Ambulatory Blood Pressure Monitoring Of Elderly Hypertensive Patients And The Effect Of Continunous Nursing Intervention In Community

Objectives1. To find the differences of the indexes of Ambulatory Blood Pressure Monitoring (ABPM) between patients with different socio-demographic and clinical characteristics; To explore the interfering factors of ambulatory arterial stiffness index (AASI) and symmetrical AASI (Sym_AASI); To determine the relationship between AASI, Sym_AASI and CAVI (Cardio-ankle vascular index).2. To explore the effectiveness of the continuous nursing interventions directed by chronotherapeutics so as to provide the easy, noninvasive, effective and acceptable interventions for hypertensive patients in the community.Methods1. The cross-sectional study was used. A convenience sample of hypertensive patients was recruited in Wangdingdi community of Tianjin, China from May 2009 to October 2010. Sociodemographic and medical data were obtained and 24h ABPM and CAVI were measured. T test and ANOVA were used to find the differences of the indexes of ABPM and arterial stiffness between patients of different characteristics. The interfering factors of AASI and Sym_AASI were found by Logistic analysis and correlation analysis was used to explore the relationship between AASI, Sym_AASI and CAVI.2. The semi-experimental study was used and 60 patients from the first part were recruited and separated into two groups randomly, which were intervention group A (Behaviour and chronotherapy intervention) and intervention group B (Behaviour intervention). Another 30 hypertensive patients were recruited in the control group from the community. At 6m and 12m after the intervention ABPM and CAVI were measured for the intervetntion groups. Repeated measures and multivariate analysis of variance were used to evaluate the effectiveness.Results1. Patients'ABPM indexes were interfered by different sociodemographic and medical data. Daytime ABPM indexes were interfered more than nighttime by patients'different characteristics.2. There were statistical differences in daytime, nighttime and 24h systolic blood pressure (SP) between patients with different rhythm of blood pressure (P<0.01). The pulse pressure (PP), nighttime diastolic blood pressure (DBP) and the coefficient of variation (CV) of 24h DBP had statistical differences between patients with different rhythm of blood pressure (P<0.05). There were statistical differences in daytime SP, daytime and 24h PP, daytime and 24h SP load between patients with or without morning surge (P<0.05).3. There was significantly moderate positive correlation between AASI, Sym_AASI and CAVI. The cholesterol, duration of hypertension and diabetes interfered AASI, and Sym_AASI was interfered by cholesterol, gender and age.4. There were statistical differences in ABPM indexes between two intervention groups at different measurement time (P<0.01). There were statistical differences in the mean of ABPM between 6m,12m after and before the intervention and between the two groups at different measurement time. BP load of intervention group A had statistical differences at 6m and 12m after and before the intervention (P<0.01).5. The number of patients with dipper increased and patients with reverse dipper decreased in group A as the interventions were applied. There were statistical differences between two groups. The number of patients with morning surge decreased in two groups but the number in group A decreased more and there were statistical differences between two groups at 6m after the intervention.6. AASI and Sym_AASI of two intervention groups had statistical differences at different measurement time. Intervention group A had statistical differences between 6m and 12m after the intervention and before the intervention (P<0.0i).Conclusions1. The continuous nursing intervention based on patients'ABPM could control BP much better and decrease the CV of BP.2. The continuous nursing intervention could increase patients'nocturnal SP drop, increase patients with dipper and decrease patients with reverse dipper. Besides the nursing intervention could control patients'morning surge significantly.3. Sym_AASI could reflect the arterial stiffness better than AASI. AASI was interfered by cholesterol, duration of hypertension and diabetes. Sym_AASI was interfered by cholesterol, gender and age. The continuous nursing intervention could decrease AASI and Sym_AASI.