Study On Traditional Chinese Medical Syndrome Of Middle-aged And Older H-type Hypertension

ObjectivesTo explore the Traditional Chinese Medical(TCM)syndrome characteristics of Middle-aged and Older H-type hypertension,providing evidence for the macrocosmic diagnostic criteria of Middle-aged and Older H-type hypertension,offering new ideas for the treatment and prevention of stroke.Methods1.Based on cross-sectional study,extracting the TCM syndromes of 257 Middle-aged and Older H-type hypertensive in community by factor analysis,and then analysis its distribution and the relationship with the factors of cardiovascular risk.2.Comparing the difference of TCM syndromes between 90 H-type hypertensive and 90 primary hypertensive without hyperhomocysteinemia by a matched case-control study paired by age,sex,nationality and area.Results1.The TCM syndromes of 257 Middle-aged and Older H-type hypertensive were reduced to"phlegm-dampness","blood stasis","Fire","Wind","Yin deficiency","blood deficiency"and "Qi deficiency".The main syndromes were phlegm-dampness(26.5%),Yin deficiency(16.3%),Fire(16.0%),blood deficiency(15.2%),blood stasis(13.6%)and Qi deficiency(12.5%).The accompanying syndromes were blood stasis(30.0%),Yin deficiency(24.5%),blood deficiency(21.0%),Wind(10.9%),Qi deficiency(7.0%)and phlegm-dampness(6.6%).2.Among 257 Middle-aged and Older H-type hypertensive,the rate of syndrome of intermingled deficiency and excess is 49.03%,and the intermingled phlegm-dampness and Yin deficiency was the most common(12.06%).The rate of syndrome of correlation of phlegm-dampness and blood stasis(60.7%)was higher than the others(39.3%),and the intermingled phlegm-blood stasis was the most common(15.95%).3.There were significant difference in Hcy,BMI,FPG,ET,SCr,TG,ALT and AST/ALT between different main syndromes.4.Age,waist and AST/ALT were relevant to the discriminatory diagnosis of the different main syndromes among the 257 H-type hypertensive(P<0.05).Binary logistic regression analysis showed that the incidence of phlegm-dampness syndrome was positively associated with waist(P<0.05,OR=1.053),Hcy(P<0.05,OR=2.739)and AST/ALT(P<0.05,OR=2.709);blood stasis syndrome was positively associated with AST/ALT(P<0.05,OR=2.113);Fire syndrome was positively associated with ET(P<0.05,OR=1.027);blood deficiency syndrome was negatively associated with waist(P<0.05,OR=0.952);Qi deficiency syndrome was more relevant to those H-type hypertensive above 60 years old than those under 60 years old(P<0.05,OR=3.543);Yin deficiency was less relevant to women(P<0.05,OR=0.448),and positively associated with FPG(P<0.05,OR=1.511).5.The Hey,Scr and AST/ALT of case group(90 Middle-aged and Older H-type hypertensive)were higher than control group."Scr≥75μmol/L"(OR=2.492,95%CI:1.074～5.781)or"AST/ALT≥1.3"(OR=2.161,95%CI:1.070～4.364)may be the high risk associated factors of H-type hypertension.6.The connection intensity of the symptom of "constipation"(OR=2.881,95%CI:1.387～5.983)in case group was higher than that in control group,and the symptoms of "irascibility"(OR=0.303,95%CI:0.112～0.823)and "soreness of waist" were lower(OR=0.477,95%CI:0.246～0.926).7.The number of "phlegm-dampness","blood stasis","Fire" and "blood deficiency"(main syndromes)in case group were more than that in control group(P<0.05),and the number of"Yin deficiency" was less.Conditional logistic regression analysis showed that the connection intensity between "phlegm-dampness"(OR=2.836,95%CI:4.161～69.865),"blood stasis"(OR=3.078,95%CI:3.833～122.959),"Fire"(OR=2.388,95%CI:2.428～48.829)or"blood deficiency"(OR=2.818,95%CI:3.274～85.645)and case group were higher than control group.ConclusionsThe TCM syndromes of Middle-aged and Older H-type hypertensive were reduced to"phlegm-dampness","blood stasis","Fire","Wind","Yin deficiency","blood deficiency"and "Qi deficiency",and they mainly manifested as intermingled deficiency and excess."Phlegm-dampness" and "blood stasis" was respectively the most common main syndrome and the most common accompanying syndrome,and they were more relevant to factors of cardiovascular risk s than other syndromes.Age,waist and AST/ALT may have diagnostic value to the discriminatory diagnosis of the different main syndromes to Middle-aged and Older H-type hypertensive.Scr≥75μmol/L and AST/ALT≥1.3 may be the risk factors of H-type hypertension for the primary hypertension without hyperhomocysteinemia.The connection intensity between "phlegm-dampness","blood stasis","Fire" or "blood deficiency" and H-type hypertensive were higher than primary hypertension without hyperhomocysteinemia.According to the theory of TCM,H-type hypertension may have a pathogenesis feature as "heavy phlegm-blood stasis,easily produce Wind and Fire".