The Correlation Between Blood Pressure Levels In Twelve Chronos And TCM Syndromes In Hypertension Patients

Objective: To explore the distribution characteristics of TCM syndromes in hypertension and the correlation between syndromes,twelve chronos and ambulatory blood pressure monitoring data.And by analyzing the characteristics of blood pressure fluctuations throughout the day and the difference of chronological average blood pressure in different syndromes,to dig related indicators that can help guide clinical differentiation and classification and treatment,which providing objective evidence for the prevention and treatment of hypertension in traditional Chinese medicine.Methods: Collecting 269 patients with hypertension who are hospitalized in cardiovascular wards of the first affiliated hospital of Guangxi university of Traditional Chinese Medicine from January 2019 to December 2019.According to the syndrome diagnostic scale,the patients will be divided into six syndromes,such as wind phlegm upper disturbance syndrome,liver yang hyperactivity syndrome,liver and kidney yin deficiency syndrome,yin deficiency and yang hyperactivity syndrome,yin and yang deficiency syndrome,blood stasis and obstruction syndrome.The basic information,related biochemistry index and detailed dynamic blood pressure data of study subjects will be collected respectively by syndromes,and the dynamic blood pressure data of each syndrome will be divided into 12 segments based on the different chronos.Using SPSS 22.0 statistical software to analyze the correlation between the syndromes of hypertension and the twelvechronological blood pressure index.Results: 1.Among the 233 patients with hypertension that were included in this research,72 cases(30.9%)were wind phlegm upper disturbance syndrome,48 cases(20.6%)were yin and yang deficiency syndrome,and 42cases(18.0%)were liver yang hyperactivity syndrome,37 cases(15.9%)were yin deficiency and yang hyperactivity syndrome,31 cases(13.3%)were liver and kidney yin deficiency syndrome,and 3 cases(1.3%)were blood stasis and obstruction syndrome.2.There was no significant difference in the distribution of gender and ethnicity among the syndromes(P>0.05),and all showed that there were more women than men and more Han people than Zhuang people.3.There were significant differences in the distributions of age and illness duration among the syndromes(P<0.05).The age differences manifested as yin and yang deficiency syndrome>yin deficiency and yang hyperactivity syndrome,liver and kidney yin deficiency syndrome>wind phlegm upper disturbance syndrome,liver yang hyperactivity syndrome.The illness duration of liver and kidney yin deficiency syndrome,yin deficiency and yang hyperactivity syndrome,yin and yang deficiency syndrome were longer than liver yang hyperactivity syndrome.4.There were no significant differences in the distributions of hypertension classification and cardiovascular risk stratification among the syndromes(P>0.05),grade 3hypertension and very-high-risk group were the main components.5.There were significant differences in the incidence of "coronary heart disease" among the syndromes.There were no significant differences in the incidences of diabetes,cerebral infarction,dyslipidemia,chronic gastritis,fatty liver,anxiety and depression among the syndromes(P>0.05).6.In general biochemical indicators,the levels of total cholesterol and low density lipoprotein of liver yang hyperactivity syndrome were higher than those ofyin and yang deficiency syndrome.Homocysteine of liver and kidney yin deficiency syndrome was higher than other syndromes.And the levels of glycated hemoglobin A1 C,creatinine,and urea of yin deficiency and yang hyperactivity syndrome,yin and yang deficiency syndrome were higher than those with liver yang hyperactivity syndrome,and the differences were statistically significant(P<0.05).7.The chronological average systolic blood pressure of syndromes were significantly different in Chen shi,Si shi,Wu shi,Wei shi,Shen shi,You shi,Xu shi and Hai shi(P<0.05).The average systolic pressure of wind phlegm upper disturbance syndrome was higher than liver and kidney syndrome in Hai shi,and higher than yin deficiency and yang hyperactivity syndrome in Shen shi,higher than yin and yang deficiency syndrome in Zi shi,Si shi,Shen shi,You shi,Xu shi and Hai shi.The average systolic pressure of liver yang hyperactivity syndrome was higher than wind phlegm upper disturbance syndrome in Si shi and Wu shi,and higher than liver and kidney yin deficiency syndrome in Si shi,Wu shi and Hai shi,higher than yin deficiency and yang hyperactivity syndrome in Si shi,Wu shi,Wei shi,Xu shi and Hai shi,and higher than yin and yang deficiency syndrome in Chou shi,Chen shi,Si shi,Wu shi,Wei shi,Shen shi,Xu shi and Hai shi.The average systolic pressure of liver and kidney yin deficiency syndrome was higher than wind phlegm upper disturbance syndrome in Yin shi,Mao shi and Chen shi,and higher than yin deficiency and yang hyperactivity syndrome in Yin shi,Si shi and Shen shi,higher than yin and yang deficiency syndrome in Yin shi,Chen shi,Si shi,Shen shi,You shi and Xu shi,and all the differences were statistically significant(P<0.05).The chronological average diastolic blood pressure of syndromes had significant differences in twelve chronos(P<0.05).The average diastolic blood pressure of syndromes ranked from high to low in order were liver yang hyperactivity syndrome,wind phlegmupper disturbance syndrome,liver and kidney yin deficiency syndrome,yin deficiency and yang hyperactivity syndrome,yin and yang deficiency syndrome.The differences between yin deficiency and yang hyperactivity syndrome with yin and yang deficiency syndrome in chronological average blood pressure were not statistically significant(P>0.05).8.There was no significant difference in the distribution of blood pressure circadian rhythms,non-diarrheal accounts for the vast majority in all syndromes.The nocturnal diastolic blood pressure drop rate was greater than systolic blood pressure in all syndromes,and the differences were statistically significant(P<0.05).9.There was early morning hypertension in all syndromes.Among them,the early morning systolic blood pressure of liver yang hyperactivity syndrome,liver and kidney yin deficiency syndrome were higher than yin and yang deficiency syndrome,wind phlegm upper disturbance syndrome.The early morning diastolic blood pressure differences manifested as liver yang hyperactivity syndrome>wind phlegm upper disturbance syndrome>liver and kidney yin deficiency syndrome>yin deficiency and yang hyperactivity syndrome,yin and yang deficiency syndrome.And the differences were statistically significant(P<0.05).10.The peak blood pressure of liver yang hyperactivity syndrome was in Si shi.The peak blood pressure of wind phlegm upper disturbance syndrome was in You shi.The peak blood pressure of liver and kidney yin deficiency syndrome,yin deficiency and yang hyperactivity syndrome and yin and yang deficiency syndrome were all in Chen shi.11.The day and night pulse pressures of liver and kidney yin deficiency syndrome,yin deficiency and yang hyperactivity syndrome,yin and yang deficiency syndrome were greater than those of wind phlegm upper disturbance syndrome,liver yang hyperactivity syndrome.And the differences were statistically significant(P<0.05).12.The day heart rate of liver yanghyperactivity syndrome and wind phlegm upper disturbance syndrome were faster than other syndromes,and the differences were statistically significant(P<0.05).Conclusions: 1.Wind phlegm upper disturbance syndrome is the most common type of TCM syndromes for hypertension,but blood stasis and obstruction syndrome rarely occurs alone.The age and illness duration of deficiency syndromes are significantly older or longer than the empirical evidence syndromes.2.High blood pressure level,high cardiovascular risk,often prone to combine coronary heart disease,diabetes,and cerebral infarction are the important characteristics of hypertension,and patients with deficiency syndromes are more prominent.3.The differences of chronological average blood pressure among the syndromes usually remain stable in some special periods.The blood pressure of liver yang hyperactivity syndrome is higher than other syndromes in Si shi,Wu shi and Wei shi.The blood pressure of liver and kidney yin deficiency syndrome is higher than other syndromes in Yin shi,Mao shi and Chen shi.The blood pressure level of yin deficiency and yang hyperactivity syndrome and yin and yang deficiency syndrome is similar in the twelve chronos.4.The chrono of peak blood pressure has certain guiding significance for the diagnosis of TCM syndromes of hypertension.The peak blood pressure of liver yang hyperactivity syndrome is in Si shi.The peak blood pressure of wind phlegm upper disturbance syndrome is in You shi.The peak blood pressure of liver and kidney yin deficiency syndrome,yin deficiency and yang hyperactivity syndrome and yin and yang deficiency syndrome are all in Chen shi.