| Objective:To study the related factors of blood pressure variability and morning blood pressure peak in elderly patients with H-type hypertension,and provide clinical evidence for the elderly with H-type hypertension to better prevent target organ damage and reduce the incidence of cardiovascular and cerebrovascular events.Methods:1.Research objects:280 elderly hypertensive patients who were hospitalized in the general medical department of our hospital from September 2019 to October 2020 were included.The inclusion criteria met the diagnostic criteria for essential hypertension in the "Chinese Guidelines for Hypertension Prevention and Control 2010";Among them,there were 129 males and 151 females,aged 60-93 years old,with an average of(70.19±7.88)years old.Exclusion criteria: secondary hypertension and white coat hypertension;suffered from acute cardiovascular and cerebrovascular diseases(acute stroke,acute myocardial infarction)within six months;combined with severe liver and kidney insufficiency;diabetes;hypokalemia;anemia Hyperthyroidism or hypothyroidism;severe trauma or the latter of major surgery;severe infections in various systems;mental patients;ambulatory blood pressure monitoring data missing> 20% or morning peak blood pressure data missing.The patients informed consent to this study and signed an informed consent form.2.General information collection: Collect all patients’ age,gender,family history of hypertension,smoking history,drinking history,height,weight,and calculate body mass index(BMI)based on weight/height 2(kg/m2).3.Biochemical index detection: take fasting venous blood from the morning the next morning after admission,measure blood glucose(GLU),total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),and low-density Lipoprotein cholesterol(LDL-C),urea(BUN),creatinine(CRE),uric acid(UA),homocysteine(Hcy).4.Ambulatory blood pressure monitoring: 24-hour ambulatory blood pressure monitoring adopts the German TM2430 EX non-invasive portable ambulatory blood pressure monitor.The cuff is tied to the left upper arm of the subject at 8:00 am,and the day is set(6:00-22:00)The measurement interval is 15 minutes,and the measurement interval at night(22:00～6:00)is 30 minutes.Record and store each blood pressure value.Continuously monitor for 24 hours.The effective reading is more than 80% and the blood pressure data missing from 6:00 to 8:00 in the morning is less than 2 One is deemed qualified,otherwise the test shall be re-tested the next day.The average systolic and diastolic blood pressure levels of these subjects were calculated for 24 h,daytime and night,and extreme values were removed during the calculation process.5.Blood pressure variability(BPV): Calculate blood pressure variability by calculating the average and standard deviation of 24 h,day,night systolic and diastolic blood pressure.6.Determination and grouping of morning peak phenomenon:According to the standard of "Chinese Hypertension Prevention and Control Guide 2010",calculate the morning peak blood pressure value of all subjects,that is,the average systolic blood pressure within 2h after getting up-the lowest systolic blood pressure during night sleep(including the lowest The average value of 1h systolic blood pressure within the value).The highest quartile of morning peak blood pressure of all subjects,namely 32.05 mm Hg,was used as the cut-off point for grouping.≥32.05 mm Hg was the morning peak group,and <32.05 mm Hg was the non-morning peak group.7.Statistical method: Use SPSS 22.0 statistical software for statistical analysis.Counting data is expressed as [n(%)],and measurement data is expressed as ±s.The distribution pattern is judged by KS test,and t test is used for normal distribution.,The adjusted t test is used when the overall variance is uneven,and the MWU test is used for non-normal distribution.The count data was analyzed by χ2 test to analyze the differences between groups;the single factor analysis was conducted by Pearson correlation analysis;the multivariate analysis was based on whether the morning peak blood pressure increased as the dependent variable,and the logistic regression analysis was adopted.The difference was statistically significant with P<0.05.Results:1.H-type hypertension accounts for 71.79%(201/280)of 280 elderly hypertensive patients.2.Comparison of general clinical data and risk factors of hypertension between Chenfeng group and non-chenfeng group,the difference was not statistically significant(P>0.05).3.There was no statistically significant difference in the 24 h,day and night average systolic and diastolic blood pressure levels between the morning peak group and the non-morning peak group(P>0.05).4.Comparison of 24 h systolic and diastolic blood pressure variability,daytime systolic blood pressure variability,night systolic blood pressure and diastolic blood pressure variability between the morning peak group and the non-morning peak group,the difference was statistically significant(P<0.05).There was no statistically significant difference in the diastolic blood pressure variability between the two groups(P>0.05).5.There is a linear positive correlation between morning peak blood pressure and 24 h systolic and diastolic blood pressure variability,daytime systolic blood pressure variability,night systolic blood pressure and diastolic blood pressure variability,and Pearson correlation coefficients are 0.433,0.364,0.336,0.419,0.358(P<0.05).6.The morning peak phenomenon was used as the dependent variable,and the 24 h systolic and diastolic blood pressure variability,daytime systolic blood pressure variability,night systolic blood pressure and diastolic blood pressure variability were used as independent variables in univariate analysis,and Logistic regression analysis was performed to show,24 h systolic blood pressure variability,daytime systolic blood pressure variability,and night systolic blood pressure variability were independent risk factors for the morning peak phenomenon(P<0.05).Conclusion:1.The incidence of H-type hypertension in elderly hypertensive patients is relatively high.It is important to pay attention to Hcy screening in elderly hypertensive patients,and reducing Hcy levels is of great significance for the prevention and treatment of hypertensive target organ damage.2.24 h systolic and diastolic blood pressure variability,daytime systolic blood pressure variability,nocturnal systolic blood pressure and diastolic blood pressure variability in elderly patients with H-type hypertension are important risk factors for the morning peak of blood pressure.Pay attention to the dynamics of elderly patients with H-type hypertension Blood pressure monitoring,reasonable use of antihypertensive drugs for those with increased blood pressure variability to reduce blood pressure variability,and help control morning peak blood pressure.3.Compared with diastolic blood pressure variability,the correlation between morning peak phenomenon and systolic blood pressure variability in elderly patients with H-type hypertension is stronger;compared with daytime systolic blood pressure variability,morning peak blood pressure and night systolic blood pressure variability and The24-hour systolic blood pressure variability is more relevant;the use of long-acting antihypertensive drugs to reasonably adjust the medication time,targeted reduction of night systolic blood pressure variability and24-hour systolic blood pressure variability,and effective control of morning peak blood pressure to prevent target organ damage and reduce The incidence of cardiovascular and cerebrovascular events has important clinical significance. |
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