Effect Of Blood Pressure Variability On Target Organ Damage In Elderly Hypertension

Objective:At present,hypertension has been a worldwide problem,it has a serious impact on people's quality of life.With the coming of aging society,especially the elderly hypertension prevalence rate is higher and higher,and the target organ damage caused by hypertension is one cause of multiple organ dysfunction or increased mortality in elderly patients.We already have literature proved that increasing blood pressure variability have effect on the development of target organ damage.However,for the elderly there is less research data,this study confirmed the correlation between blood pressure variability with target organ damage of hypertension in elderly patients.Lead out another concerning point in antihypertensive treatment: blood pressure variability.Thus,in the treatment of hypertension in elderly,we should remind not only focuses on the control of blood pressure value but also pay attention to the control of blood pressure variability to prevent the occurrence and development of target organ damage protect of hypertension.And it will provide background information for future research.Method:Choose the patients from geriatric department of the Chinese-Japan Union Hospital of Jilin University in September 2014 to November 2017.The patient's condition relative stability who can complete the study,and hypertension was their first diagnosis.At last,retained 108 cases,male 39 cases,female 69 cases,age 60~95 years,mean age 73.33 ± 9.18 years.Record the sex,age,height,weight in general,and the smoking history,heart disease history,cerebrovascular disease history.Hospitalization second days they were tested fasting blood routine,fasting blood glucose,blood lipid and renal function.Then complete heart color Doppler ultrasound recorded left ventricular end diastolic diameter(LVEDD),left ventricular end diastolic posterior wall thickness(PWT),end diastolic ventricular septal thickness(VST),left ventricular mass index was calculated according to formula(LVMI),and complete carotid artery color Doppler ultrasound recorded whether carotid atherosclerosis,combined with history complete cerebral C T examination recorded the existence of cerebral vascular events.According to history,electrocardiogram,coronary artery CTA and coronary artery angiography recorded the existence of cardiovascular events.On the third day as early as 8 began ambulatory blood pressure monitoring(ABPM),to next day 8 a.m.end,recorded the dynamic blood pressure 24 hour systolic blood pressure variability(SD and CV),24 hour diastolic blood pressure variability,daytime systolic blood pressure variability,daytime diastolic blood pressure variability,nighttime systolic blood pressure variability,nocturnal diastolic blood pressure variability.The data was analyzed by using SPSS20.0 software,analysis the risk factors of systolic pressure variability,and the influence on left ventricular hypertrophy,creatinine clearance rate in 24 h systolic blood pressure standard deviation,moreover,analysis its effect on cardiovascular and cerebrovascular events and carotid atherosclerosis incidence,calculate prediction effect of systolic blood pressure variability on the rate of the event.Result:1.In elderly patients with essential hypertension gender(O R =6.372,95%CI:1.694~23.976,p=0.006),age(OR =1.091,95%CI:1.028 to 1.159,p=0.004),smoking history(OR =24.296,95%CI:5.496 to 107.411,and p=0.000)have impact on 24 h systolic blood pressure variability,smoking history effect most,and BMI,fasting blood glucose,total cholesterol,triglyceride,low density lipoprotein have no impact on 24 h systolic blood pressure variability.2.The greater the systolic blood pressure variability,the higher the left ventricular mass index was(p=0.021),and the left ventricular end diastolic diameter(p=0.016)was also affected by the systolic blood pressure variability.3.24 h systolic blood pressure variability has an effect on renal function index Ccr(p=0.042),and damage to renal function.4.24 h systolic blood pressure variability(p=0.008),24 h diastolic blood pressure variability(p=0.026),daytime systolic blood pressure variability(p=0.025)and daytime diastolic blood pressure variability(p=0.004)has a clear effect on cardiovascular events,nighttime systolic blood pressure has a clear effect on cerebrovascular events(p=0.043).5.The variability of 24 h systolic blood pressure / diastolic blood pressure has a predictive effect on cardiovascular events.The best limit value of 24 h systolic blood pressure variability is 14.45,sensitivity 0.686,specificity 0.491,and the best limit value of 24 h diastolic pressure variability is 9.35,sensitivity 0.667,specificity 0.509.24 h systolic blood pressure variability has a certain predictive effect on the occurrence of cerebrovascular events.The optimal threshold value is 14.45,the sensitivity is 0.649,and the specificity is 0.441.Conclusion:1.In elderly hypertensive patients,women,age,smoking history were all risk factors of systolic blood pressure variability.Smoking history had the most influence,while high BMI,fasting blood glucose,cholesterol,triglycerides and LDL were not related.2.The increase of systolic blood pressure has an effect on left ventricular hypertrophy,and there is a positive correlation within a certain range.3.The creatinine clearance rate is lower in the high systolic blood pressure variability group,therefore the systolic blood pressure variability lead s to the decrease of renal function.4.The increase of systolic and diastolic blood pressure variability causes the increase of cardiovascular incidence,and the nocturnal systolic blood pressure variability leads to the increase in the incidence of cerebrovascular events.5.The systolic blood pressure variability can be used as a predictor of cardiac and cerebral vascular events.Diastolic blood pressure variability can be used as a predictor of cardiovascular events.