| Purpose:This study is aimed to observe the correlation between debilitation and ambulatory blood pressure parameters and risk factors in elderly patients with hypertension,as well as to explore the difference of debilitation between different TCM syndromes,and whether it can achieve better control of blood pressure by improving the debilitation of patients.Material and method:According to Chinese hypertension management guidelines for the elderly 2019,A total of 86 patients over 65 years old with primary hypertension were divided into non frail group,pre-frail group and frail group in Geriatrics and Cardiology Department of Liaoning University of Traditional Chinese Medicine affiliated hospital according to the results of Frail Scale,all patients underwent general investigation?24-hour ambulatory blood pressure tests and Diagnosis of TCM syndromes.Taking 24-hour ambulatory blood pressure parameters as the observation index,this paper observed the risk factors of frailty in 3 groups of elderly patients with hypertension,as well as their blood pressure variability and diural fluctuation rule,and discussed whether there were differences in frailty among different TCM syndromes,and analyzed the change trend.Finally,SPSS22.0statistical software was used to analyze the collected data,and descriptive analysis was conducted by means of standard deviation and median.Logistic regression was used for inferential analysis,and P<0.05 was considered statistically significant.Results:1.In this study,39cases(45.3%)were in the frail group,27cases(31.4%)were in pre-frail group,and 20cases(23.3%)were in the non frail group.According to gender,there were 24 males and 62 females.The age of the enrolled population ranged from 65 to 98 years old,with an average age of 78.30±8.44 years old,51 patients aged 65-79 years old,and 35 patients aged80 years old.Among the elderly patients with hypertension,grade3 were the most,with a total of 60 cases,grade2 were the second,with a total of 21 cases and garde1 were the least,with a total of 5 cases.The average course of the disease was from 1 year to 50 years,with an average course of(13.51±10.72)years old.In this study,76% of the elderly patients had multiplediseases and 80% of the elderly patients had multiple drugs.There were 11 cases(12.8%)with normal blood pressure circadian rhythm(dipper blood pressure),75cases(87.2%)with abnormal blood pressure circadian rhythm,including 40 cases(46.5%)with reverse blood pressure,31 cases(36.0%)with non-dipper blood pressure,and 4 cases(4.7%)with extreme dipper blood pressure;Among the 75 patients with abnormal blood pressure circadian rhythm,18 cases(24%)of them were in the non frail stage,23 cases(30.7%)in the per-frail stage,and34cases(45.3%)in the frail stage.With the increasing of frail stage,the proportion of patients with the elderly patients with hypertension who belong to the abnormal blood pressure circadian rhythm type gradually increased(P>0.999).2.There was statistical significance in the comparison of BMI,course of hypertension,education level,work nature,physical activity,combined with the number of comorbidity and grugs in the three groups(P<0.05).There was no statistical significance in age,gender,smoking,drinking,diet,blood pressure classification and cardiovascular risk factors stratification,family history of hypertension and marital status among the three group(P>0.05).3.Among the three group,24 h SBP?d SBP?Morning SBP?24h PP?d PP?n PP?d SCV gradually increased,the difference was statistically significant(P<0.05).And others were statisticallly significant(P>0.05).4.Frailty was independently negative associated with physical activity?classification?risk stratification?BMI?d PP and n PP by the ordinal regression analysis,and frailty was independently positive associated with the number of grugs?Morning SBP and24 h PP.However,no significant difference in the others among three groups.5.Syndrome type of TCM composition ratio distribution of all patients: dual deficiency of yin and yang syndrome(31.4%)>kidney essence deficiency syndrome(28.0%)>phlegm and blood stasis syndrome(23.2%)>the yin deficiency and yang hyperactivity syndrome(17.4%).The non frail group and the frail group with deficiency of dual deficiency of yin and yang syndrome and kidney essence deficiency syndrome,accounted for 9.3%and 8.2%,and pre-frail group with deficiency of phlegm and blood stasis syndrome and kidney essence deficiency syndrome,accounted for 11.6%and 9.3%.There was statistical significance in the Frail Scale(P=0.046),in pairwise comparison,there was statistical significance in Frailth rating between dual deficiency of yin and yang syndrome and phlegm and blood stasis syndrome(P<0.05).However,no significant difference in the other TCM syndrome.Conclusion:1.Frailty was more common in elderly patients with hypertension,among which BMI,physical exercise,risk stratification of the hypertension and multiple medication were risk factors related to frailty,especially multiple medication aggravated frailty in elderly patients with hypertension.2.Frailty was positively correlated with morning SBP and 24 h PP and negatively correlated with d PP and n PP in the elderly patients with hypertension.3.Frailty was not related to coefficient of variation and standard deviation of blood pressure.4.Kidney essence dificiency syndrom was evenly distributed in frail stages.The phlegm and blood stasis syndrome turned to dual deficiency of yin and yang syndrome more when from the pre-frail stage to the frail stage.At the same time,the dual deficiency of yin and yang syndrome also had a higher proportion of the elderly frail patients with hypertension,which was basically consistent with the process of the hypertension syndrome from real to virtual. |
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