Chen Jianqiao, Ji Xinqiang, Zhao Runtao, Wang Fan
Department of Geriatrics, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China.
Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Beijing, China.
Front Cardiovasc Med. 2023 May 2;10:1111120. doi: 10.3389/fcvm.2023.1111120. eCollection 2023.
Blood pressure variability (BPV) obtained from ambulatory blood pressure monitoring (ABPM) has been demonstrated to accurately predict the risk of cerebrovascular events and death in hypertension patients, however, the association between BPV and the severity of coronary atherosclerotic plaque remains unclear.
Patients with hypertension combined with suspected coronary artery disease (CAD) were collected, who underwent both ABPM and coronary computed tomographic angiography (CCTA) from December 2017 to March 2022. Patients were divided into three groups according to the Leiden score: low-risk group (Leiden score <5), medium-risk group (Leiden score 5-20), and high-risk group (Leiden score >20). The clinical characteristics of patients were collected and analyzed. Univariate Pearson correlation and multivariate Logistics regression were used to determine the association between BPV and the severity of coronary atherosclerotic plaque.
A total of 783 patients were included, with the average age of (62.85 ± 10.17) years and 523 males. Patients in the high-risk group had higher mean systolic blood pressure (SBP), nighttime mean SBP and SBP variability ( < 0.05). Leiden score with low risk was associated with 24 h-SBP variability ( = 0.35, = 0.006) and 24 h-diastolic blood pressure (DBP) loading ( = -0.18, = 0.027). Leiden score with medium and high risk was associated with nighttime mean SBP ( = 0.23, = 0.005), 24 h-SBP variability ( = 0.32, = 0.003), and the decrease of nighttime SBP ( = 0.24, = 0.019). Multivariate Logistic analysis showed that smoking [odds ratio (OR) = 1.014, 95% confidential interval (CI): 1.0-1.07, = 0.03], diabetes (OR = 1.43, 95% CI: 1.10-2.26, = 0.01) and 24 h-SBP variability (OR = 1.35, 95% CI: 1.01-2.46, = 0.01) were independently associated with Leiden score with medium and high risk.
Larger SBP variability in hypertensive patients indicates the higher Leiden score and consequently the more serious coronary atherosclerotic plaque. Monitoring SBP variability has certain significance for predicting the severity of coronary atherosclerotic plaque and preventing its progression.
动态血压监测（ABPM）所获得的血压变异性（BPV）已被证明能准确预测高血压患者发生脑血管事件和死亡的风险，然而，BPV与冠状动脉粥样硬化斑块严重程度之间的关联仍不清楚。
收集2017年12月至2022年3月期间接受ABPM和冠状动脉计算机断层血管造影（CCTA）检查的高血压合并疑似冠状动脉疾病（CAD）患者。根据莱顿评分将患者分为三组：低风险组（莱顿评分<5）、中风险组（莱顿评分5 - 20）和高风险组（莱顿评分>20）。收集并分析患者的临床特征。采用单因素Pearson相关性分析和多因素Logistic回归分析来确定BPV与冠状动脉粥样硬化斑块严重程度之间的关联。
共纳入783例患者，平均年龄为（62.85±10.17）岁，男性523例。高风险组患者的平均收缩压（SBP）、夜间平均SBP和SBP变异性更高（P<0.05）。低风险的莱顿评分与24小时SBP变异性（r = 0.35，P = 0.006）和24小时舒张压（DBP）负荷（r = -0.18，P = 0.027）相关。中高风险的莱顿评分与夜间平均SBP（r = 0.23，P = 0.005）、24小时SBP变异性（r = 0.32，P = 0.003）以及夜间SBP下降幅度（r = 0.24，P = 0.019）相关。多因素Logistic分析显示，吸烟[比值比（OR）= 1.014，95%置信区间（CI）：1.0 - 1.07，P = 0.03]、糖尿病（OR = 1.43，95%CI：1.10 - 2.26，P = 0.01）和24小时SBP变异性（OR = 1.35，95%CI：1.01 - 2.46，P = 0.01）与中高风险的莱顿评分独立相关。
高血压患者较大的SBP变异性表明莱顿评分较高，进而冠状动脉粥样硬化斑块更严重。监测SBP变异性对预测冠状动脉粥样硬化斑块的严重程度及其进展具有一定意义。
