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BackgroundHypertension (Essential hypertension, hypertensive disease) is a clinical syndrome characterized by circulation arterial systolic blood pressure (Systolic Blood Pressure, SBP), and (or) diastolic blood pressure (Diastolic Blood Pressure, DBP) elevated, which is one of the most common and important clinical cardiovascular diseases. With the improvement of living standards, the prevalence of hypertension is also increasing year by year. Hypertension is not only one of most common serious hazards to human health, but also most important risk factors for coronary heart disease, stroke, heart and kidney failure,. Blood pressure monitoring is the most important method for diagnosis, treatment and prognosis evaluation. For a long time, patients only rely on clinic blood pressure (CBP), but the CBP is often affected by human factors、psychological disturbance, with some limitations. From late 60s of 20th century, the birth of noninvasive automatic ambulatory blood pressure monitoring (ABPM), which gets 30 years of development and improvement, and it has been widely used clinically for the diagnosis of hypertension, prediction Evaluation of target organ damage and the efficacy of antihypertensive therapy, and so on. Traditional Chinese Medicine (TCM) theory says kidney is the essential organ of the five internal organs, contains true yin and yang, yin and yang of human internal organs chosen by kidney yin, yang to support. You Shi(5pm～7pm) :blood flows into Foot Shao Yin Kidney Meridian, and the Meridian is the most productive at the times, also it was the most prominent moment that imbalance of yin and yang, so with the highest blood pressure;Zi Shi(11pm～00) blood flows into Foot-Shaoyang Gallbladder Meridian, which lord determination, storage and excretion of bile, so it has less relationship with the body regulating yin and yang, qi and blood, imbalance of yin and yang is not obvious contradictions so relatively low blood pressure. When at Mao Shi (5am～7am), Yang Qi gas stronger, and Yin declines, blood pressure rises inevitablily.ObjectiveThrough analyzing ABPs of hypertensive patients, get a preliminary summary of the relationship of TCM differentiation types、day-and-night rhythm and twelve meridians.MethodCollects 128 cases inpatients diagnosised HBP ABPs of the Guangdong Provincial Hospital of TCM during 2008 to 2010,100 cases of these cases are choosen by the Inclusion criteria. Reviews the data of ABPs of the Selected inpatients, collects Related clinic information TCM differentiation types and so on about them.100 cases were divided into two groups, excessive rising of liver-Yang and non-excessive rising of liver-Yang (specific criteria for diagnosis of excessive rising of liver-Yang at Schedule). Collects data of ABPs in all cases, ABP data were divided into twelve groups accordance with the dynamic12-hour for each case, each group were calculated coefficient of variation of SBP, SBP smoothing index, SBP standard deviation, coefficient of variation of DBP smoothing index, DBP standard deviation. And then set a database to analyze the result.ResultsSmoothing index、standard deviation、Standard deviation of SBP and DBP of excessive rising of liver-Yang and non-excessive rising of liver-Yang group use t-test respectively to subsequent 12-hour data, There is significant differences between coefficient of variation in SBP of excessive rising of liver-Yang and non-excessive rising of liver-Yang at all 12-hour data (P <0.05), Coefficient of variation of blood pressure is larger than other time, it suggests that Variability of SBP of excessive rising of liver-Yang group is larger, blood pressure unstable, but non-excessive rising of liver-Yang group not. P-values of Smoothing index of SBP in two group shows: Smooth blood pressure index groups have significant difference at 12-hour data except Zishi and Weishi, smoothing index of BP of excessive rising of liver-Yang group is less at Zishi than other time, the stability of SBP is less at the time, but non-excessive rising of liver-Yang group not. P-values of standard deviation of SBP of the two groups shows:there are significant differences at all 12-hour data (P<0.05). Similarly, DBP variation coefficients have statistically significant difference (P<0.05) at Zishi, Choushi, Yanshi, Maoshi, Wushi, Youshi. Variability of excessive rising of liver-Yang group is larger at Choushi, but non-excessive rising of liver-Yang group not. Smoothness index of DBP have differences at Choushi, Youshi (P<0.05), smooth index have low values at Choushi in excessive rising of liver-Yang group, indicating that diastolic blood pressure less stable, but non-excessive rising of liver-Yang group not. Standard deviation of DBP have statistically difference at Yinshi, Chenshi, Shishi, Wushi, Haishi (P<0.05), variability of excessive rising of liver-Yang group is larger, but non-excessive rising of liver-Yang group not. Of 100 cases data of ABP, diversity of coefficient of variation, smoothing index, standard deviation of SBP and DBP have statistically difference at some time in a day, the results are comparable. Observations, data at Choushi in 6 group-data have statistically significant, differences of SBP and DBP has statistically significant in the two groups at Choushi when is the time of liver- meridian except Standard deviation of DBP. Stability index of SBP of excessive rising of liver-Yang group is worse than the other one at Choushi, movement of Qi and blood at Choushi in excessive rising of liver-Yang group more disorder than the other group, it can’t maintain the normal operation of blood and make that Stationary targets of BP disorder.ConclusionCompared with non-excessive rising of liver-Yang group, BP is more unstable at Choushi based on five indicators (smoothing index of SBP、standard deviation of SBP、Standard deviation of SBP、smoothing index of DBP、standard deviation of DBP). It maybe has some relationshio with the disorder of Qi and blood of liver- meridian at the time.Excessive rising of liver-Yang is the most important TCM type of HBP, deficiency of the liver and kidney, unbalanced of Yin and Yang, excessive Yang are important mechanism. According to the mechanism, adjustment effect of body to Qi and blood get weaker at time of excessive rising of liver-Yang, disorder of Qi and blood cause instability of BP. According to characteristics of twelve meridian, Qi and blood flow into liver-meridian at Choushi, if the function of liver-meridian is normal, Qi and blood move orderly; or Qi and blood disorder, it causes unstable of BP. In summary, the instability of BP is more obvious at Choushi than other time in patients of excessive rising of liver-Yang. The conclusion helps find new idea cure HBP associating with TCM and modern medicine, mode of treatment and evaluation of the dialectical change from original 24-hour rhythm under long-time variation to rhythm of short-term. It has positive meaning at improving efficacy for HBP and reducing damage of target organ.
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