The Relationship Between Lipoprotein-associated Phospholipase A2 And Abnormal-dipper Circadian Rhythm Of Blood Pressure

Background: Essential Hypertension(EH)is the most common chronic disease in the world,which is the primary risk factor for cardiovascular and cerebrovascular diseases.In recent years,some studies have shown that changes in circadian rhythm of blood pressure are closely related to target organ damage and the occurrence of complications in patients with essential hypertension.Inflammatory reaction plays a crucial role in the development of hypertension which is an inflammatory disease.Some studies investigated that the plasma lipoprotein-associated phospholipase A2(Lp-PLA2)is an inflammatory factor associated with inflammatory reaction.According to the study about the relationship between this inflammatory marker and the circadian rhythm of blood pressure,it provides an evidenve for the changes of circadian rhythm of blood pressure to reflect target organ damage and predict cardiovascular and cerebrovascular events.Objective: The aim of this study was to investigate the relationship between plasma Lp-PLA2 and abnormal-dipper circadian rhythm of blood pressure in patients with essential hypertention.Methods: A total of 229 hypertensive patients were recruited from Shaanxi Province People’s Hospital from April 2016 to October 2016,including 121 males and 108 females,the age from 29 years old to 79 years old,the average age was(64.68 ± 10.66)years old.The patients was diagnosed as hypertention based on the 2010 revised edition of Guidelines for Prevention and Treatment of Hypertension in China.Patients were excluded from the population if they had secondary hypertension,large area cerebral infarction,hemorrhagic stroke,infectious disease,myocardial infarction,heart failure,severe liver or kidney disease,malignant neoplasms,autoimmune diseases,stress status,and recently used lipid-lowering drugs,antihypertensive drugs and anti-inflammatory analgesic drugs and so on.The datas for basic information,detailed history,liver and kidney function,blood lipids,blood glucose,plasma Lp-PLA2,and 24-hour ambulatory blood pressure monitoring(ABPM)were collected.The plasma Lp-PLA2 concentration was measured by double antibody sandwich enzyme linked immunosorbent assay.According to 24-hour ABPM,individuals were divided into dipper group(n=109),abnormal-dipper group(n=120).SPSS 22.0(SPSS Inc,Chicago,IL)was used to describe and analyze all the data.A p-value of less than 0.05 was considered to be statistical significance.Result: 1.Comparison of general clinical data and blood biochemical indexes between dipper group and abnormal-dipper groupThere was no statistical significance between dipper group and abnormal-dipper group in age(P=0.273)、gender(P=0.687)、smoking(P=0.407)、drinking(P=0.961)、diabetes(P=0.453)、coronary heart disease(P=0.369)、BMI(P=0.941)、FBG(P=0.583)、Hb A1c(P=0.396)、UA(P=0.665)、CRE(P=0.273)、BUN(P=0.796)、AST(P=0.904)、ALT(P=0.888)、TBi L(P=0.569)、TC(P=0.352)、TG(P=0.281)、HDL-C(P=0.371)and LDL-C(P=0.081).In addition,plasma Lp-PLA2 was higher in the abnormal-dipper group than in the dipper group(t=-9.510,P <0.001),and the difference has statistical significance(P <0.01).2.Comparison of 24-hour ambulatory blood pressure monitoring parameters in dipper group and abnormal-dipper groupThere was no statistical significance between dipper group and abnormal-dipper group in BPM(t=-0.012,P=0.990)、24-h SBP(t=-0.996,P=0.320)、24-h DBP(t=-0.824,P=0.411)、d SBP(t=2.024,P=0.054)and d DBP(t=0.251,P=0.802).n SBP(t=-6.705,P<0.001)、n DBP(t=-6.289,P<0.001)was significantly higher in the abnormal-dipper group than in the dipper group,and the difference has statistical significance.Night-time systolic blood pressure drop rate(t=23.835,P<0.001)、night-time diastolic blood pressure drop rate(t=16.887,P<0.001)were lower in the abnormal-dipper group than in the dipper group,the difference has statistical significance(P <0.01).3.Analysis of the relationship between plasma Lp-PLA2 level and each variableThere was a significantly negative correlation between plasma Lp-PLA2 and night-time systolic blood pressure(r=-0.420,P<0.001)and night-time diastolic blood pressure(r=-0.332,P=0.012)(P <0.01).And there was no correlation between plasma Lp-PLA2 and the rest of the variables(P> 0.05).4.Analysis Factors that affect abnormal-dipper circadian rhythm of blood pressure by multi-factor Logistic regressionPlasma Lp-PLA2 was independently related to abnormal-dipper blood pressure circadian rhythm(OR=2.491,95%CI:1.132-5.478,P=0.023 <0.05).Conclusion:Plasma Lp-PLA2 plays an important role in abnormal-dipper circadian rhythm of blood pressure in patients with essential hypertension,and which was an independent risk factor for abnormal-dipper circadian rhythm of blood pressure.