Influence Of Blood Pressure Circadian Rhythm In Patients With Hypertension On Carotid Atherosclerosis And Investigation Of Their Mechanism

Objective Hypertension is a common clinical disease, and its incidence is at a highlevel in the world, which also is an important risk factor of a variety of cardiovascularand cerebrovascular disease, has become a major public health problem that endanger thehuman health. The main manifestation of hypertension is the higher blood pressure,causes abnormal changes in haemodynamics and neural regulation, can promote thedevelopment of atherosclerosis. Atherosclerosis is the most important pathological basisfor the occurrence of cardiovascular disease and cerebrovascular disease, the mostcommon position of atherosclerosis is the carotid artery, and its changes of vascular wallis characterized by thickening of the carotid IMT, therefore the carotid IMT can be usedas an early predictor of carotid atherosclerosis. The carotid atherosclerosis may indirectlyreflect the degree of hardening of the systemic medium-sized artery. And it can be usedas an early indicator to observe the vivo atherosclerotic lesions, which also is animportant means to effectively assess the arteriosclerosis. High-sensitivity C-reactiveprotein (hs-CRP) is the acute phase response proteins, which is a clinical commoninflammatory markers. Hs-CRP promotes inflammation by activating the complementsystem of vascular wall, participates in the process of atherosclerosis development, is aneffective predictor of the development and occurrence of cardiovascular disease. In recentyears,24hour ambulatory blood pressure monitoring is widely used in clinical practice,blood pressure circadian rhythm has become a hotspot in the field of hypertensiveresearch. Research shows that no matter whether the hypertensive patients reached theblood pressure standard, those patients night blood pressure decreased decline or notobvious significantly increased the incidence of target organ damage, the mainlypathological basis of target organ damage is atherosclerosis. Combining with cervicalvascular ultrasound and ambulatory blood pressure monitoring technology, help us tostudy the influence of blood pressure circadian rhythm on carotid atherosclerosis in thepatients with essential hypertension, and investigate their mechanism of action.Methods103hypertensive patients had been selected in Cardiology of Hebei UnitedUniversity Affiliated Hospital from February in2012to October in2013.All the patients were performed24hours ambulatory blood pressure monitoring. The patients weredivided into the non-dipper group (n=72) and dipper group (n=31) according to the nightblood pressure decreasing rate. The carotid intima-media thickness (IMT) and arteryplaque were measured with echocardiography. We put all the information into thecomputer,. using SPSS13.0statistical software for statistical analysis.Results1The difference of24hSBP,24hDBP, dSBP, dDBP were not statisticallysignificant in the two groups; nSBP and nDBP in the non-dipper group were higher thanthose in dipper group, the difference was statistically significant.2Compared with dippergroup, IMT was thickened, and the detection rate of artery plaque was elevated in non-dipper group.3Hs-CRP in the non-dipper group was higher than those in dipper group.4Pearson correlation analysis showed a significantly positive correlation between carotidIMT and hs-CRP, serum uric acid and total cholesterol, and also showed a significantlynegative correlation between carotid IMT and the decreasing rate of night blood pressure.5The Linear regression analysis showed: carotid IMT as the dependent variable, hs-CRP,serum uric acid, total cholesterol, the decreasing rate of night blood pressure wereindependent variable.Conclusion1The changes of circadian rhythm of blood pressure in hypertensivepatients mainly had differences with night systolic blood pressure and night diastolicblood pressure.2The circadian rhythm of blood pressure in hypertensive patients hassignificant role in promoting the progress of carotid atherosclerosis.3Hs-CRP in the non-dipper group was higher than those in dipper group, this indicated that hypertensivepatients with the abnormal circadian rhythm of blood pressure had much more significantinflammatory response.4Hs-CRP, total cholesterol and the decreasing rate of night bloodpressure were closely related with the progress of carotid atherosclerosis.