Senthong Vichai, Kukongviriyapan Upa, Settasatian Nongnuch, Settasatian Chatri, Komanasin Nantarat
Faculty of Medicine, Khon Kaen University, Cardiovascular Unit, Department of Medicine, 40002 Khon Kaen, Thailand.
Cardiol J. 2018;25(3):345-352. doi: 10.5603/CJ.a2017.0109. Epub 2017 Oct 5.
The optimal blood pressure (BP) treatment target is still being debated, specifically di-astolic BP (DBP) in patients with obstructive coronary artery disease (CAD); a DBP which is too low could compromise myocardial perfusion and is associated with adverse outcomes.
This study examined the relationship between DBP levels and the severity and atheroscle-rotic burden of CAD in 231 consecutive stable patients with evidence of obstructive CAD as detected by elective coronary angiography. The SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) Score and SYNTAX Score II were used to quantify the atherosclerotic burden.
The patients were male (71%), median age 62, interquartile range [IQR] of 57 to 67, and 84% had hypertension. The median DBP was 71.0 mmHg (IQR: 61 to 80) and the median SYNTAX Score was 16.0 (IQR 9.0-23.0). DBP levels were inversely correlated with SYNTAX Score (r = -0.61) and SYNTAX Score II (r = -0.73). Adjusting for traditional risk factors, unprotected left main CAD, systolic BP, renal function, and medications, DBP levels remained independently inversely associated with a higher tertile of SYNTAX Score (adjusted odds ratio [OR] 0.89; 95% confidence interval [CI] 0.85-0.92, p < 0.001) and SYNTAX Score II (adjusted OR 0.75; 95% CI 0.69-0.80, p < 0.001). The frequency of high athero-sclerotic burden identified by the presence of intermediate or high SYNTAX Score and SYNTAX Score II was significantly higher among patients with a DBP < 60 mmHg.
Low DBP levels are independently associated with high SYNTAX Score and SYNTAX Score II in stable patients with obstructive CAD.
最佳血压（BP）治疗目标仍存在争议，尤其是在患有阻塞性冠状动脉疾病（CAD）的患者中舒张压（DBP）的目标值；过低的DBP可能会损害心肌灌注并与不良结局相关。
本研究调查了231例经选择性冠状动脉造影证实患有阻塞性CAD的连续稳定患者的DBP水平与CAD严重程度和动脉粥样硬化负荷之间的关系。采用SYNTAX（紫杉醇药物涂层支架与心脏外科手术协同作用）评分和SYNTAX评分II来量化动脉粥样硬化负荷。
患者以男性为主（71%），中位年龄62岁，四分位间距[IQR]为57至67岁，84%患有高血压。中位DBP为71.0 mmHg（IQR：61至80），中位SYNTAX评分为16.0（IQR 9.0 - 23.0）。DBP水平与SYNTAX评分（r = -0.61）和SYNTAX评分II（r = -0.73）呈负相关。在调整了传统危险因素、无保护左主干CAD、收缩压、肾功能和药物治疗后，DBP水平仍与较高三分位数的SYNTAX评分（调整后的优势比[OR] 0.89；95%置信区间[CI] 0.85 - 0.92，p < 0.001）和SYNTAX评分II（调整后的OR 0.75；95% CI 0.69 - 0.80，p < 0.001）独立呈负相关。在DBP < 60 mmHg的患者中，通过中等或高SYNTAX评分和SYNTAX评分II确定的高动脉粥样硬化负荷的频率显著更高。
在患有阻塞性CAD的稳定患者中，低DBP水平与高SYNTAX评分和SYNTAX评分II独立相关。
