血压晨峰值变化与高血压合并冠心病患者发生心脑血管事件的相关性

Correlation between changes in peak morning blood pressure and occurrence of cardiovascular and cerebrovascular events in patients with hypertension complicated by coronary heart disease

目的分析血压晨峰值变化与高血压合并冠心病患者发生心脑血管事件的相关性。方法抽取2015年3月至2018年3月驻马店市中心医院收治的90例高血压合并冠心病患者为研究对象,采用动态血压检测仪记录24 h血压,将血压晨峰值≥35 mmHg(1 mmHg=0.133 kPa)的40例患者设定为晨峰组,将血压晨峰值<35 mmHg的50例患者设定为非晨峰组。比较两组的一般资料、血压参数、心脑血管事件发生率,并进行1年随访,分析血压晨峰值变化与发生心脑血管事件的相关性。结果晨峰组血压晨峰值、清晨平均动脉压(MAP)、24 h收缩压均高于非晨峰组(P均<0.05),两组清晨脉压差(PP)、24 h PP、24 h MAP、24 h舒张压比较差异未见统计学意义(P>0.05)。对患者进行1年随访,晨峰组急性冠状动脉综合征[25.00%(10/40)]、心律失常[22.50%(9/40)]、缺血性脑血管病[20.00%(8/40)]及出血性脑血管病[20.00%(8/40)]发生率均高于非晨峰组[8.00%(4/50)、6.00%(3/50)、4.00%(2/50)、4.00%(2/50)],P均<0.05。Spearman相关性分析显示,晨峰值组血压晨峰值与心脑血管事件呈正相关(P<0.05),非晨峰值组血压晨峰值与心脑血管事件无相关性(P>0.05)。结论高血压合并冠心病患者血压晨峰值与心脑血管事件发生密切相关,临床应对其进行监测,控制血压晨峰值。

Objective To analyze the correlation between changes in peak morning blood pressure and occurrence of cardiovascular and cerebrovascular events in patients with hypertension complicated by coronary heart disease (CHD).Methods Ninety patients with hypertension complicanted by CHD who were admitted to Zhumadian Central Hospital from March 2015 to March 2018 were selected as research objects. The 24 h blood pressure was detected and recorded by dynamic blood pressure monitor. Patients with peak morning blood pressure greater than or equal to 35 mmHg (1 mmHg=0.133 kPa) were included in morning peak group (n=40), and patients with peak morning blood pressure lower than 35 mmHg were included in non-morning peak group (n=50). The general data, blood pressure parameters, incidences of cardiovascular and cerebrovascular events were compared between the two groups. All patients were followed up for one year. And the correlation between changes in peak morning blood pressure and occurrence of cardiovascular and cerebrovascular events was analyzed.Results The peak morning value, mean morning arterial pressure (MAP) and 24 h systolic blood pressure in morning peak group were higher than those in non-morning peak group (all P<0.05). There was no statistical difference in morning pulse pressure (PP), 24 h PP, 24 h MAP or 24 h diastolic blood pressure between the two groups (P>0.05). During one-year follow-up, the morbidity rates of acute coronary syndrome, arrhythmia, ischemic cerebrovascular disease and hemorrhagic cerebrovascular disease in morning peak group were 25.00% (10/40), 22.50% (9/40), 20.00% (8/40) and 20.00% (8/40), respectively, higher than the 8.00%(4/50), 6.00%(3/50), 4.00%(2/50)amd 4.00%(2/50) in non-morning peak group (P<0.05). Spearman correlation analysis showed that peak morning blood pressure was positively correlated with occurrence of cardiovascular and cerebrovascular events in morning peak group (all P<0.05);however, there was no correlation between peak morning blood pressure and occurrence of cardiovascular and cerebrovascular events in non-morning peak group (P>0.05).Conclusions The peak morning blood pressure in patients with hypertension complicated by CHD is closely related to occurrence of cardiovascular and cerebrovascular events. Therefore, for patients with hypertension complicated by CHD, peak morning blood pressure value should be monitored and controlled in clinical.