A Clinical Study Of Relationship Between Blood Pressure Variability And Target Organ Damage In H-type Hypertensive Patients

Objective:To study the relationship between blood pressure variability and related target organs damage in the H- type hypertensive patients, in order to demonstrate the synergistic effects of homocysteine and the blood pressure variability on target organ damage in the hypertensive patients.Methods:174 essential hypertensive patients were enrolled in our study from 2013.1 to2014.12, and 52 health subjects were served as controls. According to the level of serum Hcy, all the hypertensive patients were divided into two groups: high homocysteine hypertensive group(HH group, Hcy>10μmol/L, n=89)and normol homocysteine hypertensive group(NH group, Hcy<10μmol/L,n= 85). All patients were required to measure height, body weight, blood pressure, blood liver and renal function tests, serum lipid, fasting plasma glucose, homocysteine(Hcy), urinary albumin, estimate glomerular filtration rate. All subjects were underwent ambulatory blood pressure monitoring, and record: 24 hour average systolic blood pressure, 24 hour average diastolic blood pressure and the corresponding standard deviation; day average systolic blood pressure, day average diastolic blood pressure and the corresponding standard deviation; night verage systolic blood pressure,night average diastolic blood pressure and the corresponding standard deviation, at the same time to calculate the coefficient of variation ultrasound. Done the echocardiography examination and measured left ventricular end-diastolic dimension(LVDd), interventricular septal thickness(IVST)and left ventricular posterior wall thickness(LVPWT), then calculated left ventricular mass index(LVMI) was calculated. And ultrasonography was introduced to messure carotid artery intima media thickness(IMT). And the cerebrovascular diseases were checked by cerebral CT or MRI scan. The differences of related indicators between three groups were compared, and correlation of hcy, blood pressure variability and renal function, LVMI, IMT, cerebrovascular disease was analyzed by SPSS 17.0,then the relationship between Hcy, blood pressure variability and the related indicators was analyzed by parallel multiple linear stepwise regression analysis and Logistic regression analysis.Results:1.There was no difference of all subjects in age, male ratio, body mass index(BMI), triacylglycerol(TG), total cholesterol(TCHO), high density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol(LDL- C), alanine aminotransferase(ALT),aspartate aminotransferase(AST),γ-glutamyl transpeptidase(GGT), fasting plasma glucose(FPG). And the time course of hypertension and office blood pressure showed no statistically significant differences in hypertensive patients.2.In HH group, the levels of IMT, LVMI, UAlb, UA, Scr and the detection rate of cerebrovascular disease were significantly higher than in NH group, while the level of e GFR was lower(P < 0.05).3.Blood pressure variability(BPV) in the two hypertensive groups were greater than in the control group(P < 0.05). Day average diastolic blood pressure(d DBP) in the HH group was significantly lower than in the NH group, and the other blood pressure variability(BPV) indexes were no significant difference between two groups.4.The target organ damages of heart, brain, kidney, blood vessels were significantly correlated with Hcy; IMT was positively correlated with 24 hours average systolic blood pressure, day average systolic blood pressure, night average systolic blood pressure and their blood pressure variability; e GFR was negatively correlated with24 hours average systolic blood pressure, night average systolic blood pressureand and their blood pressure variability(P < 0.05).5. With multiple linear stepwise regression analysis: the IMT, LVMI,cerebrovascular disease, Scr and Hcy were positively correlated; e GFR were negatively correlated with Hcy and night average systolic blood pressure coefficient of variation(n SCV), as well positively related with day average diastolic blood pressure(d DBP); LVMI was positively related with night average systolic blood pressure standard deviation(n SSD), also negatively correlated with e GFR and night average systolic blood pressure coefficient of variation(n SCV);.6. Logistic regression analysis showed that: Hcy and n DSD have synergy to LVMI,Hcy and d DCV have superimposed effects to UAlb, also 24 h SBP, d SBP, d DCV and Hcy have superposition to e GFR.Conclusion:1. The target organ damage of hypertension patients has a certain relevance to the short-term blood pressure variability.2. In H-type hypertensive patients, elevated plasma homocysteine levels is an important influencing factor of the target organ damage, plasma homocysteine levels was positively associated with the risk for target organ damage.3. 24 hour average systolic blood pressure, day average systolic blood pressure and Hcy have synergistic effects on the impaired renal function in H-type hypertensive patients.4. The increased blood pressure variability and Hcy have superimposed effects on the heart and kidney damage in H-type hypertensive patients.