Correlation Between Serum Hs-CRP,Homocysteine And Nocturnal Blood Pressure Variability In Patients With Essential Hypertension

ObjectiveHypertension is a global epidemic and a major public health concern with significant economic implications.To improve the prognosis of patients with essential hypertension,there has been interest in the therapeutic goals and targets.Previous data from the Systolic Blood Pressure Intervention Trial(SPRINT),demonstrating mortality benefit with lower target systolic blood pressure.Current studies have found that blood pressure variability(BPV)is significant in improving the prognosis of patients with hypertension.BPV has been found to affect all-cause,cardiovascular and non-cardiovascular morbidity and mortality in recent results.A lot of research shows,nocturnal blood pressure variability(nBPV)has been found to be an independent predictors of end-organ injury and all-cause mortality,cardiovascular mortality,and cardiovascular events in patients with essential hypertension,nevertheless the exact pathogenesis is still unclear.Several studies have shown that serum high-sensitivity C-reactive protein(hs-CRP)and homocysteine(Hcy)are independent risk factors or predictors of BPV,however,the relationship between serum hs-CRP,Hcy and nBPV has not been fully identified to date.To investigate the correlation between serum hs-CRP,Hcy and nBPV in patients with essential hypertension,so as to provide a clinical reference for the management of hypertension.Methods210 patients with essential hypertension were selected,who were diagnosed and treated at the Department of Cardiology,the Second Affiliated Hospital of Zhengzhou University from January 2016 to December 2018.Demographics and baseline parameters(age,sex,height,body mass index,heart rate,fasting blood glucose,blood fat,uric acid,creatinine,hs-CRP,Hcy),blood pressure and BPV were collected and measured in all patients.A total of 210 hypertensive patients were divided into three groups according to the serum hs-CRP tertile value with the cut-off value of 4.217 mg/L and 7.450mg/L.Similarly,these patients were divided into three groups according to the different levels of Hcy:106 cases with Hcy<15.0μmol/L(group I),45 cases with 15.0μmol/L<Hcy<20.0μmol/L(group II),and 59 cases with Hcy≥20.0μmol/L(group Ⅲ).SPSS24.0 software was used for statistical analysis.General data,hs-crp,Hcy,blood pressure variability and other indicators were analyzed and compared.The correlation analysis and multiple linear regression analysis were performed to identify the independent correlation between serum hs-CRP,Hcy and nBPV in patients with essential hypertension.Results(1)There were significant differences in low density lipoprotein cholesterol(LDL-C),uric acid(UA),24h mean systolic blood pressure(24hmSBP),24h systolic blood pressure standard deviation(24hSSD),24h diastolic blood pressure standard deviation(24hDSD),mean nocturnal systolic blood pressure(nmSBP),nocturnal systolic blood pressure standard deviation(nSSD)and nocturnal diastolic blood pressure standard deviation(nDSD)among hs-CRP tertile groups(P<0.05).Compared to the lowest tripartite of hs-CRP,24h blood pressure variability(24hBPV)and nBPV were significant higher in the highest tripartite.(2)LDL-C,UA,24hmSBP,24hSSD,24hDSD,nmSBP,nSSD and nDSD were significantly different among Hcy groups(P<0.05).24hBPV and nBPV in group Ⅲwere significant higher than that in group I.(3)The correlation analysis indicated that 24hmSBP,24hSSD,24hDSD,nmSBP,nSSD and nDSD were linearly and positively correlated to hs-CRP(r=0.197,0.485,0.478,0.375,0.564,0.401,all P<0.01)and Hcy(r=0.227,0.473,0.457,0.258,0.501,0.384,all P<0.01)respectively.(4)The multiple linear regression analysis revealed that 24hSSD(B=0.389,P<0.01),24hDSD(B=0.373,P<0.01),nSSD(B=0.719,P<0.01),nDSD(B=0.358,P<0.01)were significantly independent and positively correlated with hs-CRP.At the same time,24hSSD(B=0.137,P<0.01)、24hDSD(B=0.126,P<0.01)、nSSD(B=0.206,P<0.01)、nDSD(B=0.121,P<0.01)were positively and significantly independent correlated with Hcy.ConclusionIn the present study,we demonstrated that Serum hs-CRP and Hcy were independently and positively correlated with 24hBPV and nBPV,especially nBPV.