| With the transformation of China’s economic and social development and the work way of life, hypertension has become a common disease. It will reach to300million Chinese hypertensive patients in2025. Hypertension has become a major global public health problem.Hypertension is an important risk the first risk factor for stroke, cardiovascular disease and kidney disease, its complications are various and severe. The circadian rhythm of blood pressure as a measure of blood pressure control is an effective method for evaluating the stability index which can also reflect the effect of treatment and prognosis. At present, the study relationship of TCM syndrome types with target organ damage of hypertension disease syndromes are increasing. The research literature on elderly hypertension patients of circadian rhythm of blood pressure and TCM syndrome factors as background, and investigate the prospective studies and analysis of the relationship between syndromes and target organ damage according to heart rate and blood pressure variability.Objective:Summarize the circadian rhythm of blood pressure in elderly patients with essential hypertension, target organ damage, blood pressure variability and heart rate variability related elements of TCM literature in recent years. The research on symptoms, syndromes and syndrome elements and other aspects of the elderly hypertension were classified and sorted. To explore the TCM syndrome factors and hypertension patients distribution characteristic, then correlation analysis of each syndrome factor and the blood pressure, heart rate variability, target organ damage.Method:The total600cases of elderly patients (age>65) diagnosed as essential hypertension in Xiyuan hospital were recruited according to the inclusion and exclusion criteria determined. Syndromes factors of aging hypertension was summarized and conceptions of each factor were defined basing on the"the part term in the clinical diagnosis and treatment of TCM syndrome " and syndrome classification of head wind and vertigo in " standard of diagnosis of disease and curative effect of traditional Chinese medicine. According to professor Zhu WenFeng "syndrome element scale", designing parameters and TCM symptoms scale survey, and monitoring and consulting room of24hour ambulatory blood pressure, blood pressure and heart rate in hypertensive patients. The initial medical record information quantization and the establishment of related research database would be extracted by SQLserver2005draws the TCM elements syndrome of patients, and using the software SPSS17.0syndrome factors to make frequency analysis and measurement data were expressed as X±S. Spearman correlation analysis was used to explore the relationship between different BPCR and TCM syndrome factors with target organ damage, heart rate and blood pressure variability.Result:1. General demographic data:(1) Gender:Included in the study of600cases, statistic showed that268cases were male, while the other were332female cases and the average duration were15years. According to the characteristics of hypertension, divided into dipper, non dipper, ultra dipper, anti dipper and non dipper type, and there were largest number of379cases of various types of cases.(2) The course duration:There were divided course duration into four groups, which ere0-9years,10-19years,19-29years, more than30years. According to the characteristics of hypertension, the dipper type, group and the hypertension course had positive correlation, r=0.09.(3) The age:There were divided age into four groups, which were60-69years old, according to70-79years,80-89years old, above90years old. Through the Spearman statistical analysis that the results showed abnormal circadian rhythm of blood pressure of hypertension with age had no relationship.2. Distribution characteristics of600cases of aging hypertension in TCM syndrome factors:(1) Distribution of disease location factors in descending order:kidney> liver> heart> lung> spleen, and kidney is of the most frequency (372cases).(2) Disease nature factors:Distribution regularity of deficiency disease nature syndrome elements in descending order:yin deficiency> qi deficiency> yang deficiency> blood deficiency. While the yin deficiency and qi deficiency were more frequent than the other groups (yin deficiency248, qi deficiency170, respectively);Distribution regularity of excess disease nature syndrome elements in descending order:phlegm> blood stasis>qi stagnation> hyperactivity of yang> heat. While the phlegm and blood stasis were more frequent than the other groups (phlegm248, blood stasis160respectively).(3) Miscellaneous syndrome factorsThe patients with disease located in liver and kidney were165cases, taking the largest share of miscellaneous syndrome element. The rest were heart and kidney63cases, lung and kidney55cases, heart and lung45cases, and heart and liver41cases respectively.Deficiency miscellaneous syndrome elements:qi and yin deficiency cases is82, and40cases are deficiency of qi and blood, yin and yang deficiency are36cases,22cases are yin and blood deficiency, and the cases belong to none above are11.Excess miscellaneous syndrome elements:67patients are phlegm stasis transresistance cases, qi stagnation and blood stasis patients are55, qi stagnation and sputum patients are23,28patients belong to phlegm hot alternating knot, and the rest cases belong to none above are26.Miscellaneous syndrome types composed by deficiency and excess:80patients belong to yin deficiency coupled with sputum, yin deficiency with yang excess cases are58, yang deficiency coupled with sputum cases were48,29patients belong to qi deficiency coupled with sputum36.3. Relationship between circadian rhythm of blood pressure and TCM Syndromes(1) Syndrome factor of elderly hypertensive patients on location of single disease analysis have showed that kidney was positively correlated with dipper hypertension patients(r=0.23,p=0.00), and liver and kidney was positively correlated with dipper hypertension patients especially for kidney(r are0.22,0.21). Study in the miscellaneous disease that the liver and kidney disease have the strongest correlation with all types of hypertension patients(r are0.22,0.31,0.44).(2) Syndrome factor of elderly hypertensive patients on single nature of deficiency disease analysis have showed that Yin deficiency was positively correlated with all types of hypertension patients (r are0.22,0.31,0.44). while on single nature of excessive disease analysis have showed that Phlegm have the strongest correlation with all types of hypertension patients(r are0.42,0.29,0.26).(3) In study of deficiency disease and miscellaneous syndrome have showed that both qi and Yin deficiency disease have the strongest correlation with all types of hypertension patients(r are0.27,0.28,0.31). In study of excessive disease and miscellaneous syndrome have showed that phlegm and blood stasis have the strongest correlation with non dipper and anti dipper hypertension patients(r are0.18,0.16). In study of deficiency and excessive disease in miscellaneous syndrome have showed that phlegm with Yin deficiency disease have the strongest correlation with all types of hypertension patients(r are0.35,0.07,0.12).4. Correlation between heart rate variability and TCM Syndrome Elements:PNN50index in non dipper hypertensive patients decreased, while RMSSD index, SDNN index, SDNN index in patients of anti dipper increased.Conclusion:1. Through the general demographic data analysis:there were large numbers of females cases in600patients with hypertension. Dipper type group was positively correlated with duration of hypertension (r=0.09), and abnormal circadian rhythm of blood pressure of hypertension with age no any rsrelationship.2. There are different distribution characteristics of syndrome factors in the patients with aging hypertension, the disease location syndrome element of kidney plays the most important role, blood stasis, sputum, and yin deficiency are all the main characteristics. The main miscellaneous syndrome elements of aging hypertension patients are liver and kidney, sputum and blood stasis, qi and yin deficiency, and yin deficiency and sputum.3. The dipper, non dipper,anti dipper in elderly hypertensive patients with single disease of TCM syndrome elements of traditional Chinese medicine have strongest correlation with kidney, while deficiency of single disease—Yin have the strongest correlation with the dipper, non dipper, anti dipper in elderly hypertensive patients, and miscellaneous syndrome is deficiency of both qi and Yin. The strongest correlation of complex deficiency and excess syndrome elements is the deficiency of Yin and phlegm. Correlation between non dipper type, anti dipper in elderly patients with essential hypertension and turbid phlegm is blood stasis.4. PNN50index in non dipper hypertensive patients decreased, while RMSSD index, SDNN index, SDNN index in patients of anti dipper increased. |
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