The Effects Of Enhanced External Counterpulsation On Blood Pressure Variability And Vascular Endothelial Function In Patients With Vascular Cognitive Impairment No-dementia

Background:With the aging of the population,the prevalence of Cardiocerebrovascular disease is on the rise,and the incidence of vascular dementia(VaD)is also increasing.A large number of evidences have indicated that Cardiocerebrovascular disease will eventually cause different degrees of cognitive impairment,and VaD is currently the second most common cause of dementia after Alzheimer’s disease(AD).VaD is irreversible and brings a great burden to the family and even the society.However,vascular cognitive impairment nodementia(VCIND)as an early stage of VaD has a certain reversibility.Therefore,it is essential to find effective interventions at this stage.Recently,the application of enhanced external counterpulsation(EECP)in ischemic heart disease and ischemic cerebrovascular disease has achieved significant benefits.In our previous research,it was found that EECP can effectively improve the cognitive function of VCIND patients.Currently,related studies have shown that EECP can improve vascular endothelial function in patients with coronary heart disease and cerebral infarction,but there are few reports on the effect of EECP on blood pressure variability and vascular endothelial function in patients with VCIND.Purpose:Our study aimed to observe the blood pressure variability and serum nitric oxide(NO),endothelin-1(ET-1),asymmetric dimethylarginine(ADMA),vascular endothelial growth factor(VEGF)and vascular cell adhesion molecule-1(VCAM-1)in VCIND patients before and after EECP treatment,to investigate the effects of EECP on blood pressure variability and vascular endothelial function in patients with VCIND,and to provide new clinical ideas for the mechanism of EECP in the treatment of VCIND.Methods:Seventy patients diagnosed with VCIND from the Department of Cardiology and Neurology in our hospital from June 2020 to January 2021 were selected and randomly divided into EECP treatment group and control group,and the general baseline information that age,gender,body mass index,etc.of the two groups of patients were recorded.Both groups of patients were treated with basic medications to control the risk factors of VCIND sequentially,while the EECP group was treated with EECP on this basic medication plan,once a day,60 minutes each time,5 times a week,a total of 35 times.Before and after treatment,record the blood pressure variability related data of the patient,and collect serum samples to detect serum NO,ET-1,ADMA,VEGF,and VCAM-1.Compare the changes and differences of the above indicators before and after treatment.Results:Eventually,a total of 66 patients with VCIND were included in this study,33 in each of the EECP treatment group and the control group.There were no significant statistical differences in age,gender,height,weight,body mass index,education,fasting blood glucose,glycated hemoglobin,liver and kidney function,smoking history,alcohol abuse history,history of stroke,history of hypertension,history of hyperlipidemia,history of coronary heart disease,and history of diabetes between the two groups(P>0.05).And the conditions of basic drug utilization of the two groups had no significant statistical difference(P>0.05).After treatment,the blood pressure variability in EECP treatment group were decreased with varying degrees,which involves 24-hour systolic blood pressure variability(24hSCV),24hour diastolic blood pressure variability(24hDCV),daytime systolic blood pressure variability(dSCV),daytime diastolic blood pressure variability(dDCV),nocturnal systolic blood pressure variability(nSCV)and nocturnal diastolic blood pressure variability(nDCV),And the difference was statistically significant(P<0.05);however there was no significant changes in 24hSCV、24hDCV、dSCV、dDCV、nSCV、nDCV in control group(P>0.05).In EECP group,The levels of NO and VEGF were increased,ET-1,ADMA and VCAM-1 were decreased after treatment.and the difference was statistically significant(P<0.05).While the NO,ET-1,ADMA,VEGF,and VCAM-1 of the control group had little change compared with the previous after treatment,and there was no significant statistical difference(P>0.05).Conclusion:EECP can reduce blood pressure variability in patients with VCIND.EECP can improve the vascular endothelial function of VCIND patients.