Objectives This study sought to evaluate the diagnostic value of abnormal increase of postexercise systolic blood pressure (SBP) for detecting coronary artery disease (CAD) in patients with or without hypertension. Me...Objectives This study sought to evaluate the diagnostic value of abnormal increase of postexercise systolic blood pressure (SBP) for detecting coronary artery disease (CAD) in patients with or without hypertension. Methods Treadmill exercise testing (TET) was conducted in 88 patients (40 CAD patients, 48 control subjects) with or without hypertension, each of whom underwent selective coronary angiography (CAG). The abnormal increase of postexercise SBP was defined as 10mmHg higher than earlier periods during the recovery phase (6 minutes) of exercise testing. Results The abnormal increase of postexercise SBP had higher sensitivity, specificity, and accuracy for detecting CAD than those of ST - segment depression in patients with or without hypertension. Its accuracy increased with the severity of CAD while decreased in patients with hypertension, and the increase value of SBP had a positive correlation with the extent of coronary artery lesion. The combination of ST - segment depression and abnormal increase of postexercise SBP diagnosed CAD most accurately in patients with hypertension. Conclusions Abnormal increase of postexercise SBP may be a useful index for diagnosing CAD.展开更多
Background:Arterial stiffening increases with age and blood pressure and is associated with cardiovascular disease(CVD),but the relationship between blood pressure lowering and arterial stiffening is still uncertain,e...Background:Arterial stiffening increases with age and blood pressure and is associated with cardiovascular disease(CVD),but the relationship between blood pressure lowering and arterial stiffening is still uncertain,especially in older people.This study aimed to evaluate the effect of intensive blood pressure treatment on the progression of arterial stiffness and risk of CVD in older patients with hypertension.Methods:The Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients(STEP)trial was a multicenter,randomized,controlled trial performed at 42 clinical centers throughout China,and 8511 patients aged 60-80 years with essential hypertension were enrolled and randomly assigned to systolic blood pressure(SBP)target of 110 mmHg to<130 mmHg(intensive treatment)or 130 mmHg to<150 mmHg(standard treatment).Patients underwent repeated examinations of the brachial-ankle pulse wave velocity(baPWV)and ankle-brachial index(ABI)at baseline,and the arterial stiffness was evaluated at the 3-year follow-up.A total of 5339 patients who had twice repeated measurements were included in this study.Changes in arterial stiffness between the intensive and standard treatment groups were analyzed using a multivariate linear regression model.The Cox proportional hazard regression model was used to evaluate the effect of intensive treatment on primary CVD outcomes.Results:The changes in baPWV were 61.5 cm/s(95%confidence interval[CI]:49.8-73.2 cm/s)in the intensive treatment group and 98.4 cm/s(95%CI:86.7-110.1 cm/s)in the standard treatment group(P<0.001).Intensive treatment significantly delayed the progression of arterial stiffness,with an annual change of 23.1 cm·s^(-1)·year-1 vs.36.7 cm·s^(-1)·year^(-1)of baPWV in the intensive and standard treatment groups,respectively.During a median follow-up period of 3.36 years,primary CVD outcomes occurred in 77(2.9%)patients in the intensive treatment group compared with 93(3.5%)in the standard treatment group.Intensive treatment resulted in a significantly lower CVD risk in patients aged 70-80 years or with SBP<140 mmHg.Conclusion:Intensive blood pressure control with an SBP target of 110 mmHg to<130 mmHg could delay the progression of arterial stiffness and reduce the risk of CVD in older patients with hypertension.Clinical trial registration:http://www.clinicaltrials.gov;No.NCT03015311.展开更多
目的通过无创检测动脉弹性指数探讨外周动脉弹性与心室舒张功能变化的相关性。方法回顾性分析2020年6月—2021年6月上海市XX区中心医院就诊的390例疑似冠心病(Coronary heart disease,CHD)并完善冠状动脉造影(Coronary angiography,CAG...目的通过无创检测动脉弹性指数探讨外周动脉弹性与心室舒张功能变化的相关性。方法回顾性分析2020年6月—2021年6月上海市XX区中心医院就诊的390例疑似冠心病(Coronary heart disease,CHD)并完善冠状动脉造影(Coronary angiography,CAG)患者的临床资料,根据冠状动脉病变程度分为对照组(n=73)、冠状动脉粥样硬化组(n=128)和CHD组(n=189)三组。采用相关性分析及多元线性回归分析动脉弹性指数与心功能指标的关系。结果冠状动脉粥样硬化组二尖瓣舒张早期血流峰值与二尖瓣环速度之比(Ratio of peak mitral valve blood flow during early diastolic period to mitral ring velocity,E/e')、颈-股脉搏波传导速度(Carotid-femoral pulse wave conduction velocity,cfPWV)、左心室等容舒张松弛时间常数T均高于对照组,左心室射血分数(Left ventricular ejection fraction,LVEF)低于对照组,差异有统计学意义(P<0.05);CHD组LVEF低于对照组,左心室压力上升最大速度(Maximum velocity of left ventricular rise,LV+dp/dtmax)、左心室压力下降最大速度(Maximum velocity of left ventricular descent,LV-dp/dtmax)均慢于对照组,差异有统计学意义(P<0.05);E/e'、左心房容积指数(Left atrial volume index,LAVI)、左心室质量指数(Left ventricular mass index,LVMI)、E峰减速时间(Deceleration time,DT)、T均高于对照组,cfPWV快于对照组,差异有统计学意义(P均<0.05);CHD组LVEF、左心室舒张末期容积(Left ventricular end-diastolic volume,LVEDV)低于冠状动脉粥样硬化组,LV+dp/dtmax、LV-dp/dtmax均慢于冠状动脉粥样硬化组,E/e'、LAVI、DT、T均高于冠状动脉粥样硬化组,cfPWV快于冠状动脉粥样硬化组,差异有统计学意义(P均<0.05)。调整性别、年龄、吸烟史、高血压病史、糖尿病病史、血脂指标、肌酐、肌钙蛋白I(Cardiac troponin,cTnI)、B型利尿钛(B-type natriuretic peptide,BNP)、体表面积(Body surface area,BSA)评分等相关因子后,Partial分析显示,cfPWV与T(r=0.42,P<0.001)、E/e'(r=0.26,P<0.001)、LAVI(r=0.22,P<0.001)呈正相关,与LV-dp/dtmax(r=-0.12,P=0.02)呈负相关,而与其他指标不相关。线性回归分析,结果显示,E/e'、LAVI、T、LV+dp/dtmax是cfPWV的影响因素。结论cfPWV与CHD患者左心室舒张功能减退显著相关,可作为预测左室舒张功能减退的敏感指标。展开更多
目的探讨血压正常高值者中心动脉压与颈动脉内膜中层厚度(IMT)的关系。方法选择健康体检人群346例,根据血压将患者分为理想血压组151例(血压<120/80 mm Hg,1mm Hg=0.133 kPa)和血压正常高值组195例(血压120～139/80～89 mm Hg),应用...目的探讨血压正常高值者中心动脉压与颈动脉内膜中层厚度(IMT)的关系。方法选择健康体检人群346例,根据血压将患者分为理想血压组151例(血压<120/80 mm Hg,1mm Hg=0.133 kPa)和血压正常高值组195例(血压120～139/80～89 mm Hg),应用大动脉测量仪测量入选者中心动脉压;应用颈动脉超声测量颈动脉IMT。结果血压正常高值组中心动脉收缩压、舒张压、脉压、平均收缩压、平均舒张压、收缩末压及IMT均高于理想血压组(P<0.01);中心动脉增强压及增强指数高于理想血压组(P<0.05)。中心动脉收缩压和脉压是IMT的影响因素(β=0.344,0.296,P<0.05)。结论血压正常高值者的中心动脉压和颈动脉IMT已增加,中心动脉收缩压和脉压是影响颈动脉IMT的主要因素。展开更多
文摘Objectives This study sought to evaluate the diagnostic value of abnormal increase of postexercise systolic blood pressure (SBP) for detecting coronary artery disease (CAD) in patients with or without hypertension. Methods Treadmill exercise testing (TET) was conducted in 88 patients (40 CAD patients, 48 control subjects) with or without hypertension, each of whom underwent selective coronary angiography (CAG). The abnormal increase of postexercise SBP was defined as 10mmHg higher than earlier periods during the recovery phase (6 minutes) of exercise testing. Results The abnormal increase of postexercise SBP had higher sensitivity, specificity, and accuracy for detecting CAD than those of ST - segment depression in patients with or without hypertension. Its accuracy increased with the severity of CAD while decreased in patients with hypertension, and the increase value of SBP had a positive correlation with the extent of coronary artery lesion. The combination of ST - segment depression and abnormal increase of postexercise SBP diagnosed CAD most accurately in patients with hypertension. Conclusions Abnormal increase of postexercise SBP may be a useful index for diagnosing CAD.
基金supported by grants from the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(Nos.2016-I2M-1-006 and 2021-I2M-1-011)
文摘Background:Arterial stiffening increases with age and blood pressure and is associated with cardiovascular disease(CVD),but the relationship between blood pressure lowering and arterial stiffening is still uncertain,especially in older people.This study aimed to evaluate the effect of intensive blood pressure treatment on the progression of arterial stiffness and risk of CVD in older patients with hypertension.Methods:The Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients(STEP)trial was a multicenter,randomized,controlled trial performed at 42 clinical centers throughout China,and 8511 patients aged 60-80 years with essential hypertension were enrolled and randomly assigned to systolic blood pressure(SBP)target of 110 mmHg to<130 mmHg(intensive treatment)or 130 mmHg to<150 mmHg(standard treatment).Patients underwent repeated examinations of the brachial-ankle pulse wave velocity(baPWV)and ankle-brachial index(ABI)at baseline,and the arterial stiffness was evaluated at the 3-year follow-up.A total of 5339 patients who had twice repeated measurements were included in this study.Changes in arterial stiffness between the intensive and standard treatment groups were analyzed using a multivariate linear regression model.The Cox proportional hazard regression model was used to evaluate the effect of intensive treatment on primary CVD outcomes.Results:The changes in baPWV were 61.5 cm/s(95%confidence interval[CI]:49.8-73.2 cm/s)in the intensive treatment group and 98.4 cm/s(95%CI:86.7-110.1 cm/s)in the standard treatment group(P<0.001).Intensive treatment significantly delayed the progression of arterial stiffness,with an annual change of 23.1 cm·s^(-1)·year-1 vs.36.7 cm·s^(-1)·year^(-1)of baPWV in the intensive and standard treatment groups,respectively.During a median follow-up period of 3.36 years,primary CVD outcomes occurred in 77(2.9%)patients in the intensive treatment group compared with 93(3.5%)in the standard treatment group.Intensive treatment resulted in a significantly lower CVD risk in patients aged 70-80 years or with SBP<140 mmHg.Conclusion:Intensive blood pressure control with an SBP target of 110 mmHg to<130 mmHg could delay the progression of arterial stiffness and reduce the risk of CVD in older patients with hypertension.Clinical trial registration:http://www.clinicaltrials.gov;No.NCT03015311.
文摘目的通过无创检测动脉弹性指数探讨外周动脉弹性与心室舒张功能变化的相关性。方法回顾性分析2020年6月—2021年6月上海市XX区中心医院就诊的390例疑似冠心病(Coronary heart disease,CHD)并完善冠状动脉造影(Coronary angiography,CAG)患者的临床资料,根据冠状动脉病变程度分为对照组(n=73)、冠状动脉粥样硬化组(n=128)和CHD组(n=189)三组。采用相关性分析及多元线性回归分析动脉弹性指数与心功能指标的关系。结果冠状动脉粥样硬化组二尖瓣舒张早期血流峰值与二尖瓣环速度之比(Ratio of peak mitral valve blood flow during early diastolic period to mitral ring velocity,E/e')、颈-股脉搏波传导速度(Carotid-femoral pulse wave conduction velocity,cfPWV)、左心室等容舒张松弛时间常数T均高于对照组,左心室射血分数(Left ventricular ejection fraction,LVEF)低于对照组,差异有统计学意义(P<0.05);CHD组LVEF低于对照组,左心室压力上升最大速度(Maximum velocity of left ventricular rise,LV+dp/dtmax)、左心室压力下降最大速度(Maximum velocity of left ventricular descent,LV-dp/dtmax)均慢于对照组,差异有统计学意义(P<0.05);E/e'、左心房容积指数(Left atrial volume index,LAVI)、左心室质量指数(Left ventricular mass index,LVMI)、E峰减速时间(Deceleration time,DT)、T均高于对照组,cfPWV快于对照组,差异有统计学意义(P均<0.05);CHD组LVEF、左心室舒张末期容积(Left ventricular end-diastolic volume,LVEDV)低于冠状动脉粥样硬化组,LV+dp/dtmax、LV-dp/dtmax均慢于冠状动脉粥样硬化组,E/e'、LAVI、DT、T均高于冠状动脉粥样硬化组,cfPWV快于冠状动脉粥样硬化组,差异有统计学意义(P均<0.05)。调整性别、年龄、吸烟史、高血压病史、糖尿病病史、血脂指标、肌酐、肌钙蛋白I(Cardiac troponin,cTnI)、B型利尿钛(B-type natriuretic peptide,BNP)、体表面积(Body surface area,BSA)评分等相关因子后,Partial分析显示,cfPWV与T(r=0.42,P<0.001)、E/e'(r=0.26,P<0.001)、LAVI(r=0.22,P<0.001)呈正相关,与LV-dp/dtmax(r=-0.12,P=0.02)呈负相关,而与其他指标不相关。线性回归分析,结果显示,E/e'、LAVI、T、LV+dp/dtmax是cfPWV的影响因素。结论cfPWV与CHD患者左心室舒张功能减退显著相关,可作为预测左室舒张功能减退的敏感指标。
文摘目的探讨血压正常高值者中心动脉压与颈动脉内膜中层厚度(IMT)的关系。方法选择健康体检人群346例,根据血压将患者分为理想血压组151例(血压<120/80 mm Hg,1mm Hg=0.133 kPa)和血压正常高值组195例(血压120～139/80～89 mm Hg),应用大动脉测量仪测量入选者中心动脉压;应用颈动脉超声测量颈动脉IMT。结果血压正常高值组中心动脉收缩压、舒张压、脉压、平均收缩压、平均舒张压、收缩末压及IMT均高于理想血压组(P<0.01);中心动脉增强压及增强指数高于理想血压组(P<0.05)。中心动脉收缩压和脉压是IMT的影响因素(β=0.344,0.296,P<0.05)。结论血压正常高值者的中心动脉压和颈动脉IMT已增加,中心动脉收缩压和脉压是影响颈动脉IMT的主要因素。
