冠心病合并高血压患者血压控制程度对动脉弹性功能的影响

The impact of blood pressure level on arterial elasticity in patients with coronary heart disease and hypertension

目的探讨冠心病合并高血压患者血压控制程度对动脉弹性功能的影响。方法选择经过冠状动脉造影证实的冠心病合并高血压患者46例,全部患者均经过降压药物治疗。根据血压水平将患者分为2组,其中23例为血压控制不良组(收缩压≥140 mm Hg或舒张压≥90 mm Hg),另23例为血压控制良好组(收缩压<140 mm Hg且舒张压<90 mm Hg)作为配对(1∶1)。对2组患者血压、血管弹性功能[颈动脉-股动脉脉搏波速度(cfPWV),系统血管顺应性(SVC)、肱动脉扩张性(BAD)、系统血管阻力(SVR)]进行测定和分析。结果 (1)在血压控制良好组cfPWV(m/s)明显低于控制不良组(10.38±1.73比12.83±3.13,P<0.01)。(2)血压控制良好组的SVC(ml/mm Hg)、BAD(%/mm Hg)与血压控制不良组相比增高(1.16±0.23比0.94±0.17,6.01±0.98比4.63±0.71,均为P<0.01)。(3)cfPWV与年龄、收缩压、脉压正相关,相关系数r分别为0.374、0.416、0.507。多元线性逐步回归分析显示,cfPWV=4.796+0.099×脉压,即cfPWV与脉压成线性关系,提示收缩压及脉压增大加重患者的大动脉功能减退。结论冠心病合并高血压患者存在血管弹性功能异常,并与血压控制不良直接相关。血压控制良好的患者SVC、BAD、cfPWV均有改善,冠心病合并高血压患者需要良好的血压控制。

Objective To explore the relationship of blood pressure level with the arterial elasticity in patients suffered from essential hypertension and coronary heart disease. Methods Fourty-six patients with essential hypertension and coronary heart disease were enrolled in. The coronary heart disease was diagnosed by coronary angiography. Patients were divided into two groups. One group was poor-controlled blood pressure group, whose SBP〉140 mm Hg and/or DBP〉90 mm Hg. The partnership group （ 1：1 ）was well-controlled blood pressure group, which was defined as SBP 〈 140 mm Hg and DBP 〈 90 mm Hg. Arterial elasticity including [ SVC （ systemic vascular compliance ）, SVR （ systemic vascular resistance ）, BAD （ brachial artery distensibility） and cfPWV （ carotid-femoral pulse wave velocity） ] was measured in all patients. Results The cfPWV was higher in poor-controlled pressure group than that in well-controlled blood pressure group（ 12. 83 ± 3. 13 vs. 10. 38 ± 1.73 ,P 〈 0. 01 ）. The SVC and BAD were both lower in poor- controlled blood pressure group （0. 94 ± 0. 17 vs. 1.16 ± 0. 23,4. 63 ± 0. 71 vs. 6. 01 ± 0. 98, P 〈 0. 01 ）. cfPWV was positively related to Age, SBP and PP（ r = 0. 374,0. 416 and 0. 507 ）. Multiple linearregression analysis showed that cfPWV = 4. 796 ± 0. 099 x PP, which suggested that cfPWV was positively related to SBP and PP. Conclusions Artery elasticity abnormity is found in patients with essential hypertension and coronary heart disease, especially in those with poor-controlled blood pressure. It will be more beneficial for these patients to control blood pressure better.