Clinical Study Of The Relationship Between Blood Pressure Variability And White Matter Lesions In Patients With Essential Hypertension

Objective: To investigate the relationship between blood pressure variability and white matter lesions in patients with essential hypertension(EH patients).Methods:From Mar 2014 to Jan 2015, there were 182 patients with primary hypertension staying in the NO.3 People's Hospital of neurology medicine.All patients were examined cerebral MRI and 24 h ambulatory blood pressure(ABP). According to the number of cerebral white matter lesions Fazekas rating scale patients were subdivided into mild WMLs, moderate WMLs and severe WMLs. The three grades were collapsed into two categories of severity: non and mild WMLs(n=110); moderate and severe WMLs(n=72). Medical histories were documented such as age, the history of smoking,drinking history,the use of antihypertensive drug and laboratory test including,fasting blood glucose, glycoseylated hemoglobin, Triglyceride, serum cholesterol,high density lipoprotein cholesterol and low density lipoprotein cholesterol.All were underwent examination of the 24 h ambulatory blood pressure monitoring,then wrote down the mean blood pressures(systolic blood pressures and diastolic blood pressures) and the blood pressure variability(the standard deviations(SD) and coefficient variation(CV) of systolic blood pressure,diastolic blood pressure)of 24 h blood pressure,daytime and night time.Data were analyzed using SPSS, version 19.0. The data of standard normal distribution were presented as mean ± SD.Student t test was used for between–group comparisons. Non-normal distribution by using rank and inspection.The chi-square(?2) test was used for nominal data. Logistic multiple regression was used to analyze the independent predictors. All tests were considered significance if p<0.05.Results: Single factor analysis showed that age, gender, smoking proportion,drinking alcohol, diabetes history,history of hypercholesterolemia, single antihypertensive grug,drug combination, circadian rhythm of blood pressure, CRP, FBG, A1 c A, TG, CH and LDL have no obvious statistical differnece between the group with non and mild WMLs and the moderate and severe WMLs(p>0.05).(1) Age in the group of moderate and severe WMLs(73.26±9.07)was higher than that in the group of non and mild WMLs(66.71±10.82), the difference was significant(p< 0.001).(2) The high density lipoprotein(HDL) in the group of moderate and severe WMLs(1.10±0.26) was lower than that in the group of non and mild WMLs(1.19±0.25), the difference was statistically significant(p<0.05). (3) According to the results of the 24 h ambulatory blood pressure monitoring,The 24 hMAP?24hmSBP?dmSBP?nmSBP of moderate and severe WMLs group were higher than that in the group of non and mild WMLs(p<0.05).(4) The correlation analysis of WMLs and BPV showed that The 24 hMAPSD?24hSBPSD?dSBPSD?dDBPSD?dSBPCV?dDBPCV of moderate and severe WMLs group were higher than that in the group of non and mild WMLs(p<0.05).(5) About the circadian rhythm of blood pressure, non-dipper, dipper, reverse-dipper, extrem-dipper were have no significant differences between moderate and severe WMLs group and non and mild WMLs group(p>0.05). Multi-factor analysis showed that with the growth of the age,the risk of moderate and severe WMLs is increased by 1.06 times, the incidence of the moderate and severe WMLs increased 1.191 times with the rise of d SBPSD(OR:1.06,1.191;p<0.05).Conclusions: Our results showed that gender, smoking proportion, drinking alcohol,diabetes history, history of hypercholesterolemia, antihypertensive grug, circadian rhythm of blood pressure, CRP, FBG, A1cA, TG, CH and LDL have no obvious statistical differnece with the WMLs. age and d SBPSD was independent risk factors for WMLs(OR:1.06,1.191;p<0.05)...