The Association Between Nonenzymatic Glycation(NEG) And Angiosclerosis And Left Ventricular Diastolic Function In Elderly Hypertensive Patients

Objective：To study the association of nonenzymatic glycation(NEG) and bloodpressure variability(BPV) with angiosclerosis and left ventricular diastolic functionin elderly patients with essential hypertension， we measured plasmacarboxymethyl(lysine)-adducts(CML)and soluble Receptor for Advanced GlycationEnd-products(sRAGE)and monitored24-hour ambulatory blood pressure.Methods: Serum levels of CML and sRAGE were measured by ELISA in84hypertensive elderly patients;Auto-survey atherosclerosis apparatus was applied toexamine pulse wave velocity(PWV).The maximal velocity of mitral flow E peak andA,the early diastolic velocity(Em) and the late diastolic velocity (Am) weremeasured by the two-dimensional echocardiography.We also measured E/A andEm/Am respectively. Non-invasive portable ambulatory blood pressure monitoringwas used to monitor24-hour ambulatory blood pressure.All-time blood pressurestandard deviation(s) were used as indicators of the blood pressure variability,including24h systolic blood pressure variation standard deviation(24hSs),24hdiastolic blood pressure variation standard deviation(24hDs), daytime systolic bloodpressure variation standard deviation(dSs), daytime diastolic blood pressurevariation standard deviation(dDs),nighttime systolic blood pressure variabilitystandard deviation(nSs)，and nighttime diastolic blood pressure variation standarddeviation(nDs).Result:1.A significantly positive association between sRAGE and CML level wasidentified (P <0.01). 2.24hSs,nSs and CML were positively corrected(P <0.05)，but there was noassociation between the rest of the blood pressure variability index and CMLlevels.However,no significant correlation was found between all the blood pressurevariability indicators and sRAGE.3.E/A， Em/Am were all negatively correlated to PWV respectively（r=-0.422，P=0.000；r=-0.308，P=0.004）。4.In the univariate analysis, PWV and age, CML, sRAGE,24hSs,dSs or nSswas positively correlated (P <0.05).In contrast, E/A, Em/Am were all negativelycorrelated to age, CML, sRAGE,24hSs or dSs(P<0.05).In addition,E/A wasnegatively correlated to nSs(P<0.05).5.Multiple linear regression models revealed that PWV and CML,24hSs,dSsor nSs,as well as E/A,Em/Am and CML (P<0.05,inversely),still remainedsignificantly independently (P<0.05, positively) after adjusting for age, gender,smoking, body mass index (BMI), fasting blood glucose, blood lipids and otherparameters,.There was no significant correlation in sRAGE with PWV, E/A, Em/Am or all blood pressure variability indicators (P>0.05).Conclusion: Nonenzymatic glycosylation are associated with increased arterialstiffness,while to some extent contributes to the decreased diastolic function inelderly patients with hypertension.Interventions to non-enzymatic glycation processwere putative novel strategies to lower arterial stiffness.In addition,there is asignificant association between angiosclerosis and the blood pressure variabilityindex,especially systolic blood pressure variability.So application of a24-hourambulatory blood pressure monitoring in measuring the blood pressure variabilityindex is very beneficial on the evaluation of degree of angiosclerosis in elderlyhypertensive patients.