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目的讨论高血压合并冠心病患者血压负荷对冠脉病变严重程度的影响。方法连续入选2014年9月至2015年12月在中国人民解放军总医院住院经冠脉造影诊断冠心病并合并高血压患者(n=738例),按照冠状动脉病变血管数进行严重程度分组,分为单支冠状动脉病变组(n=295例)、双支冠状动脉病变组(n=219例)和三支冠状动脉病变组(n=244例)。所有入选患者均行24h动态血压监测,根据测量所得的血压值超过高血压防治指南推荐的血压界限的比例(白天<135/85mmHg夜间<120/70mmHg),采用多元线性回归分析全天、白天及夜间SBP、DBP负荷与冠脉病变支数的关系。并进一步调整年龄、性别、体重指数、血压、血糖、血清总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯等传统心血管危险因素的影响。结果冠脉双支及三支病变患者夜间SBP负荷高于单支病变组,夜间SBP负荷与冠脉病变支数相关(R~2=0.0124,P=0.02)。进一步将冠脉病变支数分为单支和两支以上病变组,应用二分类logistic回归分析结果显示调整了传统的心血管危险因素后,发现夜间SBP负荷与冠脉严重程度相关(OR=1.67,95%CI 1.25-2.77,P=0.026)结论高血压合并冠心病患者夜间SBP负荷与冠脉病变严重程度相关。
Objective To discuss the effect of blood pressure load on the severity of coronary artery disease in hypertensive patients with coronary heart disease. Methods Patients with coronary heart disease (CHD) diagnosed with CHD and hypertension (n = 738) were enrolled in the hospital of Chinese PLA General Hospital from September 2014 to December 2015. The patients were divided into groups according to the severity of coronary artery lesion (N = 295), double-vessel coronary artery disease group (n = 219) and three coronary artery disease group (n = 244). All patients underwent 24-hour ambulatory blood pressure monitoring. Multivariate linear regression analysis was performed for all-day, daytime and day-to-day variability based on the proportion of measured blood pressure exceeding the recommended blood pressure limit for hypertension guidelines (daytime <135 / 85mmHg night <120 / 70mmHg) Relationship between SBP, DBP load and coronary lesion count at night. And further adjusted the influence of traditional cardiovascular risk factors such as age, sex, body mass index, blood pressure, blood glucose, serum total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, and triglyceride. Results The nighttime SBP load was higher in patients with double coronary artery disease and three lesions than in single disease patients. The nighttime SBP load was correlated with the number of coronary artery lesions (R ~ 2 = 0.0124, P = 0.02). The coronary artery lesions were further divided into single and multiple lesions group. The results of binary logistic regression analysis showed that nighttime SBP load correlated with the severity of coronary artery after adjustment for traditional cardiovascular risk factors (OR = 1.67 , 95% CI 1.25-2.77, P = 0.026) Conclusions The nighttime SBP load in hypertensive patients with coronary heart disease is related to the severity of coronary artery disease.