The relationship between blood pressure variability and quality of life in essential hypertension patients

SUMMARYCinli H.İ The Relationship Between Blood Pressure Variability and Quality of Life in Essential Hypertension Patients. Celal Bayar University, Faculty of Medicine, Internal Medicine, Thesis of Speciality, Manisa 2012INTRODUCTİON: Hypertension is observable in %26,4 of the adult population in the world. It is predicted that there are almost 15-16 million hypertension patients in Turkey. Hypertension is an important health problem because of its prevalence and the risk factors. Although there are so many researches which examine the quality of life in hypertension patients, the number of studies focusing on 24 hour blood pressure variability and the effect of that variability on quality of life are limited. In our study, we aimed to examine the quality of life, the effects of the 24 hour blood pressure variablity and blood pressure variability on quality of life in hypertension patients.PATİENTS AND METHODS: In this research we included the patients who have applied to Celal Bayar University Faculty of Medicine, Internal Medicine Department between September 2011 and June 2012 and who are between 18 and 70 years old. 73 patients who were diagnosed as hypertension and had no drug treatment history have been taken to the study. Ambulatory blood pressure record device was placed to the patients who were diagnosed as hypertension. The hypertension patients were also asked to answer the questions of SF-36 survey. The quality of life of the patients were measured by this survey which has 8 main sections and a total of 36 questions.Hypertension patients were divided into 4 categories by ambulatory blood pressure monitoring: dipper hypertension: Night/day hypertension ratio is 0.8-0.9; nondipper hypertension: Night/day hypertension ratio is 0.9-1.0; inverted dipper (reversed dipper) hypertension: Night/day hypertension ratio > 1; white-coat hypertension: Clinical blood pressure measurement is bigger than 140-90; holter blood pressure measurement is less than 135-85. Blood pressure variability was measured by using the following formula: variability coefficient (VC)=(100xstandart deviation)/mean blood pressure.For group comparision in statiscical assessment, ANOVA and student t test are used. Pearson correlation test was used to search the relationship between the variables (P <0.05).FİNDİNGS: The average age of the patients was 43,2 ± 13,6. %49,3(s=36) were men and %50,7(s=37) were women. According to ABPM data, the hypertension category ratios of patients were: %39,7(s=29) dipper hypertension, %31,5(s=23) non dipper hypertension,%15,1(s=11) reverse dipper hypertension and %13,7(s=10) white-coat hypertension. White-coat hypertension blood pressure parameters were lower than the other groups according to ABPM data. Reverse dipper and dipper comparision in terms of NTSBP and NTMAP parameters showed that reverse dipper has a higher statistical blood pressure average (p:0,018), (p:0,045).Hypertension patients were compared by using SF-36 subscale points. Physical function point were higher in white-coat group but it was not statisticially significant. General health, vitality, social function and emotional well-being points were lower in non-dipper group but it was not statistically significant. When blood pressure variability and quality of life relation is examined, a negative and statistically significant relationship was observed between 24HDBPVC and physical well being (r=0,240), (p=0,041); and between DTDBPVC and physical well being (r=0,256)(p=0,028).In our study, the quality of life points were observed to be lower in those who have a higher blood pressure average. There were statistically significant results between NTSBP and physical function (p=0,033), between NTDBP and pain (p=0,016) and between 24HSBP and DTSBP and general health parameters (p=0,024), (p=0,006).CONCLUSİON: General healt, vitality, social function and emotional well-being parameters of quality of life were observed to be lower in non-dipper group but it was not statistically significant. We think that a more extensive research is needed to get statistically significant results. A negative statistically significant relationship was observed between 24HDBPVC and DTDBPVC and physical well being. The patients who have a higher blood pressure average were observed to have a lower quality of life point. There were statistically significant results between NTSBP and physical function, NTDBP and pain, 24HSBP and DTSBP and general health parameters.Key Words: Hypertension, dipper, non dipper, reverse dipper, white-coat, quality of life, SF-36.