Relevant Research Of EH In Middle And Elderly Age Patients With TCM Syndrom And HRV, Left Ventricular Structure And Function Change

Objective:Investigating the middle and elderly age patients in essential Hypertension of the indexes of age、heart rate variability and the left ventricular structure,functional, to explore the correlation between different syndromes of Traditional Chinese Medicine and autonomic nerve function and the left ventricular structure,functional in patients with essential hypertension to assessment of disease and prognosis, and guiding clinical treatment based on syndrome differentiation.Methods:According to the standards for differentitation of syndrome about guidelines for the diagnosis and treatment of Chinese Medicine on hypertension in2011,choosing402patients in Xiyuan Hospital from January to December in2013,including182cases of aged patients,220cases of elderly patients,put them divided into anger on the inflammation group, phlegm, blood stasis group group, Yang due to yin deficiency and Qi and blood deficiency group5group。 Through the outpatient service, to collect95cases of healthy people as control group,including60cases of the aged,35cases of the elderly,measure and compare the heart rate variability indexes and left ventricular structure and the function index by24h Holter ECG and the color doppler ultrasonography. Using SPSS2.0software, analysis of variance and rank sum test to measurement data, Spearman rank correlation, Logistic regression optimization to explore the correlation of different age groups of TCM syndrome types of hypertension and heart rate variability, left ventricular structure and function.Results:l.Middle and elderly aged hypertensive syndrome type of relationship with age:In the middle age group, the majority of patients were in anger on the inflammation group and phlegm resistance group,empirical group of anger on the inflammation,phlegm resistance,bleeding resistance were more than Yang due to yin deficiency and Qi and blood deficiency group.In older group,the patients in Qi and blood deficiency group was most and the age was oldest, the patients in deficiency group were more than empirical group’.2.Studies in middle and elderly hypertensive heart rate variability2.1the relationship between heart rate variability and ageHRV,in normal control group,there was no significant difference in middle and elderly group.Hypertensive elderly group of SDNN, SDANN, RMSSD, HRVtriangular index, VLF, LF, HF, VLF/HF, LF/HF,(VLF+LF)/HF and LFnorm were lower than middle group, HFnorm in hypertensive elderly group was higher than the middle-aged group’. Time domain,hypertensive middle and elderly aged group with the control group of middle and elderly, SDNN, SDANN, RMSSD, HRVtriangular index were lower than the control group, there were significant differences between the two groups. Frequency-domain indexes, VLF, LF, HF, hypertensive middle and elderly aged group were lower than the control group, the other indexes of VLF/HF, LF/HF,(VLF+LF)/HF, hypertensive middle and elderly aged group were higher than the control group, except for VLF in hypertensive middle group, LF/HF, LFnorm,HFnorm in hypertension elderly aged group, the others were statistically significant with the control group of middle-aged, elderly control group(P<0.05).2.2In middle and elderly hypertensive patients with different syndromes characterized by changes in heart rate variabilityHypertensive in middle and elderly aged group,SDNN, SDANN,RMSSD and HRV triangular index, VLF, LF, VLF/HF, LF/HF, LFnorm, in anger on the inflammation group, phlegm group, blood stasis group were higher than Yang due to yin deficiency and Qi and blood deficiency group’.(VLF+LF)/HF level, the empirical group in middle age group was higher than that of deficiency syndrome group, elderly group’(VLF+LF)/HF level from high to low order was anger on the inflammation group> phlegm wet resistance>Yang due to yin deficiency> blood stasis resistance> Qi and blood deficiency group.HF in middle empirical group of anger on the inflammation group, phlegm group was higher than deficiency group’s,HF in middle empirical group was higher than deficiency group’s,while HFnorm in middle and elderly empirical group was low.LFnorm in middle group from high to low order was phlegm wet resistance> blood stasis resistance>anger on the inflammation group>Yang due to yin deficiency> Qi and blood deficiency group;HFnorm from high to low order was Qi and blood deficiency group>Yang due to yin deficiency>anger on the inflammation group> blood stasis resistance>phlegm wet resistance.LFnorm in elderly group from high to low order was phlegm wet resistance>anger on the inflammation group> blood stasis resistance>Yang due to yin deficiency> Qi and blood deficiency group,HFnorm from high to low order was Qi and blood deficiency group>Yang due to yin deficiency>blood stasis resistance>anger on the inflammation group>phlegm wet resistance.Different ages in the same syndromes of HRV,elderly group of SDNN、 HRVtriangular index in phlegm wet resistance,blood stasis resistance and Yang due to yin deficiency were lower than middle group’s.elderly group of SDNN、HRVtriangular index in anger on the inflammation group and Qi and blood deficiency group were higher than middle group’s. In elderly group of SDANN, VLF, LF, VLF/HF, LFnorm, in anger on the inflammation group, phlegm group, blood stasis group were lower than middle age group’s,HFnorm was contrary.Yang due to yin deficiency in elderly group of SDANN、VLF、HF、LFnorm were lower than middle age group’s,RMSSD、VLF/HF、LF/HF、(VLF+LF)/HF、HFnorm were opponent. In elderly group of SDANN RMSSD、VLF、VLF/HF、(VLF+LF)/HF、HFnorm in Qi and blood deficiency group were higher than middle age group’s,HF、LF/HF、LFnorm were otherwise.3.Studies in middle and elderly with left ventricular structure function relationship3.1the relationship between left ventricular structure function and ageControl in the middle and elderly group,LA,LV, PWT,LVM, A peak, E/A were statistically significant differences,except E/A,indexes in elderly group were bigger than middle group’s; there were significant differences between the middle and elderly group in LA,IVST, LV,PWT,LVM,E peak,A peak,E/A,except E peak and E/A,the rest in elderly group were greater than the middle age group’s.Compared with the control group,hypertensive in middle and elderly aged group of LA,IVST,LV,PWT,LVM were bigger and A peak was bigger and E/A was smaller,were statistically significant differences (P<0.001).Hypertensive in middle-aged group and the control group,E peak had reduced trends,hypertensive in eldery-aged group and the control group, E peak was significantly reduced and there was significant (P<0.001),EF were statistically significant reduction (P<0.05)3.2The changes characteristic of left ventricular structure and functional in different syndromes in hypertensive in middle and elderly group In different TCM syndromesof hypertensive in middle and elderly group,LA,IVST,LV,PWT,LVM in deficiency group were higher than empirical group’s,and EF,E/A,E in middle age group were opponnet,left ventricular structure from small to big order was anger on the inflammation group> phlegm wet resistance> blood stasis resistance>Yang due to yin deficiency> Qi and blood deficiency group. LA and LV in Qi and blood deficiency group was significantly greater than the anger on the inflammation group. E peak in elderly group from high to low order was blood stasis resistance>anger on the inflammation group> phlegm wet resistance>Yang due to yin deficiency> Qi and blood deficiency group.A peak in middle-aged group from high to iow order was Qi and blood deficiency group> phlegm wet resistance and Yang due to yin deficiency>anger on the inflammation group.A peak in elder group from high to iow order was Qi and blood deficiency group> phlegm wet resistance> Yang due to yin deficiency>anger on the inflammation group. The same syndrome of different age groups, LA of elderly in phlegm wet resistance,Yang due to yin deficiency,Qi and blood deficiency group was bigger than middle’s.IVST of middle in anger on the inflammation group,phlegm wet resistance was bigger than middle’s,LV of elderly in phlegm wet resistance,blood stasis resistance,Qi and blood deficiency group was bigger than middle’s,the rest were opponent;PWT in elderly group were bigger than middle group’.LVM in elderly group except anger on the inflammation group were bigger than middle group’Hypertensive of the same age group in different syndromes,EF in elderly group in phlegm wet resistance,Yang due to yin deficiency and Qi and blood deficiency group was smaller than middle’s,in elderly anger on the inflammation group, blood deficiency group was bigger than middle’s.E peak in elderly,except Qi and blood deficiency group was smaller than the middle;A peak various syndromes in elderly was bigger than the middle’s,E/A was smaller than the middle’s.4.Different syndromes of hypertension and heart rate variability and left ventricular structure and function of the correlation4.1Correlation between age and heart rate variability and left ventricular structure and functionNormal control group of IVST and LF/HF, LFnorm was negatively correlated,positively correlated with HFnorm was. Age and LV, LVM, A peak and HFnorm was positively correlated, with LFnorm negative correlation.Age and HRV in patients with hypertension have some relevant indicators, in addition to HFnorm,was negative correlation, particularly in the VLF (r=-0.384), LF (r=-0.396) correlated significantly; and the index was positively correlated with left ventricular structure, and left ventricular function EF, E peak, E/A were negatively correlated,with A peak was positively correlated, A peak (r=0.402), E/A values (r=-0.448) was correlated significantly.4.2The correlation of HRV in patients with hypertension and left ventricular structure and functionSingle factor in patients with hypertension linear correlation analysis, LA and RMSSD, LF, HF; IVST and SDNN,SDANN,RMSSD,VLF, LF,HF,LF/HF was negatively correlated; LV and SDNN, SDANN, RMSSD, HRVtriangular index, VLF, LF; PWT and SDNN,SDANN,RMSSD. HRV triangular index, VLF. LF, HF, LF/HF;LVM and SDNN, SDANN, RMSSD, HRV triangular index, VLF, LF, HF was negatively correlated. Multivariate regression analysis, LA,LV, LVM was negatively correlated with RMSSD; LVM, IVST were negatively correlated with SDNN and LF; PWT and VLF/HF were positively correlated.Single factor in patients with hypertension linear correlation analysis, EF and SDNN, SDANN, RMSSD, HRVtriangular index was positively correlated; E peak was positive correlation with LF; A peak with SDNN,SDANN,RMSSD, HRVtriangular index, VLF, LF, HF, LF/HF was negatively correlated; E/A with SDNN,SDANN，RMSSD,HRVtriangular index, VLF, LF, HF was positively correlated. Multivariate regression analysis showed that, EF only positively correlated with RMSSD, E/A was positively correlated with LF.4.3The correlation of hypertensive with different syndromes and HRV,left ventricular structure and functionThe correlation of middle-aged group of syndromes and HRV and left ventricular structure,function, univariate linear correlation and multivariate regression analysis,anger on the inflammation group was positively correlated with SDNN、RMSSD、HF and E/A,was negativly correlated with IVST、PWT and A peak.RMSSD index is high, IVST、PWT、the peak value of A index is small,the greater the chance appears this card type.Phlegm group was positively correlated with SDNN、HRV triangular index、VLF、LF、 LF/HF、LFnorm,was negativly correlated with LV and LVM.LF/HF and LFnorm are bigger, the greater chance appears this card type.Blood stasis group was negativly correlated with LF and HF, was positively correlated with IVST.HF value is small,IVST is greater, the greater chance appears this card type.Yang due to yin deficiency was negativly correlated with SDNN、RMSSD、VLF、LF,was positively correlated with IVST,LV,LVM,PWT.SDNN and RMSSD are smaller, LV is greater, the greater the probability of emergence of this card type.Qi and blood deficiency group was negativly correlated with SDNN、SDANN、RMSSD、HRV triangular index VLF、LF、LFnorm、 Epeak、 E/A,was positively correlated with HFnorm,LA,IVST,LVM.SDANN is smaller, HFnorm and I VST are bigger, the greater chance appears this card type.The correlation of elderly group of syndromes and HRV and left ventricular structure,function, univariate linear correlation and multivariate regression analysis,anger on the inflammation group was positively correlated with SDNN、RMSSD、HRV triangular index、 VLF、 LF and E/A,was negativly correlated withLA、LV、PWT、LVM、A peak.VLF is bigger, LV is smaller, the greater the chance appears this card type.Phlegm group was positively correlated with SDNN、SDANN、HRV triangular index、LF、LF/HF、LFnorm,was negativly correlated with HFnorm、IVST、PWT.SDNN, LF/HF are bigger,HFnorm and IVST are smaller,the greater the chance appears this card type.Blood stasis group was negativly correlated with SDNN、SDANN、RMSSD、HRV triangular index、LF,was positively correlated with EF、 IVST.SDNN, RMSSD are smaller,appear more chance of blood stasis type.Yang due to yin deficiency was negativly correlated with SDNN、 RMSSD、 HF,was positively correlated with IVST、PWT.SDNN、 RMSSD are smaller,IVST is bigger the greater chance appears this card type.Qi and blood deficiency group was negativly correlated with SDNN、 SDANN、 RMSSD、 HRV triangular index、 VLF、 LF、HF\TP、 LF/HF、 LFnorm and EF, was positively correlated with HFnorm、LA、 IVST、LV、 PWT、LVM.SDNN, RMSSD, LFnorm is more smaller,PWT is bigger,the greater the chance appears this card typeConclusion:1.Hypertension in middle and elderly group of TCM syndromes in different age groups are differences in the distribution.2.Age factors on HRV in hypertension reflecting dysfunction of the autonomic nervous system has a certain impact, the normal group, left ventricular structure may expansion, the function decreased with age,this situation in hypertension was more pronounced, more pronounced in elderly patients compared to middle’.3.Hypertension positive patients’autonomic dysfunction of sympathetic hyperactivity, vagus nerve dysfunction is obviouser than deficiency group,deficiency group’s reducing autonomic regulatory functions is obviouser than positive patients’.With age, the disease progresses, the degree of autonomic dysfunction gradually increased, the older group autonomic regulation of various syndromes dysfunction is more complex.4. Hypertension of Empirical, left ventricular structure changed a litte; developing deficiency stage, left ventricular structure and function changed significantly over the evidence, Qi and blood deficiency group appears the most serious cardiac target organ damage.5.Autonomic dysregulation in hypertension and left ventricular structural abnormalities is closely related; abnormal left ventricular structure may primarily affect the regulation of autonomic nervous system, left ventricular systolic function may walk with neurological conditions more closely, left ventricular diastolic function may be more closer with sympathetic functional.6.Different syndromes of hypertension and HRV, left ventricular structure and function have some relevance, among middle-aged and elderly patients are also different.The anger on the inflammationand Phlegm resistance of autonomic function and sympathetic are increased, the former of vaga is also increased, no significant changes in left ventricular structure.Blood stasis type sympathetic and vagal function were relatively lower,autonomic nervous function relatively weakened in elderly patients, increased left ventricular structure began to change.Yang due to yin deficiency of autonomic nervous and vagal function are relatively lower, the middle-aged group sympathetic nerve function also weakened,expansion of left ventricular structure is obvious.Qi and blood deficiency group’s autonomic nervous,sympathetic and vagal function relative decrease and vagal function relative increases, left ventricular structure and function has changed.