The Relationship Between Circadian Rhythm Of Blood Pressure And Target Organ Damage In Essential Hypertensive Patients

Background:Studies have shown, abnormal blood pressure variability increases risk of cardiovascular and cerebrovascular events. Noninvasive 24-hour ambulatory blood pressure monitoring (ABPM) showed a certain extent, the circadian rhythm of blood pressure, blood pressure variability, blood pressure load and other indicators of value; Understanding blood pressure rhythm of hypertension by ambulatory blood pressure monitoring in patients who were also observed the damage of the major target organ, and analyze the relationship between circadian rhythm of blood pressure and target organ damage, will help clarify the impact of blood pressure circadian rhythm to the prognosis of essential hypertensive patients.Objectives:1.Compare the clinical value of 24h ambulatory blood pressure monitoring with office blood pressure measurement.2.The relationship between circadian rhythm of blood pressure and target organ damage in hypertensive patients.Methods:1.According to the hypertension diagnostic criteria of guidelines for hypertension prevention and treatment in China 2009 included 109 cases of essential hypertension. The office blood pressure measurement and ambulatory blood pressure monitoring were taking. Acquire the OSBP, ODBP, MSBP, MDBP, PP, dSBP, dDBP, nSBP, nDBP, and the circadian rhythm of blood pressure.2.Determination of biochemical: determination of creatinine in patients(Cr), blood urea nitrogen(BUN), uric acid(UA), fasting blood glucose(FBG), glycosylated hemoglobin (HbA1c%), total cholesterol(TC), triglyceride(TG), high density lipoprotein cholesterol /(HDL-C), low density lipoprotein cholesterol(LDL-C). Calculated body mass index BMI(kg/m~2), creatinine clearance Ccr(ml/min). Detection of the 24h microalbuminuria. 3.Target organ damage assessment: detection of left ventricular mass index (LVMI), corrected QT dispersion (QTcd), carotid artery intima-media thickness (IMT), atherosclerotic plaque formation, asymptomatic cerebral infarction. Run statistical analysis.Results:1.Left ventricular mass index(LVMI) related to mean blood pressure; Left ventricular hypertrophy related to the disappearance or weakening of circadian rhythm of blood pressure; Left ventricular hypertrophy was significantly and positively related to OSBP, dSBP, nSBP, MSBP, PP, and was significantly and negatively related to dDBP, nDBP, MDBP. Corrected QT dispersion(QTcd) related to the average blood pressure.2.The occurrence of carotid artery plaque related to mean blood pressure and circadian rhythm of blood pressure (anti-dipper group> non-dipper group> dipper group); Correlation analysis showed that IMT was significant correlation with ODBP, nSBP, MSBP, PP, regression analysis showed that OSBP, nSBP, PP, nDBP, dSBP all its factors, which ODBP , NSBP influence stronger.3.The 24h microalbuminuria related to mean blood pressure and circadian rhythm of blood pressure (anti-dipper group> non-dipper group> dipper group, X~2=6.929,P=0.031); Related analysis showed that the 24h microalbuminuria had no obvious correlation to office blood pressure OSBP, ODBP, but significantly related to ambulatory blood pressure nSBP, nDBP.4.In the incidence of asymptomatic cerebral infarction related to circadian rhythm of blood pressure (anti-dipper group>non-dipper group>dipper group); The occurrence of asymptomatic cerebral infarction was significantly related to dSBP, nSBP, MSBP (the night systolic blood pressure nSBP had the highest correlation coefficient Z=1.811,P=0.003), but had nothing to do with office blood pressure.Conclusions:1.Ambulatory blood pressure monitoring reflected the blood pressure circadian rhythm in a certain extent, and its relationship to target organ damage was better than office blood pressure; 2.Left ventricular hypertrophy, corrected QT dispersion (QTcd) related to the average blood pressure;3.Carotid artery intima-media thickness (IMT),related to the circadian rhythm of blood pressure; Carotid artery atherosclerotic plaque formation related to the average and the circadian rhythm of blood pressure;4.24h microalbuminuria (MCA) related to the average and the circadian rhythm of blood pressure, significantly related to ambulatory blood pressure nSBP, nDBP;5.Asymptomatic cerebral infarction (ACI) related to the circadian rhythm of blood pressure, significantly related to ambulatory blood pressure nSBP.