高血压病患者血压变异性与冠脉粥样硬化斑块病变严重程度的关系研究

纪欣强; 赵润涛; 单冬凯; 王凡

doi:10.3969/j.issn.2095-5227.2023.03.001

高血压病患者血压变异性与冠脉粥样硬化斑块病变严重程度的关系研究

Relationship between blood pressure variability and coronary atherosclerotic plaque severity in patients with hypertension

摘要

摘要:
背景既往研究显示高血压病患者动态血压监测体现的血压变异性等指标能够准确地预测心脑血管事件和死亡风险，但血压变异性与冠脉粥样硬化斑块病变严重程度的关系尚不明确。
目的探讨高血压病患者血压变异性与冠脉粥样硬化斑块病变严重程度的关系。
方法选择2017年12月 - 2022年3月因高血压合并疑似冠心病(coronary artery disease，CAD)行动态血压监测和冠状动脉计算机断层扫描血管成像(coronary computed tomographic angiography，CCTA)的患者，根据Leiden评分进行分组，＜5分为低危组，5 ~ 20分为中危组，＞20分为高危组，比较三组临床资料。采用Spearsman相关和单因素、多因素logistic回归，明确血压变异性与冠脉粥样硬化斑块病变严重程度之间的关系。
结果 783例患者中，男性523例，平均年龄(62.85 ± 10.17)岁。三组间24 h平均收缩压、夜间平均收缩压、收缩压变异性、收缩压变异系数、舒张压变异系数和夜间收缩压下降率的差异均有统计学意义(P均＜0.05)。低危组中夜间收缩期下降率(r=-0.178，P=0.039)与Leiden评分存在关联，中高危组中舒张压变异性(r=0.189，P=0.015)、收缩压变异系数(r=-0.167，P=0.029)、舒张压变异系数(r=-0.156，P=0.038)、夜间舒张压下降率(r=0.167，P=0.029)与Leiden评分存在关联。多因素logistic分析显示，年龄(OR=0.958，95% CI： 0.936 ~ 0.981，P＜0.001)、血脂异常(OR=0.293，95% CI： 0.159 ~ 0.541，P＜0.001)、24 h平均收缩压(OR=0.992，95% CI： 0.984 ~ 1.000，P=0.032)、夜间平均收缩压(OR=0.989，95% CI： 0.981 ~ 0.997，P=0.004)、收缩压变异性(OR=1.054，95% CI：1.026 ~ 1.084，P＜0.001)、收缩压变异系数(OR=0.842，95% CI： 0.752 ~ 0.943，P=0.003)、夜间收缩压下降率(OR=1.004，95% CI： 1.000 ~ 1.008，P=0.037)与Leiden评分中高危独立关联。
结论高血压病患者收缩压变异性越大，Leiden评分越高，冠脉粥样硬化斑块病变程度越严重，监测收缩压变异性对预测冠脉粥样硬化斑块病变严重程度及预防冠脉粥样硬化斑块病变进展有一定意义。

Abstract:
Background Previous studies show that parameters such as blood pressure variability reflected by ambulatory blood pressure monitoring can predict the risk of cardiovascular and cerebrovascular events and death accurately in patients with hypertension, but no studies have been conducted to determine the relationship between blood pressure variability and coronary atherosclerotic plaque severity.
Objective To explore the relationship between blood pressure variability and coronary atherosclerotic plaque severity in patients with hypertension.
Methods Patients who underwent ambulatory blood pressure monitoring and coronary computed tomographic angiography (CCTA) due to hypertension complicated with suspected angina pectoris from December 2017 to March 2022 were selected and they were divided into three groups according to the Leiden score, including low risk group (<5pts), medium risk group (5-20pts) and high risk group (>20pts), the clinical characteristics of the three groups were compared. Spearsman correlation and univariate/multivariate Logistics regression were used to determine the relationship between blood pressure variability and coronary atherosclerotic plaque severity progression.
Results A total of 783 cases were involved, including 523 males, with an average age of (62.85 ± 10.17) years old. The differences in mean systolic blood pressure (SBP), daytime mean DBP, nighttime mean SBP, SBP variability, SBP loading value, diastolic blood pressure (DBP), decrease of nighttime SBP between the groups were statistically significant (P<0.05). The low-risk Leiden score group was associated with decrease of nighttime SBP (r=-0.178, P=0.039), and the medium-risk and high-risk group were associated with DBP variability (r=0.189, P=0.015), SBP loading value (r=-0.167, P=0.029), DBP loading value (r=-0.156, P=0.038) and decrease of nighttime DBP (r=0.167, P=0.029). Age (OR=0.958, 95%CI: 0.936-0.981, P<0.001), dyslipidemia (OR=0.293, 95%CI: 0.159-0.541, P<0.001), mean SBP (OR=0.992, 95%CI: 0.984-1.000, P=0.032), nighttime mean SBP (OR=0.989, 95%CI: 0.981-0.997, P=0.004), SBP variability (OR=1.054, 95%CI: 1.026-1.084, P<0.001), SBP loading value (OR=0.842, 95%CI: 0.752-0.943, P=0.003) and decrease of nighttime SBP (OR=1.00, 95%CI: 0.94-1.08, P=0.037) were independent risk factors for medium-risk and high risk of Leiden score.
Conclusion The greater the SBP variability in hypertensive patients, the higher the Leiden score and the severer the coronary atherosclerotic plaque. Monitoring SBP variability has a certain significance for predicting and preventing coronary atherosclerotic plaque severity progression.

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