Clinical Studies Of Blood Pressure Variability Characteristics And Corresponding Target Organ Damage In Patients With Essential Hypertension And Postprandial Hyperglycemia

Objective: Through a large number of clinical observation and retrospective study,based on 24-hour ambulatory blood pressure monitoring(24hABPM) results,investigate the effect of postprandial hyperglycemia on blood pressure variability in patients with essential hypertension and target organ damage characteristics corresponding to understand postprandial hyperglycemia impact on the prognosis of patients with essential hypertension.Method: Collected from January 2013 to December 2014 at the First Affiliated Hospital of Dalian Medical University, hypertension and congenital heart disease inpatient diagnosis of primary high adult blood pressure in patients with essential hypertension, and meet other inclusion criteria of 228 cases.According to 1999 WHO(World Health Organization) diagnostic criteria for postprandial hyperglycemia, and were divided into three groups according to OGTT(oral glucose tolerance test, a simple glucose tolerance test): Essential hypertension group(OGTT normal)(group A, n = 72),essential hypertension and IGT(Impaired Glucose Tolerance) group(group B, n = 81),essential hypertension and postprandial diabetic group(group C, n = 75).Records of patients in general: sex, age, smoking and drinking history, BMI(Body Mass Index),duration of hypertension, antihypertensive drug application.All patients were fasted for12 hours, venous blood in the morning, and immediately inspected, measured renal function, blood lipids, high-sensitivity C-reactive protein(hs-CRP), uric acid(UA), and further line OGTT, specimens of urine specimens and related physical examination,glycated hemoglobin(HbA1c), fasting plasma glucose(FPG), 2-hour postprandial glucose(2hPBG), urinary Microalbumin / creatinine(urine MA / Cre) and echocardiography, carotid artery ultrasound other indicators.According the results of24 hABPM obtained corresponding period of blood pressure variability indicators.All data have been processed and analyzed by SPSS 21.0.Usingx?Sto demonstrate the result.Among the groups were compared using ANOVA and rank sum test,the rates between the groups were compared using chi-square test,study various risk factors and target organ damage using Spearman correlation analysis.If P <0.05, there is statistical difference. If P <0.01,there is statistically significant difference.Results:1.Comparison of the clinical background information among the three groups of patients: Three sets of data on age, sex, BMI, duration of hypertension,smoking, drinking history, family history and drug use so there was no statistical difference(P > 0.05).Among the three groups in fasting glucose blood biochemistry(FPG), 2h postprandial glucose(2hPBG), glycated hemoglobin(HbA1c) and triglycerides(TG) were statistical different(P <0.05), the rest of the group,there was no statistical difference in index.2.Comparison of the blood pressure levels between the three groups : By 24 h ABPM to analyze the results showed no statistical difference in their blood pressure levels among the three groups.3.Comparison of blood pressure variability indicators among three groups: â‘  The results showed that systolic blood pressure variability:Compared with group A, group B and group C nighttime systolic standard deviation(nSSD) and nighttime systolic blood pressure coefficient of variation(nSCV) were statistical difference, and the group C more significant difference than group B(0.003 vs 0.023)(0.006 vs 0.039), but there was no difference between groups B and C.â‘¡The results showed that diastolic blood pressure variability:There are group C compared with group A nighttime diastolic blood pressure standard deviation(nDSD)and nighttime diastolic blood pressure coefficient of variation(nDCV) statistical differences(P <0.05).While group B and group A compared to these two indicators are currently no statistical difference.Each observation group compared with the control group than in blood pressure variability parameters were not statistical differences,observed between the two groups of the variability in blood pressure showed no statistical difference.4.Through each group of target organ damage(including left ventricular mass index, carotid intima-media thickness and urinary Microalbumin /creatinine) comparative analysis showed that, compared with group A and group B,group C urinary MA / Cre were statistical difference, and the group C more significant difference than group B(0.001 vs 0.046),the rest of the group had no statistical difference.5.Correlation analysis of the variability of blood pressure and target organ damage indicator line indicates:â‘ 24hSSD, dSSD, dDSD positively correlated with LVMI,the rest of blood pressure variability index and no correlation between LVMI no significant correlation between LVMI; â‘¡ 24 hSSD, 24 hDSD urinary MA / Cre was positively correlated,the rest of blood pressure variability index and urinary MA / Cre no correlation;â‘¢The blood pressure variability index and no correlation between IMT.Conclusions:1.The early stage of diabetes, postprandial hyperglycemia can increase blood pressure in patients with essential hypertension increased variability, and the first performance of the impact on nocturnal blood pressure variability.2.Blood pressure variability increases relatively more sensitive to fluctuations in blood pressure levels, independent of blood pressure levels in itself increase the target organ damage in patients with essential hypertension.