Impaction Of Blood Pressure, Lipids, Glucose And Renal Function Level On Cardiovascular Events In The Elderly Patients With Hypertension

Objective:Analyze the prognostic factors of elderly patients with hypertension in thecommunity hypertension standardized management; analyze the affect of the bloodpressure, blood lipids, blood glucose level of renal function in elderly hypertensivepatients with cardiovascular events; Provide a basis for further improving thecommunity elderly hypertensive standardized management model.Method:1. Subjects: Force retired elderly population （≥65years of age） who accept theblood pressure, lipid, hypoglycemic treatment,846cases of hypertensive patientsincluded in the study.2.Follow-up from March2003to August2010, followed up for at least one year.Make clinical epidemiology survey, fill out the "senile cardio-cerebral vasculardiseases and risk factors questionnaire".3.Levels were grouped according to the2003systolic blood pressure （SBP）,diastolic blood pressure （DBP）, pulse pressure （PP）, total cholesterol （TC）, fastingblood glucose （FBG） control baseline level and estimated glomerular filtration rate （eGFR）.4. Using the SPSS17.0software statistical methods to process data. Thenumerical variables were expressed as mean±standard deviation between the twogroups were compared using single factor analysis of variance; count the statistics ofthe data sample rate, using the χ²test analysis of normally distributed continuousvariables using t test or single factor ANOVA analysis, non-normally distributedvariables using non-parametric test, and categorical variables application χ²test. Wereto grade the level of blood pressure, blood glucose, lipids, renal function, respectively,to calculate the incidence of clinical events of various parameters at different levels,each parameter difference using χ²test was used to compare different levels ofclinical event rates, it is estimated that the relative risk RR and calculate the95%confidence interval. Cox regression analysis of prognostic factors and survival curves.Test with p <0.05statistically significant.Result:1.In this study, the rate of hypertension control was58.2%, the mortality ofcardiovascular and cerebrovascular was31.3%, coronary heart disease events/strokeevents is1:1.2.Compared with the non-event group, the people in clinical events were elder,PP, FBG high, DBP and eGFR low, high-risk smokers more, combined stroke,coronary heart disease, diabetes and hyperlipidemia more, chronic renal insufficiency,the difference between the two groups was statistically significant （P <0.05）. The SBP,TC, and body mass index were no significant difference （P>0.05）.The degree of riskof hypertension, with cardiovascular disease, estimated glomerular filtration ratelower, and age amomg elderly patients with hypertension were independent riskfactors for cardiovascular disease.3. The grouping results of systolic blood pressure level:1) With the systolicblood pressure increased, diastolic pressure, pulse pressure and BMI increased, thedifferences between their groups were statistically significant （P <0.05）.2) When the SBP≥150mmHg, among the cardiovascular mortality, coronary heart diseasemortality, non fatal MI and acute acute stroke incidence was highest; when the SBPwas controled between the140-149mmHg, cardiovascular mortality, crown heartdisease mortality, and nonfatal MI were the lowest rate; the differences between theirgroups were statistically significant （P <0.05）.3) The survival curves has nosignificant separation （P>0.05）, but the trend of SBP≥150mmHg group’s survivalrate was lowest and the highest survival rate of140-149mmHg.4. Analysis prognostic impact of diastolic blood pressure in elderly hypertensivepatients:1) systolic pressure、pulse pressure With diastolic blood pressure,which wasstatistically significant（P<0.05）.2) If DBP was above90mmHg, all-causes mortalityand incidence of cardiovascular events were the highest.If DBP was between the80and89mmHg, all-causes mortality、cardiovascular mortality、CHD mortality werethe lower.It was statistically significant difference between groups（P<0.05）.3)It wasno significant separation in the survival curves of5groups（P>0.05）,but it was trendthat survival rate was the lowest if SBP above90mmHg and urvival rate was thehighest if SBP between80and89mmHg.5. Analysis prognostic impact of pulse pressure in elderly hypertensivepatients:1)Systolic pressure and age increased with pulse pressure.Howere,diastolicdecreased with pulse pressure.It was statistically significant（P<0.05）.2) Incidence ofcardiovascular events in group with PP≥60mmHg was higher than in group withPP<60mmHg,and survival rate in group with PP≥60mmHg was lower than ingroup with PP<60mmHg. It was statistically significant（P<0.05）.6. Analysis prognostic impact of TC in elderly hypertensive patients:1)Thelevels of Age、SBP DBP、FBG、BMI、eGFR in4groups had no Significant difference（P>0.05）.2) If TC was above5.2mmol/l,incidence of nonfatal MI and nonfatalstroke were the highest.If TC was below3.12mmol/l, all-causes mortality、cardiovascular mortality、 CHD mortality were the highest.If TC was between3.12mmol/l and5.2mmol/l, all-causes mortality、incidence of cardiovascular eventswere lower.It was significant statistic difference between groups（P<0.05）.3)It wassignificant separation in the survival curves of5groups（P>0.05） during analysising CHD mortality、nonfatal MI and nonfatal stroke:Surve rates of nonfatal MI andnonfatal stroke were the lowest if TC>5.2mmol/l. Surve rates of all-causesmortality、 cardiovascular mortality and CHD mortality were the lowest ifTC>5.2mmol/l. Surve rates were the highest if TC was between3.12mmol/l and5.19mmol/l.7. Analysis prognostic impact of FBG in elderly hypertensive patients:1)Thelevels of Age、SBP DBP、TC、BMI、eGFR in4groups had no Significant difference（P>0.05）.2) If FBG was above8.1mmol/l, all-causes mortality and incidence ofcardiovascular events were the highest. If TC was between7.1mmol/l and8.0mmHg, cardiovascular mortality and incidence of nonfatal MI and nonfatal strokewere the lowest.If TC was below6.1mmol/l, all-causes mortality、incidence ofcardiovascular events were higher.It was significant statistic difference betweengroups（P<0.05）.3) It was no significant separation in the survival curves of5groups（P>0.05）,but it was trend that survival rates were lower if FBG above8.1mmol/l or FBG below6.1mmol/l.8. Analysis prognostic impact of eGFR in elderly hypertensive patients:1)Thelevels of Age、SBP DBP、TC、BMI、FBG in4groups had no Significant difference（P>0.05）.2) With eGFR reducing(below40ml.min^-1.1.73^-2),all-causes mortalityand incidence of cardiovascular events increased.Meanwhile,surve rate decreaseddecreased.It was significant statistic difference between groups（P<0.05）.Conclusions:1.By community standard management of hypertension, the degree of risk ofhypertension, combined cardio-cerebrovascular disease, the estimated glomerularfiltration rate and age were independent risk factors for the elderly hypertensivecardiovascular disease;2. In the older hypertension community population, relationship between SBP,DBP, TC, FBG and all cause death, cardiovascular events may be the "J" shaped, Inthe process of comprehensive intervention, when the level of blood pressure, blood lipids, and blood sugar droped below a certain value, the all cause mortality,cardiovascular event rates drop and the survival rate of increase as further decline inall cause mortality, cardiovascular events but increased and the survival rate willdecrease. The results of this study showed:1) the appropriate range of the systolicblood pressure control among the elderly hypertensive patients was between140mmHg and149mmHg.2) the appropriate range of the diastolic blood pressurecontrol among the elderly hypertensive patients was between80and89mmHg.3) theappropriate range of TC among the elderly hypertensive patients was between3.12mmol/l and5.19mmol/l.4) the appropriate range of FBG among the elderlyhypertensive patients accompanied by DM was between6.1mmol/l and8.0mmol/l.3.Chronic renal insufficiency （eGFR decrease） was the independent risk factor inall-cause death and cardiovascular and cerebrovascular events of elderly hypertensivepatients with community-based management; Of eGFR＜40ml/min·1.732in elderlyhypertensive patients is closely related to all-cause death and cardiovascular events.