The Correlation Between Circadian Rhythm Of Blood Pressure,Plasma Endothelin-1 And Lacunar Infarction In Essential Hypertension

Objective:With the broad application of MRI on clinical experience in recent years,more and more lacunar infarction(LI) in Essential Hypertension(EH) had been diagnosed.Most patients had no symptom,and recovered in a short time,however,the rate of stroke and cardiovascular event in these patients was far higher than normal controls several years later.This study Will intend to investigate risk factors and their relationship of lacunar infarction in EH,by using monitoring the circadian rhythm of blood pressure that contained Hypertension in morning and evening,and plasma Endothelin-1(ET-1) of morning,s and evening,s.Methods:To select 142 patients in department of Cardiology of second affiliated hospital of Nan Hua University from 2004.6~2006.10,including 60 EH with LI,52 EH without LI and 30 normal controls.All of them were performed MRI of head,ABPM and plasma ET-1 of morning,s and evening,s and analysis these data by using spss13.0. Results:(1)The percentage of Grade 3 EH was significantly higher in EH with LI than in EH (P<0.05).(2)The incidence rate of Hypertension in morning and evening was significantly higher in Grade 3 EH than in Grade 2 EH and Grade 1 (P<0.05).(3)In the same stages,The incidence rate of Hypertension in evening was significantly higher in EH with LI than in EH (P<0.05), but not the incidence rate of Hypertension in morning(P>0.05). (4) Plasma ET-1 of morning,s and evening,s was significantly higher in Grade 3,Grade 2 and Grade 1 EH than in normal (P<0.05), and there was differences between Grade 3,Grade 2 and Grade 1 EH (P<0.05).(5) In the same stages and target organ damage(LI):the plasma ET-1 of evening,s was significantly higher of patients with Hypertension in evening than without (P<0.05), plasma ET-1 difference between morning,s and evening,s was significantly higher of patients with Hypertension in morning than without (P<0.05)(6) Plasma ET-1 of morning,s,Plasma ET-1 of evening,s and plasma ET-1 difference between morning,s and evening,s was significantly higher in EH and EH with LI than in normal(P<0.05), In the same stages and same circadian rhythm, plasma ET-1 of morning,s and evening,s was significantly higher in EH with LI than in EH (P<0.05).(7)Logistic regression analysis of LI in Essential Hypertension:plasma ET-1 of evening,s and morning,s,Hypertension in evening,the stages of clinical blood pressure,Hypertension in morning can enter in the equation(P<0.05).conclusions:(1)grade 3 was correlated with abnormal circadian rhythm (Hypertension in morning and evening),Plasma ET-1of morning,s and evening,s and LI in EH.(2)The increased plasma ET-1 may be one of the reason of the abnormal circadian rhythm.(3) stages,Hypertension in evening,plasma ET-1 of evening,s and morning,s were risk factors of EH with LI. However, the effect of Hypertension in morning to LI in EH may not independent of stages.