高血压患者血压晨峰与稳定性冠状动脉疾病严重程度的相关性研究

Correlation between morning blood pressure surge and severity of stable coronary artery disease in hypertension patients

目的探究高血压患者血压晨峰与稳定性冠状动脉疾病严重程度的相关性。方法选择2017年12月~2020年12月于天津市第五中心医院就诊的稳定性冠状动脉疾病并伴有高血压的患者525例作为研究对象,收集患者基本临床资料,行冠状动脉造影、超声心动图检查及动态血压监测,计算血压晨峰,将患者分为晨峰组[血压晨峰≥35 mm Hg(1 mm Hg=0.133 kPa)]、非晨峰组(血压晨峰<35 mm Hg),比较2组患者稳定性冠状动脉疾病严重程度、心功能指标以及动态血压值之间的差异。分析影响稳定性冠状动脉疾病严重程度的独立相关因素。结果晨峰组患者年龄、体质量指数(BMI)、吸烟、饮酒、糖尿病比例、Gensini评分显著高于非晨峰组,差异有统计学意义(P<0.05,P<0.01)。单因素logistic回归分析显示,晨峰组患者年龄、BMI、糖尿病、24 h平均收缩压(24 h SBP)、24 h平均脉压(24 h APP)、昼间平均收缩压、昼间平均脉压及晨峰血压与冠状动脉病变严重程度呈正相关(P<0.05,P<0.01)。多因素logistic回归分析显示,糖尿病(OR=1.406,95%CI:1.114~2.406,P=0.000)、24 h SBP(OR=1.253,95%CI:1.165~1.508,P=0.007)、24 h APP(OR=1.332,95%CI:1.124~2.164,P=0.000)以及晨峰血压(OR=1.886,95%CI:1.541~2.762,P=0.000)均是影响冠状动脉病变严重程度的独立相关因素。结论高血压患者血压晨峰≥35 mm Hg是影响稳定性冠状动脉疾病严重程度的危险因素。

Objective To explore the correlation between morning blood pressure surge and severity of stable coronary artery disease in patients with hypertension.Methods A total of 525 patients with stable coronary artery disease and hypertension admitted in Tianjin Fifth Central Hospital from December 2017 to December 2020 were subjected in this study.The baseline clinical data of the patients were collected.Coronary angiography,echocardiography and ambulatory blood pressure monitoring were performed on all patients.The patients were divided into morning blood pressure surge group(≥35 mm Hg,1 mm Hg=0.133 kPa)and non-morning blood pressure surge group(<35 mm Hg).The severity of stable coronary artery disease,cardiac function index and ambulatory blood pressure were compared between the two groups.Independent related factors affecting the severity of stable coronary artery disease were analyzed.Results The morning blood pressure surge group had older age,higher BMI,larger proportions of smoking,drinking and diabetes,and higher Gensini score than the non-morning blood pressure surge group(P<0.05,P<0.01).Univariate logistic regression analysis showed that age,BMI,diabetes,24 h mean systolic blood pressure(24 h SBP),24 h average pulse pressure(24 h APP),daytime mean SBP,daytime APP and morning blood pressure surge were positively correlated with the severity of coronary artery lesions in the morning blood pressure surge group(P<0.05,P<0.01).Multivariate logistic regression analysis indicated that diabetes(OR=1.406,95%CI:1.114-2.406,P=0.000),24 h SBP(OR=1.253,95%CI:1.165-1.508,P=0.007),24 h APP(OR=1.332,95%CI:1.124-2.164,P=0.000)and morning blood pressure peak(OR=1.886,95%CI:1.541-2.762,P=0.000)were independent factors of severity of coronary artery lesions.Conclusion Morning blood pressure surge≥35 mm Hg is a risk factor affecting the severity of stable coronary artery disease in hypertensive patients.