Study on blood pressure rhythm in hypertensive patients with Yin deficiency syndrome and a random forest model for predicting hypertension with Yin deficiency syndrome

doi:10.19852/j.cnki.jtcm.20240308.003

Journal of Traditional Chinese Medicine ›› 2024, Vol. 44 ›› Issue (3): 564-571.DOI: 10.19852/j.cnki.jtcm.20240308.003

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Study on blood pressure rhythm in hypertensive patients with Yin deficiency syndrome and a random forest model for predicting hypertension with Yin deficiency syndrome

ZHOU Ying¹, LI Ping², LUAN Jianwei², SHEN Rui², WU Yinglan², XU Qiwen², WANG Xinyue², ZHU Yao², XU Xiangru⁴, LIU Zitian², JIANG Yuning², ZHONG Yong⁵, HE Yun³(), JIANG Weimin²()

1 Department of Cardiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing 210029, China; Department of Health Management Centre, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
2 Department of Cardiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing 210029, China
3 Department of General Internal Medicine, the Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing 210029, China
4 Emergency Department, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
5 Department of Health Management Centre, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China

Received:2023-02-22 Accepted:2023-05-19 Online:2024-06-15 Published:2024-03-08
Contact: Prof. JIANG Weimin, Department of Cardiology, the Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing 210029, China. Jwm0410@njucm.edu.cn; HE Yun, General Medicine Department, the Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing 210029, China. heyunxinxueguan@163.com Telephone: +86-25-86617147
Supported by:
National Key R&D Program of China Project: Study on Syndrome Differentiation Standard of Yin deficiency Syndrome in Hypertension(2018YFC1704403);National Key R&D Program of China Project: Systematic Study on the Standard of Syndrome Differentiation of Yin Deficiency Syndrome(2018YFC1704400);Natural Science Foundation of Jiangsu Province: Exploring the Cardioprotective Effect and Mechanism of Qinggan Zishen Formula on Obesity and Hypertension Based on Nrf2 Regulation of Cardiac Homeostasis(BK20221422);Natural Science Foundation of Jiangsu Province: Mechanism Study on the Promotion of Cardiac Energy Metabolism Balance and Inhibition of DOX Induced Heart Failure through Nr1d1/Nfil3 Mediated Circadian Pathway by Yiqi Wenyang Formula(BK20220739)

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Abstract

Abstract:

OBJECTIVE: To investigate blood pressure rhythm (BPR) in Yin deficiency syndrome of hypertension (YDSH) patients and develop a random forest model for predicting YDSH.

METHODS: Our study was consistent with technical processes and specification for developing guidelines of Evidence-based Chinese medicine clinical practice (T/CACM 1032-2017). We enrolled 234 patients who had been diagnosed with primary hypertension without antihypertensive medications prior to the enrollment. All participants were divided into Yin deficiency group (YX, n = 74) and non-Yin deficiency group (NYX, n = 160). Participants were professionally grouped by three experienced chief Traditional Chinese Medicine (TCM) physicians according to four examinations (i.e., inspection, listening and smelling, inquiry and palpation). We collected data on 24 h ambulatory blood pressure monitoring (ABPM) and YDSH rating scale. We divided 24 h of a day into 12 two-hour periods [Chen-Shi (7:00-9:00), Si-Shi (9:00-11:00), Wu-Shi (11:00-13:00), Wei-Shi (13:00-15:00), Shen-Shi (15:00-17:00), You-Shi (17:00-19:00), Xu-Shi (19:00-21:00), Hai-Shi (21:00-23:00), Zi-Shi (23:00-1:00), Chou-Shi (1:00-3:00), Yin-Shi (3:00-5:00), Mao-Shi (5:00-7:00)] according to the theory of “midnight-midday ebb flow”. We used random forest to build the diagnostic model of YDSH, with whether it was Yin deficiency syndrome as the outcome.

RESULTS: Compared with NYX group, YX group had more female participants with older age, lower waist circumference, body mass index (BMI), diastolic blood pressure (DBP), and smoking and drinking rate (all P ＜ 0.05). The YDSH rating scores of YX group [28.5 (21.0-36.0)] were significantly higher than NYX group [13.0 (8.0-22.0)] (P < 0.001), and the typical symptoms of YX group included vexing heat in the chest, palms and soles, dizziness, dry eyes, string-like and fine pulse, soreness and weakness of lumbus and knees, palpitations, reddened cheeks, and tinnitus (all P < 0.05). The ratio of non-dipper hypertension in YX group was higher than in NYX group (56.9% vs 44.4%, P = 0.004). Compared with NYX group, 24 h DBP standard deviation (SD), nighttime DBP SD, Si-Shi DBP, Si-Shi mean arterial pressure (MAP), Hi-Shi systolic blood pressure (SBP), Hi-Shi DBP, Hi-Shi MAP, Zi-Shi SBP, Zi-Shi DBP, Zi-Shi MAP, Chou-Shi SBP SD, Chou-Shi DBP SD, Chou-Shi SBP coefficient of variation (CV) were lower in YX group (all P ＜ 0.05). Binary Logistic Regression analysis showed that the diagnosis of YDSH was positively correlated with age, heart rate, YDSH rating scores, and four TCM symptoms including vexing heat in the chest, palms and soles, string-like and fine pulse, soreness and weakness of lumbus and knees, and reddened cheeks (all P ＜ 0.05), but was negatively correlated with smoking (P﹥0.05). In addition, the diagnosis of YDSH was positively correlated with daytime SBP SD, nighttime SBP SD, nighttime SBP CV, and Hi-Shi SBP CV, but was negatively correlated with 24 h SBP CV, daytime DBP SD, nighttime DBP SD, and Hi-Shi DBP (all P ＜ 0.05). Hi-Shi SBP CV had independent and positive correlation with the diagnosis of YDSH after adjusting the variables of age, gender, course of hypertension, BMI, waist circumference, SBP, DBP, heart rate, smoking and drinking (P = 0.029). Diagnostic model of YDSH was established and verified based on the random forest. The results showed that the calculation accuracy, specificity and sensitivity were 77.3%, 77.8% and 76.9%, respectively.

CONCLUSION: The BPR was significantly attenuated in YDSH patients, including lower 24 h DBP SD and nighttime DBP SD, and Hi-Shi SBP CV is independently correlated with the diagnosis of YDSH. The prediction accuracy of diagnosis model of YDSH based on the random forest was good, which could be valuable for clinicians to differentiate YDSH and non-Yin deficiency patients for more effective hypertensive treatment of TCM.

Key words: hypertension, Yin deficiency syndrome, random forest, blood pressure rhythm, blood pressure variability

ZHOU Ying, LI Ping, LUAN Jianwei, SHEN Rui, WU Yinglan, XU Qiwen, WANG Xinyue, ZHU Yao, XU Xiangru, LIU Zitian, JIANG Yuning, ZHONG Yong, HE Yun, JIANG Weimin. Study on blood pressure rhythm in hypertensive patients with Yin deficiency syndrome and a random forest model for predicting hypertension with Yin deficiency syndrome[J]. Journal of Traditional Chinese Medicine, 2024, 44(3): 564-571.

Figures/Tables 7

References 22.

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Characteristic	Total sample (n = 234)	YX (n = 74)	NYX (n = 160)	t/χ²/F value	P value
Gender (Male/Female, n)	154/80	39/35	115/45	8.266	0.004
Age (years)	45±11	47±12	43±11	-2.804	0.005
Course (mouth)	9 (1-24)	11 (1-36)	6 (0-24)	-1.171	0.242
Waist (cm)	91±9	87±9	93±9	4.712	<0.001
BMI (kg/m2)	26±3	25±3	27±3	4.075	<0.001
SBP (mm Hg)	147±16	146±15	148±16	0.927	0.355
DBP (mm Hg)	94±12	91±14	95±12	2.358	0.019
Heart rate (bpm)	81±10	82±11	81±10	-1.026	0.306
Smoking (yes/no)	53/181	8/66	45/115	8.658	0.003
Drinking (yes/no)	41/193	7/67	34/126	4.867	0.027

Characteristic	Total sample (n = 234)	YX (n = 74)	NYX (n = 160)	t/χ²/F value	P value
Gender (Male/Female, n)	154/80	39/35	115/45	8.266	0.004
Age (years)	45±11	47±12	43±11	-2.804	0.005
Course (mouth)	9 (1-24)	11 (1-36)	6 (0-24)	-1.171	0.242
Waist (cm)	91±9	87±9	93±9	4.712	<0.001
BMI (kg/m2)	26±3	25±3	27±3	4.075	<0.001
SBP (mm Hg)	147±16	146±15	148±16	0.927	0.355
DBP (mm Hg)	94±12	91±14	95±12	2.358	0.019
Heart rate (bpm)	81±10	82±11	81±10	-1.026	0.306
Smoking (yes/no)	53/181	8/66	45/115	8.658	0.003
Drinking (yes/no)	41/193	7/67	34/126	4.867	0.027

Characteristic	Total sample (n = 234)	YX (n = 74)	NYX (n = 160)	t/χ²/F value	P value
24SBP (mm Hg)	131.8±13.8	130.2±12.6	132.6±14.3	1.226	0.222
dSBP (mm Hg)	134.7±14.2	133.1±13.1	135.5±14.7	1.179	0.240
nSBP (mm Hg)	122.0±14.6	120.5±13.1	122.7±15.2	1.075	0.283
24DBP (mm Hg)	83.2±11.4	81.2±11.0	84.2±11.5	1.871	0.063
dDBP (mm Hg)	85.6±11.9	83.4±11.5	86.6±12.0	1.882	0.061
nDBP (mm Hg)	75.±11.2	73.8±10.5	76.2±11.5	1.515	0.131
24MAP (mm Hg)	99.4±11.6	97.5±10.9	100.3±11.9	1.702	0.090
dMAP (mm Hg)	102.0±12.1	100.0±11.3	102.9±12.4	1.692	0.092
nMAP (mm Hg)	91.0±11.8	89.4±10.8	91.7±12.2	1.399	0.163
24SBPSD (mm Hg)	13.7±3.2	13.5±3.5	13.7±3.1	0.610	0.543
24DBPSD (mm Hg)	10.7±2.4	10.2±2.4	11.0±2.5	2.171	0.031
dSBPSD (mm Hg)	12.4±3.3	12.4±3.3	12.4±3.3	-0.055	0.956
dDBPSD (mm Hg)	9.7±2.7	9.4±2.4	9.8±2.8	1.129	0.260
nSBPSD (mm Hg)	10.8±3.6	10.4±3.7	11.0±3.6	1.254	0.211
nDBPSD (mm Hg)	8.7±2.9	7.9±2.4	9.0±3.0	2.648	0.009
24SBPCV (%)	10.4±2.4	10.4±2.7	10.4±2.2	0.126	0.900
24DBPCV (%)	13.0±3.0	12.7±3.2	13.1±2.9	0.949	0.344
dSBPCV (%)	10.1±2.2	10.1±2.5	10.1±2.1	0.185	0.853
nSBPCV (%)	12.6±2.8	12.4±2.9	12.8±2.7	1.012	0.313
dDBPCV (%)	11.3±3.0	11.3±3.6	11.32±2.8	-0.002	0.998
nDBPCV (%)	14.5±4.1	14.2±4.6	14.7±3.8	0.794	0.428
Circadian rhythm of BP				9.919	0.019
Dipper [n (%)]	88 (37.6)	22 (29.7)	66 (41.3)	22	<0.001
Non-dipper [n (%)]	113 (48.3)	41 (55.4)	72 (45.0)	8.504	0.004
Riser [n (%)]	21 (9.0)	4 (5.4)	17 (10.6)	8.048	0.005
Extreme-dipper [n (%)]	12 (5.1)	7 (9.5)	5 (3.1)	0.333	0.564

Characteristic	Total sample (n = 234)	YX (n = 74)	NYX (n = 160)	t/χ²/F value	P value
24SBP (mm Hg)	131.8±13.8	130.2±12.6	132.6±14.3	1.226	0.222
dSBP (mm Hg)	134.7±14.2	133.1±13.1	135.5±14.7	1.179	0.240
nSBP (mm Hg)	122.0±14.6	120.5±13.1	122.7±15.2	1.075	0.283
24DBP (mm Hg)	83.2±11.4	81.2±11.0	84.2±11.5	1.871	0.063
dDBP (mm Hg)	85.6±11.9	83.4±11.5	86.6±12.0	1.882	0.061
nDBP (mm Hg)	75.±11.2	73.8±10.5	76.2±11.5	1.515	0.131
24MAP (mm Hg)	99.4±11.6	97.5±10.9	100.3±11.9	1.702	0.090
dMAP (mm Hg)	102.0±12.1	100.0±11.3	102.9±12.4	1.692	0.092
nMAP (mm Hg)	91.0±11.8	89.4±10.8	91.7±12.2	1.399	0.163
24SBPSD (mm Hg)	13.7±3.2	13.5±3.5	13.7±3.1	0.610	0.543
24DBPSD (mm Hg)	10.7±2.4	10.2±2.4	11.0±2.5	2.171	0.031
dSBPSD (mm Hg)	12.4±3.3	12.4±3.3	12.4±3.3	-0.055	0.956
dDBPSD (mm Hg)	9.7±2.7	9.4±2.4	9.8±2.8	1.129	0.260
nSBPSD (mm Hg)	10.8±3.6	10.4±3.7	11.0±3.6	1.254	0.211
nDBPSD (mm Hg)	8.7±2.9	7.9±2.4	9.0±3.0	2.648	0.009
24SBPCV (%)	10.4±2.4	10.4±2.7	10.4±2.2	0.126	0.900
24DBPCV (%)	13.0±3.0	12.7±3.2	13.1±2.9	0.949	0.344
dSBPCV (%)	10.1±2.2	10.1±2.5	10.1±2.1	0.185	0.853
nSBPCV (%)	12.6±2.8	12.4±2.9	12.8±2.7	1.012	0.313
dDBPCV (%)	11.3±3.0	11.3±3.6	11.32±2.8	-0.002	0.998
nDBPCV (%)	14.5±4.1	14.2±4.6	14.7±3.8	0.794	0.428
Circadian rhythm of BP				9.919	0.019
Dipper [n (%)]	88 (37.6)	22 (29.7)	66 (41.3)	22	<0.001
Non-dipper [n (%)]	113 (48.3)	41 (55.4)	72 (45.0)	8.504	0.004
Riser [n (%)]	21 (9.0)	4 (5.4)	17 (10.6)	8.048	0.005
Extreme-dipper [n (%)]	12 (5.1)	7 (9.5)	5 (3.1)	0.333	0.564

Characteristic (mm Hg)	YX (n = 74)	NYX (n = 160)	t value	P value
Si-Shi DBP	88±12.6	91±13	-2.183	0.029
Si-Shi MAP	104±12	107±13	-2.105	0.035
Hai-Shi SBP	128±16	134±18	-2.644	0.008
Hai-Shi DBP	78±14	85±15	-3.079	0.002
Hai-Shi MAP	95±14	101±15	2.978	0.003
Zi-Shi SBP	120±15	125±18	2.188	0.030
Zi-Shi DBP	72±12	77±13	2.424	0.016
Zi-Shi MAP	88±12	93±14	2.588	0.011
Chou-Shi SSD	6±4	7±4	-2.423	0.015
Chou-Shi DSD	5±3	6±3	-2.214	0.027
Chou-Shi SCV	6±5	8±5	-2.207	0.027

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Study on blood pressure rhythm in hypertensive patients with Yin deficiency syndrome and a random forest model for predicting hypertension with Yin deficiency syndrome

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Figures/Tables 7

References 22.

Related Articles 15

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Characteristic	b	SE	Wald	P value	OR	95% CI
Szxr	0.156	0.049	10.159	0.001	1.169	1.062-1.287
Ty	0.095	0.052	3.302	0.069	1.100	0.993-1.219
Lmgs	-	-	-	0.124	-	-
Mxx	0.189	0.036	27.279	<0.001	1.208	1.125-1.297
Ystr	0.268	0.102	6.919	0.009	1.307	1.071-1.595
Mx	-	-	-	0.477	-	-
Xj	-	-	-	0.213	-	-
Qh	0.176	0.050	12.233	<0.001	1.192	1.080-1.315
Em	-	-	-	0.219	-	-
Md	-	-	-	0.125	-	-

Characteristic	b	SE	Wald	P	OR	95% CI
24SBPCV	-1.587	0.685	5.360	0.021	0.205	0.053-0.784
dSBPSD	0.529	0.177	8.916	0.003	1.697	1.199-2.402
dDBPSD	-0.190	0.09	4.506	0.034	0.827	0.693-0.986
nSBPSD	0.147	0.072	4.156	0.041	1.158	1.006-1.334
nSBPCV	0.993	0.434	5.238	0.022	2.699	1.153-6.317
nDBPSD	-0.204	0.077	7.002	0.008	0.815	0.701-0.948
Hai-Shi DBP	-0.051	0.025	4.262	0.039	0.950	0.906-0.997
Hai-Shi SCV	0.104	0.052	3.941	0.047	1.109	1.001-1.229

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