Correlation Between Carotid Vulnerable Plaque And Abnormal Blood Pressure Fluctuations In The Elderly And Intervention By Heat-clearing Method

Background:Along with the development of social economic,people's living environment change and the progress of medical examination means,the detection and incidence of atherosclerosis(AS)is increasing,the Incidence and mortality of acute cerebrovascular and cardiovascular events caused by rupture of vulnerable plaques and secondary thrombus remain high.AS is more common in elderly patients,compared with the general population,the incidence of vulnerable plaques in elderly patients with AS increased significantly.As the pathological basis of many major adverse cardiovascular events(MACE),there is a certain relevance between the rupture of vulnerable plaques and secondary thrombus and the high incidence of elderly patients with cardiovascular disease events,and the stability of vulnerable plaques is helpful to prevent the cardiovascular events.From the point of formation and progress of vulnerable plaques,high blood pressure as a risk factor for carotid vulnerable plaques,high blood pressure variability for the occurrence of carotid plaques and stability has a certain influence.We found that the morning blood pressure surge(MBPS)with postprandial hypotension(PPH)phenomenon is common in the elderly hypertensive patients group,studies have shown that morning peak and postprandial hypotension phenomenon respectively with Carotid atherosclerosis(CAS)and the nature of the plaques correlation.We believe that the coexistence of morning blood pressure surge and postprandial hypotension in elderly patients with hypertension will increase the variability of blood pressure,further discussion about whether the vulnerability of vulnerable plaques will increase is needed,Therefore,this research will study whether the coexistence of morning blood pressure surge and postprandial hypotension increases the occurrence of vulnerable plaque and its mechanism in elderly patients with hypertension.From the Angle of treatment,a large number of studies have shown that statin lipids have had a significant effect in stabilizing plaque to prevent cardiovascular events,but even if the application of statin lipids has become so common that about the incidence of elderly patients with cardiovascular disease events continues to climb.Traditional Chinese medicine plays an important role in stabilizing plaques and delaying atherosclerosis.The previous studies have shown that Qingre Quyu Granule(QRQYG)method has a good effect to stabilize the role of carotid artery vulnerable plaque,and in elderly patients,the atherosclerotic plaques often exist in multiple sites,while there is a correlation between the atherosclerosis of the whole body.Therefore,we will further study whether it can delay the progression of coronary atherosclerosis in elderly patients with coronary artery disease with stable carotid artery plaque,and to preliminarily explore its mechanism,to find effective prevention of elderly patients with a new method for cardiovascular events.Objective:1.To explore whether the coexistence of MBPS and PPH in senile patients with hypertension is more prone to carotid arterial plaque than normal hypertension with MBPS patients and explore its possible mechanism.2.To explore the stabilizing effect of QRQYG on carotid artery vulnerable plaque in elderly patients with coronary heart disease and its effect on the progression of coronary atherosclerosis.Methods:1.Choose 136 elderly patients with MBPS who were diagnosed as severe carotid atherosclerotic plaques and serious luminal stenosis(stenosis rate?70%)as the research objects and all the patients underwent carotid endarterectomy.According to whether the patients with PPH,they were divided into the MBPS group(n=68)and the MBPS+PPH group(n=68),the general datas of the two groups are comparable.And 24-hour blood pressure monitoring was used to evaluate the blood pressure variation of the two groups,the carotid artery plaque was assessed by high-frequency ultrasound.And the plaques were observed and evaluated after operation,the expression of CD68,MMP-9,CD40L,NF-?B/P65 and ubiquitin in plaque and the activity of proteasome were determined.2.Selected patients with carotid artery vulnerable plaque and coronary heart disease treated in our hospital.We randomly divided the patients into treatment group(n=49)and control group(n=49).The treatment group were given QRQYG and western medicine while the control group were given simple western medicine,and the course of treatment was 25 weeks.Before and after treatment,high frequency ultrasound was used to observe and evaluate the vulnerable plaque of carotid artery,coronary artery atherosclerosis was evaluated by coronary angiography.Results:1.The variation of blood pressure in the elderly patients with MBPS and PPH increased significantly,the expression of CD68,MMP-9,CD40L,NF-?B/P65 and ubiquitin increased significantly(P<0.01),and the activity of proteasome increased significantly(P<0.01).2.The therapy of QRQYG can stabilize the plaque of carotid artery in elderly patients with coronary heart disease.Conclusion:1.In elderly hypertension patients with MBPS and PPH are more likely to appear carotid artery vulnerable plaque,its mechanism is related to the activation of ubiquitin proteasome pathway and NF-?B,meanwhile to raise the expression of inflammatory related factors.2.QRQYG has a certain stabilizing effect on the vulnerable plaque of carotid artery in elderly patients with coronary heart disease and no significant effect on the progression of coronary atherosclerosis.