| The data of Sixth national census showed that aged60and above accounted for13.26%of the population, aged65and above accounted for8.87%, China has entered the aging society. According to the data of National Health and Nutrition Examination Survey in2002, China’s population aged60and above hypertension prevalence was49%. Hypertension is the most important risk factors of elderly cardiovascular disease. Stroke, myocardial infarction, heart failure and chronic kidney disease and other complications are the main reason of disability and death.The prognostic significance of blood pressure variability has lately enjoyed considerable attention. Some post-hoc studies and meta-analysis indicate that blood pressure variability is the strong predictor of the risk in adverse vascular events, independent from mean blood pressure. Visit to visit blood pressure variability,24-h ambulatory blood pressure variability and home blood pressure monitoring variability show the same prognostic significance, especially in systolic blood pressure variability. Antihypertensive drugs have not the same effect of blood pressure variability as blood pressure readings. Calcium antagonists reduced between-subject BP variability, while b-blockers, ACE inhibitors and ARBs increased the variance ratio.As the physiological function degradation, increasing in senile arteriosclerosis vascular wall stiffness, baroreflex control decreased, the blood pressure variability increases in elderly patients. Recent studies found that blood pressure variability is an independent predictor of cardiovascular events such as stroke, coronary heart disease, the greater the variability of blood pressure, the greater the risk the risk of the event.Now, there has no recognized TCM syndrome distribution characteristics of the elderly patients with hypertension, and we do not know the relationship between blood pressure variability and syndromes characteristics of TCM, we also do not know the effect of traditional chinese medicine on changing blood pressure variability.This study first conducted two literature reviews, one of blood pressure variability in elderly patients, and the other of elderly hypertension in TCM and Western research progress. And then we conducted two parts study to explore the relationship of blood pressure variability and TCM.Part I:Clinical investigation1. ObjectivesTo investigate TCM syndrome characters in elderly hypertensive patients by factor analysis, and then explore the relationship between blood pressure variability and TCM syndromes.2. MethodsHypertensive patients who aged60and over, signed informed consent were interviewed. We made clinical investigation through questionnaire and medical examination. Trained doctors completed questionnaires regarding to general states of health, treatment history, symptoms, physical signs, etc.Data were managed and statistically analyzed by SPSS16.0. Two-sample t test or the One-Way ANOVA tested normal distribution data. Non-normal distribution Data were tested by NPAR test, such as Mann-Whitney test, Kruskal—Wallis test, Chi-square and analyses.Symptom characters were tested by factor analysis.3. Results3.1General informationA total of320hypertensive patients were enrolled, but12patients were removed because of the lack of important information, so308patients were included in the statistical analysis. Among them,139are male (45.1%),169are female(54.9%); From age part, the youngest is60year-old, the oldest is89year-old, the mean age is70.12±8.747year-old.3.2TCM Syndromes of elderly hypertensive patientsThe44variables which Frequency was more than10%were included in the factor analysis.16common factors were selected, which could explain71.122%of the total variance of original variables. According to the stander of syndromes, expert group determined the TCM syndromes. At first, there were8kinds of syndromes, some of them had been united into one, and then5TCM syndromes were obtained. The5syndromes are yin deficiency with yang hyperactivity syndrome, dual deficiency of qi and yin syndrome, dual deficiency of yin and yang syndrome, liver-wind and phlegm syndrome, phlegm and blood stasis syndromeAmong the5syndrome, the yin deficiency with yang hyperactivity syndrome are the most common one, which are119cases (38.6%).60are dual deficiency of qi and yin syndrome(19.4%),25are dual deficiency of yin and yang syndrome (8.1%), liver wind phlegm in57are liver-wind and phlegm syndrome (18.4%),47are phlegm and blood stasis syndrome (15.2%).According to syndrome of phlegm and blood stasis, there are105with phlegm syndrome (34.1%),59are with phlegm and blood stasis (19.1%),144are with blood stasis (46.8%).Overall, the yin deficiency with yang hyperactivity syndrome is the most common syndrome in elderly hypertensive patients, phlegm syndrome and blood stasis syndrome are the chief plus syndrome.3.3The relationship between blood pressure and TCM syndromeThe blood pressure of systolic and diastolic in all the time are no significant difference (P>0.05) between the5syndromes.3.4The relationship between blood pressure variability and TCM syndromeSystolic blood pressure variability (SBP-SD) is significant difference (P<0.05) in5syndromes. The yin deficiency with yang hyperactivity syndrome has the maximum SD, thus the SD of liver-wind and phlegm syndrome is the minimum. There are no significant difference (P>0.05) in Diastolic blood pressure SD, mean arterial blood pressure SD in the5syndromes.Systolic blood pressure coefficient of variability (SBP-CV) is significant difference (P<0.05) in5syndromes. The yin deficiency with yang hyperactivity syndrome has the maximum CV, thus the CV of liver-wind and phlegm syndrome is the minimum. There are no significant difference (P>0.05) in Diastolic blood pressure CV, mean arterial blood pressure CV in the5syndromes. 3.5The relationship between LVMI and TCM syndromeBlood pressure variability and LVMI correlation analysis, daytime systolic blood pressure variability (DSBP-SD) and coefficient of variation (DSBP-CV) are positive correlation with LVMI, a correlation coefficient of0.480and0.460. There has no relevant between LVMI and DBP-SD. LVMI is significant difference (P<0.05) in5syndromes. The yin deficiency with yang hyperactivity syndrome is heavier than other syndromes (P<0.05).3.6The relationship between IMT and TCM syndromeIMT is significant difference (P<0.05) in5syndromes. IMT of the yin deficiency with yang hyperactivity syndrome is thicker than other syndromes (P<0.05). The plaques are statistically significant in5syndromes, the plaques of dual deficiency of qi and yin syndrome are larger (P<0.05).3.7The relationship between symptom scores and TCM syndromeSymptom scores are significant differences (P<0.05) in5syndrome, scores of the yin deficiency with yang hyperactivity syndrome are the highest, and then scores of the dual deficiency of qi and yin syndrome. Scores of SBP-CV over P50are higher than others (P<0.05).4ConclusionsThrough factor analysis, there are5syndromes in elderly hypertensive patients which are yin deficiency with yang hyperactivity syndrome, dual deficiency of qi and yin syndrome, dual deficiency of yin and yang syndrome, liver-wind and phlegm syndrome and phlegm and blood stasis syndrome. Among the5syndromes the yin deficiency with yang hyperactivity syndrome are the most common syndrome in elderly hypertensive patients, phlegm syndrome and blood stasis are the chief plus syndrome.SBP-SD and SBP-CV are Significant difference between the5syndromes. SBP-SD and SBP-CV of yin deficiency with yang hyperactivity syndrome are larger than other syndromes.LVMI and IMT of yin deficiency with yang hyperactivity syndrome are thicker than other syndromes. The plaques of dual deficiency of qi and yin syndrome are larger.(P<0.05). Scores of the yin deficiency with yang hyperactivity syndrome are the highest. Scores of SBP-CV over P50are higher than others.Part Ⅱ:Clinical study1ObjectiveTo evaluate the effect of Tianmashuxin decoction (TMSX) on decreasing the blood pressure variability of elderly hypertensive patients.2MethodsA total of sixty hypertensive patients over the age of60years and below the age of85years with yin deficiency with yang hyperactivity syndrome were randomized into treated group(n=30) and control group(n=30).The treated group were treated with Amlodipinc+TMSX, the control group patient were distributed with Amlodipine only. The therapeutic course was4weeks. Security indicators:WBC, RBC, HGB, PLT, Cr, BUN, ALT, AST. Efficacy indicators:blood pressure (clinic blood pressure, ambulatory blood pressure monitoring), blood pressure variability (SD), coefficient of variation (CV); TCM symptoms and signs; renin (PRA), angiotensin Ⅱ (Ang Ⅱ); total cholesterol (CHO), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL). Data were managed and statistically analyzed by SPSS16.0. Two-sample t test tested normal distribution data. Non-normal distribution Data were tested by NPAR test, such as Mann-Whitney test, Chi-square and analyses.3. Results3.1General information60cases were enrolled the study.48were outpatients (80.0%),12were hospitalized patients (20.0%);31are males (51.7%) and29are females (48.3%); aged range from60to75years old.Before the course, there were no significant difference between two group in age, course, complications, blood pressure readings, classify of risks, BP-SD, BP-CV, PRA, Ang II, CHO, TG, HDL, LDL (P>0.05). The data of two groups were suit to campare. 3.2Visit to visit blood pressure readingsAfter the course, visit to visit blood pressure readings decreased significantly in two groups (P<0.05), and between the groups, SBP of treated group was lower than control group (P<0.05). But there were no significant difference in diastolic blood pressure values between the two groups (P>0.05). This result indicates that TMSX can decrease visit to visit blood pressure readings.3.3ABPM blood pressure readingsAfter the course, all time ABPM pressure readings decreased significantly in two groups (P<0.05), and between the groups, SBP of treated group was lower than control group (P<0.05) in24-hour and daytime. But there were no significant difference in diastolic blood pressure values between the two groups (P>0.05). This result indicates that TMSX can decrease SBP readings of24-hour and daytime of ABPM.3.4Blood pressure variabilityThe two groups’BP-SD of24-hours and nighttime were significant decreased after the course (P<0.05). But between the groups,24hSBP-SD,NSBP-SD of treated group was lower than control group (P<0.05), there were no difference in DBP-SD and DBP-CV (P>0.05). This result indicates that TMSX can decrease SBP-SDof24-hour and nighttime of ABPM.3.5Blood pressure coefficient of variationThe two groups’BP-CV of24-hour and nighttime were significant decreased after the course (P<0.05). But between the groups,24hSBP-CV, NSBP-CV of treated group was lower than control group (P<0.05), there were no difference in DBP-SD and DBP-CV (P>0.05). This result indicates that TMSX can decrease SBP-CV of24-hour and nighttime of ABPM.3.6PRA, Ang II, CHO, TG, HDL, LDLThere were not change of PRA, Ang II, CHO, TG, LDL within the control group (P>0.05), but the PRA, Ang II, CHO, TG, LDL in treated group were decreased significantly (P<0.01); This result indicates that TMSX can decrease PRA, Ang II, CHO,TG,LDL.3.7Symptom scoresThe two groups’symtom scores were significant decreased after the course (P<0.05). But between the groups, treated group significantly reduced the total score than the control group (P<0.05). This result indicates that TMSX can decrease symptom scores.4ConclusionsTMSX can decrease the SBP-SD and SBP-CV efficiently, in the same time it also can decrease BP readings, PRA, Ang Ⅱ, CHO, TG, and LDL. Symptoms of yin deficiency with yang hyperactivity syndrome could be improved by TMSX. There has no significant side effect. This indicates that traditional chinese medicine can improve the BP-SD, but it also need to explore the mechanic of TCM on SD. |
PDF Full Text Request