| Objective:Investigate the influencing factors of masked uncontrolled hypertension and the distribution characteristics of TCM syndromes;Observe the characteristics of 24-hour ambulatory blood pressure in patients with masked uncontrolled hypertension.Methods:In this study,a cross-sectional survey was used to target 71 patients with masked uncontrolled hypertension from the Department of Cardiology,Integrated Chinese and Western Medicine Cardiology and Cardiology Ward and Outpatient Clinic of China-Japan Friendship Hospital between October 2018 and November 2019,and 52 patients with controlled hypertension have been for investigation and comparison(The latter is the control group,and the blood pressure and the 24-hour ambulatory blood pressure of the clinic after antihypertensive treatment have reached the standard).Complete the basic information,anxiety,depression and sleep scale questionnaires to detect liver and kidney function,blood sugar,blood lipids,homocysteine,high-sensitivity C-reactive protein,ambulatory blood pressure monitoring and ambulatory electrocardiogram results.At the same time,collect the information of four consultations of traditional Chinese medicine of the patient and distinguish syndrome comprehensived.Data of masked uncontrolled hypertension and controlled hypertension were input into EXCEL and analyzed statistically by SPSS 20.0.Results:1.Comparison of concealed uncontrolled hypertension group(group A)and controlled hypertension group(group B):1.1 Comparison of baseline data The comparison of age,gender,course of hypertension,blood pressure grading,drug treatment,risk stratification,etc.between the two groups,after statistical analysis,P>0.05,indicating that there is no statistical difference between the two groups,which is comparable.1.2 Comparison of height,weight,BMI,and office blood pressure In the two groups,body weight,BMI,and office DBP were higher in group A than in group B,and P<0.05,suggesting that the difference was statistically significant.The height and office SBP comparison P>0.05,suggesting that there is no statistical difference between the two groups.1.3 Sleep quality(PSQI score),anxiety score(SAS score),depression score(SDS score)Group A and Group B compared P>0.05,suggesting that the difference was not statistically significant.1.4 Comparison of laboratory test indexes Comparison of blood ALT,BUN,HsCRP,FPG,TG,TC,LDL and HDL between two groups P>0.05,indicating that there is no statistical difference between the two groups;group A AST,Scr,HCY,UA are higher Group B,and P<0.05,suggesting that the difference between the two groups is statistically significant.Further using two-class logistic regression,it was found that office DBP,AST,HCY values were independent influencing factors for masked uncontrolled hypertension.1.5 Comparison of ambulatory blood pressure characteristics In terms of blood pressure,the average SBP,DBP,and mean arterial pressure of group A throughout the day,day,and night were higher than those of group B.And in group A,49.3%of the whole day’s blood pressure did not meet the standard,45.1%of the nighttime blood pressure did not meet the standard,and only 5.6%of the daytime blood pressure did not meet the standard.In terms of blood pressure variability,the standard deviation of DBP at night and dynamic PPI at night were higher in group A Group B.In terms of circadian blood pressure rhythm,the average blood pressure difference between day and night,SBP day and night decline rate of SBP,DBP day and night mean blood pressure difference,and DBP day and night decline rate of group A are all lower than group B,and the proportion of anti-dipper is higher than that of group B,all the above P<0.05,indicating that the difference is statistically significant.1.6 Comparison of dynamic ECG characteristics Comparison of heart rate variability indexes between the two groups,P>0.05,indicating that there is no statistical difference between the two groups.1.7 Comparison of distribution characteristics of TCM syndromes Proportion of TCM syndromes in group A Phlegm-dampness syndrome>Yin deficiency-yang hyperactivity syndrome>Blood stasis and obstruction syndrome>Concurrent folder syndrome>Liver-fire hyperactivity syndrome,and the proportion of group A phlegm dampness syndrome higher than group B,P<0.05,the difference was statistically significant.2.Masked uncontrolled hypertension patients’ blood pressure control in different periods-Comparison of the whole day blood pressure substandard group(group C)with the simple night blood pressure substandard group(group D):2.1 Comparison of gender and age composition The proportion of young and middle-aged people in group C is higher than that in group D,and the proportion of elderly people in group D is higher,and P<0.05,indicating that the difference is statistically significant.2.2 Comorbidities and complications The proportion of young and middle-aged people in group C is higher than that in group D,and the proportion of elderly people in group D is higher,and P<0.05,indicating that the difference between the two groups was statistically significant.And whether there were hypertension complications,there is no obvious difference between the two groups.2.3 Biochemical indicators ALT and HsCRP in group C were higher than those in group D,and P was both<0.05,the difference between the two groups was statistically significant.2.4 Distribution characteristics of TCM syndromes The distribution of yin deficiency and yang hyperactivity syndrome in group D was higher than that in group C,P<0.05,the difference was statistically significant.Conclusions:1.Body weight,BMI are associated with the prevalence of masked uncontrolled hypertension(MUCH),and office DBP,AST,and HCY may be independent influencing factors of MUCH.2.High average blood pressure,poor blood pressure control at night,large blood pressure variability,low circadian blood pressure drop rate,and abnormal blood pressure rhythm are clinical features of MUCH patients,which are closely related to target organ damage and have a worse prognosis.3.Traditional Chinese medicine syndrome differentiation of MUCH patients is more common in phlegm-dampness syndrome,of which the yin deficiency and yang hyperactivity syndrome are more common in patients with simple night blood pressure failure.4.Among the MUCH patients,those who do not reach the standard of all-day blood pressure are mostly young and middle-aged,the blood pressure grade is mainly blood pressure level 3,and there are many complications.The majority of those who simply failed to achieve blood pressure at night were elderly. |
