Study On The Correlation Between TCM Syndrome Types Of Senile Hypertension And The Changes Of AASI And LVMI

Objective: to study the correlation between TCM syndrome types of senile essential hypertension and ambulatory arterial stiffness index(AASI)and left ventricular mass index(LVMI),to explore the distribution law of TCM syndrome types,to analyze the arteriosclerosis(AS)and left ventricular hypertrophy of different syndrome types,and to analyze the possible influencing factors.In order to provide reference and basis for TCM syndrome differentiation and prevention and treatment of senile hypertension,targeted intervention of arteriosclerosis and target organ damage as soon as possible.Methods: from January 2020 to January 2021,478 elderly patients with essential hypertension were diagnosed in the Geriatrics Center and Cardiovascular Department of Yunnan traditional Chinese Medicine Hospital.The general clinical data,laboratory indexes,echocardiography and ambulatory blood pressure were collected,and AASI and LVMI were calculated.Refer to the "Vertigo(primary hypertension)Chinese medicine diagnosis and treatment plan optimized in March 2019" by the Geriatrics Center of Yunnan Provincial Hospital of Traditional Chinese Medicine,the elderly hypertension can be divided into phlegm stagnation syndrome,hyperactivity of liver-yang syndrome,qi deficiency and blood stasis syndrome and deficiency of kidney essence syndrome.The data were analyzed by SPSS23.0 software.Results: 1.The composition ratio of TCM syndrome types involved in 478 elderly hypertensive patients from big to small is: phlegm stagnation syndrome(28.5%)> qi deficiency and blood stasis syndrome(26.8%)> hyperactivity of liver-yang syndrome(25.5%)> deficiency of kidney essence syndrome(19.2%).2.478 elderly patients with hypertension have 224 males and 254 females,the ratio of male to female is about 1:1.13,and there is no statistical difference in the sex composition ratio of the four groups(P > 0.05).3.The age of different syndrome types from big to small is: Qi deficiency and blood stasis syndrome/deficiency of kidney essence syndrome > phlegm stagnation syndrome >liver yang hyperactivity syndrome.There is no statistical difference in age between qi deficiency and blood stasis syndrome and deficiency of kidney essence syndrome(P >0.05),but there is significant difference in age between other groups(P <0.01).According to age stratification,the syndrome of hyperactivity of liver-yang and stagnation of phlegm and turbidity is mainly 60-79 years old,and the syndrome of qi deficiency and blood stasis and deficiency of kidney essence is mainly 70-89 years old.4.The course of the syndrome types in each group from long to short is deficiency of kidney essence syndrome/qi deficiency and blood stasis syndrome > phlegm stagnation syndrome > hyperactivity of liver-yang syndrome(P < 0.01).5.Comparison of blood lipids in each group: TG and TC values of phlegm stagnation syndrome and qi deficiency and blood stasis syndrome were significantly higher than those of liver yang hyperactivity syndrome and kidney essence deficiency syndrome(P < 0.01);The LDL-C values of qi deficiency and blood stasis syndrome and kidney essence deficiency syndrome were significantly higher than those of liver yang hyperactivity syndrome,and those of kidney essence deficiency and qi deficiency and blood stasis syndrome were significantly higher than those of phlegm stagnation syndrome(P < 0.01).HDL-C values of hyperactivity of liver yang and deficiency of kidney essence were significantly higher than those of phlegm stagnation and qi deficiency and blood stasis(p <0.01).6.Body mass index(BMI)and left atrial diameter(LAD)of Qi deficiency and blood stasis syndrome and phlegm stagnation syndrome were significantly higher than those of hyperactivity of liver-yang syndrome and deficiency of kidney essence syndrome(P <0.01).The serum creatinine(SCr)value of Qi deficiency and blood stasis syndrome and phlegm stagnation syndrome was higher than that of hyperactivity of liver-yang syndrome(P < 0.05).There was no significant difference in blood uric acid(UA),fasting blood glucose and ejection fraction(EF)among syndrome types in each group(P > 0.05).7.The results of blood pressure classification among different syndromes show that the proportion of hypertension grade 3 is the highest.Rank sum test shows that there is a significant difference in blood pressure classification among different syndromes(P <0.001).The order of blood pressure classification from high to low is Qi deficiency and blood stasis syndrome > phlegm stagnation syndrome > deficiency of kidney essence syndrome > hyperactivity of liver-yang syndrome.8.In blood pressure classification,LVMI and AASI of hypertension grade 3 were the highest(P < 0.05).Comparison of LVMI among different syndromes: qi deficiency and blood stasis syndrome/phlegm stagnation syndrome > hyperactivity of liver-yang,qi deficiency and blood stasis syndrome/phlegm stagnation syndrome > deficiency of kidney essence(p < 0.01).the abnormal rates of qi deficiency and blood stasis syndrome and phlegm stagnation syndrome are higher than hyperactivity of liver-yang syndrome(p <0.01).The comparison of AASI among different syndromes: Qi deficiency and blood stasis syndrome/phlegm stagnation syndrome/deficiency of kidney essence syndrome >hyperactivity of liver-yang syndrome(P < 0.01),and the abnormal rate of qi deficiency and blood stasis syndrome and phlegm stagnation syndrome is higher than hyperactivity of liver-yang syndrome(P < 0.05).9.Among 478 elderly patients with hypertension,the most common disease was cerebrovascular disease(79.70%).There are statistical differences in the occurrence of heart diseases among the syndrome types of each group(P < 0.01).The order from high to low is: Qi deficiency and blood stasis syndrome,phlegm stagnation syndrome,deficiency of kidney essence syndrome and hyperactivity of liver-yang syndrome.There are statistical differences in the occurrence of diabetes among the syndrome types of each group(P <0.01),and the order from high to low is: Qi deficiency and blood stasis syndrome,deficiency of kidney essence syndrome,phlegm stagnation syndrome and hyperactivity of liver-yang syndrome.There was no statistical difference in the incidence of cerebrovascular disease and kidney disease among the syndrome types of each group(P >0.05).10.the results of binary logistic regression analysis showed that gender,LDL-C and TG were the risk factors of left ventricular hypertrophy in elderly hypertensive patients,and the probability of developing left ventricular hypertrophy in women was higher than that in men(OR=8.492).HDL-C,LDL-C and TG are the risk factors of arteriosclerosis in elderly hypertensive patients.Conclusion: 1.Qi deficiency and blood stasis syndrome and deficiency of kidney essence syndrome are the oldest and have the longest course of disease.With the increase of age and progress of course of disease,TCM syndrome types generally evolve from excess syndrome to deficiency syndrome.2.The abnormal rate of indicators of Qi deficiency and blood stasis syndrome and phlegm stagnation syndrome is high,so it can be considered that phlegm and blood stasis are the main pathological factors of senile hypertension.3.The elderly hypertensive patients have the highest proportion of hypertension grade3 and the highest blood pressure grade of qi deficiency and blood stasis syndrome.4.The LVMI and AASI values of hypertension grade 3 are the highest,and the abnormal rates of AASI and LVMI are the highest in the syndrome of Qi deficiency and blood stasis and phlegm stagnation,namely,the incidence of arteriosclerosis and left ventricular hypertrophy is the highest in the syndrome of Qi deficiency and blood stasis and phlegm stagnation,which can be used as the basis for differentiation between syndromes.5.The most common disease in 478 elderly patients with hypertension was cerebrovascular disease,and the risk of qi deficiency and blood stasis syndrome complicated with heart disease and diabetes was the highest.6.Gender,LDL-C and TG are the risk factors of left ventricular hypertrophy in elderly hypertensive patients,and the probability of developing left ventricular hypertrophy in women is higher than that in men.HDL-C,LDL-C and TG are the risk factors of arteriosclerosis in elderly hypertensive patients.