Characteristics Of Heart, Kidney And Periphery Arteries Damage In Patients Of Hypertension With Metabolic Syndrome

Objective To investigate the characteristics of target-organ damage in patients of hypertension (EH) with metabolic syndrome (MS).Methods Screening68cases of patients confirmed EH with MS,59cases of patients confirmed EH without MS according to the2010Chinese Hypertension Guidelines and the modified MS diagnostic criteria of National Cholesterol Education Program-Third Adult Treatment Panel (NCEP ATP III) with the method of cross-sectional parallel control.The54healthy subjects were matched as controls.The cardiac structure and function, carotid intima-media thickness (IMT), ankle brachial index (ABI),estimated glomerular filtration rate (eGFR) and the level of the urine albumin were investigated in three groups. And used the partial correlation analysis and Logistic regression analysis to study the relationship between target organ damage indexes and metabolic factors.Results(1) The clinical data:here were no statistical differences among three groups in gender, age,diastolic blood pressure (DBP),pulse pressure (PP),total cholesterol (TC)and blood urea nitrogen (BUN)(P>0.05).And body mass index (BMI),waist circumference (WC),systolic blood pressure (SBP),mean arterial pressure (MAP),low density lipoprotein (LDL) high density lipoprotein (HDL),serum creatinine (Scr),triglycerides (TG),fasting plasma glucose (FPG),uric acid (UA) had statistical differences (P<0.05)in three groups.We used LSD multiple comparison and nonparametric test to analysis results further,compared with healthy controls, patients with EH group in BMI,levels of FPG,LDL showed no difference(P<0.05).WC,SBP,MAP,TG,HDL,Scr and UA were higher than those of control group in EH with MS group(P>0.05).Compared with EH group,EH patients with MS in BMI,WC,LDL,FPG,TG had statistical significances (P<0.05),while SBP,UA,HDL and Scr had no differences (P>0.05).(2)Target organ indicators:there were no statistical differences within three groups in ABI,eGFR, right ventricular diastolic diameter (RVDd),left atrial diameter (LAD),left ventricular systolic diameter (LVDs),left ventricular posterior wall thickness (LVPWT),ejection fraction (EF),peak E velocity (E),pulmonary venous-Ar (PV-Ar),low propagation velocity (Vp),interventricular septal thickness (IVST),the late diastolic mitral annulars velocity (Am),the ratio of E and A(E/A). And left ventricular diastolic diameter (LVDd),peak A velocity (A),mitral E velocity decreases time (DT),early diastolic mitral annulus velocity (Em),the ratio of E and Em (E/Em),the double side of the ball MT,microalbuminuria (MAU) had statistically differences (P<0.05).We used LSD multiple comparison and nonparametric test in order to learn more about the relationship between organs damage with metabolic indicators.Compared the target-organ damage with the control group, only Em had a significant difference in EH group (P=0.011),the EH with MS group had significant differences in a number of indexes,including LVDd,the ratio of E and Em, A,Em,DT,the ratio of Em and Am,also MAU,and the double side of IMT (P<0.05). Compared with EH group,the EH with MS group in LVDd,A,Em,E/A,E/Em,Em/Am,DT,MAU,bilateral carotid bulbar urethra IMT had statistical differences(P<0.05).(3)The correlation analysis of diastolic function and metabolic factors. In control group,the simple pearson correlation analysis showed DT and TC(r=0.305;P=0.025) were positive correlation relationships. E/A,Em/Am and TC (r=--0.274,-0.305,respectively;P=0.045,0.008, respectively)were negatively related.After controlled other influenced factors,the results of partial correlation analysis showed that there were no correlations between DT, E/A and TC(P>0.05).Em/Am still exists negative correlation with TC(r=-0.351,P=0.020).In hypertention group,the simple pearson correlation analysis showed DT and MAP,PP,TG(r=0.391,0.418,0.247,respectively;P=0.001,0.000,0.044,respectively),Em/Am and DBP,TG(r=0.297,0.286,respectively;P=0.014,0.018,respectively) were positive correlation relationships.Em/Am and LDL(r=-0.247,P=0.042),E/Em and DBP (r=-0.393,P=0.001) were negatively related.After controlled other influenced factors,the results of partial correlation analysis showed that there were no correlations between the DT and TG,as well as Em/Am and LDL(P>0.05).LVDd still exists positive correlation with BMI (r=0.308,P=0.010),Em/Am and TG, DBP (r=0.305,0.297,respectively;P=0.018,0.015,respectively),DT and MAP,PP also were positive relationships(r=0.315,0.308,respectively;P=0.017,0.020,respectively).E/Em was negatively related to the DBP (r=-0.401,P=0.001).In EH with MS group,the simple pearson correlation analysis showed DT and TG,TC,FPG(r=0.337,0.291,0.344,respectively;P=0.009,0.025,0.008,respectively),E/Em and TG (r=0.307,P=0.018)were positive correlation relationships.DT and BMI(r=-0.341,P=0.008),E/A and LDL(r=0.399,P=0.002),Em/AmandTG,FPG(r=-0.328,-0.378,respectively;P=0.011,0.003,respectiv ely)were negatively related. After controlled other influenced factors, the results of partial correlation analysis showed that there were no correlations between DT and TG,TC,FPG,E/Em and TG,as well as Em/Am and TG,FPG(P>0.05).DT and BMI(r=-0.363,P=0.010),E/A and LDL(r=-0.454,P=0.001) was negatively related. (4)Target organ damage index and metabolic factors.In hypertention group,with target organ damage index (E/A, Em/Am, E/Em, IMT, MAU) as the dependent variable.the Logistic regression analysis results were no statistical significance(P<0.05),indicating that metabolic factors were not risk factor for early target organ damage in patients with EH group.In EH with MS group,FPG was independent risk factor for Em/Am(OR was9.187,95%CI was1.771,47.661).The results of logistic regression analysis included all subjects datas showed that FPG was independent risk factor for Em/Am,E/A and E/Em (OR was3.246,1.661,1.372,respectively;95%CI was2.075,5.078and1.201,2.296and1.015,1.856, respectively).LDL was a independent risk factor for the development of MAU (OR was1.727,95%CI was1.054and2.830).BMI was a independent risk factor for ABI (OR was1.208,95%CI was1.008,1.449).On the contrary,HDL was protective factor for E/Em (OR was0.303,95%CI was0.107,0.855).Meanwhile,every metabolic factors were not independent risk factors for the development of IMT (P>0.05).ConclusionPatients with high blood pressure have appeared cardiac diastolic function decreased before systolic function, peripheral vascular,kidney damaged.Metabolic factors made the target organ damage aggravated in patients with EH.In EH patients, antihypertensive therapy was the key of the prevention and treatment of diastolic dysfunction, while for patients with EH and MS,except the antihypertensive treatment,comprehensive therapy of including improve metabolic factors was particularly important.Compared with EH patients, more attention should be taken for patients with EH combined MS, in order to intervention earlier to prevent target organ function decompensation. FPG,LDL and obesity were independent risk factors for cardiac diastolic dysfunction and the early damage of kidney.Therefore,the early intervention to prevent the dysfunctions and decompensations of target organs should be taken into account for patients of EH with MS.