| Essential hypertension has become the first risk factor for the pathogenesis of cardiovascular disease and stroke, as well as the important risk factor for kidney disease and vascular disease, due to it brings about the functional and substantial damage of the target organs by altering normal blood pressure rhythm. Blood pressure variation (BPV) is an important index of the measurement of blood pressure fluctuation degree, as well as the condition, prognosis and efficacy of treatment of essential hypertension. There is only a small number of correlation reports for BPV, target organ damage and TCM syndrome type, dispersion of research indicators, lack of comparability in and among different studies and other problems have impeded the development of BPV research. The subject was built on the basis of literature study for the relationship among BPV, target organ damage and TCM syndrome type of essential hypertension, and explored the relationship among atherosclerosis, heart disease, renal dysfunction, and cerebrovascular events, and the breakthrough point of TCM understanding for BPV of essential hypertension by means of retrospective study.PART Ⅰ:Literature studyFirst, we reviewed the related literature on essential hypertension, BPV and target organ damage in the past five years in cnki and Pubmed, classified the related literature according to different categories as heart, brain, kidney, fundus, vascular, laboratory tests, and so on, and then collected and analyzed the related literature on BPV of essential hypertension and target organ damage. Secondly, we reviewed the related literature on essential hypertension, target organ damage, TCM syndrome type and BPV in the past five years in cnki, sorted out the understanding of the geographical, genetic, physical fitness, risk factors, symptom, syndrome type and target organ damage and other aspects of TCM towards essential hypertension, as well as the study of BPV of essential hypertension from the TCM point of view, analyzed the results and problems of the existing research.PART Ⅱ:Retrospective studyObjective1.To investigate the relationship between BPV of essential hypertension and target organ damage, analyze the influence of the blood pressure variation parameters(daytime systolic blood pressure standard deviation, daytime diastolic blood pressure standard deviation, nighttime systolic blood pressure standard deviation, nighttime diastolic blood pressure standard deviation,24-hour systolic blood pressure standard deviation,24-hour diastolic blood pressure standard deviation and daytime systolic blood pressure variation coefficient, daytime diastolic blood pressure variation coefficient, nighttime systolic blood pressure variation coefficient, nighttime diastolic blood pressure variation coefficient,24-hour systolic blood pressure variation coefficient,24-hour diastolic blood pressure variation coefficient) on target organ damage, the correlation between the average level parameters day and night (daytime average systolic blood pressure, daytime average diastolic blood pressure, nighttime average systolic blood pressure, nighttime average diastolic blood pressure,24-hour mean systolic blood pressure,24-hour average diastolic blood pressure) and target organ damage.2.To explore the relationship between BPV of essential hypertension in the senile and TCM syndrome types, analyze the distribution differences among the different syndrome types and the correlation with the common syndromes of the blood pressure variation parameters and the average level parameters day and night.MethodWe reviewed the hospitalized cases of the senile patients (age=60) which took essential hypertension as the first diagnosis in Xiyuan hospital in the past three years, set up the inclusion and exclusion criteria, made the survey form containing the general condition of patients, blood pressure parameters, target organ damage and TCM syndrome type according to preliminary literature research, and applied SPSS18.0software to analyze the valid data. We took x±s to represent the measurement data, then applied t-test or analysis of variance in comparisons between groups if the measurement data meet the normal distribution and homogeneity of variance, or Wilcoxon rank sum test if the data didn’t satisfy the above two conditions. We took0and1to represent the two classification count data, then applied chi-square test in comparisons between groups. In comparisons of blood pressure parameters among different symptom types, we applied analysis of variance after the test of normal distribution and homogeneity of variance, then applied SNK-q test in comparisons between two groups. For different TCM syndrome type/target organ damage, we applied binary logistic regression of the single factor and spearman correlation analysis first to find relevant factors, then step-back multi-factor binary logistic regression to look for relationship between different parameters and TCM syndrome type/target organ damage in a variety of the relevant factors together.Result1. Study on BPV, average blood pressure level day and night and risk factors of essential hypertension in the senile and target organ damage.(1)the correlation study of BPV, average blood pressure level day and night, risk factors and heart damage,①The analysis of the risk factors and co-morbidities has shown that age, gender, alcohol consumption were related to heart damage. There was no statistical difference among the blood pressure variation parameters(daytime systolic blood pressure standard deviation, daytime diastolic blood pressure standard deviation, nighttime systolic blood pressure standard deviation, nighttime diastolic blood pressure standard deviation,24-hour systolic blood pressure standard deviation,24-hour diastolic blood pressure standard deviation and daytime systolic blood pressure variation coefficient, daytime diastolic blood pressure variation coefficient, nighttime systolic blood pressure variation coefficient, nighttime diastolic blood pressure variation coefficient,24-hour systolic blood pressure variation coefficient,24-hour diastolic blood pressure variation coefficient) in groups with and without heart damage. ②Among the average level parameters day and night (daytime average systolic blood pressure, daytime average diastolic blood pressure, nighttime average systolic blood pressure, nighttime average diastolic blood pressure,24-hour mean systolic blood pressure,24-hour average diastolic blood pressure), there was statistical difference in daytime average diastolic blood pressure between two groups with and without heart damage. Binary logistic regression of the single factor has shown that gender, smoking, alcohol consumption, low-density lipoprotein and daytime average diastolic blood pressure were related to heart damage. Further more, step-back multi-factor binary logistic regression has shown that senile women had less probability to suffer from heart damage than senile men, which also meant senile women had a lower risk of suffering from heart damage.(2)the correlation study of BPV, average blood pressure level day and night, risk factors and brain damage,①The analysis of the risk factors and co-morbidities has shown that gender, course of disease, LDL-C were related to brain damage. There was no statistical difference among the blood pressure variation parameters in groups with and without brain damage.②There was no statistical difference among the average level parameters day and night in groups with and without brain damage.③The analysis of the risk factors has shown that gender, course of disease and low-density lipoprotein were related to brain damage. Senile women, longer course and increased LDL-C were high risk factors of brain damage.(3)the correlation study of BPV, average blood pressure level day and night, risk factors and kidney damage,①There was no statistical difference among the risk factors and co-morbidities in groups with and without kidney damage. There was no statistical difference among the blood pressure variation parameters in groups with and without kidney damage.②Among the average level parameters day and night, daytime average systolic blood pressure, daytime average diastolic blood pressure, nighttime average systolic blood pressure, nighttime average diastolic blood pressure,24-hour mean systolic blood pressure and24-hour average diastolic blood pressure were related to kidney damage. Binary logistic regression of the single factor has shown that daytime average systolic blood pressure, daytime average diastolic blood pressure, nighttime average systolic blood pressure, nighttime average diastolic blood pressure,24-hour mean systolic blood pressure and24-hour average diastolic blood pressure were related to kidney damage. Further more, step-back multi-factor binary logistic regression has shown that there was increased probability of combined renal impairment and an increased risk of kidney damage occurrence as daytime average systolic blood pressure increased, in which we removed24-hour mean systolic blood pressure and24-hour average diastolic blood pressure due to their interaction with daytime average systolic blood pressure and nighttime average systolic blood pressure.(4)the correlation study of BPV, average blood pressure level day and night, risk factors and vascular damage,①The analysis of the risk factors and co-morbidities has shown that course of disease, TG and HDL-C were related to vascular damage. The general clinical data were comparable in groups with and without vascular damage. Among the blood pressure variation parameters, nighttime systolic blood pressure standard deviation and nighttime systolic blood pressure variation coefficient were related to vascular damage. Binary logistic regression of the single factor respectively has shown that the risk of vascular damage increased as nighttime systolic blood pressure standard deviation and nighttime systolic blood pressure variation coefficient increased.②For there were only5negative cervical vascular ultrasound result cases, we applied Wilcoxon rank sum test and found out that there was no statistical difference among the average level parameters day and night in groups with and without vascular damage.③The analysis of the risk factors and co-morbidities has shown that gender, course of disease, triglycerides and high-density lipoprotein were related to vascular damage. Senile women, relatively longer course of disease, increased triglycerides and decreased HDL-C were high risk factors of vascular damage.2.Study on BPV, average blood pressure level day and night and risk factors of essential hypertension in the senile and TCM syndrome type.(1)According to Guidelines for Clinical Research of TCM New Drugs (2002) and TCM Internal Medicine (2007), we divided the existing clinical data into four syndrome types, as yin deficiency and yang excess, phlegm dampness excess, qi deficiency and blood stasis and qi stagnation and blood stasis. There was no statistical difference in the risk factors and co-morbidities among the above four groups. There was no statistical difference in the blood pressure variation parameters and the average level parameters day and night among the above four groups.(2)We selected the yin deficiency and yang excess group and the phlegm dampness excess group in which more cases were concentrated to analyze.①There was no statistical difference among the risk factors and co-morbidities in the phlegm dampness excess group and the non-phlegm dampness excess group. There was no statistical difference among the blood pressure variation parameters between the above two groups. Binary logistic regression of the single factor respectively has shown that daytime average systolic blood pressure, daytime average diastolic blood pressure, nighttime average systolic blood pressure, nighttime average diastolic blood pressure,24-hour mean systolic blood pressure,24-hour average diastolic blood pressure were related to the phlegm dampness excess syndrome type at a=0.1level. Further more, step-back multi-factor binary logistic regression has shown that there was increased probability of access to the phlegm dampness excess group and increased risk of being classified as the phlegm dampness excess syndrome type as nighttime average diastolic blood pressure increased, in which we removed24-hour mean systolic blood pressure and24-hour average diastolic blood pressure due to their interaction with average blood pressure day and night.②There was no statistical difference among the risk factors and co-morbidities in the yin deficiency and yang excess group and the non-yin deficiency and yang excess group. The general clinical data were comparable between the yin deficiency and yang excess group and the non-yin deficiency and yang excess group. There was no statistical difference among the blood pressure variation parameters and the average level parameters day and night between the above two groups.Conclusion1.Nighttime systolic blood pressure standard deviation and nighttime systolic blood pressure variation coefficient are related to vascular damage.2.Gender, smoking, alcohol consumption, low-density lipoprotein and daytime average diastolic blood pressure are related to heart damage. Senile men have been more likely to suffer from heart damage than senile women, which also means senile men have a higher risk of suffering from heart damage.3.Gender, daytime average systolic blood pressure, daytime average diastolic blood pressure, nighttime average systolic blood pressure, nighttime average diastolic blood pressure,24-hour mean systolic blood pressure are related to kidney damage. There is increased probability of combined renal impairment and an increased risk of kidney damage occurrence as daytime average systolic blood pressure increases.4.Daytime average systolic blood pressure, daytime average diastolic blood pressure, nighttime average systolic blood pressure, nighttime average diastolic blood pressure,24-hour mean systolic blood pressure,24-hour average diastolic blood pressure are related to the phlegm dampness excess syndrome type. There is an increased risk of being classified as the phlegm dampness excess syndrome type as nighttime average diastolic blood pressure increases. |
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