Study On The Influencing Factors Of Short-term Blood Pressure Variability In Patients With Essential Hypertension

Objective:To explore the influencing factors of short-term blood pressure variability in patients with essential hypertension in the cardiology department,to find a target that may reduce short-term blood pressure variability,and provide new treatment ideas for preventing cardiovascular and cerebrovascular events in patients with hypertension.Methods:Retrospective analysis of 345 patients with primary hypertension who were aged 18 years old from October 31,2017 to March 1,2018 in the Department of Cardiology,China-Japan Friendship Hospital.All patients underwent ambulatory blood pressure monitoring and had a complete clinical situation.Laboratory observation indicators,auxiliary examination observation indicators,etc.,select daytime,nighttime,all-day systolic blood pressure and diastolic blood pressure standard deviation and coefficient of variation as short-term blood pressure variability indicators,according to the nighttime diastolic blood pressure coefficient of variation quartile patients Group comparisons were made for the lower,lower,higher,and higher groups.In addition,Spearman correlation analysis and logistic regression statistical methods were used to analyze the influencing factors of short-term blood pressure variability in patients with essential hypertensionResults:A total of 345 patients were enrolled in the study.There were more males than females(including 215 males and 130 females),43.3%had diabetes,nearly one-third had smoking history,half had coronary heart disease,and more than half had dyslipidemia..According to the quartile of nighttime diastolic blood pressure coefficient of variation(NDCV),the results showed that the age of the high variability group was significantly higher than that of the other groups(P<0.001);the gender composition was significantly different between the groups.Among the laboratory parameters,HGB,RBC and LDL-C were significantly higher in the NDCV group than in the other groups(P<0.001;P<0.05;P<0.05;);Apo-B,Apo-E,eGFR were significantly lower than Other groups(P=0.001;P=0.003;P=0.001)The echocardiographic index LAD was significantly greater in the NDCV high group than in the other groups(P<0.05).Spearman correlation of systolic variability throughout the day showed that age,WBC,RBC,HGB,CR,Apo-A1 were associated with 24h SCV(r=0.173,P=0.001;r=-0.133,P=0.013;r=-0.141).,P=0.009;r=-0.117,P=0.031;r=0.120,P=0.026;r=0.117,P=0.034).Spearman correlation of all-day diastolic variability showed that WBC,RBC,HGB,and eGFR were negatively correlated with 24h DCV(r=-0.131,P=0.015;r=-0.231,P<0.001;r=0.205,P<0.001;r=-0.221,P<0.001).Daytime systolic pressure variability Spearman correlation showed age,WBC,RBC,HGB,CR,eGFR,Apo-A1 and DSCV correlation(r=0.257,P<0.001;r=-0.164,P=0.002;r=-0.225,P<0.001;r=-0.196,P<0.001;r=-0.117,P=0.029;r=0.151,P=0.005;r=0.143,P=0.009).Spearman correlation analysis of diastolic variability during the day showed that age,WBC,RBC,HGB,CR,eGFR,LAD were associated with DDCV(r=0.296,P<0.001;r=-0.116,P=0.031;r=-0.248,P<0.001;r=-0.240,P<0.001;r=-0.201,P<0.001;r=0.136,P=0.015).Spearman correlation analysis of nocturnal systolic blood pressure variability showed that age,BMI and NSSD were positively correlated,but the correlation was weak(r=0.137,P<0.05;r=0.129,P<0.05).Nighttime diastolic variability Spearman correlation analysis showed age,red blood cells,hemoglobin,glomerular filtration rate,homocysteine,total cholesterol,Apo-E,LDL-C,PWV,IVSD.Among them,age,eGFR and PWV were strongly correlated,and the correlation coefficient was r>0.2.eGFR,TC,Apo-E,LDL-C were negatively correlated with NDSD(r=-0.112,P<0.05;r=-0.143,P<0.01;r=-0.112,P<0.05;r=-0.116,P<0.05),Hcy was positively correlated(r=0.113,P<0.05);eGFR was significantly negatively correlated with NDCV(r=-0.235,P<0.001).After adjusting for the mixed blood pressure,clinical comorbidity,medication,and other confounding factors,logistic regression analysis showed that age,BMI,Apo-B reduction and 24-hour diastolic blood pressure coefficient of variation(OR=0.96,P=0.004;OR=0.90,P=0.012;OR=8.85,P=0.004),daytime diastolic pressure coefficient of variation was independently correlated(OR=0.89,P=0.004;OR=0.96,P=0.016;OR=20.74,P=0.000).Age,BMI and nighttime diastolic blood pressure coefficient of variation were independently correlated(OR=0.89,P=0.004;OR=0.94,P=0.000)Conclusions:1.Age,BMI,eGFR,Apo-B,LDL-C,LAD,LPWV,etc.of hospitalized hypertensive patients are associated with short-term blood pressure variability.2.Adjusted confounding factors,age,BMI,Apo-B reduction were independently associated with 24-hour diastolic blood pressure coefficient of variation and daytime diastolic blood pressure coefficient of variation.Age,BMI and nighttime diastolic blood pressure coefficient of variation were independently correlated.