| Objective: Over-diet or postprandial high blood glucose and lipoproteins are correlated with cardiovascular diseases; however, the status of postprandial blood pressure and pulse pressure and their relationship with organ damages are little known in patients with essential hypertension( EH ),type 2 diabetes mellitus(DM) and diabetes mellitus with hypertension (EH+DM). In present study, we observed the characterization of postprandial blood pressure and pulse pressure and we studied their correlation with function and structure of cardiovascular and kidney in EH ,DM and EH+DM. We aim to provide a practical clinical method to control postprandial hypertension and evaluate the organ damages in hypertension and diabetes. Methods: Two hundred fivty-five subjects were hospitalized. All of the patients were diagnosed by the guidline of WHO 1999 and 1998. Patients with secondary hypertension, secondary diabetes, valvular heart diseases, myocardiopathy,. myocardial infarction, congential heart diseases and severial vascular or kideny diseases were exclused. They received a diet containing standard nutritional ingredients. Patients were divided into three groups by the category of disease: EH (n=92); DM(n=87) and EH+DM (n=80). PPH was defined as the mean difference of systolic blood pressure(SBP),diastolic blood pressure(DBP) or pulse pressure(PP) before and after food intake at the same time pionts. According to PPH, patients also were divided into the following two groups according to the mean postprandial chang in SBP,DBP or PP for three meals: PPH1(ΔSBP <10mmHg,ΔDBP <5mmHg,ΔPP <10mmHg) and PPH-2(ΔSBP≥10mmHg,ΔDBP≥5mmHg,ΔPP≥10mmHg). Ambulatory blood pressure monitor (ABPM) and invasive arterial blood pressure were examined before and after food intake. the ratio between early diastolic peak flow velocity and atrial peak flow velocity(E/A), EF, LVMI and carotid artery were examined by echocardiography. Meanwhile, microalbuminuria(MAU),blood urea nitrogen(BUN),creatinine(Cr),creatinine clearance rate(CcR) were detected. Results: 1. 24 hours ambulatory DBP(24hABPD) in hypertensive DM was significantly lower than EH (P<0.01) ,but 24 hours ambulatory PP(24hABPP) was the highest among three groups(P<0.01). EF, E/A,CcR were lowest in three groups. However, LVMI, carotid artery plaque rate(CAPR), intimal medial thickness(IMT) and MAU were increased in hypertensive DM than EH or DM (P<0.01). E/A, LVMI, CAPR, IMT, CcR and carotid arterial diameter (CAD) are higher in EH than DM, but MAU and EF were lower in EH than DM. 2. Postprandial blood pressure(BP) increased significantly in EH(p<0.01). On contrast, postprandial BP decreased significantly in DM and hypertensive DM(P<0.05；P<0.01). Postprandial pulse pressure ( PP ) was significantly increased in EH and hypertensive DM(P<0.01), but not in DM alone(p>0.05). Postprandial BP and PP returning to preprandial level were slower in DM and hypertensive DM compared with EH at the same time points. 3. Relationship between the difference of pre- and postprandial BP or PP and organs damage: 1)In EH subjects: EF, E/A, and CcR were decreased in the PPH2 compared with PPH1 (P<0.01), and LVMI, CAPR, IMT, CAD, MAU were increased in PPH2 (P<0.01) compared with PPH1. but CcR was lower in the PPH2 than PPH1 (P<0.01 or P<0.05). 2)In DM and hypertensive DM groups: In group of PP,EF, E/A and CcR were significantly decreased but LVMI, CAPR, IMT, CAD, MAU were increased in the PPH2 (P<0.01). In group of SBP and DBP, MAU was higher and CcR was lower in the PPH2 than PPH1 (P<0.01 or P<0.05). 4．Correlation between postprandial BP and PP and organ damages:1)In the group of EH: IMT and LVMI significantly were correlated with postprandial SBP and PP at 1 hour and with 24hABPS and 24hABPP(P<0.01 or P<0.05). MAU was correlated with postprandial SBP, DBP, PP at 1 hour and with 24hABPS, 24hABPD, 24hABPP(P<0.01 or P<0.05).Postprandial BP and PP at 2 hour were not associated with these parametes. |
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