The Comparison Between The Effects Of Autonomic Nervous System Regulation And Vascular Function On Circadian Rhythm Blood Pressure With Hypertension

Objective:With the development of society,health condition has become an important component in measuring quality of life.As hypertension becomes a significant risk factor for human health,prevention and treatment of hypertension is very critical.Currently,the evaluation of efficacy and prognosis of hypertension has been transformed from simply controlling target value to regulating normal rhythm of hypertension.Recent studies on influential factors of circadian rhythm have received extensive attention,in which the autonomic nervous system regulation and vascular function are two important factors.This study aims to analyze the difference in roles between non-dipper hypertension circadian rhythm(NDH)group and dippers hypertension circadian rhythm(DH)group,the functional changes of autonomic nervous system regulation and vascular function,in order to reveal the role of each group in circadian rhythm of blood pressure with hypertension,investigate the impact of autonomic nervous system regulation and vascular function on circadian rhythm of blood pressure with hypertension,and provide a new direction of prevention and treatment for patients with hypertension.Methods: First,selected 220 cases from both hypertension inpatients and outpatients in our hospital between January 2015 and December 2015,all enrolled patients with hypertension diagnosis based on the 2014 WHO / ISH Hypertension Guidelines: systolic blood pressure(SBP)?140 mmHg and(or)diastolic blood pressure(DBP)?90 mmHg of persistent blood pressure or more than three times on different days in the sitting position.Second,collected all selected clinical data,including name,age,sex,underlying disease,complications and hypertension classification,serum total cholesterol(TC),triglyceride(TG),and low density lipoprotein cholesterol(LDL-C).Then,applied 90207-18 Q type US Space ambulatory blood pressure monitor to detect 24 h average blood pressure(SBP and DBP),maximum blood pressure(SBP and DBP),the minimum blood pressure(SBP and DBP)and the percentage decrease in nighttime blood pressure;Applied Japan UNEX EF detector to measure flow-mediated dilatation(FMD);applied BI9800 Holter detector to record the time domain indexes of heart rate variability(SDNN,SDANN,PNN50,RMSSD)and frequency domain(HF,LF,VLF).Finally,based on the percentage decrease in nighttime blood pressure,divided into two groups: non-dippers(NDH = 110 cases of nighttime blood pressure decrease <10%);dipper group(DH = 110 cases of nighttime blood pressure decrease ?10%),compared the differences between DH and NDH in clinical data(age,gender,hypertension grading,serum total cholesterol,triglycerides,and LDL cholesterol,24 h highest systolic / diastolic,24 h average systolic / diastolic and 24 h lowest systolic / diastolic),compared the heart rate variability(HRV)in time domain,frequency domain and flow-mediated dilatation(FMD)level of two groups,and analyzed the independent factors for circadian rhythm of blood pressure.Results: 1.Comparison of the two groups of patients with general data: the age of non-dipper hypertension circadian rhythm(NDH)group increased significantly than dipper hypertension circadian rhythm(DH)group,with statistical significance(P <0.05);gender,blood lipids(TC,TG,LDL-C),blood pressure(24h highest systolic / diastolic,24 h average systolic / diastolic,24 h lowest systolic / diastolic),and hypertension grading index showed no significant difference(P> 0.05).2.Comparison of the two groups of patients with HBV-related indicators: non-dipper group HRV indexes were lower than dipper,in which SDNN and SDANN decreased significantly,with statistical significance(P <0.05);Rmssd,PNN50,HF,LF,VLF,and other indicators on a downward trend,but the differences between the groups did not reach statistical significance(P> 0.05).3.Comparison of the two groups of patients the value of FMD: the FMD value of non-dipper group was higher than dipper group with statistically significance(P <0.05);FMD values of the two groups decreased compared to normal values.4.Considered circadian rhythm of blood pressure as response variable,statistically significant indicators of univariate analysis(age,FMD value,SDNN,SDANN)as independent variables,used multivariate logistic regression analysis to opt backward stepwise regression analysis.The results showed that age and SDANN were two independent risk factors for non-dipper hypertension,the OR value of SDANN was 1.990(95% CI1.983-1.997),and the OR value of age was 2.023(95% CI 2.002-2.043).Conclusion: 1.Age has impact on circadian rhythm of blood pressure with hypertension.As age increases,there is greater probability of circadian rhythm of blood pressure with hypertension.being non-dippers.Therefore,age is an independent factor affecting blood pressure circadian rhythm with hypertension disorders.2.Autonomic nervous system regulation has impact on circadian rhythm of blood pressure with hypertension.Non-dipper hypertension group HRV indexes decreased compared to dippers hypertension group,in which SDNN and SDANN indicators decreased significantly.Therefore,HRV SDANN index is an independent factor affecting circadian rhythm changes with hypertension.3.Vascular function has impact on circadian rhythm of blood pressure with hypertension.but may be the result joint with other factors,therefore it is different from.autonomic nervous system,it is not the independent risk factor affecting circadian rhythm changes with hypertension.