| Objective:To collect the data of 24-hour ambulatory blood pressure rhythm type of elderly patients with essential hypertension and observe it's influencing factors,it is helpful for patients with essential hypertension to make risk grading and indicate the medication of clinical hypertension.As far as possible,the patient's blood pressure would be controlled better and return to normal circadian rhythm,it can reduce the incidence of cardiovascular events and mortality in elderly hypertension.Methods:The24-hour ambulatory blood pressure monitoring data of 202 elderly patients(male=85cases,female=117cases)with essential hypertension in the Geriatrics department of China-Japan Union Hospital of Jilin University from September 2014 to Mar 2017 was continuously collected.All patients were recorded their 24 h DBP(24-hour diastolic blood pressure),24 h SBP(24-hour systolic blood pressure),d DBP(mean daytime diastolic blood pressure),d SBP(mean daytime systolic blood pressure),n DBP(nighttime diastolic blood pressure),n SBP(mean nighttime systolic blood pressure)and other clinical data.Calculating the nighttime blood pressure drop rate which decide the rhythm of blood pressure according to the above data,all patients were divided into dipper group(57 cases),non-dipper group(79 cases),reverse-dipper group(65 cases)and extreme-dipper group(1 cases)by the rhythm of blood pressure,we analyze the influencing factors in the rhythm of elderly hypertension,and explore the correlation between blood pressure decline rate at night and levels of RDW in elderly patients with essential hypertension,in the meantime,calculate the sensitivity and specificity of RDW in the diagnosis of abnormal blood pressure rhythm of elderly patients with essential hypertension.All the data was analyzed by SPSS 22.0 statistical analysis software.Results:1?The every rhythm of blood pressure groups were statistically significant between age and smoking history(p<0.05),Sex has no statistical significance(p>0.05).2?The abnormal blood pressure rhythm of very elderly group(age be equal or greater than 80 years)was higher than the elderly group(age be equal or greater than60 years or less than 80 years),which difference was statistically significant(p<0.05).3?The proportion of diabetes and dyslipidemia,and the levels of RDW and fasting blood glucose in reverse-dipper and non-dipper was higher than the dipper,The proportion of dyslipidemia in non-dipper was higher than the reverse-dipper,which difference was statistically significant(p<0.05).4?The Results of single factor Logistic regression analysis show that age(OR =1.114,95%CI:1.063~1.167,p=0.000),smoking history(OR=3.126,95%CI:1.653~5.913,p=0.000),diabetes(OR=3.106,95%CI:1.412~6.833,p=0.005),fastingblood-glucose(OR=1.311,95%CI:1.117~1.539,p=0.001)?dyslipidemia(OR=4.283,95%CI: 2.241~8.185,p=0.000)and RDW(OR =1.810,95%CI:1.376~2.380,p=0.000)were the risk factors of blood pressure rhythm abnormal in elderly patients with essential hypertension;The Results of multi-factor Logistic regression analysis showed that age(OR=1.077,95%CI1.009~1.150,p=0.025),fastingblood-glucose(OR=1.220,95%CI:1.008~1.477,p=0.041)?dyslipidemia(OR=2.613,95%CI:1.100~6.206,p=0.03)and the level of RDW(OR=2.250,95%CI:1.580~3.206,p=0.000)was the independentriskfactor of blood pressure rhythm abnormal in elderly patients with essential hypertension.5 ? RDW was negatively correlated with nocturnal blood pressure drop rate(r=-0.384,p=0.000).6?The best threshold which RDW predict the diagnosis of abnormal blood pressure rhythm was 13.5,the sensitivity was 66.7%,the specificity was 71.9%.Conclusions:1?The age and smoking history of reverse-dipper group and non-dipper group were higher than the dipper group,however,Sex of different rhythm of blood pressure groups was no statistical significance..2?The abnormal blood pressure rhythm of very elderly group was higher than the elderly group.3?The proportion of diabetes and dyslipidemia,and the levels of the fasting blood glucose and the RDW in reverse-dipper and non-dipper were higher than the dipper.4?Age,smoking history,diabetes,fasting blood-glucose,dyslipidemia and the RDW is the risk factor of blood pressure rhythm abnormal in elderly patients with essential hypertension.Age,fasting,blood-glucose,dyslipidemia and the RDW were the independent risk factor of blood pressure rhythm abnormal in elderly patients with essential hypertension.5?RDW was negatively correlated with nocturnal blood pressure drop rate.The RDW can be used as predictors which speculated the abnormal blood pressure rhythm in early.The best threshold which RDW predict the diagnosis of abnormal blood pressure rhythm was 13.5,and the sensitivity was 66.7%,the specificity was 71.9%. |
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