| Background:Hypertension is the most important risk factor of cardiovascular disease in China.Improving blood pressure evaluation and management is an important strategy to achieve healthy dreams in china.In recent years,the evaluation of blood pressure in hypertensive patients has been transformed from the single clinic blood pressure monitoring to the evaluation of multivariate blood pressure.24 hour ambulatory blood pressure monitoring can not only monitor the level of blood pressure in patients with hypertension all day long,the circadian rhythm of blood pressure and blood pressure variability,preliminary monitoring of the patient's heart rate and heart rate variability,but also can provide some special periods,such as nocturnal blood pressure,morning blood pressure.Nocturnal blood pressure and morning blood pressure are more predictive of cardiovascular risk than clinic blood pressure.So many in the blood pressure and heart rate information,if we can find some monitoring indicators closely related to target organ damage in hypertension,we can find out the optimal target for patients with hypertension,the realization of individual medical treatment in hypertensive patients.Objective:To investigate the relationship between the indexes of ambulatory blood pressure(such as blood pressure,heart rate)and the indexes of Cardiac target organ damage(such as left ventricular mass index,left atrial diameter index,mitral flow velocity/mitral annulus velocity)in untreated essential hypertension patients to finding optimal blood pressure intervention targets.Methods:This study included in 147 patients with primary hypertension treated by cardiovascular clinic or inpatient treatment in the First Affiliated Hospital of Fujian Medical University,35 patients with normal blood pressure were collected during the same period.All the subjects were not taking any antihypertensive drugs,or have short-term taking antihypertensive drugs,because of good blood pressure control and conscious self withdrawal of more than 2 weeks.The age range,19-89 years old,there were 79 males and 68 females.To exclude secondary hypertension,white coat hypertension,acute coronary syndrome,heart failure,valvular heart disease,cardiomyopathy,chronic renal insufficiency,acute stroke,diabetes,sleep apnea syndrome,chronic obstructive pulmonary disease,severe arrhythmia such as atrial fibrillation,atrial flutter,ventricular bigeminy,ventricular tachycardia and so on.The age,sex,duration of hypertension,body mass index(BMI),smoking history,alcohol consumption,family history,fasting plasma glucose(FBG),total cholesterol(CHOL),and triglyceride three(TG)were recorded.The ambulatory blood pressure monitor was used to monitor the 24 hour blood pressure and heart rate of the patients.The left ventricular mass index(LVMI),left atrial diameter index(LADI),mitral valve flow velocity/mitral valve tissue velocity(E/e')were measured by echocardiography.The correlation between ambulatory blood pressure indexes and LVMI,LADI,E/e'was analyzed.Results:(1)Compared with normal blood pressure group,the blood pressure level,heart rate,BMI and fasting blood glucose of hypertensive patients increased significantly(P<0.05),and no significant difference among other clinical basic indexes was found(P>0.05).(2)The LVMI and E/e'in the hypertensive group were significantly higher than that in the normal blood pressure group(LVMI:84.08±16.21 vs 76.31±11.93 kg/m~2,P<0.01,E/e':9.32±2.80 vs 7.56±1.64,P<0.01).(3)The third group with higher nocturnal systolic pressure,LVMI,LADI and E/e'were significantly higher than the first group with lower blood pressure.According to the morning systolic blood pressure to divide into three groups,E/e'of the third group were significantly higher than that of the other two groups,and the LADI in the second group was higher than the first group.However,LVMI,LADI and E/e'in the groups had no significant difference according to the all day long systolic pressure?all day diastolic pressure,daytime systolic blood pressure,daytime diastolic blood pressure,nocturnal diastolic blood pressure,morning diastolic blood pressure?(4)The subjects were divided into dipper type blood pressure group,non dipper blood pressure group and anti dippers blood pressure group according to the rate of nocturnal blood pressure decline.The results showed that LVMI,LADI and E/e'in the anti dipper blood pressure group were significantly higher than that of dipper blood pressure group and non dipper blood pressure group,no significant difference of target organ damage index was found among dipper blood pressure group and non dipper blood pressure group.(5)According to the rate of night heart rate decline,the subjects were divided into three groups:dipper heart rate group,non dipper heart rate group,and extreme dipper heart rate group.The results showed that the LADI and E/e'in the non dipper heart rate group were significantly higher than those in the extreme dipper heart rate group.The E/e'in the dipper heart rate group were significantly higher than those in the extreme dipper heart rate group.(6)The LVMI as the dependent variable,the nocturnal systolic blood pressure,morning systolic blood pressure,the rate of night heart rate decline,age,gender,hypertension duration,smoking history,drinking history,CHOL,TG,blood glucose and BMI as independent variables into the regression equation,multiple linear regression analysis showed that nocturnal systolic blood pressure(P=0.289.P=0.005)were independently associated with LVMI.(7)The LADI as the dependent variable,the nocturnal systolic blood pressure,morning systolic blood pressure,the rate of night heart rate decline,age,gender,hypertension duration,smoking history,drinking history,CHOL,TG,blood glucose and BMI as independent variables into the regression equation,multiple linear regression analysis showed that the rate of night heart rate decline(beta=-0.159,P=0.047),age(beta=0.327,P<0.001),BMI(beta=-0.178,P=0.020)were independently associated with LADI.(8)The E/e'as the dependent variable,the nocturnal systolic blood pressure,morning systolic blood pressure,the rate of night heart rate decline,age,gender,hypertension duration,smoking history,drinking history,CHOL,TG,blood glucose and BMI as independent variables into the regression equation,multiple linear regression analysis showed that the morning systolic blood pressure(beta=0.235,P=0.006),the rate of night heart rate decline(beta=-0.245,P=0.002),age(beta=0.332,P<0.001)were independently associated with E/e'.(9)LVMI,LADI and E/e'as the dependent variable respectively,the rate of nocturnal blood pressure decline,age,gender,hypertension duration,smoking history,drinking history,CHOL,TG,blood glucose and BMI as independent variables into the regression equation,multiple linear regression analysis showed that the rate of nocturnal blood pressure decline(P=-0.275,P=0.002)were independently associated with LVMI.Conclusion:The nocturnal systolic blood pressure,morning systolic blood pressure,the rate of nocturnal blood pressure decline and the rate of night heart decline were correlated with the cardiac target organ damage indexes in hypertensive patients.The nocturnal systolic blood pressure,the rate of nocturnal blood pressure decline is mainly related to LVMI,while morning systolic blood pressure,the rate of night heart rate decline is mainly related to LADI,E/e'. |
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