The Risk Factors Of Cardiovascular And Cerebrovascular Lesions In Patients With H-type Hypertension And OSAHS

Object:H-type hypertension is the hypertension associated with elevated plasma homocysteine(Hcy)≥10 μ mol/L.Obstructive sleep apnea hypopnea syndrome(OSAHS)refers to a series of pathophysiological changes such as sleep fragmentation,sleep apnea,hypercapnia,and intermittent hypoxia due to repeated partial or complete obstruction of the upper respiratory tract.Both OSAHS and H-type hypertension are associated with an increased risk of myocardial infarction,heart failure,stroke,and cognitive impairment.This study will further explore the relationship and interaction between OSAHS and H hypertension,using convenient and scientific tools such as portable sleep monitor(PSM),ambulatory blood pressure monitor(ABPM)to screen,diagnosis and analysis the risk factors of cerebrovascular diseases in H-type hypertension with OSAHS population.Methods:The clinical data of about 166 hypertensive patients from Shandong University Qilu Hospital from October 2020 to 2022 December were selected for retrospective study,which were divided into Group A:H-type hypertension and OSAHS(plasma Hcy≥ 10 μmol/L,AHI≥ 5)patients(103 cases).According to the severity of OSAHS,they were further divided into three levels,mild,moderate,and severe severity,neamed A1(5 ≤ AHI<15),A2(15 ≤ AHI<30),A3(AHI≥ 30).Group B:H-type hypertension with non-OSAHS patients(Hey≥ 10 μ mol/L,AHI<5)(33 cases),Group C:non-H-type and OSAHS hypertension group(14 cases)and Group D:non-H-type and non-OSAHS hypertension patients(16 cases).We used PSM and ABPM measured 24-hour dynamic BP,24-hour BP variation,24-hour BP difference,dynamic arterial stiffness index and sleep apnea index(AHI)ect.Hcy and serum lipid and creatinine were determined.In addition,the validation analysis was further expanded to analyze the correlation between OSAHS and Hcy levels.We used SPSS 27.0 system to statistically describe and analyse the differences among the data of each group and finish the regression analysis of risk factors.There is a significant difference in p<0.05.Results:In this study,patients with H-type hypertension accounted for 82%of the total number of hypertensive patients,of which H-type hypertension with OSAHS accounted for 76%.There were differences in gender,BMI,duration of hypertension,24-hour diastolic blood pressure variability,high-density lipoprotein cholesterol,triglyceride high-density lipoprotein cholesterol ratio,and plasma creatinine between the H-type hypertension combined with OSAHS group and the H-type hypertension non-OSAHS group and the control group,p<0.05.Among them,the 24-hour diastolic blood pressure variability in ambulatory blood pressure monitoring in the H-type hypertension combined with OSAHS group was higher than that in the H-type hypertension non-OSAHS hypertension group and higher than that in the control group,all p<0.05.Male and high body mass index were risk factors for OSAHS in patients with H-type hypertension,all p<0.05.Compared with the control group,male and low HDL-C levels were risk factors for the coexistence of H-type hypertension and OSAHS,p<0.05.The severity of AHI and OSAHS in hypertensive patients was significantly positively correlated with plasma homocysteine levels(Rho=0.209,0.218,all p<0.05).After further gender grouping,the correlation disappeared in the male hypertension group and increased in the female group(Rho=0.609,0.452,all p<0.05).Conclusion:H-type hypertension combined with OSAHS accounts for a relatively high proportion in the hypertension group.The high BMI male group is still the focus of prevention of H-type hypertension combined with OSAHS.However,when the plasma Hcy level of female hypertensive patients increases,attention should be paid to the screening of OSAHS diseases.Plasma creatinine level may be a sensitive index for monitoring H-type hypertension in hypertensive population.Therefore,in the prevention and treatment of chronic diseases of cardiovascular and cerebrovascular diseases,strengthening the screening of H-type hypertension and OSAHS and establishing a disease prediction model will be a new idea for individualized disease management.