Relationship Between Orthostatic Hypotension With Circadian Rhythm,Left Ventricular Structure And Function In Hypertensive Patients

Objective:To study the relationship between Orthostatic hypotension(OH)with circadian rhythm,left ventricular structure and function in hypertensive patients.Methods:256 patients with primary hypotension were collected from April 15,2015 to April 14,2016 in hospital cardiology and geriatric outpatient service,134 male and 122 females,aged 60-80 years(mean:68.47 ± 8.15).All subjects were tested for lying-standing blood pressure,24-hour ambulatory blood pressure monitoring,and echocardiography to measure cardiac structure and function.All the pateints were orthostatic hypotension?Result:1)Comparison of clinical data between the two groups of subjectsThe incidence of OH was 34.8%in 258 subjects,89 in OH group and 167 in non-OH group.Compared with non-OH group,the age,severity of hypertension,systolic pressure,supine diastolic blood pressure and LDL-C(LDL-C)were significantly higher than those of OH group,and the difference was statistically significant(P<0.05).Compared with the non-OH groups,the gender,body mass index,TCH(TC),TG(triglycerides),HDL-C(high density lipoprotein cholesterol),fasting glucose,angiotensin-converting enzyme inhibitor and angiotensin receptor antagonists,calcium antagonists,a receptor blockers,beta blockers,diuretics were no significant changes in OH group,the difference was not statistically significant(P>0.05).2)Comparison of 24hABPM parameters between the two groupsCompared with the non-OH group,OH 24h average systolic blood pressure(24hSBP),the average nighttime systolic blood pressure(nSBP)were significantly increased in OH group;however,the nocturnal systolic pressure drop(SBPF),diastolic blood pressure drop at night(DBPF)were decreased in OH group,and the difference was statistically significant(P<0.05).There was no significant difference between the two groups in 24 h average diastolic blood pressure(24hDBP),the day the average systolic blood pressure(dSBP),the day the average diastolic blood pressure(dDBP)and night average diastolic blood pressure(nDBP)(P>0.05).3)Comparison of left ventricular structure parameters between two groups of subjectsCompared with non-OH group,left ventricular diastolic late diameter(LVEDD),diastolic period room interval thickness(IVSD),left ventricular contraction late diameter(LVESD)and the left ventricular quality index(LVMI)were higher than those in non-OH group,The difference was statistically significant(P<0.05).There was no significant difference in the posterior wall thickness of left ventricle between the two groups(P>0.05)4)Comparison of Left Ventricular Function Parameters in Two SubjectsCompared with non-OH group,the left ventricular ejection fraction(LVEF),stroke volume(SV)and E/A ratio of OH group were significantly lower than those of non-OH group,the difference was statistically significant(P<0.05).There was no significant difference in left ventricular short axis shortening(FS)and cardiac output(CO)between the two groups,the difference was not statistically significant(P>0.05).Conclusion:1)Elderly hypertensive patients with orthostatic hypotension and blood pressure circadian rhythm changes are closely related.2)Elderly hypertensive patients with orthostatic hypotension significantly affect the left ventricular structure,left ventricular end diastolic diameter,systolic diameter,diastolic ventricular septal thickness3)Elderly hypertensive patients with orthostatic hypotension can affect left ventricular function and significantly affect the left ventricular ejection fraction,stroke volume,and E/A ratiot.