正常高值血压者血压模式与冠状动脉病变严重程度的关系

Correlation between blood pressure pattern and severity of coronary artery disease in individuals with normal high blood pressure

目的探讨正常高值血压者的不同血压模式与冠状动脉病变严重程度的相关性.方法选择正常高值血压可疑冠状动脉粥样硬化患者218例,均行24 h动态血压监测及冠状动脉造影术.根据动态血压结果,将患者分为杓型、非杓型、反杓型及超杓型血压模式组.冠状动脉病变的狭窄程度用病变血管支数、类型及Gensini积分表示.分析四组血压模式与冠状动脉病变程度的关系.结果①与杓型血压组相比非杓型组、反杓型组、超杓型组24h MSBP(24 h平均收缩压)、dMSBP(白昼平均收缩压)、nMSBP(夜间平均收缩压)均明显增高,且差异有统计学意义(P<0.05);②杓型组中单支病变(43.8%)、A型病变(41.7%)发生率最高,多支病变(27.1%)、C型病变(27.0%)发生率最低,其与非杓型(单支:311%,A型:29.2%)、反杓型(单支:27.7%,A型:16.9%)、超杓型(单支:34.1%,A型:27.2%)组相比差异均有统计学意义(P<0.05),反杓型组中多支病变(40.0%)、C型病变(44.6%)发生率最高,与杓型(多支:27.1%,C型:27.0%)、非杓型(多支:34.4%,C型:32.8%)、超杓型(多支:34.0%,C型:36.4%)组相比差异有统计学意义(P<0.05);③反杓型、非杓型、超杓型组中Gensini积分均高于杓型组(反杓型组:2.86±0.43,非杓型组:2.15±0.61,超杓型组:2.08±0.64,杓型组:0.96±0.52),差异有统计学意义(P<0.05),反杓型组高于非杓型组及超杓型组,差异有统计学意义(P<0.05);④冠状动脉病变的多元线性回归分析结果显示,年龄、nMSBP、反杓型血压模式为冠状动脉病变的独立危险因素.结论正常高值血压者血压模式与冠状动脉病变程度密切相关.正常高值血压者中反杓型血压模式对冠状动脉病变影响最大,恢复患者正常杓型血压模式对减少靶器官损害有重要意义.

Objective To study the correlation between different blood pressure patterns with severity of coronary artery disease in patients with normal high blood pressure. Methods A total of 218 patients with normal high blood pressure and doubtful coronary heart disease (CHD) who received coronary angiography and 24-hour ambulatory blood pressure monitoring (24 h ABPM) were studied. The patients were divided into:dipper, nondipper, anti-dipper, over-dipper blood pressure pattern group. The degree of stenosis of the coronary artery lesions was showed in number of arteries. the type and the Gensini score. Analysis of correlation betwwen four types of ambulatory blood pressure pattern and coronary artery lesions was conducted. Results (l)Compared with dipper blood pressure group, that in non-dipper, anti-dipper and over-dipper group were significantly higher at 24 h MSBP. dMSBP, nMSBP and the differences were statistically significant(P<0.05).⑵In the dipper group. the single vessel lesion (43.8%) and type A lesion (41.7%) were the most, the multi branches (27.1%) and type C (27.0%) were the lowest. The differences were statistically significant compared with non-dipper(the single vessel lesion: 31.1%, type A: 29.2%), anti-dipper(the single vessel lesion: 27.7%, type A: 16.9%) and over-dipper(the single vessel lesion: 34.1%, type A: 27.2%) group (P<0.05). In the over-dipper group, the multi branches (40.0%) and type C (44.6%) were the most;the differences were statistically significant compared with that of dipper (multi branches: 27.1%, type C: 27.0%), non-dippe (multi branches: 34.4%, type C: 32.8%) and overdipper (multi branches: 34.0%, type C: 36.4%) group(P<0.05).(3)Gensini scores of anti-dipper( 2.86±0.43),nondipper( 2.15±0.61) and over-dipper( 2.08±0.64) groups were higher than that of dipper(0.96±0.52) pressure blood group;the differences were statistically significant (P<0.05). The anti-dipper group's was higher than that of the non-dipper group and the over dipper group;the difference was statistically significant (P<0.05).(4)Multiple linear regression analysis of coronary artery lesion showed that age, nMSBP and anti-dipper blood pressure pattern were independent risk factors for coronary artery disease. Conclusion The anti-dipper blood pressure pattern is closely related to the severity of coronary lesion in patients with normal high blood pressure. The antidipper blood pressure pattern had the greatest effect on coronary artery disease. Restoring dipper blood pressure pattern plays an important role in reducing target organ damage in normal high blood pressure.