The Relatiaoship Between 24 Hours Ambulatory Blood Pressure Complicated And Hypertension Complicated With White Matter Lesions

Objective: The pathological process of brain injury caused by Ischemic cerebral white matter lesions(White matter lesions WML)is very heterogeneous.While the risk factors of various clinical symptoms and signs of the patients showing it can not present specific pathogenesis of the disease,related risk factors is still in the research stage.The analysis confirmed the relevant risk factors according to patients with specific lesions of the same grade.Itclarify the pathogenesis of WML.Different individuals can take appropriate treatment(i.e.individual treatment).This study focuses on the analysis of the correlation of WML in the location and degree of vascular risk factors.Blood pressure variability were taken to emphasize the dynamic changes of blood pressure in hypertensive patients(Blood pressure,variability,BPV).To discuss the the correlation of severity of hypertension in patients with ischemic cerebral and matter lesion.To make further assumptions in the pathophysiology of WML.Method: From September 2014 to October 2016,hypertensive patients acceptied to the Second People’s Hospital Of Wuhu,who had risk factors for cerebrovascular disease screening and at the age of 50 or older were selected as the research objects.The clinical data was collected from all participants.Twenty-Four-hour ambulatory blood pressure monitored on the ambulatory(blood pressuremonitoring ABPM).Brain magnetic resonance imaging(MRI)were taken for all patients.The complete clinical data of a total of 178 cases,which based on the results with brain MRI were divided into two groups: one group with cerebral white matter lesion group(named WML group),with a total nmber of 112cases;another group with cerebral white matter lesions(named no WML group),with a total number of 66 cases.According to Fazekas score,WML group were divided into two types,namely the periventricular white matter lesions(Periventricular lesions PVL)and subcortical white matter lesions(Deep white matter lesions DWML).The severity of type was evaluated.In addition,the change of blood pressure was collected by applying each patient’s 24 h dynamic monitoring.Day(day)and night(night)diurnal blood pressure mean systolic blood pressure(systolic blood pressure,SBP),diastolic blood pressure(diastolic blood pressure,DBP)and blood pressure variability(Coefficient of variability CV)were recorded.The peak and valley of its 24 h SBP and 24 h DBP numerical statistics were recorded as the ambulatory blood pressure parameters.Applying single factor and multi factor Logistic regression analysis method to study whether ambulatory blood pressure parameters and traditional vascular risk factors have effects on ischemic cerebral white matter lesions.Pearson or Spearman analysis were taken for the analyses of each part of the risk factors and the parameters of ambulatory blood pressure and specific lesions.Special attention was laied on the relationship of ambulatory blood pressure parameters and the degree of cerebral white matter lesions in different parts.Result: 1.Comparison between WML group and no comparison of WML group: Compared to the no WML group,larger age,longer history of hypertension,higher Hcy were observed in WML group(P < 0.05),With statistical significance;two groups of patients with ambulatory blood pressure parameters were compared.SBP,dsbp,nsbp,24 h SBP-CV,d SBP-CV and 24 hsbp valley values were higherin non WML group(P < 0.05,with statistical significance).2.PVL analyses of risk factors: Ambulatory blood pressure parameters and traditional vascular risk factors(such as gender,age,hyperlipidemia,hypertension etc.)were taken as covariates.PVL were found as dependent variable.In the single factor analysis: age,homocysteine,duration of hypertension,n SBP,d SBP,24 h SBP,24 h SBP-CV,d SBP-CV High-,the 24 h SBP-value,9 indicators in total were taken.All factors showed a possibility in affecting the PVL,which had statistical significance(P<0.05).Logistic regression analysis of multiple factors of the 9 indicators were taken to find that age,homocysteine,d SBP-CV,High-,24 h SBP-value these 4 indicators are the risk factors of PVL.The calculated OR the values were 1.046,4.093,1.791,1.079,,SBP-C V is the most dangerous factor of PVL.3.The risk factors of DWML: Ambulatory blood pressure parameters and traditional vascular risk factors(such as gender,age,drinking,hypertension etc.)were taken as covariates.DWML was dependent variable,while the single factor analysis: age,homocysteine,drinking,hypertension,Cheng n SBP,d SBP,24 h SBP,24 h SBP-CV,d SBP-CV High-,the 24 h SBP-value of a total of 10 indicators were all factors that may affect the DWML,which has statistical significance(P<0.05).Logistic regression analysis of multiple factors of the 10 indicators were taken to find that: d SBP-CV,24 h DBP,24 h SBP-alcohol,High-value all these 4 indicators were the risk factors of DWML.The calculated OR the values were6.571,1.063,1.079,3.176.The D SBP-CV is the most dangerous factor of DWML.4.PVL degree related factors analyses: The PVL risk factors and disease severity grading were statistically correlation analysis that PVL1 lesions.24Hsbp-trough to peak value correlation;and PVL2,grade 3 lesions with age,where the same type of cysteine,d SBP-CV,24 h SBP-Valley peak were correlated.5.DWML degree related risk factors analyses: DWML risk factors and disease severity grading were statistically related.DWML1 lesions were correlated with 24 h SBP-trough to peak value correlation;2 lesions,d SBP-CV and 24 h SBP-High values.Lesions and 24 hdbp and d SBP-CV,24 h SBP-Gufeng values were correlated.Conclusion:1,For different parts or different degree of WML,the risk factors are not the same.2,Relationof the PVL and DWML parameters of ambulatory blood pressure was overlapping and different.3,Correlations were observed in hypertension ambulatory blood pressure parameters on all levels of PVL and DWML.Increase of the level of lesion,the related parameters of ambulatory blood pressure gradually increased.