Study Of The Relationship Between Blood Pressure And Function And Structure Of Left Ventricular In Primary Hypertension With Obstructive Sleep Apnea Hypopnea Syndrom

Objective To investigate the risk factors of essential hypertension(EH) with obstructive sleep apnea hypopnea syndrome(OSAHS), as well as to research the effect of OSAHS on blood pressure and the abnormalities of left ventricular structure and function.Method We randomly selected the total of 120 hospitalized patients with EH combined with OSAS in Respiratory Medicine Department of Xianshuigu Hospital of Jinnan District, Tianjin, from January 2014 to June 2015. All the subjects were divided into four groups according to apnea hypopnea index(AHI)score. Thirty-two youths(AHI<5) were set into simple EH group; Fifteen youths(AHI 5-15) were set into EH combined with mild OSAHS group; Twenty-six youths(AHI15-30) were set into EH combined with moderate OSAHS group; And forty-five youths(AHI>30) were set into EH combined with severe OSAHS group. We recorded their clinical indexes, including gender, age, smoking coefficient, drinking coefficient and body mass index. In the same time, we detected ambulatory blood pressure indexes(24 h MSP, 24 h MDP, DMSP, DMDP, NMSP, NMDP and the circadian rhythms of blood pressure). As well, color Doppler echocardiography and pathology were performed and examination results were recorded, including LVIDD, LVIDS, IVST, LVPWT, IVST, LVPWT, SV, LVEF, E peak, A peak, EDA, LVMI and so on. Single factor analysis of variance was used to analysis examination results in order to discuss the influence on left ventricular structure and function.Result1, General comparison: There were no statistical significance(P > 0.05) between the gender, age, and drinking rate of the patients in four groups; while there were statistical significance(P < 0.05) between the smoking rates and BMI.2, Sleep test index comparison: The differences of AHI, mean oxygen saturation(MSa O2), time ratio of oxygen saturation lower 90%(TSa O2L90) among the four groups were statistically significant(P < 0.05).3, Ambulatory blood pressure monitoring index comparison: The differences between the 24 h MSP, 24 h MDP, DMSP, DMDP, and NMDP of the OSAHS mild group versus pure hypertension group, OSAHS moderate group versus OSAHS mild group, OSAHS severe group versus OSAHS moderate group were all statistically significant(P < 0.05). The differences between the NMSP of the inter-group comparisons among the OSAHS mild, moderate, severe groups were highly statistically significant(P < 0.001). The differences between the four groups non-dipper blood pressure percentage(blood pressure rhythm variation)(24.60%, 46.40%, 52.80%, 24.60%) of the OSAHS mild group versus pure hypertension group, OSAHS moderate group versus OSAHS mild group, OSAHS severe group versus OSAHS moderate group were all statistically significant(P < 0.05).4, Left ventricular remodeling index comparison: The differences between the IVST, LVPWT, LVMI of the inter-group comparisons among the three OSAHS associated with hypertension groups(mild, moderate and severe), and the differences of each group versus the control pure hypertension group respectively were all statistically significant(P < 0.05).5, Left ventricular function index comparison: The differences between the LVIDD, EDV, E/A of the patients with mild and severe OSAHS associated with hypertension versus those with mild OSAHS associated with hypertension and pure hypertension were statistically significant(P < 0.05). And the differences between the LVIDS, ESV, SV, LVEF of the patients with severe OSAHS associated with hypertension versus those with mild or moderate OSAHS associated with hypertension and pure hypertension were statistically significant(P < 0.05).Conclusion1,Overweight or obese were independent risk factors for OSAHS, and smoking played an additive role in the development of disease.But,we still did not know about weather smoking was an independent risk factor from this research.2,As OSAHS got worse, there were growing signs of the circadian rhythm blood pressure. And the incidence of hypertension was increasing greatly in night.3,Compared with EH combined with mild OSAHS group, EH combined with severe OSAHS group had worse left ventricular diastolic function. Meanwhile,in comparison with other groups there was a weakening of left ventri-cular systolic function in EH combined with severe OSAHS group.4,OSAHS could lead to a left ventricular structure remodeling, which influenced on left ventricular diastolic and affected left ventricular systolic function.5,OSAHS could lead to a left ventricular concentric hypertrophy in EH combined with OSAHS at the start of the disease. As OSAHS got worse, this kind of influence had being extended, which finally affected left ventricular diastolic and systolic function in EH combined with moderate and severe OSAHS.