Correlation Between Level Of Blood Pressure Measured By Telemonitoring System And Target Organ Damage In Older Patients With Different Blood Pressure Treatment Targets

Background: As the population aged,the prevalence of hypertension is increasing significantly.With the long course of hypertension and many combined basic diseases,it often leads to serious damage to the heart,kidneys,blood vessels and other target organs.The prevention and treatment for the elderly patients with hypertension is particularly important.Increased Systolic blood pressure(SBP)is the main risk factor related with cardiovascular and cerebrovascular events in the elderly.Antihypertensive treatment can effectively reduce the risk.However,there is still controversy about whether intensive antihypertensive therapy should be used in olderly patients aged 60 to80 with hypertension.Objective: To analyze the target organ damage in elderly patients with different SBP treatment targets,and to explore its correlation with blood pressure and blood pressure variability(BPV).Methods: Between January 2017 and June 2017,236 essential hypertension patients(60-80 years old)were recruited from our department of the First Affiliated Hospital of Dalian Medical University.Subjects were assigned to a SBP target of less than 150 mm Hg(standard-treatment group)or a target of less than 130 mm Hg(intensive-treatment group).After accepcting anti-hypertensive medications,all participants’ blood pressure reached the aims within three months.Home blood pressure was measured during follow-up by telemonitoring system.The participants were followed up three years from September 2017 to Auguest 2020.The differences of target organ damage,primary endpoint events and long-term home BPV between the two groups were compared,and to explore the correlation between target organ damage and blood pressure and BPV.Results:1.The comparison of general data between groupsThe study included 236 elderly patients with essential hypertension,ninety-two patients were males(39.0%),one hundred and forty-four patients were females(61.0%).The mean age of the subjects was 66(63,70)years.The mean duration of hypertention was 11(6,20)years.There were no significant differences in general baseline data,including duration of hypertention,office blood pressure,BMI,laboratory parameters and baseline antihypertensive drugs.2.The comparison of blood pressure between two groupsMean SBP was 134.34±6.04 mm Hg in the standard treatment group and127.34±6.18 mm Hg in the intensive treatment group,the difference was 7 mm Hg,which met the requirements of SBP aims in this study.The compliance rate of blood pressure was 79.7%.Systolic blood pressure variability(SBPV)was decreased significantly in the intensive treatment group than the standard treatment group(p<0.001).3.Comparison of target organ damage between two groups(1)Brachial-ankle Pulse Wave Velocity(baPWV)was obviously higher in the standard treatment group than the intensive treatment group respectively(p<0.05).However,there was no significant difference between the two groups.(2)There were no statistically significant differences in e GFR,urinary protein and the incidence of renal dysfunction and renal disease between the two groups.(3)Left atrial diameter index(LADI)were significantly increased in the standard treatment than in the intensive treatment(P<0.05).The incidence of left ventricular hypertrophy was higher in the standard treatment.Parameters of left ventricular diastolic function were significantly deteriorated in the standard treatment.4.Correlation analysis of target organ damage indexSBP was a risk factor for the acceleration of baPWV[OR=1.057(95%CI:1.012-1.104),P<0.05] and the increase of LVMI[OR=1.067(95%CI:1.015-1.122),P<0.05].SBPV[OR=1.217(95%CI:1.041-1.422),P<0.05] was a risk factor for the increase of LVMI.Conclusions:1.During long-term follow-up,we found that intensive treatment is more effective than standard treatment in reducing long-term home SBPV,delaying arteriosclerosis,protecting heart structure and left ventricular diastolic function,and not aggravating the renal damage for the elderly patients with hypertension in China.2.The remote blood pressure monitoring system is helpful for the management of home blood pressure and can significantly improve the compliance rate of blood pressure.