The Effects Of Ambulatory Blood Pressure Monitoring On The Quality Of Sleep And The Monitoring Parameters In Aged Patients With Hypertension

Objective: Baroreceptor reflex sensitivity (BRS) is blunted and sympathetic nerves activityis augmented,Vaso active Substance secretion is abnormal in aged hypertensive patients, for theabove reason, blood pressure stability will be decreased when internal and external environmentchanges. Greater variability in blood pressure and the disappearance of circadian rhythm、highermorning blood pressure surge are frequently founded in the elderly with hypertension, which wouldlead or increase target organ damage. With the broad applications of ambulatory blood pressuremonitoring(ABPM), we can obtain the continuous and variability blood pressure monitoringparameters、the blood pressure diurnal rhythm(dippers、non-dippers、reverse-dippers、over-dippers)、morning blood pressure surge(MBPS) and blood pressure load(BPL), Which will help to estimatedamage target organs (heart, brain, kidney)、forecast the disease outcome and direct the drugtreatment. But taking the blood pressure frequently at night maybe has an effect on sleeping quality.the poor sleeping will shrink nighttime blood pressure reduction rates、shift the diurnal rhythm curveand so on. The purpose of this study is to examine the effects of ambulatory blood pressuremonitoring on the quality of sleep and the monitoring parameters in aged patients with hypertension.Methods:Fifty essential hypertensive patients who aged79.5±11.3years were included fromthe Department of Geriatrics of this hospital. The patients have stable blood pressure, unruffledmood and similitude daily activities while in the process of ABPM. The same patient had twiceABPM and did not adjusted the antihypertensive medications during five days. The patients weretaking tablets of Alpraolamum during the second test(before intervention group). While the first testdid not received any drugs intervention(after intervention group). Record data:1、sleep time andawake times at night in different conditions of before and after interference by Alpraolamum duringABPM；2、24hours mean systolic blood pressure（24hSBP）、24hours mean diastolic blood pressure（24hDBP）、Daytime mean systolic blood pressure (dSBP)、Nighttime mean systolic blood pressure(nSBP)；3、four blood pressure diurnal rhythms, nighttime systolic and diastolic blood pressure reduction rates (NSBPRR, NDBPRR);4、Nighttime systolic and diastolic blood pressure standarddeviation (nSBP-SD, nDBP-SD)，Nighttime systolic and diastolic blood pressure load(nSBPL,nDBPL). All measurement data were represented by mean±standard deviation(mean士SD).Measurement data between groups were compared by t-test；chi-square test was introduced toanalyze the percentage, and P<0.05was defined as statistically different borderline.Results:1、Different significantly on the sleep time and awake times in night between thebefore and after intervention groups（P<0.05）;2、Different significantly on24hours mean systolicblood pressure(24hSBP)and Nighttime mean systolic blood pressure(nSBP) between two groups（P<0.05）, The results of24hours mean diastolic blood pressure（24hDBP）and Daytime meansystolic blood pressure(dSBP) are not significantly different；3、Different significantly on nighttimesystolic and diastolic blood pressure reduction rates(NSBPRR, NDBPRR) between two groups（P<0.05）；4、blood pressure diurnal rhythms：After taking Alpraolamum, although the dippersincreased from1to5cases，proportion of dipper rhythm had not different significance（P单侧=0102，P双侧=0204）. the proportion of non-dippers rhythm is increased, the proportion ofreverse-dippers rhythm is decreased, over-dippers rhythm is appeared also;5、The results ofMorning blood pressure surge(MBPS) are not significantly different，but different significantly on2hours after getting up mean systolic blood pressure between two groups（P<0.05）；6、Differentsignificantly on Nighttime systolic and diastolic blood pressure standard deviation(nSBP-SD,nDBP-SD) and Nighttime systolic and diastolic blood pressure load(nSBPL, nDBPL) between twogroups（P<0.05）.Conclusions:1、Aged patients with hypertension will bring about a poor sleeping qualityduring ABPM examination；2、nighttime blood pressure reduction rates(NSBPRR, NDBPRR) isshrink and the diurnal rhythm curve is shifted during ABPM examination；3、ABPM has littleinfluence on MBPS data, but has influence on mean systolic blood pressure after getting up in2hours；4、During ABPM examination, Blood pressure variability(BPV) is increased, Nighttime bloodpressure load(nBPL) is heighten；5、Though ABPM have obvious comparative advantage for clinicaldiagnoses and treatment as contrast with causal blood pressure monitoring, and is supported bymedicine guild and in widespread use. We should pay attention to the effects of ambulatory bloodpressure monitoring on the quality of sleeping, because a poor sleeping will have an effect on thetruth of blood pressure and will create discrepancy in diagnosis and treatment of hypertension.