group A and group C are lower than group B (72.97±8.08vs76.97±10.29, P=0.000;72.09±10.88vs76.97±10.29, P=0.000), the difference has a statistically significant; compare the nDBP between group A and C (72.97±8.08vs 72.09±10.88, P=0.476), the difference has no statistically significant.2.8compare the24-hour heart rate(24hHR)、 daytime heart rate(dHR)、nighttime rate(nHR) among the three groups:The24-hour heart rate(24hHR)、daytime heart rate(dHR)、nighttime rate(nHR) are lower than group A, the difference has a statistically significant.(P<0.01).2.9compare the morning surge among the group A,B,C:The morning peak blood pressure in group A has32cases(accounted for22.1%), group B has21cases(accounted for12.5%),group C has9cases(accounted for11.1%),the case in group A are more than in group C, the difference has a statistically significant.(P<0.05).Conclusions:1. Clinic patients with normal blood pressure,there are still some variation about blood pressure fluctation.2. Although clinic blood pressure to standard,but the blood pressure of some patients in24hour still have not arrived at standard.