Study On The Relationship Between Blood Pressure Variability And Pulse Wave Conduction Velocity,Heart Structure And Function In Patients With Essential Hypertension

Objective: To investigate the relationship between blood pressure variability(BPV)and brachial ankle pulse wave velocity(ba PWV),as well as the structure and function of the heart in patients with essential hypertension.Methods: The clinical data of 504 patients with essential hypertension admitted to 5th department of Cardiology of Second Hospital of Dalian Medical University from January 2018 to July 2019 were analyzed retrospectively.According to the percentage of decrease in systolic blood pressure at night,the patients were divided into dipper group,non dipper group,anti dipper group and extreme dipper group.The clinical characteristics of different circadian rhythm of blood pressure were analyzed retrospectively,and the results of ba PWV and echocardiography were compared in each group.All patients received ambulatory blood pressure monitoring and recorded all blood pressure indexes.Standard deviation(SD),coefficient of variation(CV)and weighted standard deviation(WSD)of systolic and diastolic blood pressure were used as observation indexes for BPV.According to the value of ba PWV,the patients were divided into two groups: high ba PWV group and normal group.According to the left ventricular mass index(LVMI),the patients were divided into left ventricular hypertrophy(LVH)group and non LVH group.According to the left atrial diameter index(LADI),the patients were divided into left atrial enlargement(LAE)group and non LAE group.According to the E/A ratio of mitral valve diastolic velocity,the patients were divided into left ventricular diastolic dysfunction(LVDD)group and non LVDD group.The baseline data,blood pressure and blood pressure variability between the above groups were detected and compared respectively.The correlation between different BPV indexes and high ba PWV,cardiac structural dysfunction was analyzed.The predictive value of different BPV indexes on high ba PWV,cardiac structural dysfunction was analyzed by using logistic regression method.Result: Compared with patients with different blood pressure rhythms,LADI in the anti dipper group was higher than that in the dipper group and the non dipper group(P=0.019,P=0.006).The BPV indexes standard deviation of daytime systolic pressure(d SBP-SD)and weighted standard deviation of 24-hour systolic pressure(24h SBP-WSD)in EH with increased ba PWV group were significantly higher than those in normal ba PWV group,standard deviation of systolic pressure at night(n SBP-SD)and 24 h SBP-WSD in LVH group were significantly higher than those in non-LVH group,d SBP-SD and 24 h SBP-WSD in LAE group were significantly higher than those in non-LAE group,and SBP decreased rate of LVDD group was lower than that of non LVDD group,with statistical significance(P<0.05).In the correlation analysis,the increase of ba PWV in EH was positively correlated with age,hypertension course,glycosylated hemoglobin,N-teminal pro-brain natriuretic peptide,24-hour systolic blood pressure(24h SBP),day-time systolic blood pressure(d SBP),night-time systolic blood pressure(n SBP),24 h SBP-SD,d SBP-SD,SBP-WSD,and negatively correlated with the decrease rate of SBP and DBP;EH with LVH was positively correlated with age,course of hypertension,Serum creatinine,N-teminal pro-brain natriuretic peptide,24 h SBP,d SBP,n SBP and 24 h SBP-SD;EH with LAE was positively correlated with age,course of hypertension,glycosylated hemoglobin,N-teminal pro-brain natriuretic peptide,and n SBP,and negatively correlated with SBP decline rate.Logistic regression analysis showed that coefficient of variation of 24-hour systolic pressure(24h SBP-CV)(?=1.271,P=0.048)was the risk factor of high ba PWV(P<0.05);24h SBP-SD(?=1.162,P=0.030)was the risk factor of left atrial enlargement(P<0.05).Conclusion:(1)LADI in the anti dipper group was higher than that in the dipper group and the non dipper group,suggesting that the abnormal circadian rhythm of blood pressure(especially the abnormal circadian rhythm of blood pressure at night)was more likely to lead to the enlargement of left atrium;the decrease rate of SBP in the LVDD group was lower than that in the non LVDD group,indicating that the diastolic dysfunction was related to the abnormal circadian rhythm of blood pressure.(2)The SBP variability of the patients with increased ba PWV was higher than that of the patients with normal ba PWV.The 24-hour SBP variability was positively correlated with the increase of ba PWV,suggesting that the degree of systolic blood pressure variation was related to ba PWV(3)SBP variability increased in patients with LVH and LAE.24-hour SBP variability was positively correlated with LVH and LAE,suggesting that the greater the degree of systolic blood pressure variation,the more likely to produce subclinical cardiac damage.(4)ba PWV is independently correlated with 24 h SBP-CV in patients with essential hypertension,and LAE is independently correlated with 24 h SBP-SD.