| Hypertension (HT) is a common disease of the circulatory system, which endanger human health. The traditional risk factors for hypertension include insulin resistance, high sodium potassium diet, heavy drinking and so on. But in recent years, a number of studies have shown that the formation and development of hypertension also related with hyperuricemia (HUA). They mutually influence on pathological mechanisms, often creating a vicious cycle.Hyperuricemia is a metabolic diseases caused by purine metabolic disorder, often occuring with high blood pressure, obesity and arteriosclerosis aggregation. Hyperuricemia itself is related cardiac hypertrophy, coronary heart disease, cerebral infarction, renal dysfunction and other diseases. When it associated with hypertension they exacerbated target organ damage. Therefore, to study and explorate characteristics of HT with HUA is important for treatment and protect the vital organ.Chinese medicine have good effect for HT with HUA. It greatly relieves the symptoms and has little side effects. The chemical class of drugs has incomparable advantages. However, due to complex etiology and pathogenesis of HT with HUA, it is difficult to study the impact on the progress of Chinese medicine prevention. In this study, after clinical observation, the application of modern statistical analysis, we initially pick out the common syndromes of HT with HUA, which laid the foundation for the study of syndrome of HT with HUA and provides reference and basis for further prevention.The study includes the following three aspects:1. Theoretical studyIn theory part, I reviewed the research progress of modern medicine and medical research of HT with HUA by referring to the relevant literature study and preliminary summarise the epidemiological characteristics, pathogenesis, treatment and TCM characteristics. That provides theoretical basis to further investigate for syndromes study and clinical treatment approach.2. TCM syndrome research2.1ObjectTo study the general characteristics, syndromes characteristic, syndromes typing of HT with HUA and preliminary clarify the law of syndromes. 2.2MethodI adopted the questionnaire and physical examination for133patients from Guanganmen hospital, including outpatient clinics and wards. The main survey included gender, age, dietary preferences, dizziness, headache, and other signs, such as blood pressure, heart rate, lip color, and electrocardiogram, cardiac ultrasound examination. Then fill in the form.All data were entered SPSS17.0statistical software for analysis. Syndrome type is applied for cluster analysis and principal component analysis. Meet or basically in line with the normal distribution of measurement data, using a one-dimensional analysis of variance, the results are described as mean±standard deviation (x±s) expressed; non-normal distribution of measurement data, using rank-sum test. Count data input EXCEL software, database, using the frequency, the frequency is described, and its differences compared using x2test. Level data using rank sum test.2.3Result2.3.1General informationA total of133patients met the inclusion criteria to participate in the survey, both from Grandmaster comprehensive outpatient and ward from March2013to September. The youngest is28years old. The oldest is75. Mean age is58.11±9.81. the average age of male is58.74+9.74while the average age of women is57.45±9.92years old. There are68males (51.12%) while65females (48.87%).Hypertension classification, risk stratification distribution:high blood pressure classification,1level of80people (60.15%),2level of31(23.31%),3level of22people (16.54%). Hypertension risk stratification:low risk is of2people (1.50%), medium risk of14(10.53%), high-risk of62(46.62%), very high risk of54(40.60%). The serum uric acid (SUA) average is491.08+37.19mmol/1. Males is494.54+38.55mmol/1while females is487.78+35.81mmol/1.2.3.2Feature of a HT with HUA2.3.2.1The impact of hypertension on SUASUA level increases as blood pressure increase. SUA value of level-2and level-3hypertension was significantly higher than level1, whose differences were wvey significant (P<0.01). SUA values increases as HT risk stratification gradually increased. The very high-risk group is higher than high-risk groups (P<0.05). 2.3.2.2The impact on of hypertension with clinical condition on SUACompared with the group without hyperlipidemia, hyperlipidemia group had significantly higher mean SUA (P<0.05); compared with non-diabetic group, diabetic group had significantly higher mean SUA (P<0.05); compared with the group without gout, gout group had significantly higher mean SUA (P<0.01); compared with the group without coronary heart disease, coronary heart disease group had significantly higher mean SUA (P<0.05); compared with non-cerebral arteriosclerosis group, the cerebral arteriosclerosis group had significantly higher mean SUA (P<0.05); compared with non-lower limb arteriosclerosis group, lower limb arteriosclerosis group had significantly higher mean SUA (P<0.05); There is no difference between cerebral infarction group and non-cerebral infarction group.2.3.2.3Impact of drugs on SUASUA in patients taking diuretics group was significantly higher than the not taking group (P<0.05); SUA of patients taking the sodium bicarbonate group or Benzbromarone group was significantly lower than the not taking group (P<0.05). There is no difference between other drug groups.2.3.2.4Iimpact of lifestyle on SUA2.3.2.4.1CigaretteThe daily smokers had highest average SUA, followed by sometimes smokers never-smokers and ex-smokers group. The never-smokers and ex-smokers group had significantly lower SUA than daily smokers SUA group (P<0.01)2.3.2.4.1AlcoholSUA of beer group wine group and spirit group was significantly higher than the no drinking or quit group (P<0.01); SUA of spirit group is higher than wine group (P>0.05); SUA of beer group had no difference compared with other groups (P>0.05). Sometimes drinking group, quit group and no drinking group had significantly lower level of SUA than the daily groups (P<0.05); SUA of no drinking group and the quit group was also significantly lower than the sometimes drinking group (P<0.05).2.3.2.4.2Impact of food preferences on SUASUA of fat and seafood group is higher than the lean meat and vegetarian food group (P<0.05); SUA value gradually increases with the consumption of milk and egg, in which the SUA of larger group was significantly higher than the other groups (P<0.05); SUA of eating more beans group was significantly higher than the less group (P<0.05). The impact of staple kind on SUA is not clear (P>0.05). The influence of salt intake on SUA mean is not clear, no significant difference among the three groups(P>0.05).2.3.2.4.4The impact of exercise on SUAThe SUA level decreased with the frequency of exercise increase. The SUA of1-3times a week group and4-6times a week group was significantly lower than no exercise group, with a significant difference (P<0.05).2.3.2.4.5The impact of BMI on SUAThe SUA increased with BMI increase. The SUA of overweight group and obesity group was significantly higher than the normal group. The obese group was significantly higher than the overweight group (P<0.05).2.3.2.4.6The impact of career on SUAThe SUA of business group was significantly higher than administrative groups, worker groups and farmer groups (P<0.05). The SUA of technology group is higher than worker group (P<0.05)2.3.3Distribution of symptoms and signs scoringIn this survey, symptoms frequency of occurrence greater than50%:dizziness (113cases,86.5%), stretching (67cases,50.4%), head of Mongolia (71cases,53.3%), dry mouth (68cases,51.1%), pain (72cases,54.9%), mouth sticky (80cases,60.1%), vomiting phlegm (68cases,51.1%). Sign frequency of occurrence greater than20%is dull (29cases,21.8%), two zygomatic red red (29cases,21.8%), dark purple lips (24cases,18.0%), Mukuang dark (26cases,19.5%), nail dark (28cases,21.1%). Most of tongue is normal, followed by big fat tongue and thin thin tongue. Dark, dark red, pink and red tongue were more common. Tongue with thin yellow, greasy, yellow greasy moss is most prevalent.2.3.4TCM syndrome DistributionAfter cluster analysis and principal component analysis, according to the relevant diagnostic criteria and principles, combined with the actual situation and clinical experience of tutor, we consider HT merger HUA as the following three categories:Category I:blood stasis syndrome, with liver wind phlegm and liver and kidney yin deficiencyCategory II:liver wind phlegm syndrome with liver and kidney yin deficiencyCategory III:wet heat resistance syndrome Category IV:li liver and kidney yin deficiency syndrome with blood stasisTaking cluster analysis, principal component analysis and rank sum test into consideration, referring to the relevant diagnostic criteria and principles, clinical experience and tongue, pulse, we initially identified HT with HUA main syndromes as follows:(1) blood stasis syndrome:dizziness, palpitations, chest pain, insomnia, headache (fixed position), chest tightness, Mukuang dark, dark purple lips, palms dark, dark tongue, dark red tongue, dark purple or stasis spots petechiae tongue, string astringent or astringent pulse.(2) liver wind phlegm syndrome:dizziness, head of the Mongolian, stretching, items strong, bitter mouth, sticky mouth, chest tightness, phlegm, vomiting, numbness, fat tongue greasy fur, slippery string or thin string, number pulse.(3) wet heat resistance syndrome:the first Shen, dizziness, pain, nausea, body weight difficulties, poor appetite, loose stools, red or dark red tongue, greasy, slippery pulse.(4) liver and kidney yin deficiency syndrome:vertigo, tinnitus, such as cicadas, night sweats, Fan, backache, soft knee, red tongue, thin, string or string pulse.2.3.5Study on syndrome of HT with HUAThere is no difference in gender distribution (P>0.05).There is difference in liver wind phlegm syndrome and liver and kidney yin deficiency syndrome in age distribution (P<0.05). liver wind phlegm syndrome usually occur in people of50-69while liver and kidney yin deficiency syndrome increase with aging. So age play an important role in liver and kidney yin deficiency syndrome of HT with HUA. There is no difference in age distribution of wet heat resistance syndrome and blood stasis syndrome.There is no difference in blood pressure level distribution of those syndromes(P>0.05).The intermediate risk group, high risk group and very high risk group distributes differently in the four syndromes. Liver wind phlegm syndrome occur often in intermediate risk group; Liver wind phlegm syndrome and wet heat resistance syndrome occur often in high risk group; blood stasis syndrome and liver and kidney yin deficiency syndrome occur often in very high risk group.2.3.5.2HT with HUA symptoms consolidation morbidity HT with HUA in patients with gout, diabetes, hyperlipidemia, lacunar infarction, unstable angina coronary heart disease distribute differently in different syndromes(P<0.05). When combined with gout, the prevalence of resistance syndrome is high; When combined with diabetes, hyperlipidemia, the prevalence of liver wind phlegm is high; When combined with lacunar infarction and unstable angina of coronary heart disease, the prevalence of blood stasis syndrome is high.3Experiment3.1ObjectTo study the effect of Tianmashuxin to reduce blood pressure and uric acid, and to investigate the feasibility of TCM to treat HT with HUA.3.2MethodWe divided80SHRs into model group, western medicine group, Chinese medicine large-dose group, Chinese medicine medium-dose group and Chinese medicine small-dose group.15WISTARs worked as the normal group. Chinese medicine group were given large (11.592g/kg/day), medium (5.796g/kg/day), small (2.898g/kg/day) dose Tianmashuxin extract liquid. Western medicine group had losartan potassium tablets suspension (17.5mg/kg/day). Model group and control group had equal volume of distilled water. We gavaged them, once a day for18weeks. Within18weeks, blood pressure were measured once every two weeks. After18weeks, the animals were sacrificed. Then we abdominal aorta blood and detect SUA.3.3Result3.3.1Effect on blood pressure of SHRsBefore administration the model group, blood pressure of large-dose group, media-dose group, small-dose group was significantly higher (P<0.01). After2weeks, the large-dose group, media-dose group, western medicine group and the control group was significantly lower than blood pressure of SHR model group (P<0.01). After14weeks, blood pressure values in each group were significantly lower than in the model group (P<0.01). As age increase, with the absence of drug intervention, the model group showed a clear upward trend in blood pressure, positive drug losartan potassium tablets can reverse this trend, and its antihypertensive effect is better than medicine groups. Although blood pressure of Tianmashuxin groups were rising, the rate of increase is lower than the model group.3.3.2Effect on AngⅡ of SHR After18weeks, AngII values of the large-dose group, media-dose group, small-dose group and western medicine group were higher than the untreated group. The large-dose group, western medicine group compared with model group were significantly different (P<0.05); There is no difference between the the large-dose group and western medicine group (P>0.05).3.3.3Effect on SUA of SHRAfter18weeks, the SUA of control group, large-dose group, media-dose group, western medicine group were lower than the model group (P<0.01). Among them, the SUA of western group is lower than small-dose group (P<0.05). But there was no difference when it compared with large-dose group or media-dose group. There was no differencebetween each group of Chinese medicine (P>0.05).3.4ConclusionTianmashuxin has a good effect on reducing blood pressure and serum uric acid. It is feasible to treat HT with HUA by TCM. |
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