Correlational Study Between Ambulatory Blood Pressure And Target Organ Damage In Hypertensive Patients Whose Clinical Blood Pressure Reaches The Standard

Purpose: This study aims to explore the relationship between changes in ambulatory blood pressure and hypertension-mediated target organ damage in patients with essential hypertension whose blood pressure in the office reaches the standard,and to further clarify that patients with hypertension who meet the blood pressure standard in the office should actively undergo ambulatory blood pressure monitoring to reduce target organs damage.Methods: A retrospective collection of hypertensive patients in the Department of Hypertension in The First Affiliated Hospital of Dalian Medical University from January 2015 to May 2020,whose office blood pressure had reached the standard.A total of 347 cases met the criteria for entry.Complete name,gender,age,height,weight,body mass index,course of hypertension,fasting blood glucose,glycosylated hemoglobin,total cholesterol,triglycerides,high-density lipoprotein,low-density lipoprotein,alanine aminotransferase,aspartate aminotransferase,medication plan and other general information;at the same time improve cardiac ultrasound,dynamic electrocardiogram,carotid ultrasound,pulse wave velocity,ankle-brachial index,vascular endothelium-dependent diastolic function,UACR,ABPM and other observation indicators.And apply SPSS 22.0 software for statistical analysis.For the comparison of differences between the two groups of general data,the data normality test is first performed.The chi-square test was used to compare the rates of gender,medication regimen,blood pressure variability,carotid IMT,heart rate and the variability,and cardiac geometry;the t test was used to compare general data such as age,height,weight,ambulatory blood pressure,Cardiac ultrasound,pulse wave velocity,ankle-brachial index,vascular endothelium-dependent diastolic function,and UACR were used to compare the differences between the two groups.Logistic regression analysis was used to determine whether ABPM uncontrolled was a risk factor for hypertension-mediated target organ damage.Linear regression analysis was used to determine whether ABPM failure to reach the standard was a risk factor for pulse wave velocity.Spearman correlation was used to analyze the correlation between ABPM and heart rate variability and target organ damage.Results: 1.A total of 347 patients were enrolled in this study.Among them,the ABPM controlled group: 148 people;the ABPM uncontrolled group: 199 people.The average age of patients in the ABPM controlled group: 62.00±12.49 years old,including 66 male patients;the average age of patients in the ABPM uncontrolled group: 58.00±13.80 years old,including 124 male patients.The two groups are in medication regimen,total cholesterol,and triglyceride There was no statistical difference in esters,low-density lipoprotein,alanine aminotransferase,and aspartate aminotransferase(P<0.05).Compared with the ABPM controlled group,the proportion of males,height,weight,body mass index,duration of hypertension,fasting blood glucose,and glycosylated hemoglobin were significantly higher in the ABPM uncontrolled group than in the ABPM controlled group(P<0.05).The ABPM uncontrolled group was significantly lower in age and high-density lipoprotein than the ABPM controlled group(P<0.05).There was no significant difference in combination medication between the two groups(P>0.05),but in terms of ARB single-drug use rate,the use rate of ABPM uncontrolled group was significantly higher than that of ABPM controlled group(P<0.05).2.The incidence of ambulatory blood pressure,abnormal circadian rhythms and curve types in the ABPM uncontrolled group were significantly higher than the ABPM controlled group(P<0.05)in each time period,but the incidence of morning peak phenomenon was lower than that of ABPM controlled group(P < 0.05).3.Compared with the ABPM controlled group,the thickness of the ventricular septum,the inner diameter of the left atrium and the thickness of the posterior wall of the left ventricle were significantly increased in the ABPM uncontrolled group(P<0.05).Risk factors for the inner diameter of the left atrium(OR: 1.755,95%CI: 1.141 — 2.701,P=0.011).The failure of ABPM is an independent risk factor for the thickness of the ventricular septum and the thickness of the posterior wall of the left ventricle(OR:2.737,95%CI: 1.470—5.096,P=0.002;OR: 3.597,95%CI: 1.136-11.394,P=0.030).4.Compared with the ABPM controlled group,the PWV was significantly increased in the ABPM uncontrolled group(P<0.05),but in terms of ABI,FMD,carotid artery intima thickening and stenosis plaque formation There was no statistical difference between the two groups(P>0.05).Through linear regression analysis,it is found that ABPM uncontrolled is a risk factor for PWV(left and right)(B coefficient and P value respectively: B coefficient = 98.313,P = 0.005;B coefficient = 86.239,P = 0.006).5.The UACR of the ABPM uncontrolled group was significantly higher than that of the ABPM controlled group(P<0.05).Through Logistic regression analysis,it was found that ABPM uncontrolled was an independent risk factor for UACR(OR: 4.131,95% CI:1.845-9.252,P=0.001).6.There was no significant difference between the two groups in terms of the fastest heart rate and the incidence of arrhythmia.The average heart rate and the slowest heart rate of the ABPM uncontrolled group were higher than those of the ABPM controlled group(P<0.05).In the ABPM uncontrolled group,SDNN(Standard Diviation of NN intervals,The standard deviation of all sinus heart beats NN intervals),SDANN(Standard Diviation Average of NN intervals,the standard deviation of all sinus heart beats NN intervals)were significantly lower than the ABPM controlled group(P<0.05).7.Spearman correlation analysis between the average blood pressure of each time period of ABPM and the target organ damage observation index found that the degree of target organ damage has the greatest correlation with night systolic blood pressure,and it is positively correlated.8.Spearman correlation analysis of blood pressure variability and target organ damage index found that abnormal blood pressure variability can aggravate target organ damage.9.Spearman correlation analysis of ABPM index and heart rate variability found that the average value of SBP in each time period and the percentage of night SBP decrease are closely related to heart rate variability(P<0.05),while diastolic blood pressure is not statistically related to it Significance(P>0.05).Conclusion:1.Hypertensive patients whose blood pressure in the office reaches the standard but the 24-hour ABPM does not meet the standard have significantly more hypertension-mediated target organ damage than those in the office and the 24-hour blood pressure meet the standard.The ABPM uncontrolled is an independent risk factor for hypertension-mediated target organ damage.2.In the 24-hour blood pressure,uncontrolled of SBP at night is significantly positively correlated with target organ damage mediated by hypertension.3.Compared with office blood pressure,24-hour ABPM can more accurately reflect blood pressure compliance and guide antihypertensive treatment,which is of greater value in preventing and reversing hypertension-mediated damage to target organs and autonomic nerves.4.For hypertensive patients whose blood pressure in the office reaches the standard,they should actively perform 24-hour ABPM to assess whether the patient’s blood pressure is up to the standard in 24 hours,screen out the hypertensive patients whose ABPM uncontrolled,and adjust the antihypertensive treatment to further reduce hypertension mediated target organ damage and the risk of cardiovascular events.