隐蔽性高血压对冠心病合并代谢综合征患者心脑血管事件的影响

Effect of masked hypertension on cardio-cerebral vascular events in patients with coronary heart disease complicated with metabolic syndrome

目的探讨隐蔽性高血压(MH)对冠心病合并代谢综合征患者心脑血管事件的影响。方法选择2015-08~2017-08在该院经冠脉造影确诊的冠心病合并代谢综合征患者66例,根据24h动态血压监测结果将其分为正常血压组(n=32)和MH组(n=34),分析两组动态血压参数的差异,随访并比较两组患者主要心脑血管事件(MACCE)的发生情况。结果MH组体质量指数(BMI)、腰围水平高于正常血压组(P<0.05)。MH组24h平均收缩压(24hSBP)、白天平均收缩压(dSBP)、夜间平均收缩压(nSBP)、白天收缩压平台、夜间收缩压平台、清晨收缩压上升速度水平均高于正常血压组(P<0.05)。单因素相关分析显示,24hSBP与腰围及BMI呈正相关(P<0.05)。Logistic回归分析显示,较大的腰围和BMI是MH的危险因素(P<0.05)。Kaplan-Meier生存分析显示,MH患者发生MACCE风险增加(P<0.05)。Cox回归分析显示,较高水平的24hSBP和患有MH是MACCE发生的危险因素(P<0.05)。结论超重和肥胖会升高血压水平和加剧清晨血压波动,24hSBP水平升高是冠心病合并代谢综合征患者发生MACCE的危险因素。

Objective To explore the effects of masked hypertension(MH) on cardio-cerebral vascular events in patients with coronary heart disease complicated with metabolic syndrome. Methods A total of 66 patients with coronary heart disease complicated with metabolic syndrome proven by coronary angiography in our hospital from August 2015 to August 2017 were selected and divided into normotension group( n =32) and MH group( n =34) according to their 24-hour ambulatory blood pressure monitoring results. The difference in the parameters of 24-hour ambulatory blood pressure was compared between the two groups and the major adverse cardio-cerebral vascular events(MACCE) were compared between the two groups after a follow-up. Results The body mass index(BMI) and waist circumference in the MH group were higher than those in the normotension group( P <0.05). The levels of 24-hour mean systolic blood pressure(24hSBP), daytime mean systolic blood pressure(dSBP), nighttime mean systolic blood pressure(nSBP), daytime systolic blood pressure(SBP) plateau, nighttime SBP plateau and increasing rate of morning SBP in the MH group were significantly higher than those in the normotension group( P <0.05). Univariate correlation analysis showed that 24hSBP was positively correlated with waist circumference and BMI( P <0.05). Logistic regression analysis showed that larger waist circumference and BMI were the risk factors of MH( P <0.05). Kaplan-Meier survival curves showed that MACCE was significantly higher in the MH group( P <0.05). Multivariable Cox regression analysis showed that the higher level of 24hSBP and suffered with MH were the risk factors of MACCE( P <0.05). Conclusion Overweight and obesity may raise the level of blood pressure and aggravate morning blood pressure fluctuations. The elevated levels of 24hSBP may be an important risk factor of MACCE in patients with coronary heart disease complicated with metabolic syndrome.