The Correlation Analysis Between Morning Blood Pressure Surge And Ventricular Remodeling,Early Renal Injury In Essential Hypertension Patients

Objective:To study the connection between the phenomenon of morning blood pressure surge(MBPS)and left ventricular remodeling,early renal injury index(GRF??2-MG?Cys-C)amongthe essential hypertension patients.Methods:Collected 86 patients who were hospitalized and diagnosed with essential hypertension from Yan'an University Affiliated Hospital cardiology department.All of the patients received the 24 hours ambulatory blood pressure monitoring(24h ABMP).The patients were separatated into two groups,according to the results of dynamic blood pressure that whether theyhave the morning pressure phenomenon.All patients were asked in detail about the general clinical data including symptom and duration of hypertension,smoking,drinking habits and measure height and weight accurately.The serum creatinine,?2-microglobulin and cystatin C were collected by the fasting blood assay and then estimated value of glomerular filtration rate(GRF)was calculated according to the MDRD formula the next day morning.The serum total cholesterol(TC),triglyceride(TG),low density lipoprotein(LDL),high density lipoprotein(HDL),fasting blood glucose(FBG)and other routine examination were carried out meanwhile.After the patients hospitilized,all recieved cardiac color Doppler ultrasonography,pecific project containedleft ventricular end diastolic diameter(LVEDd),Interventricular septumthickness(IVST),left ventricular posterior wall thickness(LVPWT).Then the left ventricular index(LVMI)was calculated by formulathe.All patients underwent cervical ultrasonography to determine whether Carotid intima thickening and Carotid endometrial plaque formed.To compare the difference between the following indexes observed in the morning blood pressuresurgre group and the non-morning blood pressuresurgre group in patients with essential hypertension:1.Comparison of blood pressure between the two groups of patients at 24 h ABMP in different period;2.The distinctives of left ventricular remodeling index(LVEDd,IVST,LVPWT,LVMI)and early renal injury index(GFR,?2-microglobulin,cystatin C)were observed in the two groups;3.To observe the difference of the incidence of carotid artery disease between the two groups;4.The correlation between the peak value of blood pressure surge and the target organ damage degreeaboat the heart and kidney was analyzed.5.The correlationbetween the peak value of blood pressure and age,BMI,fasting blood glucose(FBG),smoking,drinking were analyzed.Result:1.There were no significant differences in age,sex,smoking history,history of alcohol consumption,BMI,blood lipid and other clinical data in the two groups.2.Comparison of the 24-hour ambulatory blood pressure among the two groups in different perids: the MBPS group has a higher mean level blood pressure than the non-MBPS group including the following items:the 24-hour mean systolic blood pressure,the average daily blood pressure and diastolic blood pressure,the distinctive was statistically different;the mean blood pressure in other period was not statistically different.3.In the morning blood pressure surge group,the value of left ventricular diastolic diameter(LVEDd),ventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT)and left ventricular index(LVMI)were obviously higher thanthose in the non-morning blood pressure group,which was statisticallydistinctly.4.In the morning blood pressure surge group,the expression of GRF were lower compared with non-MBPS group,?2-microglobulin and Cys-C were higher compared with those in the non-morning blood pressure surge group,the distinctive was statistically different.5.The incidence of left ventricular hypertrophy in the morning blood pressure surge group was higher than that in the non-morning blood pressure surge group,the distinctive was statistically different.6.In the morning blood pressure surge group,the incidence of carotid artery disease contained carotid intima thickening and / or plaque formation has a high levelcompared with the non-morning blood pressure surge group,the distinctive was statistically different.7.The peak value of blood pressure was positively correlated with left ventricular index(LVMI),?2-microglobulin and cystatin C(Cys-C);and negatively correlated with glomerular filtration rate(GRF),which was analysed bypearson correlation.8.The peak value of blood pressure was positively correlated with age,BMI,fasting blood glucose(FBG),24 h SBP,d SBP,smoking and drinking analysed by pearson correlation;Multivariate linear stepwise regression analysis suggested that the morning blood pressure surge was independently correlated with age,BMI,FBG,24 h SBP,and smoking.Conclusion1.In regard tohypertensionpatients suffered by morning blood pressure surge,they have higher pressure level,including the 24-hour mean systolic blood pressure,mean systolic blood pressure and diastolic blood pressurein daytime.ABMP can observe the trend of blood pressure fluctating effectively,which can be used for management of whole-scale blood pressure.2.The phenomenon of morning blood pressure surge is closedly corelated with left ventricular remodeling,the left ventricular end diastolic diameter(LVEDd),ventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT),and left ventricular index(LVMI)has a higher level in the MBPS group than these in the non-MBPS group,MBPS phenomenon can aggravate the occurrence of left ventricular remodeling.3.The phenomenon of morning blood pressure surge is closedly corelated with early renal injury index(GRF??2-MG?Cys-C),the varieties of glomerular filtration rate(GRF),?2-microglobulin and cystatin C(Cys-C)were more obvious in hypertensive patients with morning blood pressure surge,MBPS may aggregated the early renal injury.4.The phenomenon of morning blood pressure surge was corelated with carotid atherosclerosis lesions,blood pressure morning peak phenomenon can promote the occurrence of carotid artery disease.5.The peak value of morning blood pressure in hypertensive patients was positively correlated with the target organ disease index(?2-microglobulin,Cys-C,LVMI),and negtively correlated with GRF,suggesting that with the morning peak higher,blood pressure fluctuating more widely,the target organ damage index changed more obviously.6.The peak value of morning blood pressure in hypertensive patients was positively correlated with age,BMI,FBG,24 h SBP,d SBP,smoking and drinking;and the age,BMI,FBG,24 h SBP,smoking were independently related with peak value of morning blood pressure surge,indicating that the clinical control of BMI,FBG,24 h SBP,smoking may reduce the occurrence of blood pressure morning peak phenomenon.