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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