高血压伴或不伴2型糖尿病患者血压晨峰与冠脉病变严重程度的相关性

Correlation of morning blood pressure surge with severity of coronary artery lesions in essential hypertension patients with or without type 2 diabetes mellitus

目的探讨高血压伴或不伴2型糖尿病患者血压晨峰的患病特点及其与冠脉病变严重程度的相关性。方法选择2014年1月至2015年8月我科住院的高血压患者244例,其中男性118例,女性126例,年龄(64.7±11.5)岁,根据是否合并糖尿病及其动态血压监测结果将其分为4组:糖尿病晨峰组(D-S,36例)、糖尿病非晨峰组(D-n S,56例)、非糖尿病晨峰组(n D-S,72例)、非糖尿病非晨峰组(n D-n S,80例),入选的244例患者全部进行冠状动脉造影检查,分别比较4组患者冠状动脉病变程度。结果糖尿病晨峰组、糖尿病非晨峰组和非糖尿病晨峰组24 h平均收缩压、白天平均收缩压均高于非糖尿病非晨峰组(P<0.05);糖尿病晨峰组24 h平均舒张压、白天平均舒张压高于糖尿病非晨峰组、非糖尿病晨峰组和非糖尿病非晨峰组(P<0.05);晨峰组三支病变率、C型病变率及晨峰组Gensini总积分显著高于非晨峰组(P<0.01);Pearson相关分析显示,冠状动脉病变严重程度与年龄(r=0.786,P<0.01)、BMI(r=0.284,P<0.05)、空腹血糖(r=0.712,P<0.05)、LDL-C(r=0.765,P<0.05)、晨峰程度(r=0.852,P<0.01)及24 h MSBP(r=0.804,P<0.01)呈正相关;多元线性回归分析显示,年龄、空腹血糖、24 h平均收缩压及血压晨峰为冠状动脉病变严重程度独立危险因素。结论原发性高血压合并糖尿病患者血压晨峰是预测冠状动脉病变严重程度的独立危险因素,有效控制该类患者的晨峰血压及24 h长效平稳的降压可减少对靶器官的损害,降低心血管事件发生。

Objective To explore the characteristics of morning blood pressure surge in the hypertensive patients combined with or without type 2 diabetes mellitus （T2DM） and its correlation with the severity of coronary artery lesions. Methods A total of 244 hypertensive inpatients （118 males and 126 females, at a mean age of 64.7±11.5） admitted in our department from January 2014 to August 2015 were recruited in this study. According to their morning blood pressure surge （MBPS） and complication with T2DM or not, the subjects were divided into 4 groups, that is, diabetes＋MBPS group （D-S group, n=36）, diabetes＋ non-MBPS group （D-nS group, n=56）, non-diabetic＋ MBPS group （nD-S group, n=72）, and non-diabetic group＋non-MBPS （nD-nS group, n=80）. All 244 patients received coronary angiography, and the severity of coronary artery lesions were compared in the 4 groups. Results The 24-hour mean systolic blood pressure （24 h MSB） and day systolic blood pressure （dSBP） were significantly higher in the D-S group, D-nS group and nD-S group than the nD-nS group （P〈0.05）. The 24-hour mean diastolic blood pressure （24 h MDBP） and day diastolic blood pressure （dDBP） were higher in the D-S group than the D-nS group, nD-S group and nD-nS group （P〈0.05）. The MBPS groups had higher rates of 3-essel disease and type C lesion, and higher total Gensini scores （P〈0.01）. Pearson correlation analysis showed that the severity of coronary lesions was positively correlated to age （r=0.786, P〈0.01）, body mass index （BMI, r=0.284, P〈0.05）, fasting blood glucose （FBG, r=0.712, P〈0.05）, low-density lipoprotein-cholesterol （LDL-C, r=0.765, P〈0.05）, MBPS （r=0.852, P〈0.01） and 24-hour mean systolic blood pressure （24 h MSBP, r=0.804, P〈0.01）. Multivariate linear regression analysis indicated that FBG, 24 h MSBP and MBPS were the independent risk factors for coronary lesions. Conclusion MBPS is an independent risk factor to predict the severity of coronary heart disease in essential hypertension patients with diabetes. Effective controlling of blood pressure and stably 24-hour long-term reducing blood pressure in this kind of patients can reduce target-organ damage and cardiovascular events in the patients .