| ObjectiveTo investigate the relationship between blood pressure variability and other cardiovascular risk factors in patients with essential hypertension and the severity of carotid atherosclerosis(CAS),the incidence of silent cerebral infarction(SCI),as well as its impact on stroke morbidity and/or recurrence rates.Methods1.A total of 372 patients with primary hypertension were enrolled in the study,24-hour ambulatory blood pressure monitoring,carotid ultrasonography and other laboratory and adjuvant tests(dyslipidemia,blood glucose,hypersensitive C-reactive protein,blood homocysteine,etc.)were completed.Multiple linear regression analysis was used to analyze the related factors of carotid intima-media thickness(IMT)in patients.According to IMT and plaque test results to determine whether patients were combined with CAS.IMT normal group(IMT<0.9 mm)180 cases,IMT thickening group(1.0-1.2 mm)145 cases,IMT patch group(IMT ≥1.3 mm)47 cases,of which IMT thickening group and IMT patch group was judged as CAS group.A variety of blood pressure variability indexes and other related data were analyzed and compared,and multivariate logistic regression analysis was made on the possible influencing factors.A variety of blood pressure variability indexes and other related data were analyzed and compared,and multivariate logistic regression analysis was made on the possible influencing factors.2.The above 372 cases of primary hypertension in hospital patients were divided into two groups,one group was simple hypertensive control group(173 csaes),the other group was SCI group(199 csaes).The general clinical data(including blood lipids,blood glucose,hypersensitive C-reactive protein,blood homocysteine,carotid atherosclerosis,etc.)and 24h ambulatory blood pressure were compared between the two groups of patients,and the multivariate logistic regression analysis was made on the possible influencing factors.3.For the 372 patients with primary hypertension,they were followed up for 1 to 2 years after discharge(follow up every 3-6 months).The results of 24-hour ambulatory blood pressure monitoring and general clinical data were recorded in patients with recurrent stroke and/or stroke recurrence and those without disease.Laboratory and adjuvant examination results were compared to explore its relationship with symptomatic stroke morbidity and/or recurrence rate.Results1.(1)In patients with essential hypertension,the degree of CAS lesions gradually increased with age.(2)Univariate analysis showed that age,smoking history,stroke history,history of diabetes mellitus,the years of hypertension history,body mass index(BMI),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),fasting blood glucose(FBG)Hypersensitive C-reactive protein(Hs-CRP),homocysteine(Hcy),Lipoprotein-associated phospholipase A2(Lp-PLA2),and urinary protein were associated with the severity of CAS.(3)24h ambulatory blood pressure and carotid atherosclerosis:daytime mean systolic blood pressure(dSBP),nighttime mean systolic blood pressure(nSBP),24h mean systolic blood pressure(24hSBP),daytime systolic blood pressure standard deviation(dSSD),nighttime systolic blood pressure standard deviation(nSSD),24h systolic blood pressure standard deviation(24hSSD),standard deviation of daytime diastolic blood pressure(dDSD),standard deviation of nighttime diastolic blood pressure(nDSD),standard deviation of 24h diastolic blood pressure and maximum-minimum difference(MMD)were higher in patients with primary hypertension than in IMT normal group(p<0.001,0.01 Or 0.05).(4)Multiple linear stepwise regression analysis showed that:dSSD(B = 0.012,p = 0.011)、MMD(B =0.002,p = 0.031)were the influencing factors of IMT.Age(B = 0.011,p = 0.000),history of stroke(B = 0.051,p = 0.004),the years of hypertension history(B = 0.108,p = 0.000),fasting plasma glucose(B = 0.048,p = 0.001)and Hey(B = 0.003,p =0.001)were also the influencing factors of IMT after adjusting sex,age,smoking,history of hypertension and other factors.(5)Multivariate logistic regression analysis showed that dSSD(OR:1.225,95%CI:1.075-1.396),age(OR:1.130,95%CI:1.067-1.196),smoking(OR:2.689,95%Cl:1.239-5.837),the years of hypertension history(OR:4.288,95%Cl:2.122-8.662),fasting plasma glucose(OR:4.347,95%CI:2.874-6.574),homocysteine(OR:1.072,95%CI:1.011-1.137)were significantly associated with the severity of CAS in patients with hypertension.2.(1)Age,stroke history,diabetes history,Smoking,drinking,the years of hypertension history,IMT,FBG,Hcy,Lp-PLA2 were higher in patients with essential hypertension complicated with silent cerebral infarction than in those with simple hypertension.(2)The results of 24h ambulatory blood pressure monitoring showed that dSBP、dSSD、24hSBP、nSSD、dDBP、dDSD、nDSD、24hDSD、ddnSBP were higher in hypertensive patients complicated with silent cerebral infarction than those with simple hypertension,and non-dipper type blood pressure were more common.(3)Multivariate logistic regression analysis showed that the standard deviation of daytime systolic blood pressure(dSSD)(OR:1.374,95%Cl:1.173-1.609),standard deviation of 24h diastolic blood pressure(24hDSD)(OR:1.194,95%Cl:1.017-1.402),Average systolic blood pressure during the day(dSBP)(OR:1.062,95%CI:1.022-1.103),age(OR:1.042,95%CI:1.005-1.080),smoking(OR:2.610,95%CI:1.495-4.556),fasting blood glucose(OR:1.183,95%CI:1.040-1.345),Lp-PLA2(OR:1.004,95%CI:1.003-1.006)were positively correlated with SCI in patients with hypertension.3.Daytime systolic blood pressure standard deviation(dSSD)、24h systolic blood pressure standard deviation(24hSSD),maximum-minimum difference between systolic blood pressure(MMD),24h systolic blood pressure(24hSBP),daytime mean systolic blood pressure(dSBP),age,stroke history,smoking,history of diabetes,the years of hypertension history,fasting blood glucose levels(FBG),homocysteine(Hey),Lp-PLA2 level,silent cerebral infarction(SCI),carotid intima thickness(IMT)in patients with primary onset and/or recurrence of symptomatic stroke in thoses with essential hypertension were higher than those in the undeveloped.Conclusions1.BPV(dSSD)was independently associated with the degree of CAS lesion in patients with essential hypertension.In addition,the traditional risk factors,age,smoking,the years of hypertension history,fasting blood glucose and homocysteine were also independently associated with the severity of CAS lesions in hypertensive patients.2.Blood pressure variability(dSSD,24hDSD)and blood pressure(dSBP)were independently associated with SCI in patients with essential hypertension.In addition,the traditional risk factors,age,smoking,FBG and Lp-PLA2 were also independently associated with SCI in patients with essential hypertension.3.BPV(dSSD,24hSSD,MMD),blood pressure level(24hSBP,dSBP)and traditional risk factors,age,stroke history,history of diabetes,the years of hypertension history,FBG,Hcy,Lp-PLA2 level,combined with SCI,IMT may help to predict morbidity and/or recurrence rate of symptomatic stroke in patients with essential hypertension.SignificanceActing as the leading disability,fatal disease in the world,cardiovascular disease(including stroke,coronary atherosclerotic heart disease,peripheral arterial disease)has been of concern.Hypertension is the most important risk factor for cardiovascular disease and is the focus of attention in preventive medicine.For more than half a century,people have done a lot of research work to reduce the mean blood pressure in hypertensive patients,confirming that lowering blood pressure levels can significantly reduce the morbidity and mortality of cardiovascular disease.However,the reality is that more than 50 years have passed,the incidence of hypertension has not significantly reduced,cardiovascular disease caused by high blood pressure is still on the rise.Which has aroused the attention of relevant scholars and clinicians,and they began to find the way to the other side of blood pressure,that is,BPV.In recent years,academic research has made some progress on BPV,but there is a lot of controversy.BPV and blood pressure levels are closely related,but not exactly the same.There are many factors that affect BPV,far more than the factors that affect blood pressure levels.The relationship between BPV and target organ damage in hypertension is also reported,such as left ventricular hypertrophy,coronary heart disease,hypertensive nephropathy,etc.,and they have a positive correlation between BPV.The relationship between BPV and CAS has also been reported,but the conclusion is not uniform.In addition,there are a number of BPV evaluation indicators,the relationship between the various indicators is uncertain.And there is not a well-known indicators of clear meaning,and so far there is no reliable effective range.Standard deviation(SD)is the most studied and reliable BPV evaluation index.In addition,the high incidence and morbidity of stroke in recent years also exceeded coronary heart disease,and the relationship between hypertension and stroke also exceeded the relationship between hypertension and coronary heart disease.Due to anatomical factors and hemodynamic principles,the impact of blood pressure fluctuations on stroke is very obvious,and the primary pathological problem of stroke is CAS,the focus of prevention of stroke is to improve the CAS.Therefore,the relationship between BPV and CAS has become a major research topic,especially to find a BPV indicator which has a clear relationship with CAS.This is significant for improving the CAS,thereby reducing the incidence of stroke and/or recurrence.Secondly,studies on the relationship between BPV and SCI in patients with hypertension at home and abroad are very few studies,because there are many uncertainties by BPV itself.In addition,there is a lot of controversy about the definition,diagnostic criteria,imaging changes of SCI.Therefore,it is important to explore the relationship between BPV and SCI in patients with hypertension.Finally,we briefly discuss the relationship between BPV and the incidence and/or recurrence rate of symptomatic stroke in hypertensive patients,which have a long-term implications for further prevention of symptomatic ischemic stroke from improving BPV.The first part of the study found that BPV(mainly dSSD)has an independent correlation with CAS degree in patients with primary hypertension,no other BPV indicators were found related to CAS.Therefore,controlling daytime systolic blood pressure variability may be useful for improving the severity of CAS lesions in hypertensive patients and preventing their progression.The second part of the study found that BPV(mainly dSSD,24hDSD)has an independent correlationand with SCI in patients with primary hypertension,no other BPV indicators were found related to SCI.Therefore,controlling of daytime systolic blood pressure variability and all day diastolic blood pressure variation may be significant for the prevention of hypertension in patients with SCI.The third part of the study found that BPV(mainly dSSD,24hSSD,MMD)may help to predict the incidence of symptomatic stroke and/or recurrence in patients with essential hypertension.Because of the few cases of patients with symptomatic stroke,there is no in-depth discussion that affects the reliability of the conclusions and is subject to further studies to further confirm.However,the results still suggest that BPV,especially daytime and all day systolic blood pressure,should be concerned about the prevention of symptom onset and/or recurrence of symptomatic stroke in hypertensive patients.Based on our findings,it was confirmed that there was a positive correlation between BPV and target organ damage(predominantly CAS)in hypertensive patients.In addition,BPV abnormalities in patients with hypertension were related with the incidence of SCI and symptomatic stroke.Therefore,in the diagnosis of hypertension,risk assessment,target organ protection and start antihypertensive therapy,it is necessary to pay attention to blood pressure levels,but also to pay attention to BPV,which has significance in reducing the risk of target organ disease risk,especially the incidence of stroke rate. |
