| Objectives:(1)To explore the pathogenesis of primary hypotension in TCM;(2)To evaluate the clinical efficacy applied ambulatory blood pressure monitoring(ABPM)compare to clinic blood pressure(CBP)in patients of pattern of both Yin and Yang deficiency treated by self-designed six-flavor decoction of elevating blood pressure;(3)To observe the safety of self-designed six-flavor decoction of elevating blood pressure in patients of pattern of both Yin and yang deficiency.Methods: The CBP and ABPM were measured in randomly selected untreated outpatient patients who had the history of hypotension repeatedly and excluded of secondary hypotension.Total of 48 cases of primary hypotension of pattern of both Yin and yang deficiency who was in conformity with the diagnostic criteria in each period of average blood pressure ? 100/60 mmHg or low blood pressure load values ? 25% / 20% were treated by self-designed six-flavor decoction of elevating blood pressure(150ml,tid)for 4 weeks.The symptoms and adverse reaction of patients,CBP,24 hour mean blood pressure,daytime mean blood pressure,nighttime mean blood pressure,mean arterial pressure,blood pressure variability,blood pressure load value and heart rate were compared befor and after treatment.Results:1.The improvement in syndrome of Chinese medicine: The symptoms of patients such as dizziness,fatigue,lacking in strength,shortness of breath and intolerance of cold etc.were obviously relieved after treatment,the effective rate in syndrome of Chinese medicine was 89.6%(43/48);The improving of symptoms was faster and more obvious than the recovery of blood pressure.2.The comparison of CBP:(1)After treatment,CBP was higher than that of before treatment(119.33±13.16/70.95±7.21 vs 115.14±15.35/67.29±8.94 mmHg,P<0.05);(2)Before treatment,the CBP was higher than the average daytime blood pressure(115.14±15.35/67.29±8.94 vs 103.20±9.44/62.64±5.90,P<0.01);(3)After treatment,the CBP was also higher than the average daytime blood pressure(119.33±13.16/70.95±7.21 vs 112.93±11.30/68.00±6.39,P<0.01).3.The comparisons of mean ambulatory blood pressure:(1)The average blood pressure of 24 hours after treatment was higher than that of before treatment(108.45±8.82/63.87±5.06 vs 98.39±9.63/58.50±5.00 mmHg,P<0.01),and the ascensional amplitude of average 24 hours SBP was higher than that of average 24 hours DBP(10.06±11.19 vs 5.37±4.68 mmHg,P<0.01);(2)The average daytime blood pressure was higher than that of before treatment,(112.93±11.30/68.00±6.39 vs 103.20±9.44/62.64±5.90 mmHg,P < 0.01),and the ascensional amplitude of average daytime SBP was higher than that of average daytime DBP(9.72±11.22 vs 5.35±5.22 mmHg,P<0.01);(3)The average nighttime blood pressure was higher than that of before treatment(107.29±10.02/62.41±5.94 vs 96.70 ± 9.50/57.27 ±5.44 mmHg,P<0.01),and the ascensional range of average nighttime SBP was more than that of average nighttime DBP(10.58±9.65 vs 5.14±6.08 mmHg,P<0.01).4.The comparisons of blood pressure load value and low blood pressure load value:(1)There was no significant change of blood pressure load during the daytime after treatment than that of before treatment(2.08±4.88/0.48±1.00 vs 1.78±3.90/0.72±0.92,P>0.05);and there was also no significant change of blood pressure load at nighttime between before and after treatment(1.89±3.10/0.50±1.67 vs 1.73±3.37/0.60±1.63,P>0.05);(2)The blood pressure reverse load value in the daytime after treatment was smaller than that of before treatment(3.35±7.78/19.02±16.28 vs 8.86±11.92/33.50±22.17,P<0.01);After treatment,the blood pressure reverse load value at nighttime was smaller than that of before treatment(9.89±15.12/22.60±15.60 vs 21.64±24.25/47.22±22.49,P<0.01).5.Making a comparison of blood pressure variability:(1)There was no significant difference in the standard deviation of blood pressure in the daytime between before and after treatment(11.22 + 2.90/7.55 + 1.66 vs 11.48 + 2.56/7.61 + 2.02,P > 0.05).(2)There was also no significant difference in the standard deviation of blood pressure at nighttime between before and after treatment(10.65 + 3.21/9.05 + 8.28 vs 9.45+3.65/6.94+1.98,P>0.05).6.The contrasting of nocturnal blood pressure drop rate:After treatment,the nocturnal blood pressure drop rate was not significantly different from that of before treatment(11.41±2.96/13.35±1.76 vs 11.97±2.88/13.79±1.38,P>0.05).7.The contrasting of average arterial pressure:(1)The 24 hours average arterial pressure after treatment was increased(84.41+5.81 vs 80.52+6.07 mmHg,P<0.01);(2)The daytime average arterial pressure after treatment was increased(85.95+6.15 vs 82.16+6.47 mmHg,P<0.01);(3)The nighttime mean arterial pressure after treatment was higher than that of before treatment(79.08±6.72 vs 74.83±6.73 mmHg,P<0.01);(4)There was no evident difference in elevated value of average arterial pressure after treatment between daytime and nighttime(3.79+5.79 vs 4.25+7.37 mmHg,P>0.05).8.The comparings of heart rate changes:(1)There was no significant difference in 24 hours mean heart rate before and after treatment(70.18±9.16 vs 70.37±7.71 bpm,P>0.05);(2)There was no significant difference in daytime average heart rate before and after treatment(73.16±9.19 vs 72.41±8.44 bpm,P>0.05);(3)There was no significant difference in nighttime average heart rate before and after treatment(62.64±6.76 vs 63.33±6.63 bpm,P>0.05).9.The adverse reaction: There were 2 cases of mild diarrhea and 1 case of facial flushing in taking medicine at the first week,but all of those disappeared quickly.The rate of adverse reaction was 6.25%(3/48).Conclusions:1.The clinical symptoms can be significantly improved in patients with primary hypotension of pattern of both Yin and Yang deficiency treated by self-designed sixflavor decoction of elevating blood pressure;The improving of symptoms is faster and more obvious than the recovery of blood pressure.2.It can effectively elevate those of 24 hours and daytime or nighttime average blood pressure especially average systolic blood pressure;It can also increase CBP and mean arterial pressure in each period.3.After treatment the blood pressure load values,heart rate,blood pressure variability,the night falling rate of BP are no obvious change,only the low blood pressure load values can be decreased.4.It has less or mild adverse reaction and good security.5.There are different pathogenesis and clinical syndromes in TCM for patients with primary hypotension,The dialectical treatment is effect obviously. |
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