不同降压模式在老年高血压合并冠心病患者PCI术后的应用效果研究

Application effect research of different antihypertensive modes in elderly hypertensive patients with coronary heart disease and PCI

目的探讨强化降压与标准降压治疗老年高血压合并冠心病患者经皮冠状动脉介入术(PCI)术后的效果及安全性。方法86例老年高血压合并冠心病PCI患者以随机数字表法分为对照组和研究组,每组43例。对照组给予标准降压治疗[目标收缩压(SBP)<135 mmHg],研究组给予强化降压治疗(目标SBP<120 mmHg),自治疗起始随访12个月观察效果。记录2组患者治疗前后的24 h SBP和舒张压(DBP)变异系数;采用超声心动图评价治疗前后心功能改变;采用欧洲五维健康评价量表(EQ-5D-3L)中的视觉模拟量表评价健康状况,采用患者健康问卷抑郁量表(PHQ-9)评价抑郁情绪,采用焦虑自评量表(SAS)评价焦虑情绪,采用国际版跌倒效能量表(FES-I)评价跌倒风险。结果2组患者治疗前24 h SBP及24 h DBP变异系数、左心室射血分数(LVEF)、左心室质量指数(LVMI)、左心房容积指数(LAVI)、EQ-5D-3L得分、PHQ-9得分、SAS得分、FES-I得分差异均无统计学意义(P>0.05);研究组治疗后的24 h SBP、24 h DBP变异系数、LAVI、PHQ-9得分、SAS得分及FES-I得分均低于对照组,LVEF、LVMI、EQ-5D-3L得分高于对照组(P<0.05);研究组、对照组治疗期间总不良反应发生率比较差异无统计学意义(P>0.05);研究组心脑血管新发事件总发生率低于对照组(P<0.05)。结论强化降压治疗在降低老年高血压合并冠心病患者PCI术后的24 h血压变异系数、改善心功能方面优于标准降压治疗,可提高患者生活质量,且安全性良好。

Objective To investigate the efficacy and safety of intensive antihypertensive therapy and standard antihypertensive therapy after percutaneous coronary intervention(PCI)in elderly hypertensive patients with coronary heart disease.Methods A total of 86 elderly patients with hypertension complicated with coronary heart disease were randomly divided into the control group and the study group with 43 cases in each group.The control group was given standard antihypertensive therapy[target systolic blood pressure(SBP)<135 mmHg],and the study group was given intensive antihypertensive therapy target SBP<120 mmHg).Follow-up was conducted for 12 months from the beginning of treatment.The variation rate of blood pressure before and after treatment was recorded by wearing a home blood pressure monitor.Color Doppler ultrasound was used to evaluate the cardiac function indexes before and after treatment.The visual analogue scale of the European Five-Dimensional Health Assessment Scale(EQ-5D-3L)was used to evaluate the health status of patients.The patient Health Questionnaire Depression Scale(PHQ-9)was used to evaluate the depression mood of the patients.The Self-rating Anxiety Scale(SAS)was used to evaluate anxiety mood,and the fall Efficacy Scale International version(FES-I)was used to evaluate fall risk.Results There were no significant differences in 24 h SBP and 24 h diastolic blood pressure(DBP)coefficient of variation,left ventricular ejection fraction(LVEF),left ventricular mass index(LVMI),left atrial volume index(LAVI),EQ-5D-3L score,PHQ-9 score,SAS score and FES-I score before treatment between the two groups(P>0.05).The coefficients of variation of 24 h SBP and 24 h DBP were lower in the study group than those in the control group(P<0.05).Data of LVEF,LVMI and EQ-5D-3L were higher in the study group than those in the control group(P<0.05).LAVI,PHQ-9,SAS and FES-I were lower than those in the control group(P<0.05).There was no significant difference in the incidence of total adverse reactions between the study group and the control group(P>0.05).The total incidence of new cardiovascular and cerebrovascular events were lower in the study group than those in the control group(P<0.05).Conclusion Intensive antihypertensive therapy is better than standard antihypertensive therapy in controlling blood pressure(24 h)rhythm variability and cardiac function after PCI in elderly hypertensive patients with coronary heart disease and can reduce the risk of cardiovascular and cerebrovascular adverse events,improve the quality of life with good safety.