Analysis Of Blood Pressure Difference And Related Factors Between Patients With Hypertension In And Out Of Hospital In The Morning

Research background and objective: As a chronic cardiovascular disease,hypertension can cause damage to heart,brain,kidney and other important organs,even lead to functional failure,which seriously affects the prognosis of patients.At present,the target value of blood pressure reduction recommended by relevant guidelines at home and abroad is generally 130/80 mmHg.On the other hand,if the blood pressure is lower than this target value,especially the diastolic pressure of patients with coronary heart disease is lower than 70 mmHg,it will lead to the increase of cardiovascular events,i.e."J" curve effect,so long-term stable control of blood pressure is very important.For patients with hypertension or associated hypertension in hospital,due to many different factors including the environment,whether the ideal antihypertensive treatment plan in hospital is the same as the ideal one out of hospital and suitable for the long-term treatment of patients deserves attention.This paper prospectively observed the difference of morning blood pressure between the day of discharge and the day 7 after discharge,and analyzed the related factors.Methods: from March 2019 to November 2019,200 patients were selected from the Department of Cardiology of our hospital,who were definitely diagnosed as hypertension and met the inclusion criteria and exclusion criteria.The baseline data of the patients were recorded,and the antihypertensive drugs were selected according to the guidelines.On the morning of the day of discharge,the blood pressure of the right upper limb was measured by the medical cuff sphygmomanometer and the home electronic sphygmomanometer(provided by the patient)three times,with an interval of1 min,and the mean value of each blood pressure was calculated.The mean value of the medical cuff blood pressure was taken as the hospital morning blood pressure(H1),and the difference between H1 and the mean value of the electronic sphygmomanometer was calculated as the correction value(H0).On the 7th day after discharge,follow-up call was carried out to obtain the three morning blood pressure values measured by home electronic sphygmomanometer on that day,and the average value was corrected by Ho as the morning blood pressure(H2)outside the hospital.According to the difference between H2 and H1(systolic and / or diastolic blood pressure),the overall H1 and H2 control rates were statistically analyzed and divided into the following three groups: group A(increased blood pressure group,H2>H1,H2-H1 ≥ 5mmHg);group B(no significant change in blood pressure group,| H2-H1 | < 5mmHg;group C(decreased blood pressure group,H2 < H1,H1-H2 ≥ 5mmHg).At the same time,a unified questionnaire was used to investigate the factors that may affect blood pressure(sleep status,lifestyle,medication compliance).Statistical analysis was carried out on the recorded data,including logistic regression analysis,to screen out the relevant factors leading to the difference of morning blood pressure in and out of the hospital.Results: 1.Blood pressure value and standard rate of all patients in and out of hospital in the morning:The blood pressure of all patients in and out of hospital in the morning was 131.1 ± 9.9 / 77.7 ± 7.9mmHg in H1,129.9 ± 12.5 / 77.2 ± 8.8mmHg in H2.There was no significant difference in the mean blood pressure between the two groups(P >0.05);the blood pressure in the morning(53.0%)was significantly lower than that in the morning(87.0%),the difference was statistically significant(P< 0.05).2.The number and percentage of patients in the three groups: 76 cases in group A(38.0%),40 cases in group B(20.0%),84 cases in group C(42.0%).There were statistically significant differences between group A and group B,between group C and group B(P < 0.05).There was no statistically significant difference between group A and group C(P >0.05).3.There was no significant difference in baseline data among the three groups(P>0.05).4.Com Parison of the changes of related factors in and out of Hospital of the three groups: 4.1 changes of related factors in general Physical education: 63Patients(31.5%),102 Patients(51.0%)with changes in slee P quality,60 Patients(30.0%)with changes in drug com Pliance.4.2 com Parison of related factors among groups: 4.2.1 com Parison in hospital: the incidence of poor sleep quality in group C was higher than that in group A and B(P < 0.05).The main cause of poor sleep quality was environmental interference,and the incidence of group C was higher than that in group A and B(P<0.05).4.2.2 out of hospital comparison: the adverse life style(smoking,drinking)and drug compliance of the three groups were compared: the incidence of smoking,drinking and drug compliance in group A was higher than that in group B and C,the difference was statistically significant(P<0.05);the drug compliance was mainly related to missed drugs,and the incidence in group A was higher than that in group B and C(P<0.05).5.Univariate and multivariate analysis:univariate analysis showed that: Poor sleep quality in hospital,bad life style outside hospital(smoking,drinking),Poor drug compliance outside hospital,sleep improvement,poor life style recovery(smoking,drinking),poor drug compliance were related factors(P < 0.1);logistic multivariate regression analysis showed that:recovery of bad life style(drinking)(OR= 3.391,95% Cl: 1.066-10.791,P = 0.039),poor compliance with drugs(OR =6.435,95% Cl: 2.137-19.374,P=001)were independent risk factors for out of hospital blood pressure rise;poor sleep quality(OR=6.528,95%Cl:2.258-18.878,P=0.001),sleep improvement(OR =6.233,95%Cl:2.126-18.275,P=0.001)is an inde Pendent risk factor for out of hospital blood Pressure reduction.Conclusion:1.There are many factors affecting blood pressure in hospital.The incidence of poor blood pressure control is higher in a short period after discharge,which is higher or further lower than that in hospital.2.The increase of blood pressure outside the hospital is mainly related to the poor compliance and / or recovery of poor life style;the further decrease of blood pressure outside the hospital is related to the improvement of sleep after discharge.3.The ideal antihypertensive treatment plan in hospital is not necessarily suitable for all patients out of hospital long-term treatment.After discharge,family blood pressure monitoring is very important for the managementof hypertension patients out of hospital.