| Backgroud and objective Hypertension is a common cardiovascular disease.At present,hypertension in China is generally characterized by high prevalence and low control rate.According to the epidemiological survey,the current control rate of hypertension in China is only 16.8%,accounting for only one third of hypertension patients receiving treatment.A number of surveys found the main factors of lower control rate of hypertension in China includ high salt diets,volume overload,doctors’ prescribing abits and drug choices,medication compliance,comorbid with other cardiovascular diseases or diabetes mellitus,smoking,drinking and genetic features,etc.Among many factors,volume overload is one of the important factors leading to low blood pressure control rate.In the past,the assessment of volume load depend on clinical assessment methods mainly,but its evaluation indicators were rough,and its sensitivity and accuracy were poor relatively.In recent years,with the increasing maturity of bioresistance-based body composition analysis(BIA),it has provided a non-invasive,fast,accurate,inexpensive,and easy accepted method for physicians and patients for evaluating body volume load.It has been reported previously that evaluation the volume of body fluid by chest impedance to guide dialysis and antihypertensive therapy gain good curative effect in patients with renal hypertension and obstination hypertension.However it is unclear whether the use of systemic impedance volume-load testing,especially including lower limb volume-load testing,to guide comprehensive volume management,including drug adjustment and dietary guidance,is beneficial for improving blood pressure control rate.In present study we would use BIA to assess the volume load and observe the impact of active volume management on blood pressue control rate and vascular function,to explore a more accurate antihypertensive regimen to improve blood pressure contal rate in ordinary essential hypertension patients.Method1.From March 2018-May 2018 in the health management department of the First Affiliated Hospital of Guangdong Pharmaceutical University individuals of healthy physical examination were screened and recruited.Participants underwent a standardized evaluation that included a medical history,physician-administered physical examination,height and weight collected,messurement of fasting glucose,high-density lipoprotein cholesterol,low density lipoprotein cholesterol,total cholesterol,triglyceride,serum creatinine,alanine aminotransferase,nmda transaminase and chest X-ray check.105 healthy individuals were defined as those with normal results of above check and enrolled.They were examined by BIA for human body composition analysis,measuring total body water(TBW),extracellular water(ECW),intracellular water(ICW),segmental intracellular water and extracellular water ratio.The kolmogtor-smirnov method was used for the normality test,and the normal distribution method was used to calculate the bilateral 95%confidence interval of extracellular water ratio(ECW/TBW)as the normal reference range.2.92 patients with essential hypertension who met the inclusion criteria in the Cardiology Department of the First Affiliated Hospital of Guangdong Pharmaceutical University from June to September 2018 were enrolled.According to the volume load stratification,they were randomly divided into a volume management group and a control group.For all the groups,the measurement of blood pressure,serum creatinine,urea nitrogen,electrolytes(Na+,K+,Cl-),endothelial function(Flow-mediated dilatation(FMD),arteriosclerosis(ba PWV,ABI),,oral salt sensitivity check and BIA volume load tests(ie,extracellular water ratio)were performed.Volume management measures were implemented for hypertensive patients in the volume management group(including informing physicians of patients’ volume load test results,adding or changing diuretics for patients with volume overload,and giving them lifestyle guidance including salt-limiting,physical exercise ect.by nurses);while,no volume management measures were implemented in the control group(the volume load test results were not informed to the physician,the use type of antihypertensive drugs was determined by the physician,and the nurse only gave general lifestyle guidance for hypertension,without emphasizing salt limit measures).All patients were instructed to measure and record home blood pressure as required for a follow-up period of 4weeks.AT the 4th week,all observation indicators were returned to the hospital for re-examination and the measurement data before and after the intervention were compared by paired t-test.The data differences between the two groups were compared by independent sample t-test,and p<0.05 was considered to be statistically significant.Result1.The 95% confidence interval on both sides of the extracellular water content(ECW / TBW)of 105 healthy individuals obtained by the normal distribution method is that the whole body ECW / TBW is 0.364 ~0.391,the right upper limb ECW / TBW is 0.368 ~ 0.384,and the left upper limb when ECW / TBW is 0.370 ~ 0.386,trunk ECW / TBW is 0.363 ~ 0.391,right lower limb ECW / TBW is 0.362 ~ 0.394,left lower limb ECW / TBW is 0.364 ~ 0.397.2.Baseline data of the two groups: ECW / TBW measurement results of the whole body,upper limbs,trunk,and lower limbs within the above range was definited as normal volume load.While,it was definited as volume overload that if one of the ECW / TBW was greater than the upper limit of above parameters.According to this criteria,among the 92 enrolled patients with hypertension,42 cases in the volume management group,21 cases(50%)of volume overload,and 50 cases in the control group,16 cases(32%)of volume overload.The proportion of volume overload,age(64 ±8.2 years old vs.63 ±7.6 years old),BMI(25.69 ±3.65kg/m2 vs 24.37± 2.58 kg/m2),initial blood pressure(165 ±8.22/69±8.31vs161 ±3.98/65 ±7.53 mm Hg),and indexes of electrolyte,liver and kidney function showed no statistically significant difference between the two groups.3.Blood pressure control rate after the intervention: In volume management group,39 patients reached the target standard of blood pressure,with a blood pressure control rate of 93%;in the control group,32 patients reached the target standard of blood pressure,with a compliance rate of 64%.The blood pressure control rate in the volume management group was significantly higher than in the control group(p <0.05).4.Within 4 weeks of intervention,the average blood pressure level and blood pressure variability: The average levels of systolic blood pressure in the volume management group were significantly lower and the coefficient of variation in blood pressure was significantly smaller than those in the control group(p <0.05).5.Comparison of diuretic usage rate and medication quantity: The diuretic usage rate of patients with volume overload in the volume management group was 100%,while that in the control group was only57.1%(p <0.05).The usage rate of diuretics of normal volume patients in the volume management group and the control group was 23.% vs.67.6%,respectively(p>0.05).There was no significant difference in the number of medications between the two groups(p> 0.05).6.Changes in extracellular water ratio:For patients with volume overload,after treatment,the extracellular water ratio decreased significantly in the volume management group was significantly lower after treatment,and was significantly lower than that in the control group(p<0.05).Extracellular water ratio also decreased in the control group,but not significantly(p > 0.05).For patients without volume overload,extracellular water ratio decreased significantly in the volume management group after treatment(p<0.05),but the difference was not significant compared with the control group.The extracellular water ratio in the control group was increased slightly(p> 0.05).7.Oral salt sensitivity changes: Before intervention,there were a total of 33 patients with volume overload and 57 patients without volume overload in the two groups.The office systolic pressure of patients with volume overload were higher than those of patients without volume overload(p<0.05).The taste loss scores of patients with volume overload were also higher than those of patients without volume overload(p<0.05).After group intervention,the changes of oral salt sensitivity in patients with or without volume overload were not significant(p> 0.05).8.Changes in FMD,ba PWV and ABI: There was a significant decrease in ba PWV after treatment in the volume management group(p<0.05),but no significant difference in FMD and ABI(p>0.05).There was no significant difference between the two groups before and after treatment(p> 0.05).Conclusion Comprehensive volume management measures can enhance the accuracy of antihypertensive treatment and significantly improve the blood pressure control rate in patients with essential hypertension. |
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