The Influence Of Morning Blood Pressure Surge On Target Organ Damage In Patients With Hypertension

Background and PurposesSo-called morning blood pressure surge refers to the phenomenon of a sharp rise in blood pressure after waking in the early morning in patients with essential hypertension. For a normal person’s blood pressure,no matter systolic blood pressure or diastolic blood pressure, has obvisously circadian rhythm.When a human body wakes from sleeping and starts an activity, the blood pressure rises rapidly from a relatively low level to a much higher level. The rise in the patients with hypertension is higher. At present, a lot of studies have suggested that morning blood pressure surge has a great effect on target organ damage in patients with hypertension, This paper will use this base to discuss the influence of morning blood pressure surge (MBPS) on target organ damage in patients with essential hypertension. MethodsWe selected94patients with hypertension that were being treated at our hospital. Even though all the patients were clinical diagnosed, most had not been medicated for hypertension. The few who had taken hypertension medication stopped taking the medication when the symptoms were under control or blood pressure level were back to normal at least more than two weeks. A24hour ambulatory blood pressure monitoring (24hABPM) divided the patients into two groups, those with morning blood pressure surge group (MBPS) which was49cases,and45cases with non morning blood pressure surge group (NMBPS). Before the test is taken the patients cannot drink caffeine or alcohol. All the patients in both groups were also asked their medical history including their habits of drinking and smoking, age, course of diseases, measured height and body mass. Their body mass index (BMI) was also calculated. We also studied their fasting plasma glucose (FPG), triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). Both groups also had immunofluorescence method to determine high sensitive C-reactive protein (hs-CRP), brain natriuretic peptide (BNP), and enzyme linked immunosorbent assay (ELISA) to determine the urine microalbumin (U-mAlb). All patients also had to pass an echocardiography that measured the left ventricular mass index (LVMI) and a carotid ultrasound to measure the common carotid artery intima-media thickness (CCA-IMT). In52cases (28cases of MBPS,24cases of NMBPS) a brachial artery ultrasound was used to measure vascular flow-mediated dilation (FMD). All of these test were run to compare the two groups for differences related to morning blood pressure surge and its effects on target organ damage in a patient with hypertension. Results(1) When the two groups were compared by BMI, FPG, TG, TC, LDL-C and HDL-C levels, the difference was not statistically significant (P>0.05).(2) When the24hABPM was used to compare the two groups, the morning blood pressure surge was a significant increase in the MBPS group. It was also noticed that the average systolic blood pressure remained at a higher level at different time sections in the MBPS group, much higher than NMBPS group.The difference was statistically significant (P<0.05).However, the average diastolic blood pressure at different time sections was no statistically significant (P>0.05).(3) The MBPS group also showed much higher levels of hs-CRP, U-mAlB, and BNP, the difference was statistically significant (P<0.05).The MBPS group’s CCA-IMT was also greater than NMBPS group.the difference was statistically significant (P<0.05).The LVMI of the MBPS group was obviously higher than that of NMBPS group,the difference was statistically significant (P<0.05).Also the FMD of MBPS group was significantly lower than that of NMBPS group,the difference was statistically significant (P<0.05).(4) According to the relation analysis of Pearson, MBPS had a linear relationship with hs-CRP, mAlb, BNP, CCA-IMT, LVMI and FMD, in which hs-CRP,mAlb, BNP, CCA-IMT, LVMI showed a positive correlation, but has a negative correlation with the FMD. Multiple linear stepwise regression analysis showed that MBPS was positively associated with hs-CRP, mAlb, BNP, CCA-IMT, LVMI, has a negative correlation with FMD. ConclusionIn this study, two tests can be proved. One is that the results suggest that morning blood pressure surge and damage to a target organ are greatly connected. Knowing more about MBPS is important for prevention of hypertension complications. Secondly, morning blood pressure surge in hypertensive patients is a good reference index for the severity of the disease, and enable to show the objective conditionn of the patients.