| Background:Epidemiological investigation shows that the incidence rate of hypertension and insomnia in China is at a high level.The two often occur together and belong to the category of dual heart disease.The normal blood pressure rhythm of the human body is characterized by a "double peak and one valley" fluctuation curve.Insomnia can increase the proportion of non dipper blood pressure rhythm in hypertensive patients and increase the risk of cardiovascular disease.Enriching traditional Chinese and western medicine research on the impact of insomnia on blood pressure variability has a positive impact on the prevention and treatment of hypertension.Objectives:1.Study the impact of essential hypertension combined with insomnia on blood pressure variability,as well as the correlation between blood pressure variability and general clinical data;2.Study the characteristics of TCM syndromes in patients with essential hypertension combined with insomnia,and explore the similarities and differences between the characteristics of TCM syndromes in patients without insomnia;Study the correlation between the syndrome characteristics and various clinical indicators of patients with essential hypertension combined with insomnia.Study 1:A cross-sectional study on the correlation between blood pressure variability and insomnia in essential hypertension1 Methods:A cross-sectional survey was used to collect relevant information about hospitalized patients using a questionnaire.The study subjects were divided into an insomnia group and a control group based on whether they met the diagnosis of insomnia.Input the research data into Excel 2019 software and build a database.After data preprocessing of the questionnaire,SPSS 25.0 was used for frequency statistics and correlation analysis.2 Results:From 602 hospitalized patients who completed ambulatory blood pressure monitoring,157 eligible hypertensive patients were selected,of which 74 belonged to the insomnia group and 83 belonged to the control group.The analysis of the included cases showed that:(1)baseline data:there were no statistically significant differences between the insomnia group and the control group in terms of gender,age,smoking and alcohol history,cardiovascular risk stratification,other cardiovascular risk factors,target organ damage,etc.The baseline data of the two groups of patients were comparable;(2)Comparison of blood pressure variability between two groups of study subjects:the morning peak blood pressure in the insomnia group was 10.50(0.00,19.00)mmHg,while the morning peak blood pressure in the control group was 0.00(0.00,14.00)mmHg.The overall morning peak blood pressure in the insomnia group was higher than that in the control group,and the differences between the groups were statistically significant.The 24hMSBPSD,24hMDBPSD,DMSBPSD,and NMSBPCV of the insomnia group were higher than those of the control group,and the nocturnal decrease rate of systolic blood pressure was lower than that of the control group,but the difference was not statistically significant(P>0.05).The proportion of dipper type blood pressure in the insomnia group was significantly higher than that in the control group,but the difference was not statistically significant(P>0.05);(3)Correlation analysis between blood pressure variability and PSQI and various components of the scale in patients with hypertension and insomnia:There is a negative correlation between all kinds of SD,CV and PSQI,subjective sleep quality,and there is a negative correlation between sleep time and daylong and diurnal SD,CV,as well as NMSBPCV,among which the correlation between DMDBPSD,DMDBPCV and sleep time is statistically significant;The daylong and diurnal SD and CV,NMSBPCV and NMSBPSD were negatively correlated with hypnotics,while NMDBPSD and NMDBPCV were positively correlated with hypnotics,of which the correlation between DMSBPCV,DMDBPCV and hypnotics was statistically significant;The morning peak blood pressure was negatively correlated with PSQI,sleep latency and sleep time,and positively correlated with subjective sleep quality,sleep efficiency,sleep disorders,daytime dysfunction,and hypnotics,but the correlation was not statistically significant;The blood pressure rhythm was positively correlated with PSQI,subjective sleep quality,sleep time,sleep disorder,daytime dysfunction,and hypnotics,among which the correlation with daytime dysfunction and hypnotics was statistically significant;The nighttime decline rate of systolic blood pressure and diastolic blood pressure is positively correlated with daytime dysfunction,with statistical significance between the nighttime decline rate of systolic blood pressure and daytime dysfunction;(4)Multivariate regression analysis of BPV and sleep quality in patients with insomnia:whether the blood pressure rhythm is dipper type is a two categorical variable,which is used as a dependent variable to construct a binary logistic regression analysis model.The results show that there is no statistical significance(P>0.05),which cannot explain the independent influence of each variable on the blood pressure rhythm;The other BPV indicators are quantitative data,and each BPV indicator does not conform to a linear relationship with relevant influencing factors,making it impossible to conduct linear multivariate regression analysis.Therefore,it is temporarily impossible to further determine the correlation between variables.3 Conclusions:The morning peak blood pressure in the insomnia group was significantly higher than that in the control group,and insomnia may increase the risk of hypertension by causing an increase in the morning peak blood pressure;Insomnia may also increase the cardiovascular risk of hypertension by increasing the standard deviation and coefficient of variation of blood pressure;For hypertensive patients with insomnia,sleep quality may affect the risk of hypertension by affecting the standard deviation and coefficient of variation of blood pressure.The poorer the patients’ sleep quality,the smaller the amplitude of blood pressure fluctuations,and the indicators affected by different sleep quality items vary;For hypertensive patients with insomnia,the poorer the sleep quality,the more blood pressure decreases at night,and the more significant the impact on systolic blood pressure.Study 2:Study on the Characteristics of TCM Syndromes in Patients with Essential Hypertension and Insomnia1 Methods:Based on the results of previous literature surveys and expert opinions,determine the information collection form for TCM syndromes.During the first stage of the study,fill out the information collection form according to the corresponding content in the patients’ hospitalization medical record.Organize and verify the collected data,and input it into Excel 2019.Conduct frequency analysis on the four diagnostic information of traditional Chinese medicine,and have researchers classify the included research subj ects based on syndrome differentiation.Use SPSS 25.0 software to analyze the correlation between syndrome classification and relevant clinical data.2 Results:The included cases are the same as study 1:a total of 157 hypertensive patients,of which 74 belong to the insomnia group and 83 belong to the control group.(1)Analysis of the frequency of TCM syndromes in the overall research subjects:Symptoms and signs with a frequency greater than 8%include chest tightness,palpitations,dizziness,insomnia,fatigue and fatigue,loose or constipation,dry mouth,soreness and weakness of waist and knees,bitter mouth,headache,heavy head,drowsiness,mild edema of lower limbs,stuffiness in the stomach,and bloating.Tongue with a frequency greater than 8%includes dark,light red,red,and light tongue.Coating on the tongue with a frequency greater than 8%includes yellow,thin,greasy fur,white,thick.The tongue of most patients has 2-3 manifestations coexisting.Pulse signals with a frequency greater than 8%include smooth,stringy,thin,and heavy pulses.Pulse signals in most patients have two manifestations coexisting;(2)Analysis of the correlation between the syndrome types and sleep status of the overall research subjects:71 cases of stagnation of phlegm-fluid,47 cases of deficiency of kidney Yin,and 39 cases of ascendant hyperactivity of liver Yang.Among the patients with stagnation of phlegm-fluid,32 cases also showed concurrent symptoms,with 26 cases of concurrent heat and 6 cases of concurrent blood stasis.Compared with patients without insomnia,patients with hypertension complicated with insomnia had a higher proportion of ascendant hyperactivity of liver Yang and a lower proportion of deficiency of kidney Yin in the insomnia group compared to the control group.The proportion of deficiency of kidney Yin was similar to the control group,but the difference was not statistically significant(P>0.05).Among hypertensive patients with different sleep quality,patients with ascendant hyperactivity of liver Yang have more daytime dysfunction,patients with deficiency of kidney Yin have longer sleep time,and patients with deficiency of deficiency of kidney Yin have better subjective sleep quality.(3)The correlation between TCM syndrome types and various clinical indicators in patients with hypertension and insomnia:Among patients with deficiency of kidney Yin,women account for a relatively high proportion(79.2%),while in patients with the other two syndrome types,men and women account for approximately half of the proportion;The average age of patients with ascendant hyperactivity of liver Yang is lower than that of patients with the other two types;The proportion of "very high-risk"patients with deficiency of kidney Yin is significantly higher than the proportion of the other two types;The proportion of alcohol consumption in patients with ascendant hyperactivity of liver Yang is higher than that in patients with the other two types,and the proportion of non alcohol consumption is lower than that in patients with the other two types;Nearly half of patients with deficiency of kidney Yin have a nap habit,while the majority of patients with the other two syndrome types do not have a nap habit.Only the difference in alcohol consumption history is statistically significant;The 24hMDBPSD,DMDBPSD,and NMDBPSD of patients with stagnation of phlegm-fluid were higher than the other two types,and the nocturnal decrease rate of systolic blood pressure was lower than the other two types.The nocturnal decrease rate of diastolic blood pressure and morning peak blood pressure of patients with ascendant hyperactivity of liver Yang were lower than the other two types.The 24hMSBPSD of patients with deficiency of kidney Yin was lower than the other two types,and there was no significant difference in blood pressure rhythm among the three syndrome types.However,the above results were not statistically significant(P>0.05).3.Conclusions:The TCM syndrome types of patients with hypertension combined with insomnia can be divided into ascendant hyperactivity of liver Yang,stagnation of phlegmfluid and deficiency of kidney Yin The main syndrome is stagnation of phlegm-fluid,which can also be accompanied by heat syndrome or blood stasis.The current consensus among hypertension experts still has good applicability in determining the type of hypertension combined with insomnia,but in terms of individualized judgment of syndrome types,specific analysis is still needed based on the actual situation;Insomnia may not have a significant impact on the distribution of syndrome types in hypertensive patients;Drinking alcohol can increase the occurrence of ascendant hyperactivity of liver Yang;There may be a certain correlation between the syndrome types and blood pressure variability in patients with hypertension and insomnia. |
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