The Relationship Between Ambulatory Pulse Pressure And Pulse Pressure Index And Subclinical Carotid Damage In Essential Hypertensive Patients

Objective:To investigate the relationship of ambulatory pulse pressure(PP) and pulse pressure Index(PPI) to subclinical carotid damage in uncomplicated essential hypertensive(EH)patients.Methods:The protocols of 95 essential hypertensive patients(Systolic blood pressures≥140mmHg and/or Diastolic blood pressure>90mmHg) in our hospital during last 2 years and 40 healthy people in our hospital physical check-up center were reviewed retrospectively.All of the patients and healthy people were evaluated using 24-hour ambulatory blood pressure monitoring(ABPM) and Intima-media thickness(IMT) of carotid,and plaque were evaluated by ultrasonography.IMT≥1.3mm,or thickness is more 0.5mm than near spot,or deletion of color flow mapping in somewhere blood vessel was defined as plaque.The 95 EH patients were divided into subgroups:according to the PP level[group A(<45mmHg),group B(45mmHg≤PP <60mmHg) group C(≥60mmHg)];PPI(<0.5 and≥0.5);IMT(<0.9mm and≥0.9mm), subclinical atherosclerosis(AS)(IMT<0.9mm and no plaque,IMT≥0.9mm or plaque). Parameters of each group were compared between every groups people,then analyzed with the Pearson correlation analysis,the multiple linear correlation analysi and the multiple stepwise linear regression analysis.Results:1.The percent of smoking,TC,PP,PPI,IMT,the percent of IMTthicking,the percent of subclinical AS in EH patients were significantly higher than these in healthy people(P<0.05).2.PPI,IMT,the percent of IMT thicking,the percent of subclinical AS in C group of PP level were significantly higher than these in A group(P<0.01).PP,IMT,the percent of IMT thicking,the percent of subclinical AS in high PPI group were significantly higher than these in low PPI group(P<0.05).PP,PPI,the percent of subclinical AS in thicker IMT group were significantly higher than these in thin IMT group(P<0.001).PP,PPL IMT,the percent of IMT thicking in subclinical AS group were significantly higher than these in no subclinical AS group(P<0.05). 3.The multilpe linear correlation analysis indicated that PP and PPI were positively correlated to the IMT(P<0.01),but daytime diastolic blood pressure loading(dDBPL),24-hour mean diastolic blood pressure(24hDBP),daytime mean diastolic blood pressure(dDBP),body mass index(BMI),triglyeride(TG) were negatively correlated to the IMT(P<0.05),and the correlation index is PPI>PP>BMI>24hDBP>dDBP>dDBPL>TG,other factors were not significantly correlated to the IMT(P>0.05).There was significantly positive relationship respectively between PP and PPI,between PP and IMT,between PPI and IMT;and the correlation index respective is 0.908,0.525,0.541(Pall<0.001). 4.The multiple stepwise linear regression analysis indicated that only PP played the role in the development of IMT(P=0.028),only PPI played the role in the development of subclinical AS(P=0.044).The regression equation was as following:carotid IMT=2.918+0.031PP;carotid subclinical AS=56.436PPI-16.651.Conclusions:1.The percent of unhealthy life style and dyslipidemia in hypertension patients is significantly higher than that of the healthy people.2.Although the ambulatory blood pressure of essential hypertension patients is controll well,PP and PPI of this patients are still significant higher than that of the healthy people,and the carotid IMT,the percent of carotid IMT thicking and subclinical AS are significantly higher in this patients.3.PP is significantly positively correlated to SBP,but is negatively correlated to DBP.4.There was significantly positive relationship between ambulatory PP and ambulatory PPI.5.The essential hypertension is a risk factor causing carotid IMT thicking and subclinical AS.The carotid IMT in hypertension patients is significantly positively correlated to ambulatory PP and PPI,but is negatively correlated to DBP,the correlation to PP is the first and the correlation to PPI is the second.PP plays the most important role in the development of IMT, and PPI plays the most important role in the development of subclinical AS.Ambulatory PP and PPI can reflec the percent of carotid IMT thicking and subclinical AS in essential hypertension Datients.