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Effects of Non-dipper Circadian Variation (non Dipper) on Urinary Albumin Excretion Rate and Left Ventricular Mass in Normotensives

Author: ZhangQiuShi
Tutor: ZhouZhiLin
School: Anhui Medical University,
Course: Department of Cardiology
Keywords: circadian rhythm urinary albumin excretion rate left ventricular mass index
CLC: R544.1
Type: Master's thesis
Year: 2011
Downloads: 22
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Abstract

BackgroundHigh blood pressure is a powerful prediction of the cardiovascular events and mortality. Ambulatory blood pressure monitoring (ABPM) is available for clinical evaluation of the hypertensive patients at present. It is well known that ambulatory blood pressure is more closely associated with the clinical evaluation of target organ damage than the casual blood pressure. In the absence of normal nocturnal blood pressure reduction is called non-dippers compared with the dippers showed a normal circadian rhythm of blood pressure. In several previous studies of hypertensives, it has been shown that several abnormalities in BP circadian rhythm such as non-dipping status, increased morning BP (MBP) and increased MBP surge (MBPS) have an association with cardiovascular (CV) target organ damage.However, in normotensives, the relation between the abnormalities in BP circadian rhythm and target organ damage has not been examined sufficiently. This study is aimed to explore whether or not the normal circadian rhythm abnormalities (non-dippers) is closely related with the heart, kidney or other target organ damage.ObjevtiveTo Investigate the effects of non-dipper circadian variation (non dipper) on urinary albumin excretion rate and left ventricular mass in normotensives, including:1. In order to understand the characteristics of the 24-hour ambulatory blood pressure changes in normotensives. 2. In order to understand the relationship of non-dippers and dippers 24-hour ambulatory blood pressure monitoring.Methodology1. Study:Selected the Medical center of 86 cases, The Hangzhou Clinical Institute of Anhui Medical University during the period from June, 2009 to April, 2010. According to the 24-hour ambulatory blood pressure monitoring results were divided into dipper group (n=49) and non-dipper group (n=37).2. Research Methods2.1 Ambulatory blood pressure monitoring (ABPM)The 90217 automatic non-invasive cuff blood pressure monitor is produced in U.S. space laboratory, The cuff is fixed on above the elbow with left upper extremity at 5cm, appropriate tightness in order to be inserted into two finger. Subjects15 to 30minutes after the break and started for the first time blood pressure measurement during the day(06:00~22:00)every 30 minutes, night(22:00 to06:00 next day)1 time every 1 hour measurement. Total recording time more than 24 hours, the effective measurement of the total number of measurements for more than 85% of the number of valid data.2.2 The detection of urinary albumin excretion rateIn order to measurement the total amount of urine, 24-hour urine was collected. according to the standard specimens were taken by standard: The United States produced Array 360 Beckman automatic scattering turbidity meter and supporting the immune turbidity measurement of urinary MA reagents, the use of immune turbidimetry determined by standard procedures.UAER at 30~300mg/24h, or the discharge rate of 20~200ug/L as a urinary albumin-positive.2.3 All subjects were seated resting blood pressure measurement.2.4 Determination of laboratory parametersAll subjects to renal function, fasting blood glucose, blood lipids and other measured.2.5 Determination of cardiac ultrasound Using color Doppler ultrasonography to measure diastolic interventricular septum thickness (IVST), left ventricular end diastolic diameter (LVIDd) and left ventricular posterior wall thickness (LVPWT), according to Devereux formula to calculate their left ventricular mass (LVM) and left ventricular mass index (LVMI). LVM(g)=1.04[(IVST+LVIDd+PWT)~3-LVIDd~3]-13.6; LVMI(g/m2) = LVM/BSA; BSA(body surface area)=0.006×height (cm) +0.013×weight (kg)-0.153.3 Statistical analysisSPSS13.0 statistical software used for processing, measurement data using mean±standard deviation ( x±s) said that the two groups were used to compare the number of independent samples t test, x~2 test with count data. UAER and LVMI correlation using linear regression analysis, the difference statistically significant (P <0.05).Results1. The characteristics of 24-hour blood pressure changes in normotensives.1.1 The mainly type normal circadian rhythm of blood pressure in dipper and non-dipper.1.2 The non-dipper group of daytime systolic and daytime diastolic blood pressure was very closed to the dipper group. The difference was not statistically significant (P>0.05).1.3 The non-dipper group of night-time systolic and diastolic blood pressure at night were significantly higher than dipper group (P<0.01).1.4 The non-dipper group of UAER and left ventricular mass index (Left ventricular mass index, LVMI) were higher than the dipper group (P<0.05).2. Correlation analysis showed that: UAER and LVMI were positively correlated, The difference was statistical significance (r=0.28; P<0.05).3.Comparison of the total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL), low-density lipoprotein (LDL), fasting blood glucose, serum creatinine (Scr) and creatinine clearance rate (Ccr), the non-dipper group was very close to the dipper group, the difference was not statistically significant (P>0.05).ConclusionNon-dipper blood pressure changes in normotensives,UAER and left ventricular mass index were increased, indicating that the disappearance of normal circadian rhythm of blood pressure (non-dipper), may lead to subclinical heart, kidney and other target organ damage.

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CLC: > Medicine, health > Internal Medicine > Heart, blood vessels ( circulatory ) disease > Abnormal blood pressure > Hypertension
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