Distribution Characteristics Of Traditional Chinese Medicine Syndrome Types And Analysis Of Their Related Factors In 330 Cases Of Very Elderly Hypertension

Objective:To explore the distribution characteristics of Traditional Chinese Medicine(TCM)syndrome types in very elderly hypertension and their relationships with related factors to provide reference for the clinical treatment of very elderly hypertension in the future.Methods:Clinical data of 330 very elderly patients with hypertension aged 80 years or older among inpatients of Cardiology,Geriatrics,and General Department of Xiyuan Hospital CACMS from August 2017 to August 2019 was collected.Patients were differentiated and classified based on the collected four diagnosis information.And the data on demographic indicators(sex,age),smoking history,drinking history,past medical history,course of illness,laboratory examination related indicators,carotid ultrasound examination related indicators,ambulatory blood pressure related indicators was collected.Mean±standard(x±s)deviation was used to describe the measurement data.Analysis of variance was used for comparison between groups.If the variances of measurement data of the two groups were inconsistent,Mann-Whitney U rank sum test was used.Enumeration data were represented by the number of cases(composition ratio),chi-square test was used for inter-group comparison,and Fisher's exact test was used for cell value<5.Logistic regression analysis was used to carry out multivariate analysis.Stepwise method was used to screen the variables,and ?=0.05.Finally,the distribution characteristics of TCM syndrome types of very elderly hypertension and their correlation with the above factors were explored.Results:1.The distribution of TCM syndrome types in very elderly hypertension was in descending order:Yang excess and yin deficiency(32.4%),Phlegm and blood stasis(29.7%),Kidney yang deficiency(19.1%)and Qi and blood deficiency(18.8%).2.In clinical basic data:there were more women than men with very elderly hypertension.The average age of patients was 84.26± 3.84,and the number of people aged 80 to 85 was the largest.The number of smokers accounted for 10.9%and the number of alcohol drinkers accounted for 5.2%.The proportion of diseases in previous history was in descending order:coronary heart disease(38.5%),diabetes mellitus(30%),cerebral infarction(18.5%),atrial fibrillation(8.2%),lower limb atherosclerosis(1.2%).The number of patients with duration of hypertension from 10.1 to 20 years was the largest(28.8%).3.The results of multivariate Logistic regression analysis showed:(1)The difference in gender distribution between the two syndromes of Phlegm and blood stasis and Qi and blood deficiency was statistically significant.The proportion of males in patients with Phlegm and blood stasis type was significantly higher than that of patients with Qi and blood deficiency,and the odds ratio(OR)was 2.18(95%CI:1.05,4.54).(2)There was no significant difference in age,smoking history,drinking history,past medical history and course of hypertension among different TCM syndrome types.4.The results of multivariate Logistic regression analysis showed that:(1)The difference of elevated Uric acid(UA)level between Yang excess and yin deficiency and Qi and blood deficiency was statistically significant.The proportion of patients with elevated UA level in Qi and blood deficiency was significantly higher than that in Yang excess and yin deficiency,with an OR value of 2.79(95%CI:1.29,6.06).(2)The difference of UA,High density lipoprotein(HDL)and Apolipoprotein A1(Apo Al)level between the two syndrome types of Yang excess and yin deficiency and Kidney yang deficiency was statistically significant.The proportion of patients with decreased and increased UA level in Kidney yang deficiency was significantly higher than that with Yang excess and yin deficiency,with the OR values of 8.45(95%CI:1.08,66.02)and 2.60(95%CI:1.17,5.78),respectively.The proportion of patients with decreased HDL level in Kidney yang deficiency type was significantly higher than that of patients with Yang excess and yin deficiency type,with an OR value of 5.19(95%CI:1.75,15.42).The proportion of patients with decreased Apo A1 level of Yang excess and yin deficiency type was significantly higher than that of patients with Kidney yang deficiency type,and the OR value was 3.93(95%CI:1.32,11.70).(3)The difference in HDL and Lipoprotein(a)[Lp(a)]level between the two syndrome types of Yang excess and yin deficiency and Phlegm and blood stasis was statistically significant.The proportion of patients with reduced HDL level of Phlegm and blood stasis was significantly higher than that of patients with Yang excess and yin deficiency,and the OR value was 3.20(95%CI:1.23,8.32).The proportion of patients with elevated Lp(a)level of Yang excess and yin deficiency type was significantly higher than that of Phlegm and blood stasis type,and the OR value was 2.51(95%CI:1.13,5.55).(4)The difference in HDL level between Qi and blood deficiency and Kidney yang deficiency type was statistically significant.The proportion of patients with decreased HDL level in deficiency of Kidney yang deficiency type was significantly higher than that in deficiency of Qi and blood deficiency,and the OR value was 3.32(95%CI:1.05,10.51).(5)There was no statistical correlation between other laboratory examination indexes and TCM syndrome types.5.The results of multivariate logistic regression analysis showed that there was no statistical correlation between the indicators of hypertension carotid artery ultrasound examination and TCM syndrome types.6.Multivariate Logistic regression analysis results showed that:(1)The difference in curve types between Yang excess and yin deficiency and Qi and blood deficiency was statistically significant.The proportion of patients with reverse-dipper blood pressure in Qi and blood deficiency was significantly higher than that in Yang excess and yin deficiency,with an OR value of 11.78(95%CI:1.33,104.54).(2)The difference between the two syndrome types of Yang excess and yin deficiency and Kidney yang deficiency was statistically significant.The proportion of patients with reverse-dipper blood pressure in Kidney yang deficiency was significantly higher than that in Yang excess and yin deficiency,with an OR value of 10.83(95%CI:1.18,99.14).(3)There was no statistical correlation between other ambulatory blood pressure indicators and TCM syndrome types.Conclusions:The TCM syndrome types of elderly hypertension include Yang excess and yin deficiency,Phlegm and blood stasis,Qi and blood deficiency and Kidney yang deficiency.Yang excess and yin deficiency type accounted for the largest proportion.The TCM syndrome types were correlated with gender distribution,UA,HDL,Lp(a),Apo A1 and curve types.This study provided an objective basis for the differentiation of very elderly hypertension and a new idea for the prevention and treatment of very elderly hypertension by traditional Chinese medicine.