Clinical Study In Elderly Hypertensive Patients With Multiple Cardiovascular Disease Risk Factors And Their Relationships

Objectives Through investigating 200 midaged patients with essential hypertension(EH ) of multiple risk factors and related detection index and chinese medicine syndrome,to analysis sample people characteristic of multiple risk factors and regular of chinese medicine syndrome,and through association analysis from different angles,to study interactive relationship of different risk factors,and explore the correlation coefficient,to pioneer thinking of prevention and treatment of integrated chinese and western medicine,and offer the date support.Methods.The target is high risk population of essential hypertension(EH ) who visit clinic and ward of cardiovascular department of Dong Zhi Men hospital of bei jing chinese medicine from january 2007 to march 2009.On the basis of investigate epidemiology.Use the different means,such as questionnaire investigation,analysis of medical records,and telephone call interview and so on.To collect multiple risk factors and related chinese medicine syndrome,choose 202 midaged patients whose age is between 45 and 90 years old.Use statistical method,such as regression analysis, partial correlation analysis and so on.on the basis of whole view,use synthesis and analysis method to study the characteristic of multiple risk factors,study coo perativity and relativity of different risk factors;use diagnosis standard of chinese medicine which is enact by national chinese medicine.Meanwhile,carry out the test study with the quality control of laboratory biology:include Hs-CRP,PAgT,MMP-9,and so on.Results.①Logistic regression analysis shows that there is significant correlation with impaired glucose metabolism,early onset family history,Hs-CRP,HDL-C,TG, lack of sports and acute ischemia,it's the main dangerous factor of sample people.the regression equation is logit(P)≈-21.661+2.759*Impaired glucose metabolism(1 ) +2.547* TG +1.836* HDL-C(1 ) -3.882* Impaired glucose metabolism(2 ) -3.492* sports(3 ) -2.638*Hs-CRP(2 ) -1.476* early onset family history.The other regression equation is logit(P)≈-1.090+0.264*Hs-CRP+ 0.257*GLU-1.62*HDL-C-0.866* LDL-C;Inter class effect shows that Hs-CRP,TG,HDL-C is classified by 3.0mg/L, 1.7mmol/L,1.04mmol/L,there is obvious different to the events of acute cardio-cerebral vascular.②The characteristic of Chinese Medicine Syndrome of multiple risk factor of midaged EH patients as follows:Comparing the diabetic patients to the normal,phlegm syndrome is obvious high;If the patient's Hs-CRP is high,wind,phlegm,stasis syndrome are obvious high,and the tendency of heat syndrome is increased.Comparing the diabetic patients to the normal patients of Hs-CRP,P=0.088;Regression analysis shows that there is positive correlation between acute events and wind,phlegm,stasis syndrome,while there is negative correlation between deficiency syndrome.③There is closely related between the level of Hs-CRP and risk stratification;④There is related between the level of Hs-CRP and the state of high aggregation of platelet.When the level of Hs-CRP is higher,the level of PAgT is also higher.⑤There is interact effect between lipid abnormality and other risk factors, HDL-C and GLU is negative correlation,LDL-C and Hs-CRP is positive correlation;⑥There is some relativity between impaired glucose metabolism and sex,drinking and smoking history,amount of exercise.For example,there is positive correlation between the level of glucose and TC,TG,plasm PAgT,while there is negative correlation between the level of glucose and HDL-C.⑦Cross-sectional study the standard treatment condition of sample people of the first visit clinic,the standard treatment rate is only 30.6%,in the different risk factors,the lipid abnormality and diabetic patients standardize rate is the lowest,18.27%and 29.41%,the blood standardize rate of other risk factors is more than 43%.Conclusions.①Weaken the effect of sex,age of the midaged EH patients,except for the early onset family history of cardio-vascular disease,the main risk of this sample people include impaired glucose metabolism,inflammatory response,impaired lipid metabolism,lack of amount of exercise.②There is closely relation between the form of chinese syndrome of midaged patients and collection of multiple risk factors, there is respctive characteristic to the different risk factors,for example,if the Hs-CRP is high,the incidence of wind,phlegm,stasis,and heat syndrome is high.It is significant correlation with risk stratification and also same as the chinese medicine syndrome when the acute cardio-celebra vascular events happen,It is the one of the basis of biology when the wind,phlegm,stasis,and heat syndrome combined happen, It is significant correlation with acute events,it is one of the starting point to study the toxic pathogens③There are cooperativity and relativity between the main risk factors of inflammatory response,high coagulation condition of platelet impaired lipid metabolism,impaired glucose metabolism which can be intervene,it can explain the clinic question,point out the direction of using medicine;④It is still not enough to control and prevent this objects at present,the degree of execute guideline should be reinforced,and find the good way to execute the guideline,it is also find that it is bad control of multiple risk factors patient,it is necessary to comprehensive management. It is important things that consider the cooperate or relative effect to standard prevent and treatment;it should be furthermore enforce that propaganda,supervise,guide,and implement guidline into the patients,patients are the main part of prevent and treatment.