Hypertension And Syndrome Differentiation And Osteoporosis Study

Objective To investigate the correlation between primary hypertension(HT) and osteoporosis(OP) as well as its mechanism,discuss the underlying relationship with theory of traditional Chinese medicine(TCM),thus provide clinical and theoretical basis for prevention and treatment of HT and OP with integrative western and Chinese Medicine.Method Cross-sectional study was applied to collected 479 cases receiving bone densitometry in Bone Density Lab of China-Japan Friendship Hospital from Aug 2005 to Jan 2008.The subjects were divided into 272 cases in HT group and 207 cases in non-HT group.The HT patients were made a differentiation diagnosis of four TCM-syndrome types:Overabundant liver-fire,asthenic yin causing predominant yang, deficiency of both yin and yang,excessiveness of phlegm-dampness.Bone Mineral Density(BMD) of lumber spine,femoral neck,Ward triangular area and Greater trochanter of femur were determined using dual-energy x-ray absorptiometry and the BMD between HT and non-HT groups and among TCM-syndrome types were compared. The influential factors of BMD changes were analyzed by multivariate logistic regression method.In addition,bone metabolic parameters including serum bone alkaline phosphatase(BALP),bone gla protein(BGP),N-Telopeptide of TypeⅠcollagen and insulin-like growth factor-1(IGF-1) were measured.Result(1)The BMD of Ward triangular area in the HT group was significantly lower than that in the non-HT group(P＜0.01),the incidence of decreased BMD in the HT group was much higher than that in the non-HT group(P＜0.01);(2)In postmenopausal female subgroup,the BMD of Ward triangular area in HT patients was significantly lower than that in patients without HT(P＜0.05),while there were no differences in BMD of any locations between HT and no-HT patients in both non-postmenopausal female and male subgroups(P＞0.05).(3)As for the TCM-syndrome type of deficiency of both yin and yang,the BMD in the four locations were all much lower than that of the corresponding location in the other three TCM-syndrome types,taking the age as a covariate(P＜0.01). (4)Multivariate logistic regression analysis showed that HT,diabetes and age were significant influencing factors for reducing BMD,especially HT with regression coefficient of 0.69 and odds ratio of 1.99(P＜0.01);(5) There was no significant difference for any bone metabolic parameters between HT and non-HT groups and among TCM-syndrome types in HT patients,and just shy of significant difference for NTX and BALP in TCM-syndrome type of deficiency of both yin and yang,which was lower than that in TCM-syndrome type of asthenic yin causing predominant yang(P=0.07 and P=0.09 respectively).Conclusion(1)HT was an significant influential factor for decreased BMD.HT patients are more prone to suffer from reduced BMD and even OP as compared with non-HT patients,especially in postmenopausal female patients;(2)The BMD in TCM-syndrome type of deficiency of both yin and yang was much lower than that in patients of the other three TCM-syndrome types,indicating kidney deficiency might be the common pathogenesis underlying HT and OP;More attention should be paid to BMD changes for HT patients in clinical practice,especially for those HT patients with TCM-syndrome type of deficiency of both yin and yang.Bone densitometry is helpful for early detecting BMD changes in HT patients,based on which,OP might be delayed by early intervention of tonifying liver and kidney,nourishinig Yin to suppress Yang and tonifying both Yin and Yang;(3) There was no significant difference for any bone metabolic parameters between HT and non-HT groups and among TCM-syndrome types in HT patients,which might be due to small sample.