Analysis Of Sleep Status And Rhythm On Circadian Rhythm Of Blood Pressure In Elderly Patients With Hypertension

Objective To explore the characteristics and circadian rhythm of sleep rhythm(quantity and quality)in elderly hypertensive patients.To explore the risk factors of blood pressure in discipline disorder with elderly hypertensive patients.The effects of sleep rhythm on circadian rhythm were further analyzed.To improve the circadian rhythm of blood pressure,improve the quality of life and reduce the risk of cardiovascular and cerebrovascular complications in elderly patients through sleep intervention.Methods One thousand and six patients(Aged>60 years)with diagnosed hypertension in the Department of Geriatric Cardiology of People Liberation Army General Hospital from 2016 to 2017 were enrolled in the study.After admission,the clinical data,laboratory tests and examinations of patients were collected and analyzed.The patients’ sleep were investigated by Pittsburgh sleep quality index(PSQI).The cases were divided into three groups according to the rhythm of ambulatory blood pressure:reverse-dipper group(n=492),non-dipper group(n=382)and dipper group(n=132).The clinical data and sleep situation of different blood pressure rhythm group were compared,and the effect of sleep status on different blood pressure rhythm was analyzed.Results1.The 24 hours average systolic and 24 hours diastolic blood pressure decreased according to the order of the reverse dipper blood pressure group,non-dipper blood pressure group and dipper blood pressure group,and the difference was not statistically significant.The diastolic blood pressure and diastolic blood pressure were lower in the dipper blood pressure group than in reverse dipper blood pressure group and non-dipper blood pressure group during the day,and the difference was statistically significant.Compared with reverse dipper blood pressure group,the night systolic and diastolic blood pressure was lower in the non-dipper blood pressure group and dipper blood pressure group,and the difference was statistically significant.2.According to the order of the reverse dipper blood pressure group,non-dipper blood pressure group and dipper blood pressure group,PSQI score showed a decreasing trend,and the difference was statistically significant.Compared with the reverse dipper blood pressure group,the sleep quality of the non-dipper blood pressure group and dipper blood pressure group was significantly better(PSQI score and its seven components),and the difference was statistically significant.3,It can be concluded that the correlation coefficient is-0.647,the cutting rate is 6.366,equation for:Y =-0.647 + 6.366 X,when PSQI as an independent variable and the nocturnal blood pressure drop rate as an dependent variable entrancing to the linear correlation and regression equation.It indicates that the sleep condition is negatively correlated with the decrease rate of nocturnal systolic blood pressure.4.In Logistic regression equation,PSQI scores is still an independent risk factor of the reverse dipper blood pressure rhythm after adjusting for gender,age,body mass index,smoking,drinking,exercise,time history of high blood pressure and high blood pressure medications.The worse the quality of sleep,the more likely it is to have a blood pressure rhythm.In the group of non-dipper and dipper group,it did not found the PSQI score was an independent risk.The corresponding OR values were 1.17(95%Cl:1.13-1.21),0.90(95%CI,0.87-0.93),0.91(95%CI,0.86-0.96).5.In the multiple linear regression equation,it found that the nocturnal blood pressure dipping was positively correlated with exercise and ACEI/ARB,and was negatively correlated with BMI,male,smoking,age of hypertension and PSQI after adjusting for gender,age,body mass index,smoking,alcohol consumption,exercise,history of hypertension,hypertension medications,etc.The nocturnal blood pressure dipping was negatively correlated with sleep duration,sleep awakenings,use of sleep drugs,and daytime dysfunction after further adjusting for its seven components.Conclusion1.In elderly hypertensive patients,the incidence of reverse dipper blood pressure rhythm is significantly higher than other two groups.The overall control of blood pressure was poor,both the daytime blood pressure and blood pressure at night in reverse dipper group.And the sleep condition of the reverse blood pressure group was significantly worse.2.The patients,who have good sleep,more likely to have a higher rate of nocturnal blood pressure dipping,have good blood pressure rhythm and blood pressure level.The good sleep condition has a good correlation with the night blood pressure dropping and can be a protective factor for blood pressure rhythm.3.Exercise,taking appropriate antihypertensive drugs and good sleep are protective factors of blood pressure rhythm,Body mass index,smoking,men and high blood pressure were the risk factors for blood pressure rhythm.4.After adjusting for the common and possible risk factors for high blood pressure,it is showed that sleep time,sleep awakening,using drugs,daytime dysfunction is still an independent factor to predict the rhythm of blood pressure.5.The effect of sleep condition on blood pressure rhythm in elderly patients with hypertension should not be ignored.Sleep condition can be used as a predictor for blood pressure rhythm and a target for clinical intervention treatment.