The Predictive Value Of Pulse Pressure Variability In Early Renal Dysfunction In Essential Hypertensive Patients

Objective:To provide theoretical basis and treatment target for the prevention of early renal dysfunction due to essential hypertension(EH),we observe the pulse pressure variability(PPV)in patients with EH,analyze its correlation with urinary microalbumin(UmALB),serum cystatin C(Cys-C)and other indexes reflecting early renal dysfunction in patients with EH.Methods:A total of 315 cases of EH patients were selected from September 2015 to December 2018 in the cardiology of the second hospital affiliated to Dalian Medical University.The general data of the patient’s sex,age,smoking history,height,weight,body mass index(BMI)and physical surface area(BSA)were recorded,and the biochemical indicators such as serum creatinine(Scr),Cys-C,total cholesterol(TC),triglycerides(TG),low density lipoprotein(LDL-c),High density lipoprotein(HDL-c),hypersensitive C-reactive protein(HS-CRP),homocysteine(Hcy),UmALB,urine microalbuminuria/urinary creatinine(UACR)and glomerular filtration rate(eGFR)were test.24-hour dynamic blood pressure monitoring was recorded,and the average systolic pressure(ASBP),mean diastolic pressure(ADBP),mean pulse pressure difference(APP),pulse pressure difference standard and other indexes were documented.Non-invasive peripheral vascular detection was tested for recording the left and right side of the pulse wave velocity(PWV).Study Group:(1)According to the quartile of UmALB or Cys-C level,each divided into four groups.The UmALB groups included A1(UmALB≤32.13mg/L),A2(32.13mg/L< UmALB≤56.64mg/L),A3(56.64 mg/L < UmALB≤ 88.28 mg/L)and A4(UmALB >88.28 mg/L).Cys-C groups included B1(Cys-C≤0.83mg/L),B2(0.83mg/L<Cys-C≤0.93mg/L),B3(0.93mg/L<Cys-C≤1.07mg/L),B4(Cys-C>1.07mg/L).The general data,ASBP,ADBP,APP,SBP standard deviation,DBP standard deviation and PPV were compared between the different groups for statistical significance.(2)Divide APP and PPV into three groups by their value.The differences of renal function indexes such as UmALB and Cys-C were compared in different APP and PPV groups respectively.(3)We analysed the relevance of UmALB and Cys-C by Spearman correlation analysis,and explored the influence factors of UmALB by Logistic regression analysis,and explored if APP and PPV were independent risk factors of UmALB by multivariate Logistic regression analysis.(4)Assessed the predictive value of APP and PPV to UmALB levels by ROC curve.Results:1.Patients were divided into 4 groups by the quartile of UmALB level.There were differences in age,Hcy,ASBP,ADBP,APP,SBP standard deviation and PPV among the four groups,among which age,Hcy,ASBP,APP,SBP standard deviation and PPV level were A4 Group>A3 Group>A2 Group>A1 Group,the difference was statistically significant(P<0.05).2.Patients were divided into 4 groups by the quartile of Cys-C level.There were differences in age,Hcy,Hs-CRP,ASBP,APP,SBP standard deviation and PPV among the four groups,among which age,Hcy,Hs-CRP,ASBP,APP,SBP standard deviation and PPV level were B4 Group>B3 Group>B2 Group>B1 Group,the difference was statistically significant(P<0.05).3.Patients were divided into C1 Group,C2 Group and C3 Group according to the APP level.There have statistically differences of UmALB,Cys-C,eGFR among three groups,of which C3 Group UmALB,Cys-C,eGFR level is higher than C2 Group and C1 Group,C2 Group higher than C1 Group,the difference was statistically significant(P<0.05).4.Patients were divided into D1 Group,D2 Group and D3 Group according to the PPV level.There have statistically differences of UmALB,Cys-C,eGFR,UACR among three groups,of which D3 Group UmALB,Cys-C level is higher than D1 Group and D2 Group UmALB,Cys-C,eGFR,UACR,level is higher than D1 Group,the difference was statistically significant(P<0.05).5.There was a positive correlation between age,Hcy,PWV,ASBP,APP,SBP standard deviation and PPV and elevated UmALB in patients with hypertension.There was a negative correlation between height,weight,BSA,ADBP and elevated UmALB in hypertensive patients.Logistic regression analysis showed that age,SBP standard deviation,PWV,ASBP,ADBP,APP,PPV were all risk factors for UmALB elevation.Multivariate Logistic regression analysis showed that APP and PPV were independent risk factors of UmALB elevation.6.The area under the curve of APP level was 0.895,and the difference was statistically significant(P<0.05).The area under the curve of PPV level was 0.719,and the difference was statistically significant(P<0.05).Conclusion:1.There was a positive correlation between APP,PPV and UmALB values in EH patients,which indicated an increased risk of UmALB elevation in EH patients with increased APP,PPV.2.Multivariate regression analysis showed that the increase of APP and PPV was an independent risk factor for the UmALB elevation in EH patients.3.APP>57.5mmHg or PPV>7.46 mmHg has a certain significance for the diagnosis of UmALB>30mg/L in patients with EH,and has certain clinical value in predicting the early renal dysfunction in EH patients.