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Objective To analyze the effects of 24-hour diurnal blood pressure rhythm ( BPCR) changes on diastolic function in elderly hypertensive patients. Methods From February 2016 to February 2018,one hundred and twenty elderly patients with hypertension were divided into two groups according to their 24-hour ambulatory blood pressure status: dipper group with 65 cases ( nocturnal blood pressure drop rate (＞10%) and non-dipper group with 55 cases ( nocturnal blood pressure drop rate＜10%); ambulatory blood pressure and echocardiographic relaxation were detected. Posterior wall (PW),interventricular septum (IVS),left ventricular diameter (LVEDD),left ventricular mass index (LVM) and left ventricular mass index (LVMI) were examined. Fractional shortening ( FS),stroke volume ( SV),cardiac output ( CO) and cardiac index (CI) were calculated,and peak flow time (A peak flow time total integration,ATVI) and peak flow velocity (A Pea) were measured. K flow rate ventricular (APFV); E peak flow time ventricular integral (ETVI ), early Peak flow Velocity ( EPFV ) and left ventricular ejection fraction ( LVEF ) were detected. Results The 24 h DBP, 24 hSBP, nocturnal DBP, and nocturnal SBP in dipper group were (80. 27±7. 29) mmHg,(125. 29±10. 38) mmHg,(69. 98±6. 36) mmHg,(110. 39±10. 52) mmHg,which were lower than those of the noninvasive group ((83. 82±7. 51) mmHg,(130. 89±10. 71) mmHg,(79. 81 ±6. 84) mmHg,( 126. 83 ± 10. 92) mmHg), the differences were statistically significant ( t ＝ 12. 809, 13.954,11.053,13.289,P＝0.042,0.021,0.014,0.006).The EPFV in the dipper group was (65.02 ±11. 83) cm/s,which was higher than that in the non-dipper group ((60. 84±11. 29) cm/s). The A/E, ATVI,and APFV in the dipper group were (1.03±0.58),(5.59±1.72) cm,(63.74±11.06) cm/s, respectively,lower than those in non-dipper group( (1. 14±0. 54),(6. 11±1. 68) cm,(68. 82±11. 17) cm/s),the differences were statistically significant (t＝10. 895,11. 643,12. 339,10. 854,P＝0. 032,0. 027, 0. 013,0. 006). Left ventricular diastolic function was negatively correlated with daytime DBP (r＝－ 0. 195,－0. 217,－0. 174,－0. 173,P＜0. 05) and positively correlated with nighttime SBP( r＝0. 194,0. 171,0. 220, 0. 206,P＜0. 05). Conclusion In elderly hypertensive patients,the left ventricular diastolic function and left ventricular hypertrophy are more serious in non-dipper patients, and it is necessary to strengthen the control of nocturnal blood pressure in elderly hypertensive patients.
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Objective Observed the characteristics and influence factors of blood pressure circadian rhythm in continuous ambulatory peritoneal dialysis patients.To investigate the effect of residual renal function and cardiac function.Methods Prospectively collected 120 cases of continuous ambulatory peritoneal dialysis from June 2016 to March 2017 in Tangshan renal medicine dialysis centers,who combined with hypertension were treated with peritoneal dialysis for more than 3 months.According to the dynamic monitoring blood pressure circadian rhythm of blood pressure,120 cases were divided into the normal rhythm of blood pressure and the abnormal blood pressure rhythm group.Collected medical history;Tested related test index respectively;Cardiac ultrasound.According to the formula to calculate residual renal function,left ventricular mass index,Eingabe/Ausgabe,Ejection Fraction.Univariate and multivariate unconditional logistic regression analysis was used to analyze the risk factors of circadian rhythm of blood pressure.Stepwise multiple linear regression analysis was used to analyze the risk factors of residual renal function and cardiac function.Results CAPD patients with normal blood pressure rhythm in 14 cases(11.7％),abnormal blood pressure rhythm in 106 cases(88.3％),Among them,non dipper blood pressure accounted for 75 cases(62.5％).Single factor and multiple factors unconditioned logistic regression analysis revealed that after the comparison of gender and age,Risk factors for abnormal circadian rhythm of blood pressure were:UA(OR=1.197,95％CI:1.099-1.441),CRP(OR=1.170,95％CI:1.061-1.331),RRF(OR=1.389,95％CI:1.160-1.779).Using stepwise multiple linear regression analysis of dangerous factors affecting residual renal function and cardiac function,we found:Residual renal function negatively correlated with left ventricular myocardial mass index,systolic blood pressure drops at night rate,and ultrafiltration volume;LVMI (cardiac function) Positively correlated with 24 h average systolic blood pressure,and negatively correlated with systolic blood pressure drop ratio and residual renal function at night.Abnormal circadian rhythm of blood pressure may lead to the decline of residual renal function and cardiac function.Conclusions UA,CRP and RRF may affect the CAPD patients blood pressure circadian rhythm.At the same time,abnormal circadian rhythm of blood pressure may lead to the decline of residual renal function and cardiac function.Therefore,pay attention to the monitoring and control of ABPM,can better protect the residual renal function and improve cardiac function,so as to prolong and improve the survival time and quality of life of patients with CAPD.
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Objective To explore the effect of combined prescription medication on non-dipper hyperten sive patients.Methods 76 patients with non-dipper hypertensive patients were randomly divided into group A (n =38) and group B (n =38).Telmisartan tablets,hydrochlorothiazide tablets and levamlodipine tablets were given in two groups.Patients in group A take oral medicine at 8 pm,and patients in group B take oral medicine at 8 pm.The levels of plasma angiotensin Ⅱ,plasma endothelin-1 (ET-1),plasma renin,matrix metalloproteinase9 (MMP-9) and Chemerin protein were observed in both groups.Results After treatment,24 h SBP,dSBP and nSBP in group B were significantly lower than those in group A (P ＜ 0.05).The dipper value of group B was significantly higher than that of group A (P ＜ 0.05).The diversion rate of group B was significantly higher than that of group A (P ＜ 0.01).The levels of renin,angiotensin Ⅱ,ET-1,MMP-9 and Chemerin in group B were significantly lower than those in group A at 6 AM and 0:00 (P ＜ 0.05).The degree of change in group B at 0:00 was more significant than that in 6:00 AM (P ＜ 0.05).There was no significant difference in the incidence of adverse reactions between the two groups (P ＞ 0.05).Conclusion The efficacy of telmisartan,hydrochlorothiazide combined with levamlodipine in patients with non-dipper hypertensive patients performs better if patients take medicine at 8 pm other than at 8 pm.
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Objective: To investigate the inlfuence of different blood pressure (BP) circadian rhythm on cardiac function in hypertensive patients. Methods: A total of 180 hypertensive patients with well controlled day-time blood pressure were divided into 3 groups. Dipper group, n=30, Non-dipper group, n=99 and Reverse dipper group, n=51. The relationship between cardiac function, relevant clinical index and blood pressure circadian rhythm were analyzed. Results: The mean systolic and diastolic BP, BP classiifcation and the antihypertensive medication were similar among 3 groups.①The ratio of peak mitral E wave to peak mitral annulus E' wave (E/E') increased accordingly from Dipper group, Non-dipper group and Reverse-dipper group as (8.1 ± 2.4), (8.6 ± 2.5) and (9.6 ± 3.2), P Conclusion: Abnormal blood pressure circadian rhythm was associated with the cardiac injury in hypertensive patients. The cardiac injury increased accordingly from Non-dipper group to Reverse-dipper group and the main damage was in diastolic function.
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Objective To evaluate the relation of circadian blood pressure rhythm with vascular status in elderly patients with isolated systolic hypertension.MethodsAnkle-brachial index (ABI),brachial-ankle pulse wave velocity (baPWV) and carotid intima-media thickness (IMT) were measured in 74 elderly patients with non-dipper hypertension (non-dipper group)、78 elderly patients with dipper hypertension ( dipper group),and 72 healthy controls ( control group).Results In comparison with the dipper group,baPWV and IMT of the non-dipper group were significantly increased [ baPWV (1801.61± 314.27) vs (1658.67±274.80) (cm/s)],P＜0.01; IMT:(0.96 ±0.22) vs (0.87 +0.19) (mm),(P＜0.05),while ABI of the non-dipper group was decreased (1.03 ±0.17 vs1.12 ±0.18,P＜0.01).Identification rate was significantly different among 3 groups when baPWV ＞1400 cm/s (x2 =12.57,P ＜0.01) or ABI ＜0.9 ( x2 =9.74,P ＜0.01).The detection of carotid plaques was also significantly different ( x2 =16.49,P ＜ 0.01).Conclusions These findings suggest that vascular damage could be found in elderly patients with isolated systolic hypertension,especially in those with non-dipper hypertension.ABI,baPWV and IMT measurement may be helpful for the assessment of vascular status.