老年高血压患者动态脉压指数与冠状动脉狭窄程度的关系

Relationship between pulse pressure index and severity of coronary artery stenosis in elderly hypertensives

目的探讨老年高血压(EH)患者动态脉压指数(PPI)与冠状动脉(冠脉)狭窄程度的关系。方法对拟诊为冠心病(CHD)的286例老年EH患者按冠脉造影的结果分为CHD组187例,非CHD组99例,以Leaman法进行冠脉狭窄程度评分;监测患者24 h动态血压,计算其动态PPI。结果随着动态PPI逐渐增大,冠脉狭窄程度评分明显增加(P<0.01);CHD组年龄、吸烟、高血压病程、降压达标、糖尿病、血脂异常、脉压(PP)及动态PPI明显高于非CHD组,(P<0.05);Logistic回归分析显示,EH患者CHD的发生与其动态PPI显著相关。动态PPI每增加0.10,CHD发生率增加38%,在对年龄和其他危险因素进行校正后,动态PPI每增加0.10,仍显示CHD发生率增加28%。CHD的发生同样与PP和收缩压(SBP)密切相关(P<0.01),而与舒张压和平均动脉压无相关。结论老年EH患者动态PPI、PP和SBP与冠脉狭窄严重程度呈正相关。

Objective To investigate the relationship between pulse pressure index （PPI） and the severity of coronary artery stenosis in elderly hypertensive patients. Methods Two hundred and eighty-six elderly hypertensive patients who were suspected to have coronary heart disease （CHD） were divided into CHD group （187 cases） and non-CHD group （99 cases） according to the results of Judkins coronary angiography. All of the patients were evaluated for the severity of coronary artery stenosis with Leaman score. Results The scores of coronary artery stenosis obviously increased with increasing PPI （ P 〈 0.01 ）. Age, smoking, duration of hypertention, reaching the standard of decrease in blood pressure, diabetes mellitus, abnormal blood lipids, pulse pressure and PPI in CHD group were significantly higher than those in non-CHD group （ P 〈 0.05）. Logistic regression analysis showed that PPI is strongly correlated with coronary artery disease in elderly essential hypertensive patients. An increment in PPI by 0.10 led to increase in the incidence of coronary artery disease by 28% （95% CI 1.21 - 1.33, P 〈0.01）.PPI had a positive correlation with coronary artery disease. Conclusions The pulse pressure index, pulse pressure and SBP have positive correlation with the severity of coronary artery stenosis in elderly hypertensive patients. PPI is an important and independent forecasting index for the occurrence and development of coronary, artery disease in elderly hypertensive patients.