The Different Antihypertensive Strategy On The Effect Of Target Organs In Elderly Patients With Essential Hypertension

Objective To observe whether there is a different in target organ damage which in the two groups of the degree of hardening of the arteries,peripheral vascular disease,the degree of heart and kidney damage of elderly patients with essential hypertension when use different antihypertensive target of antihypertensive treatment.Methods Patients come from in the first people’s hospital of Ningxia cardiology outpatient service which 60 to 80 years of age in June 2017 were selected and to give uniform number according to the order which they see a doctor,there are 206 elderly patients with essential hypertension were Included in the study.They were randomly divided into conventional antihypertensive treatment group and intensive antihypertensive treatment group,to make the blood pressure of each group of patients met the requirements of this study under them tolerable condition at beginning in July 2017(the conventional antihypertensive treatment group,blood pressure were controlled in 131-150 / < 90 mm Hg;and the intensive antihypertensive treatment group :blood pressure were controlled in 110-130 / < 90 mm Hg),Later,they came to the clinic every month to monitor the blood pressure in the clinic and at home,According to whether the blood pressure met the standard,they adjusted the blood pressure lowering plan appropriately.After 3 months of antihypertensive treatment,the blood pressure of each group reached the standard.Biochemical tests were performed at 6 months of treatment,arteriosclerosis monitoring at 1 year of treatment,24 H urinary protein quantification and echocardiography.The differences of target organ damage caused by essential hypertension between the two groups were compared at different target values of hypotension.Results There were no significant differences in general baseline data,past history,course of hypertension,taking antihypertensive drugs and statins before and after admission,smoking and drinking history,family history and biochemical routine(kidney damage)at admission between the two groups,which accorded with the principle of complete random grouping.There was a significant difference in blood pressure between the two groups at 1 year(blood pressure mean 145.2/82.3 mm Hg in the conventional antihypertensive treatment group patients,129.1/77.2 mm Hg in the intensive antihypertensive treatment group patients,p=0.000),which met the requirements of blood pressure control in this study.(1)One year after treatment,arteriosclerosis monitoring showed that the ba PWV of the intensive antihypertensive strategy was significantly lower than that of the conventional antihypertensive strategy(the mean ba PWV of the conventional antihypertensive treatment group patients was 1983.4 cm/s,and the mean ba PWV of the intensive antihypertensive treatment group patients was 1716.2 cm/s,p=0.000);The incidence of ABI < 0.9 decreased significantly(4.5% in the conventional antihypertensive treatment group and 0.0% in the intensive antihypertensive treatment group,p=0.035).There was significant difference between the two groups.(2)One year after treatment,echocardiographic results showed that the decreased left ventricular diastolic function might be delayed by intensive antihypertensive regimen compared with conventional antihypertensive regimen(the mean of conventional antihypertensive regimen was 0.73,the mean of E/A in intensive antihypertensive regimen was 0.82,p=0.012),There were no significant differences in left ventricular hypertrophy,left atrial size and left ventricular systolic function.(3)At 6 months of treatment,the biochemical results showed that the incidence of renal dysfunction was significantly lower in intensive antihypertensive regimen than in conventional antihypertensive regimen(10(12.5%)in standard control group and 2(2.5%)in intervention group,p=0.015).There was a significant difference between the two groups.One year after treatment,24-hour urinary protein results showed that the incidence of kidney diseases in intensive antihypertensive regimen was significantly lower than that in conventional antihypertensive regimen(20(22.7%)in standard control group and 10(11.4%)in intervention group,p=0.045).There was a significant difference between the two groups.Conclusion Intensive hypotension is more effective than conventional hypotension in delaying the degree of arteriosclerosis and reducing the occurrence of peripheral arterial vascular disease in elderly patients with essential hypertension;For elderly patients with essential hypertension,intensive hypotension can delay the decline of cardiac diastolic function,but has no significant effect on cardiac structure and systolic function;For elderly patients with essential hypertension,intensive antihypertensive therapy will significantly reduce the incidence of kidney diseases caused by hypertension compared with conventional antihypertensive therapy.