Distribution Of Tradition Chinese Medicine Syndrome Types Of Primary Hypertension And Its Association With Risk Factors

Objective:To investigate the correlation between the distribution pattern of TCM evidence of essential hypertension and risk factors such as(gender,age,body mass index,dietary preference,history of smoking,history of alcohol consumption,and family history of hypertension).At the same time,the ACE2-Ang(1-7)-Mas axis in RAS was used as a signaling channel as an entry point to study the formation mechanism of TCM syndromes in patients with essential hypertension,to investigate the characteristics of changes in the levels of RAS-related active factors[ACE2,Ang(1-7),Mas] in the syndromes of patients with essential hypertension,and to explore the changes in the levels of RAS-related active factors [(ACE2,Ang(1-7),Mas] as the role in the formation of TCM symptoms in patients with essential hypertension and the clinical value as a target treatment to provide theoretical support for TCM treatment of essential hypertension.Methods:Outpatients and inpatients attending the cardiology departments of Anhui Provincial Hospital of Traditional Chinese Medicine and Anhui Provincial Hospital of Acupuncture who met the inclusion criteria from March to October 2022 were selected.The TCM evidence types of patients with essential hypertension were classified into 4 types according to the Guidelines for Clinical Research on New Chinese Medicines,including 40 cases of hyperactive liver fire,68 cases of hyperactive yin deficiency and yang,162 cases of phlegm-dampness congestion,and20 cases of yin-yang deficiency.The patients’ gender,blood pressure,body mass index,history of hypertension,family history of dietary preferences,history of smoking and history of alcohol consumption were collected by questionnaire through the design of the information collection form for the TCM symptoms of hypertension;plasma ACE2 and Mas,Ang(1-7)levels were measured by enzyme-linked immunosorbent assay(ELISA)in 52 patients with essential hypertension and 13 normal controls.Data were analyzed using spss25.0 statistical software,and those whose measurement data obeyed normal distribution were expressed as(x±s),and those that did not conform to normal distribution were expressed as M(P25,P75).Count data were expressed as the number of cases(composition ratio %).χ2 test was used for comparison of risk factors between groups of EH TCM evidence,and Fisher’s exact test was used for cell values <5.Multivariate unordered logistic regression model was used to analyze the risk factors of EH TCM evidence type.the comparison of RAS-related vasoactive factors was performed by Kruskal-Wallis H test,and the difference of P < 0.05 was statistically significant.Results:(1)The TCM evidence type of essential hypertension was dominated by phlegm-dampness congestion evidence.(2)The results of univariate analysis showed that essential hypertension TCM evidence type was correlated with age,history of alcohol consumption,family history of hypertension and dietary preference(P<0.05).Gender,smoking history and BMI were not statistically significant with essential hypertension TCM evidence type(P>0.05).(3)Unordered multicategorical logistic regression analysis showed that age ≤65years(P<0.05,OR=29.33)and a family history of hypertension(P<0.05,OR=9.50)were associated with hyperactive liver fire type;age ≤65 years(P<0.05,OR=9.24)and a salty diet(P<0.05 OR=4.84 were associated with phlegm-damp congestion;age ≤65years(P<0.05,OR=10.30 and a family history of hypertension(P<0.05,OR=8.31)were associated with Yin deficiency and Yang hyperactivity.(4)The levels of RAS-related active factors Ang-(1-7),ACE2 and Mas were statistically significant between the essential hypertension group and normal control group(P<0.05).However,there was no statistically significant difference in levels among the TCM evidence of hypertension(P < 0.05).Conclusion:Phlegm-dampness stagnation might be the main syndrome type of essential hypertension,and high-salt diet might be a risk factor for phlegm-dampness stagnation.Family history might be a risk factor for liver fire exuberance and Yin-deficiency and Yang-hyperactivity.