The Effect Of Morning Blood Pressure Surge On Carotid Internal-media Thickness

Objective: To observe the effect of morning blood pressure surge(MBPS)on Carotid intimal-media thickness(CIMT)in hypertensive patients,and to provide theoretical basis for clinical control of morning blood pressure surgeMethods: 159 hypertensive(SBP≥140mm Hg and/or DBP≥90mm Hg)subjects who were hospitalized in the First Affiliated Hospital of Fujian Medical University From March 2018 to February 2020,and another 30 healthy subjects with normal blood pressure were selected as the control group.The relevant biochemical indexes,ambulatory blood pressure,heart rate variability and CIMT in the three groups were compared,and the correlation between morning blood pressure surge and CIMT was studied.Results:(1)The age of morning blood pressure surge group was higher than that of the non-morning blood pressure surge group(P<0.05).Uric acid,creatinine,glomerular filtration rate and total cholesterol in the nonmorning blood pressure surge group were higher than those in the control group(P<0.05).Uric acid in the morning blood pressure surge group was higher than that in the control group(P<0.05).(2)The morning blood pressure surge group compared with the non-morning blood pressure surge group,24-hour systolic blood pressure(24h SBP),24-hour pulse pressure(24h PP),day pulse pressure(d PP),night pulse pressure(n PP),24-hour systolic blood pressure load(24h SBPL),24-hour systolic blood pressure-Standard deviation(24h SSD),day systolic blood pressure load(d SBPL),night systolic blood pressure-Standard deviation(n SSD)and night diastolic blood pressure-Standard deviation(n DSD)all increased(P<0.05).Non-morning blood pressure surge group compared with the control group,systolic blood pressure(SBP),diastolic blood pressure(DBP),pulse pressure(PP)are all increased in24-hour,day and night(P<0.05),night diastolic blood pressure-Standard deviation,day systolic blood pressure load,night systolic blood pressure load,day diastolic blood pressure load,night diastolic blood pressure load are all increased(P<0.05).The morning blood pressure surge group compared with the control group,systolic blood pressure(SBP),diastolic blood pressure(DBP),pulse pressure(PP),systolic blood pressure load(SBPL),diastolic blood pressure load(DBPL),systolic blood pressure-Standard deviation(SSD)are all increased in 24-hour,day and night(P<0.05).The non-arytenoid rhythm of the morning blood pressure surge group and the non-morning blood pressure surge group was higher than that of the control group.(3)PNN50 and HF in the morning blood pressure surge group were lower than those in the non-morning blood pressure surge group(P<0.05).PNN50 and HF in the morning blood pressure surge group were lower than those in the control group(P<0.05).PNN50 in the non-morning blood pressure surge group was lower than that in the control group,and LF/HF in both the morning blood pressure surge group and the non-morning blood pressure surge group were higher than that in the control group(P<0.05).(4)The mean value of CIMT in morning blood pressure surge group was0.85±0.20 mm,which was higher than 0.83±0.20mm(P<0.05)in non-morning blood pressure surge group,and The mean value of CIMT in morning blood pressure surge group and the non-morning blood pressure surge group was higher than that in control group 0.73±0.14mm(P<0.05).(5)Factors related to CIMT: the CIMT was negative correlated with SDNN、SDANN、night diastolic blood pressure and night diastolic blood pressure load,it was positively correlated with age,night systolic blood pressure load,night systolic blood pressure-Standard deviation,night diastolic blood pressure-Standard deviation and morning blood pressure surge(P<0.05).Age,morning blood pressure surge and night systolic blood pressure load were risk factors for CIMT by multiple regression analysis.Conclusion:(1)Compared with non-morning blood pressure surge patients,There were more cardiovascular risk factors,higher age,blood pressure variability and blood pressure load,reduced heart rate variability decreased,and CIMT thickening in morning blood pressure surge patients.It suggests further impairment of autonomic nervous dysfunction.(2)Age,nSBPL and MBPS were important risk factors for CIMT in hypertensive projects.