The Relationship Of Geriatric Nutritional Risk Index With Blood Pressure Variability In Elderly Patients With Hypertension

Objective The objective of the study was to explore the influence of protein-energy malnutrition on blood pressure variability of elderly patients with hypertension by evaluating the relationship between elderly nutritional risk index and 24-hour dynamic blood pressure variability,and by evaluating the relationship between other traditional malnutrition assessment indicators and 24-hour dynamic blood pressure variability.Methods A total of 400 elderly patients with essential hypertension who were hospitalized in internal medicine of dalian friendship hospital from November 2016 to November 2018 were enrolled in the study,the mean age was 79.40±7.27,including 260 men and 140 women.All patients were divided into three groups according to the degree of malnutrition assessed by GNRI value.GNRI<92 was the moderate and severe malnutrition group(Referred to as moderate-severe group),92?GNRI?98 was the mild malnutrition group(Referred to as mild group),GNRI>98 was the normal nutrition group(Referred to as normal group).General clinical data,antihypertensive drugs being taken,body mass index measurement were recorded in all patients.All patients underwent 24-hour dynamic blood pressure monitoring and relevant laboratory indicators were measured,including blood cell count,fasting blood glucose,serum lipid level,serum protein level,transaminasein,creatinine,C-reactive protein,urinary albumin/creatinine.24-hour mean systolic blood pressure(24h SBP),24-hour mean diastolic blood pressure(24h DBP),daytime mean systolic blood pressure(d SBP),daytime mean diastolic blood pressure(d DBP),nighttime mean systolic blood pressure(n SBP),nighttime mean diastolic blood pressure(n DBP),24-hour systolic blood pressure standard deviation(24h SBPSD),daytime systolic blood pressure standard deviation(d SBPSD),nighttime systolic blood pressure standard deviation(n SBPSD),24-hour diastolic blood pressure standard deviation(24h DBPSD),daytime diastolic blood pressure standard deviation(d DBPSD),nighttime diastolic blood pressure standard deviation(n DBPSD),24-hour systolic blood pressure coefficient of variation(24h SBPCV),daytime systolic blood pressure coefficient of variation(d SBPCV),nighttime systolic blood pressure coefficient of variation(n SBPCV),24-hour diastolic pressure coefficient of variation(24h DBPCV),diastolic blood pressure coefficient of variation(d DBPCV),nighttime diastolic blood pressure coefficient of variation(n DBPCV)were recorded.The general data,laboratory test results,body mass indicators,dynamic blood pressure parameters of the three groups were compared.The correlation between blood pressure variability and malnutrition indicators was analyzed with Pearson correlation analysis,multivariate linear regression analysis was performed on the influencing factors of blood pressure variability.Results1.There were no significant statistical differences in gender,height,ideal weight,smoking history,the proportion of antihypertensive drugs were taken,comorbidity of disease among the there groups(all P values>0.05).However,there were significant statistical differences in age,actual weight and body mass index among the three groups(P values<0.05).Among them,age was the largest in the moderate and severe malnutrition group,followed by the mild malnutrition group,and the smallest is the normal nutrition group.The actual body weight was the lightest in the moderate and severe malnutrition group,followed by the mild malnutrition group,and the heaviest in the normal nutrition group.BMI changes were similar to actual body weight.Patients in the moderate and severe malnutrition group had the smallest change,followed by those in the mild malnutrition group,and those in the normal nutrition group had the largest change.2.White blood cell count,lymphocyte count,hemoglobin concentration,serum prealbumin,albumin,total protein,triglyceride,alanine transaminase the moderate to severe malnutrition were significantly lower than those in the mild malnutrition group,all these indicators in the mild malnutrition group were significantly lower than those the normal nutrition group(all P values<0.05).There was no significant difference in aspertate transaminase,fasting blood-glucose,total cholesterol,high density lipoprotein cholesterol,low density lipoprotein cholesterol,blood urea nitrogen,creatinine,c-reactive protein,urinary albumin/creatinine among the three groups(all P values>0.05).3.Indicators about d DBPSD,24 h DBPCV and d DBPCV in the moderate and severe malnutrition group were significantly greater than those in the mild malnutrition group(all P values<0.05),all these indicators in the mild malnutrition group were significantly greater than those in the normal nutrition group(all P values<0.05).There ware no differences in other dynamic blood pressure indexes among groups(all P values>0.05).4.There were no significant differences in the blood pressure types of dipper,non-dipper and super dipper among three groups(all P values>0.05).5.The correlation analysis of blood pressure variability and malnutrition indicators:GNR-I was negatively correlated with 24 h DBPSD(r=-0.451),d DBPSD(r=-0.452),24 h DBPCV(r=-0.514),and d DBPCV(r=-0.453)(all p values<0.01).Prealbumin was negatively correlated with 24 h DBPSD(r=-0.261),d DBPSD(r=-0.183),24 h DBPCV(r=-0.233),d DBPCV(r=-0.165),n DBPSD(r=-0.224)(all p values<0.01).Albumin protein was negatively correlated with 24 h DBPSD(r=-0.179),24 h DBPCV(r=-0.183)and n DBPSD(r=-0.546)(all p values<0.01).Hemoglobin concentration was negatively correlated with 24 h DBPSD(r=-0.279),d DBPSD(r=-0.234),24 h DBPCV(r=-0.244),d DBPCV(r=-0.202)(all p values<0.01).Lymphocytes were negatively correlated with 24 h DBPSD(r=-0.256),d DBPSD(r=-0.212),24 h DBPCV(r=-0.211)and d DBPCV(r=-0.187)(all p value-s<0.01).Among them,blood pressure variability was the strongest correlation with GN-RI.Total protein,actual body weight and BMI were not correlated with each blood press-ure variability index(all p values>0.05).6.Analysis of regression:There was a linear regression relationship among 24 h SBPSD and GNRI,albumin,actual body weight,body mass index(all P values<0.05).There was a linear regression relationship between 24 h DBPSD and GNRI,albumin,actual body weight,BMI,hemoglobin,urinary albumin/creatinine and blood urea nitrogen(all P values<0.05).Both d DBPSD and 24 h SBPCV had a linear regression relationship with GNRI,albumin and actual body weight(all P<0.05).Both 24 h DBPCV and d DBPCV had a linear regression relationship with GNRI(all P values <0.05).Conclusion1.There is a negative correlation between GNRI and some indexes of BPV in elderly patients with hypertension,suggesting that protein-energy malnutrition may lead to increased blood pressure variability.2.Compared with traditional nutritional indicators,GNRI have a stronger correlation with BPV,and GNRI is better in evaluating the effects of protein-energy malnutrition on blood pressure variability.3.GNRI and traditional nutrition indexes have a good consistency in the nutritional assessment of the elderly.