Analysis Of Ambulatory Blood Pressure And Its Influencing Factors In Elderly Patients With Hypertension

Objective:This study mainly studied the characteristics of ambulatory blood pressure in elderly patients with hypertension,and explored the factors affecting the circadian rhythm of blood pressure in elderly patients with hypertension.To provide evidence for clinical medication and prevention of risk factors,so as to better control the blood pressure of the elderly and restore the normal rhythm of blood pressure as far as possible,so as to reduce the incidence of cardiovascular,cerebral and renal vascular events and mortality.Methods:A total of 296 eligible elderly hypertension patients(aged≥60 years)were selected from the hypertension clinic of Shanxi Bethune Hospital from January to June 2021.According to the circadian rhythm of blood pressure,they were divided into 56 patients(18.9%)in the dipper group,134 patients(45.3%)in the non-dipper group,and 106patients(35.8%)in the reverse dipper group.General clinical data of patients were collected,and blood biochemistry,24-hour ambulatory blood pressure monitoring,arteriosclerosis monitoring,24h urine electrolyte and 24h urine microalbumin detection were improved.The results were statistically analyzed by SPSS26.0 software,and P<0.05 was considered statistically significant.Results:1.Abnormal circadian rhythm of blood pressure(non-dipper group and reverse dipper group)accounted for 81.1%of the elderly hypertension patients,which was significantly higher than that of the normal blood pressure rhythm group.2.Comparison of general clinical data among the three groups:There were no significant difference in the course of hypertension,BMI,gender,drinking history,diabetes history and hyperlipidemia history(P>0.05),but there were significant difference in age and smoking history(P<0.05).The age of the dipper group[68.00years(65.00 years,70.00 years)]was lower than that of the non-dipper group[70.00 years(68.00 years,73.00 years)]and the reverse dipper group[71.00 years(69.00 years,74.00years)],and the difference was statistically significant(P<0.05).The proportion of smokers in dipper group was significantly lower than that in non-dipper group and reverse dipper group(X~2=26.663,P<0.001),and the difference was statistically significant(P<0.05).3.Comparison of 24-hour ambulatory blood pressure among the three groups:There were no significant difference in 24h SBP,24h DBP and whole-day blood pressure load(P>0.05).There were significant difference among d SBP,d DBP,n SBP,n DBP,nocturnal blood pressure drop rate,whole-day systolic blood pressure variation coefficient,daytime systolic blood pressure variation coefficient and nighttime systolic blood pressure variation coefficient(P<0.05).The d SBP in the reverse dipper group(133.08±10.20mm Hg)was lower than that in the non-dipper group(136.43±11.71mm Hg)and dipper group(136.89±10.98mm Hg),and the difference was statistically significant(P<0.05).The d DBP in the reverse dipper group(72.25±8.09mm Hg)was lower than that in the non-dipper group(75.07±8.41mm Hg)and dipper group(74.88±6.13mm Hg),and the difference was statistically significant(P<0.05).The n SBP in the dipper group,non-dipper group and reverse dipper group increased gradually(119.20±9.03mm Hg、130.97±11.49mm Hg、140.39±11.43mm Hg).There were significant differences among all groups(P<0.05).The n DBP in the dipper group,non-dipper group and reverse dipper group increased gradually(65.46±5.66mm Hg、70.97±8.09mm Hg、73.87±8.81mm Hg).There were significant differences among all groups(P<0.05).The nocturnal blood pressure drop rate in the dipper group,non-dipper group and reverse dipper group decreased gradually[12.40%(10.70%,14.78%)、3.70%(1.58%,5.83%)、-4.50%(-8.00%,-2.30%)],There were significant differences among all groups(P<0.05).The variation coefficient of the whole-day systolic blood pressure in the dipper group[13.70%(12.43%,14.78%)]was higher than that in the non-dipper group[10.90%(9.50%,13.03%)]and the reverse dipper group[10.55%(9.30%,12.00%)],and the difference was statistically significant(P<0.05).The variation coefficient of the daytime systolic blood pressure in the dipper group[12.65%(10.38%,13.98%)]was higher than that in the non-dipper group[11.10%(9.40%,13.40%)]and the reverse dipper group[10.60%(9.20%,11.93%)],and the difference was statistically significant(P<0.05).The variation coefficient of night systolic blood pressure in the dipper group[10.55%(8.93%,12.60%)]was higher than that in non-dipper group[8.80%(7.08%,10.73%)]and reverse dipper group[8.10%(6.90%,10.35%)],and the difference was statistically significant(P<0.05).4.Comparison of baPWV and ABI among the three groups:There were no significant difference in right ABI and left ABI(P>0.05).There were significant difference in right baPWV and left baPWV(P<0.05).The right baPWV in the reverse dipper group(1851.57±215.87cm/s)was significantly higher than that in the non-dipper group(1747.81±244.65cm/s)and the dipper group(1687.00±201.61cm/s),and the difference was statistically significant(P<0.05).The left baPWV in the reverse dipper group(1869.13±232.15cm/s)was higher than that in the non-dipper group(1758.57±259.18cm/s)and the dipper group(1692.25±205.34cm/s),and the difference was statistically significant(P<0.05).5.Comparison of 24-hour urinary electrolytes、24-hour urinary microalbumin and blood biochemical among the three groups:There were no significant difference in 24h urine potassium,24h urine chloride,urea,creatinine,uric acid,fasting blood glucose,triglyceride,total cholesterol,HDL-C and LDL-C(P>0.05).There were statistically significant difference in 24h urine sodium and 24h urine microalbumin(P<0.05).The24h urinary sodium in the reverse dipper group[83.00mmol/24h(59.00mmol/24h,114.75mmol/24h)]was lower than that in the dipper group[102.50mmol/24h(84.00mmol/24h,126.75mmol/24h)],and the difference was statistically significant(P<0.05).The 24h urinary microalbumin of the reverse dipper group[48.250mg/24h(36.330mg/24h,61.635mg/24h)]was higher than that of the dipper group[41.090mg/24h(32.000mg/24h,48.935mg/24h)],and the difference was statistically significant(P<0.05).6.Binary Logistic regression analysis:univariate Logistic regression analysis showed that:the age(OR=1.347,95%CI:1.204-1.508,P<0.001),smoking history(OR=9.774,95%CI:3.425-27.891,P<0.001),right baPWV(OR=1.002,95%CI:1.001-1.004,P=0.002),left baPWV(OR=1.002,95%CI:1.001-1.004,P=0.002)and 24h sodium urine(OR=0.989,95%CI:0.982-0.997,P=0.005)were the influencing factors for abnormal circadian rhythm of blood pressure in elderly patients with hypertension.Multivariate Logistic regression analysis showed that age(OR=1.302,95%CI:1.162-1.459,P<0.001),smoking history(OR=12.440,95%CI:4.083-37.901,P<0.001)and 24h sodium urine(OR=0.987,95%CI:0.978-0.997,P=0.008)were the independent influencing factors for abnormal circadian rhythm of blood pressure in elderly patients with hypertension.Conclusion:1.The incidence of abnormal circadian rhythm of blood pressure(non-dipper and reverse dipper rhythm)was significantly increased in elderly patients with hypertension.2.Age,smoking history,baPWV and 24h urine sodium were the influencing factors for abnormal circadian rhythm of blood pressure in elderly patients with hypertension;Age,smoking history and 24h urine sodium were the independent influencing factors for abnormal circadian rhythm of blood pressure in elderly patients with hypertension.