Correlation between Serum hs-CRP，Homocysteine and Nocturnal Blood Pressure Variability in Patients with Essential Hypertension

doi:10.12114/j.issn.1007-9572.2019.00.788

Abstract

Abstract: Background　The 24 h Blood pressure variability（24 hBPV），serum high-sensitivity C-reactive protein（hs-CRP） and homocysteine（Hcy） are independently associated with the target organ damage and increased risk of cardiovascular events in patients with essential hypertension.Several studies have shown that hs-CRP and Hcy are positively correlated with blood pressure variability（BPV） in hypertensives，especially the nocturnal blood pressure variability（nBPV） which is associated with the increased target organ damage and risks of cardiovascular events.However，the relationship between serum hs-CRP，Hcy and nBPV has not been fully identified in patients with essential hypertension.Objective　To investigate the correlation between serum hs-CRP，Hcy and nBPV in patients with essential hypertension.Methods　A total of 210 hypertensive patients who visited the Second Affiliated Hospital of Zhengzhou University from January 2016 to December 2018 were enrolled in the study and divided into three groups according to the serum hs-CRP tertile value with the cut-off value of 4.217 mg/L and 7.450 mg/L.Similarly，these patients were divided into three groups according to the different levels of Hcy：106 cases with Hcy<15.0 μmol/L（group A），45 cases with 15.0 μmol/L≤Hcy<20.0 μmol/L（group B），and 59 cases with Hcy≥20.0 μmol/L（group C）.The 24-hour ambulatory blood pressure monitoring was performed on all patients.The mean and standard deviations（as the index of BPV）of systolic and diastolic blood pressure in the periods of 24 hours and at nighttime were recorded.The correlations between hs-CRP，Hcy and nBPV were analyzed by Pearson correlation analysis and multiple linear regression analysis.Results　Grouped by hs-CRP level，24 hBPV and nBPV in the third tertile group were significant higher than those in the first tertile group，24 hBPV in the second tertile group was significant higher than that in the first tertile group（P<0.05）.Grouped by Hcy level，24 hBPV and nBPV in group B and group C were significant higher than that in group A，nBPV in group C was significant higher than that in group B（P<0.05）.Pearson correlation analysis indicated that the serum hs-CRP and Hcy levels were positively correlated with the standard deviation of systolic blood pressure at nighttime（nSSD） linearly（r valus were 0.564 and 0.501，P<0.05）.Multiple linear regression analysis showed that hs-CRP and Hcy were the influence factors of nBPV（P<0.05）.Conclusion　Serum hs-CRP and Hcy are positively correlated with nBPV independently in patients with essential hypertension，suggesting that they may play a role in the pathogenesis of nBPV，possibly aggravate the abnormality of nBPV，and they may be the mediators between nBPV and the terminal target organ damage and cardiovascular endpoint events of essential hypertension.

Key words: Essential hypertension, Hypertension, High-sensitivity C-reactive protein, Homocysteine, Blood pressure variability

摘要： 背景　24 h血压变异性（24 hBPV）、超敏C反应蛋白（hs-CRP）和同型半胱氨酸（Hcy）与原发性高血压病患者靶器官损伤和心血管终点事件的发生独立相关。研究表明，hs-CRP和Hcy与高血压人群血压变异性（BPV）呈正相关，特别是夜间血压的变化与靶器官损伤和心血管终点事件发生风险的增加有关。然而，在原发性高血压病患者中，hs-CRP和Hcy与夜间血压变异性（nBPV）之间的关系尚未得到充分的研究。目的　探讨原发性高血压病患者血清hs-CRP和Hcy与nBPV的关系。方法　选取2016—2018年就诊于郑州大学第二附属医院的原发性高血压病患者210例为研究对象。将所有患者根据hs-CRP三分位值分为3组，三分位切点值为4.217、7.450 mg/L；同时根据Hcy分为3组，A组（Hcy<15.0 μmol/L，106例），B组（15.0 μmol/L≤Hcy<20.0 μmol/L，45例）、C组（Hcy≥20.0 μmol/L，59例）。患者均行24 h动态血压监测，记录24 h、夜间时段的血压均值和标准差（以标准差为BPV指标），采用相关分析和多元线性逐步回归分析hs-CRP、Hcy与nBPV的关系。结果　以hs-CRP分组，第3三分位组24 hBPV、nBPV高于第1三分位组，第2分位组24 hBPV高于第1分位组（P<0.05）。以Hcy分组，B组和C组24 hBPV、nBPV高于A组，C组nBPV高于B组（P<0.05）。Pearson相关分析结果显示，hs-CRP和Hcy与夜间收缩压标准差（nSSD）呈线性正相关（r值分别为0.564、0.501，P<0.05）。多元线性逐步回归分析结果显示，hs-CRP和Hcy是nBPV的影响因素（P<0.05）。结论　血清hs-CRP和Hcy与原发性高血压病患者nBPV独立正相关，提示其可能在nBPV的发病机制中起一定作用，可能加剧nBPV异常，并可能是nBPV与原发性高血压病终末靶器官损伤及心血管终点事件联系的中介因素。

关键词: 原发性高血压病, 高血压, 超敏C反应蛋白, 同型半胱氨酸, 血压变异性

LIU Fangfang,ZHANG Qiang,YANG Lihong, et al. Correlation between Serum hs-CRP，Homocysteine and Nocturnal Blood Pressure Variability in Patients with Essential Hypertension　[J]. Chinese General Practice, 2020, 23(10): 1292-1297. DOI: 10.12114/j.issn.1007-9572.2019.00.788.
刘方方,张强,杨丽红等. 原发性高血压病患者血清超敏C反应蛋白和同型半胱氨酸与夜间血压变异性的关系研究[J]. 中国全科医学, 2020, 23(10): 1292-1297. DOI: 10.12114/j.issn.1007-9572.2019.00.788.

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