Effects Of Hypertension In Patients With Morning Blood Pressure Peak Of Carotid Atherosclerosis And Left Ventricular Remodeling

Objectives: By making a comparison between two groups of patients who are respectively normal hypertensive patients and those with morning high blood pressure surge, the author attempted to observe whether there is any difference in the occurrence rate of carotid atherosclerosis in these two groups of people and where these differences lie. Second, by observing all data about left ventricle of the two groups of patients, the thesis aims to investigate whether the differences in data can reflect any changes in the structure of left ventricle. Based on the above observation, the thesis tends to analyze the characteristics of CAS and the changes of left ventricle’s structure in those patients with morning high blood pressure surge and plus the basic functions of morning surge in these situations for the purpose of providing some references to chinese researchers of this field in their studies.Methods: Over a year’s time from June in 2013 to June in 2014, the author followed up 102 hypertensive patients hospitalized in Dong Guan branch department of the Affiliated Hospital of Yan’an University. The tenth version of Chinese hypertension prevention guide is referred when deciding whether the research object has high blood pressure or not. Among the final selected objects of study, there are 55 males and 47 females ranging from 50 years old to 84 years old, averaging at ++years old. The average length of time of high blood pressure in these patients is ++. According to the final results, the following cases are eliminated:(1) those patients with secondary hypertension instead of primary hypertension;(2) those patients who have myocardial infarction or cerebrovascular symptoms and impaired function of liver and kidney;(3) those who sleep during the day. According to the result of measurement, the subjects aredivided into elevated morning surge group(n=53) and non-elevated morning surge group(n=47). Besides, a control group which contains 10 males and 10 females with normal blood pressure is set to contrast with the research objects. Then a questionnaire survey is conducted among these targeted patients and normal people to investigate their past medical history and whether they smoke or drink alcohol. The determination of morning high blood surge is based on the measurement of their dynamic blood pressure. At first, The author measures the average blood pressure within the two hours after they get up in the morning, then he measures the nocturnal minimum blood pressure. If the gap between the two blood pressures exceeds or equals to 23.5mm Hg, these subjects belong to the elevated morning blood pressure surge group, or they are regarded as one of the non-elevated morning blood pressure surge group. Moreover, the people with normal blood pressure in the controlled group also have their blood pressure measured every day to ensure no sharp fluctuations in their blood pressure in the process of comparison. The diagnosis of carotid atherosclerosis needs supplementary instrument. In this research, the author uses high definition ultrasound doppler instrument to measure the average inner membrane thickness(IMT) of the carotid arteries. The measurement results are analyzed with the statistical software SPSSll.5. Ultrasonic cardiogram of ++ type is utilized to measure(LVEDD),(IVST) and(LVPWT). The data is processed with software SPSS17.Results:(1)The general conditions of the three groups have no obvious statistical differences(p>0.05), including their age, gender, smoking, drinking and medical history.(2)The IMT of hypertensive patients in the morning surge group has statistical significance(p<0.05) compared with non-morning surge group. The former is higher.(3)The detection rates of Carotid plaque of the three groups are different. The detection rate of morning surge group is higher than that of non-morning surge group.(4)The figures of morning surge group in IVST、LVPWT LVMI are larger than those of non-morning surge group.(5)The average 24-hour arterial pressure, the average arterial pressure during the day, the average nocturnal arterial pressure and systolic pressure fluctuation range of nonmorning surge group are higher than those of morning surge group.Conclusions:(1) Among the clinically hypertensive patients, quite a few patients have morning high blood pressure surge.(2) High blood pressure obviously stimulates the generation of carotid arteriosclerosis and the formation of carotid plaques.(3)Compared with the hypertensive patients without morning surge, those patients with morning high blood pressure surge have more serious carotid atherosclerosis and much more carotid plaques.(4)The phenomenon of morning blood pressure surge has extremely close relations with left ventricular remodeling, so the existence of morning surge can be regarded as an objective indicator in measuring the impairment of the target organs of hypertensive patients.