老年冠心病合并高血压患者的临床特征及其与全因死亡的关系

Clinical Characteristics of Elderly Patients with Coronary Artery Disease and Hypertension and Its Relationship with All-cause Mortality

目的本研究基于单中心、大样本的纵向队列研究,探究老年冠心病合并高血压患者的临床特征及其与全因死亡的关系。方法本研究为回顾性队列研究,选取2008—2018年因冠心病住院治疗且年龄大于65岁的患者,并随访至2023年9月。通过电子病历收集纳入患者的人口统计学数据、临床生化资料、既往病史、药物使用以及冠状动脉介入治疗情况等。采用多因素Cox比例风险回归模型评估院外全因死亡的风险比,分析冠心病合并高血压患者全因死亡的独立危险因素。结果最终纳入10947例老年冠心病患者,其中70.90%合并高血压。与不合并高血压的冠心病患者相比,冠心病合并高血压患者的甘油三酯、血尿酸和空腹血糖水平及合并糖尿病、贫血、脑卒中、慢性肾脏病、高尿酸血症、外周动脉疾病和心房颤动的比例更高。在中位6.63年的随访时间里,共发生全因死亡1562例。多因素Cox回归分析显示,冠心病合并高血压患者较不合并高血压的冠心病患者全因死亡风险增加17.00%(HR=1.17,95%CI:1.03~1.34),年龄、心率、收缩压、吸烟、糖尿病、贫血、慢性肾脏病、脑卒中、心力衰竭、高尿酸血症、外周动脉疾病、心脏瓣膜病、心肌梗死和利尿剂使用与老年冠心病合并高血压患者远期全因死亡风险增加相关。结论老年冠心病患者合并高血压比例较高。与不合并高血压的冠心病患者相比,冠心病合并高血压患者有更多的心血管疾病相关危险因素及共病,远期全因死亡风险更高,而院内死亡无明显差异。年龄、心率、吸烟以及大部分合并共病与冠心病合并高血压患者远期全因死亡密切相关。

Objective To reveal the clinical characteristics of elderly patients with coronary artery disease and hypertension(CAD+HT)and its relationship with all-cause mortality based on a longitudinal cohort study with a large sample size from a single center.Method From 2008 to 2018,patients with coronary artery disease(CAD)who were admitted to our hospital and were aged over 65 years were selected for this study.These patients were followed up until September 2023.Through electronic medical records,comprehensive data were collected,including general demographic information,clinical biochemistry data,medical history,medications,and coronary interventional treatment details.Cox regression model was used to assess the hazard ratio for all-cause mortality outside the hospital and analyze the independent risk factors for all-cause mortality among patients with CAD+HT.ResultsThis study included 10947 elderly CAD patients,among whom 70.90%had hypertension.Patients with CAD+HT had higher levels of triglyceride,uric acid,fasting blood glucose and more diabetes,anemia,stroke,chronic kidney disease,hyperuricemia,peripheral artery disease,and atrial fibrillation compared to those with CAD alone.Over a median follow-up period of 6.63 years,1,562 cases of all-cause mortality occurred.Multivariate Cox regression model showed that patients with CAD+HT had a 17.00%increased risk of all-cause mortality compared to those with CAD alone(HR=1.17,95%CI:1.03-1.34).Additionally,age,heart rate,systolic blood pressure,smoking,diabetes mellitus,anemia,stroke,chronic kidney disease,heart failure,hyperuricemia,peripheral artery disease,valvular heart disease,myocardial infarction and diuretic were associated with an increased risk of long-term all-cause mortality among elderly patients with CAD+HT.Conclusion The proportion of hypertension is higher in elderly patients with CAD.Compared to those with CAD alone,patients with CAD+HT exhibit a greater number of cardiovascular disease-related risk factors and comorbidities.The long-term all-cause mortality risk is higher in patients with CAD+HT compared to those with CAD alone,although there is no significant difference in in-hospital mortality between the two groups.Age,heart rate,smoking,and most comorbidities are associated with all-cause mortality among patients with CAD+HT.