Change Of HRV,BPV Monocyte Phenotype In Hypertensive Patients With Left Ventricular Hypertrophy And Intervention Of Irbesartan

Objective:Observe the change of heart rate variability(HRV),blood pressure variability(BPV),monocyte phenotype and the effect of Irbesartan on monocyte phenotype in hypertensive patients with Left ventricular hypertrophy(LVH).To explore the effects of autonomic nervous dysfunction and immune inflammation on hypertension with LVH,and provide a new therapeutic target for hypertension.Methods:(1)A total of 59 patients were diagnosed primary hypertension at 5th Department of Cardiology,the Second Hospital of Dalian Medical University from December 2016 to December 2017,According to left ventricular mass index(LVMI),they are divided into LVH group(30)and non-LVH group(29),and healthy volunteers(30)were selected as control group at the same time.Recorded Sex,age,height,weight,total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),homocysteine(H cy),high sensitivity creative protein(hs-CRP),?-2 microglobulin(?-2MG),All patients were scheduled to echocardiographic,ambulatory blood pressure,ambulatory ECG monitoring,and recorded left ventricular end diastolic diameter(LVID),ventricular septum thickness(IVST),left ventricular posterior wall thickness(PWT),24 hours systolic standard deviation(24h SSD),24 hours diastolic standard deviation(24h DSD),day systolic standard deviation(d SSD),day diastolic standard deviation(d DSD),night systolic standard deviation(n SSD),night diastolic standard deviation(n DSD);standard deviation of NN(SDNN),root mean square of successive NN differences(RMSSD),percent of the number whose difference between adjacent NN interval more than 50ms(pNN50),standard deviation of normal number of intervals,(SDNNI),standard deviation of per 5min averages normal number of intervals(SDANN).Monocytes were extracted with 10 ml of peripheral venous blood.The expression of CD 163 and CD 206 in monocytes was detected by Flowcytometry,and the concentrations of interleukin-1?(IL-10)and tumor necrosis factor-?(TNF-?)in serum were detected by ELISA.Compare the difference among of BPV,HRV,CD 163,CD 206,IL-10 and TNF-?in three groups.(2)Selected 10 patients in LVH group randomly,extracted monocyte from 10 ml of peripheral venous blood,and pretreated mononuclear cells with Irbesartan(10~-66 mol/l,10~-77 mol/l,10~-88 mol/l)in different concentrations,and collected the cells'supernatants.Then detected the expression of CD 163 and CD 206 by Flowcytometry,and the concentrations of IL-10 and TNF-?in supernatants by ELISA.Compare the changes of CD 163,CD 206,IL-10 and TNF-?expression in monocytes after different concentrations of irbesartan intervention.Results:(1)BPV in LVH group was different from that of non-LVH and control group,24-h SSD,24-h DSD,d SSD and n DSD in LVH group were higher than those in non-LVH group,24-h SSD,24-h DSD,d SSD,n SSD and n DSD in LVH group were higher than those in control group,and the 24-h SSD and d SSD in non-LVH group were higher than those in control group(p<0.05).There was no significant difference in d DSD among the three groups(p>0.05).(2)HRV in LVH group was different from that of non-LVH and control group,SDNN,pNN 50,SDANN in LVH group were lower than those in non-LVH group,SDNN,SDNN Idx,pNN 50,rMSSD,SDANN in LVH group were lower than those in control group,and SDNN,SDNN Idx,pNN 50,rMSSD,SDANN in non-LVH group were lower than those in control group(p<0.05).(3)The monocyte phenotype and inflammatory state of hypertension in LVH group were different from that of non-LVH and control group,The expression of CD 163and CD 206 in monocytes of LVH group was lower than that of non-LVH group,CD163 and CD 206 in LVH group was lower than that in control group,while CD 163 in non-LVH group was lower than that in control group(p<0.05).The concentration of TNF-?in serum of LVH group was significantly higher than that of non-LVH group(p<0.05),but there was no significant difference in the concentration of IL-10 between the two groups.the concentration of IL-10 in serum of LVH group and non-LVH group was lower than that of control group,and the concentration of TNF-?was higher than that of control group(p<0.05)(4)Effects of Irbesartan on monocyte phenotype and inflammatory status in hypertensive patients with LVH:there were significant differences in monocyte phenotype and serum inflammatory status after stimulation with Irbesartan(10~-66 mol/l,10~-77 mol/l,10~-88 mol/l):?Irbesartan can upregulate the expression of CD 163 and CD 206 in monocytes of hypertensive patients with LVH in a concentration-dependent manner,among which the difference was most significant in the group of 10~-66 mol/l(p<0.01).?Irbesartan can increase the concentration of IL-10 in monocyte culture supernatant of hypertensive patients with LVH in a concentration-dependent manner,decrease the concentration of TNF-?,and the difference was significant in the group of 10~-66 mol/l(p<0.01).Conclusion:(1)Autonomic nervous dysfunction exists in hypertensive patients with LVH,which is manifested by the decrease of HRV and the increase of BPV.(2)Inflammation was activated in hypertensive patients with LVH,monocyte phenotype was mainly pro-inflammatory,serum pro-inflammatory factor expression increased,anti-inflammatory factor expression decreased.(3)Irbesartan can change monocyte phenotype and inflammatory state in hypertensive patients with LVH,This may be a new mechanism for reversing LVH.