Correlation Between Morning Peak And Target Organ Damage Under Different Blood Pressure Detection Methods

Background:As the most important risk factor in cardiovascular and cerebrovascular diseases,hypertension seriously affects people’s normal life,the blood pressure fluctuates significantly due to many factors,within 24 hours,the time period when the blood pressure fluctuates the most is in the early morning,that is,from sleep to awake,blood pressure can rise rapidly from a relatively low level,and even reach the highest level in a day.The morning peak of blood pressure is affected by many factors,such as neuroendocrine factors,autonomic nerve activity,vascular endothelial disorders,and so on.Epidemiological survey data indicate that the morning peak of blood pressure is related to target organ damage,such as coronary heart disease,cerebral infarction,and kidney damage.There are two blood pressure monitoring methods,namely home self-test and clinic measurement,due to the different detection environments,the blood pressure in the clinic is generally higher than the family self-test blood pressure.The family self-test is convenient and fast,which can effectively eliminate the impact of the testing environment and avoid white coats hypertension.Therefore,it is extremely important to analyze the correlation between the morning peak phenomenon and target organ damage under different blood pressure detection methods.Purpose:To clarify whether there is a connection between the morning peak phenomenon and target organ damage in patients with hypertension,and the correlation between the morning peak phenomenon and the target organ damage in patients with different blood pressure detection methods is analyzed.Methods:(1)Selected 282 hypertensive patients to carry out clinical trials and conduct 24-hour ambulatory blood pressure monitoring.According to the subjects have morning blood pressure surge,the test subjects were divided into two groups,namely Chenfeng group(n=147)and non-chenfeng group(n=135),according to blood pressure,the measurement methods were different.The Chenfeng group was divided into the home self-test group(MBPS-1)(n=72)and the office measurement group(MBPS-2)(n=75).The home self-test group monitors blood pressure by self-test,and the patient in the office measurement group used the office measurement method to monitor blood pressure.(2)Detected the body mass index(BMI)of the patient,and the biochemical analyzer to detect the conventional indicators of human fasting plasma glucose(FPG),high-density lipoprotein cholestero(HDL-C),low Low density lipoprotein cholesterol(LDLC),total cholesterol(TC),triglycerides(TG).(3)Immunofluorescence method was used to determine the levels of high sensitivity C-reactive protein(Hs-CRP)and brain natriuretic peptide(BNP)in venous blood.ELISA method was used to detect morning urine microalbumin,the content of urine microalbumin(U-m Alb).Doppler ultrasound diagnostic instrument to detect common carotid artery intima-media thickness(CCA-IMT),left ventricular mass index(left ventricular mass index,LVMI).(4)Spearman correlation analysis showed that family self-test was positively correlated with Hs-CRP,U-m Alb,BNP,CCA-IMT and LVMI,morning peak was negatively correlated with FMD,and clinic measurement was negatively correlated with FMD.Univariate linear regression showed that Hs-CRP,U-m Alb,BNP,CCA-IMT,LVMI were positively correlated with MBPS-1(P<0.05),while FMD was negatively correlated with MBPS-1(P<0.05).Multivariate linear regression showed that Hs-CRP,U-m Alb,CCA-IMT and FMD were the independent influencing factors of MBPS-1.Results:(1)The results of blood pressure monitoring showed that whether it was the average systolic blood pressure or the average diastolic blood pressure,the blood pressure indicators of the morning peak group were significantly higher than the blood pressure indicators of the non-morning peak group in the comparison of 24 h,daytime,night and morning peak period.As a result,the difference between the two was statistically significant(P<0.05);whether it was self-tested blood pressure at home or in the office,the average systolic blood pressure and average diastolic blood pressure in each period of the morning peak group were higher than those of the non-morning peak group,the difference was statistically significant(P<0.05).(2)The measurement results showed that there was no significant difference in body mass index(BMI),FPG,HDL-C and other biochemical indicators between the Chenfeng group and the non-chenfeng group(P>0.05).(3)Regarding Hs-CRP,BNP,CCA-IMT,U-m Alb,and LVMI indicators,no matter what blood pressure measurement method was used in the morning peak group,the measurement results were higher than those in the non-morning peak group.Regarding FMD indicators,no matter what blood pressure measurement method was used in the morning peak group,the measurement results were lower than those in the non-morning peak group,and the difference is statistically significant(P<0.05).(4)Regardless of the method of measurement,the morning peak phenomenon was related to Hs-CRP,U-m Alb,BNP,CCA-IMT,and LVMI,and was positively correlated with the morning peak phenomenon and vascular endothelial-dependent relaxation.The functional indicators were also related,showing negative correlation characteristics.In terms of correlation coefficients,the family self-test group performs better than the office measurement group.Conclusions:1.There is a certain connection between the morning peak phenomenon and target organ damage.The morning peak phenomenon reflected by family self-tested blood pressure and the blood pressure measured in the office is related to each target organ damage.2.The correlation coefficient of the family self-test group is higher than that of the office measurement group,that is,the morning peak phenomenon shown by the family self-test blood pressure method is more closely related to target organ damage than the method of measuring blood pressure in the office.3.In daily life and clinical treatment,close monitoring of the morning peak phenomenon of hypertension can achieve the effect of effectively preventing the complications of hypertension;family self-measurement of blood pressure is a more convenient and effective way than measuring blood pressure in the clinic,and attention should be paid to monitoring of blood pressure patients’ self-tested blood pressure at home.