Ambulatory Blood Pressure Monitoring Assesses Cardiovascular Risk Stratification In Patients With Essential Hypertension

Objective: To investigate the relationships between 24 h ambulatory blood pressure monitoring(ABPM)parameters and cardiovascular risk stratification in patients with essential hypertension(EH),and explore the clinical value of ABPM to assess cardiovascular risk stratification in patients with EH.Methods: 1277 patients were enrolled from tianjin medical university general hospital in August 2014 to January 2016.Inclusion criteria as follows: first,conform to the diagnosis standard of hypertension;Second,older than 18 years old.Exclusion criteria as follows: first,the patients who with the infection,trauma,pain and stress status,or other illnesses which cause sympathetic excitement;Second,secondary hypertension;Third,the patients who had affected medications which can impact blood pressure in nearly 2 weeks;Fourth,the patients who refuse to into the group.Record the list of patients' name,sex,age,height,weight,medical history,personal history,family history;draw fasting blood to detect glucose(GLU),glycated hemoglobin(Hb A1c),total cholesterol(TC),triglycerides(TG),high-density lipoprotein(HDL),low-density lipoprotein(LDL),homocysteine(Hcy),C-reactionprotein(CRP),uric acid(UA),creatinine(Cr);24h urine to return,detection of urine protein quantitative;To have an electrocardiogram(ECG)and ultrasonic cardiogram(UCG),record left ventricular end-diastolic diameter,ventricular septal thickness,left ventricular posterior wall thickness,then calculate the left ventricular mass index(LVMI).All the list to take 24 h ABPM,then record the 24 hours mean systolic blood pressure(24h SBP),24 hours mean diastolic blood pressure(24h DBP),daytime systolic mean blood pressure(d SBP)and so on.According to the cardiovascular risk stratification standard,all patients were divided into low risk group,intermediate risk group,high-risk group,very high risk group.General characteristics,ABPM parameters between groups were compared,and the relationships between ABPM parameters and cardiovascular risk stratification were analyzed,and then took low,intermediate risk combination as a group,high,very high risk for another group,calculated the area under the ROC curve?the best cut-off point?negative predictive value?positive predictive value.Results: Between groups,age?body mass index(BMI)?GLU?Hb A1c?TC?TG?HDL?LDL?Hcy?CRP?UA?Cr?urine protein?LVMI showed no significant difference(all P > 0.05);24h SBP,24 h DBP,d SBP,daytime mean diastolic blood pressure(d DBP)?nighttime mean systolic blood pressure(n SBP)?nighttime mean diastolic blood pressure(n DBP)?the type of circadian rhythm showed very significant difference(P<0.01),the standard deviation(SD)of nighttime systolic blood pressure(n SSD)?morning blood pressure surge showed significant difference(P<0.05),the SD of daytime systolic blood pressure(d SSD)?the SD of daytime diastolic blood pressure(d DSD)? the SD of nighttime diastolic blood pressure(n DSD)showed no significant difference(P>0.05);The levels of morning blood pressure surge and n SBP were positively correlated with cardiovascular risk stratification(r=0.512?0.414;all P<0.01);the same relationships existed between 24 h SBP?n SSD and cardiovascular risk stratification(r=0.273?0.202;all P<0.05);While the type of circadian rhythm were negatively correlated with cardiovascular risk stratification(r =-0.471;P <0.01);put the low?intermediate risk group as a group,and high?very high as another group,calculated the area under the receiver operator characteristic(ROC)curve of morning blood pressure surge? n SBP?24h SBP?n SSD,were0.825?0.785?0.694?0.645;the best cut-off point were34.5mm Hg?131.5mm Hg?129.5mm Hg?8.6mm Hg;the sensitivity were0.774?0.742?0.828?0.785,the specificity were0.788?0.727?0.455?0.515;the negative predictive value were0.553?0.545?0.548?0.500,and the positive predictive value were0.924?0.900?0.827?0.860;Compared the area under the ROC curve,in addition to the morning blood pressure surge vs.n SBP? 24 h SBP vs.n SSD,other pair compare all have a significant difference(P<0.05).Conclusion: The parameters of ABPM were significant correlated with cardiovascular risk stratification,morning blood pressure surge? n SBP?24h SBP?n SSD have positive predictive value in assessing cardiovascular risk stratification.