冠状动脉计算机断层血管造影患者中高血压与冠状动脉粥样硬化及心脏事件的关系
Relationship of Hypertension to Coronary Atherosclerosis and Cardiac Events in Patients With Coronary Computed Tomographic Angiography.
作者信息
Nakanishi Rine, Baskaran Lohendran, Gransar Heidi, Budoff Matthew J, Achenbach Stephan, Al-Mallah Mouaz, Cademartiri Filippo, Callister Tracy Q, Chang Hyuk-Jae, Chinnaiyan Kavitha, Chow Benjamin J W, DeLago Augustin, Hadamitzky Martin, Hausleiter Joerg, Cury Ricardo, Feuchtner Gudrun, Kim Yong-Jin, Leipsic Jonathon, Kaufmann Philipp A, Maffei Erica, Raff Gilbert, Shaw Leslee J, Villines Todd C, Dunning Allison, Marques Hugo, Pontone Gianluca, Andreini Daniele, Rubinshtein Ronen, Bax Jeroen, Jones Erica, Hindoyan Niree, Gomez Millie, Lin Fay Y, Min James K, Berman Daniel S
机构信息
From the Los Angeles BioMedical Research Institute at Harbor UCLA Medical Center, Torrance, CA (R.N., M.J.B.); Departments of Imaging and Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (R.N., H.G., D.S.B.); Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and Weill Cornell Medicine (L.B., E.J., N.H., M.G., F.Y.L., J.K.M.); Department of Medicine, University of Erlangen, Germany (S.A.); King Saudbin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King AbdulAziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia (M.A.-M.); Department of Radiology, Montreal Heart Institute, Quebec, Canada (F.C., E.M.); Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C., G.R.); Department of Medicine and Radiology, University of Ottawa, Ontario, Canada (B.J.W.C.); Capitol Cardiology Associates, Albany, New York (A.D.); Department of Radiology and Nuclear Medicine, German Heart Center Munich, Germany (M.H.); Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Germany (J.H.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.); Department of Radiology, Medical University of Innsbruck, Austria (G.F.); Department of Medicine and Radiology, Seoul National University Hospital, South Korea (Y.-J.K.); Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada (J.L.); Department of Nuclear Cardiology, Cardiovascular Center, University Hospital, Zurich, Switzerland (P.A.K.); Department of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S.); Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD (T.C.V.); Duke Clinical Research Institute, Durham, NC (A.D.); UNICA, Cardiac CT and MRI Unit, Hospital da Luz, Lisbon, Portugal (H.M.); Department of Clinical Sciences and Community Health, University of Milan, Italy (G.P., D.A.); Centro Cardiologico Monzino, IRCCS, Italy (G.P., D.A.); Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (R.R.); and Department of Cardiology, Leiden University Medical Center, HARTZ, The Netherlands (J.B.).
出版信息
Hypertension. 2017 Aug;70(2):293-299. doi: 10.1161/HYPERTENSIONAHA.117.09402. Epub 2017 Jun 12.
Hypertension is an atherosclerosis factor and is associated with cardiovascular risk. We investigated the relationship between hypertension and the presence, extent, and severity of coronary atherosclerosis in coronary computed tomographic angiography and cardiac events risk. Of 17 181 patients enrolled in the CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) who underwent ≥64-detector row coronary computed tomographic angiography, we identified 14 803 patients without known coronary artery disease. Of these, 1434 hypertensive patients were matched to 1434 patients without hypertension. Major adverse cardiac events risk of hypertension and non-hypertensive patients was evaluated with Cox proportional hazards models. The prognostic associations between hypertension and no-hypertension with increasing degree of coronary stenosis severity (nonobstructive or obstructive ≥50%) and extent of coronary artery disease (segment involvement score of 1-5, >5) was also assessed. Hypertension patients less commonly had no coronary atherosclerosis and more commonly had nonobstructive and 1-, 2-, and 3-vessel disease than the no-hypertension group. During a mean follow-up of 5.2±1.2 years, 180 patients experienced cardiac events, with 104 (2.0%) occurring in the hypertension group and 76 (1.5%) occurring in the no-hypertension group (hazard ratios, 1.4; 95% confidence intervals, 1.0-1.9). Compared with no-hypertension patients without coronary atherosclerosis, hypertension patients with no coronary atherosclerosis and obstructive coronary disease tended to have higher risk of cardiac events. Similar trends were observed with respect to extent of coronary artery disease. Compared with no-hypertension patients, hypertensive patients have increased presence, extent, and severity of coronary atherosclerosis and tend to have an increase in major adverse cardiac events.
高血压是动脉粥样硬化的一个因素，与心血管风险相关。我们在冠状动脉计算机断层血管造影中研究了高血压与冠状动脉粥样硬化的存在、范围和严重程度以及心脏事件风险之间的关系。在17181名纳入CONFIRM注册研究（冠状动脉CT血管造影临床结果评估：一项国际多中心注册研究）且接受了≥64排冠状动脉计算机断层血管造影的患者中，我们确定了14803名无已知冠状动脉疾病的患者。其中，1434名高血压患者与1434名非高血压患者进行了匹配。采用Cox比例风险模型评估高血压患者和非高血压患者的主要不良心脏事件风险。还评估了高血压与非高血压状态随冠状动脉狭窄严重程度增加（非阻塞性或阻塞性≥50%）以及冠状动脉疾病范围（节段累及评分为1 - 5、>5）之间的预后关联。与非高血压组相比，高血压患者无冠状动脉粥样硬化的情况较少见，而非阻塞性以及单支、双支和三支血管病变的情况更常见。在平均5.2±1.2年的随访期间，180名患者发生了心脏事件，其中高血压组有104例（2.0%），非高血压组有76例（1.5%）（风险比为1.4；95%置信区间为1.0 - 1.9）。与无冠状动脉粥样硬化的非高血压患者相比，无冠状动脉粥样硬化和有阻塞性冠状动脉疾病的高血压患者发生心脏事件的风险往往更高。在冠状动脉疾病范围方面也观察到了类似趋势。与非高血压患者相比，高血压患者冠状动脉粥样硬化的存在、范围和严重程度均增加，且主要不良心脏事件往往增多。
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