Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Department of Cardiovascular Medicine, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiatong University School of Medicine, Shanghai, China.
J Clin Hypertens (Greenwich). 2023 Jul;25(7):610-617. doi: 10.1111/jch.14691. Epub 2023 Jun 28.
The clinical significance of central beyond brachial blood pressure (BP) remains unclear. In patients who underwent coronary angiography, the authors explored whether elevated central BP would be associated with coronary arterial disease (CAD) irrespective of the status of brachial hypertension. From March 2021 to April 2022, 335 patients (mean age 64.9 years, 69.9% men) hospitalized for suspected CAD or unstable angina were screened in an ongoing trial. CAD was defined if a coronary stenosis of ≥50%. According to the presence of brachial (non-invasive cuff systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg) and central (invasive systolic BP ≥130 mmHg) hypertension, patients were cross-classified as isolated brachial hypertension (n = 23), isolated central hypertension (n = 93), and concordant normotension (n = 100) or hypertension (n = 119). In continuous analyses, both brachial and central systolic BPs were significantly related to CAD with similar standardized odds ratios (OR, 1.47 and 1.45, p < .05). While categorical analyses showed that patients with isolated central hypertension or concordant hypertension had a significantly higher prevalence of CAD and the Gensini score than those with concordant normotension. Multivariate-adjusted OR (95% confidence interval [CI]) for CAD was 2.24 (1.16 to 4.33, p = .009) for isolated central hypertension and 3.02 (1.58 to 5.78, p < .001) for concordant hypertension relative to concordant normotension. The corresponding OR (95% CI) of a high Gensini score was 2.40 (1.26-4.58) and 2.17 (1.19-3.96), respectively. In conclusion, regardless of the presence of brachial hypertension, elevated central BP was associated with the presence and severity of CAD, indicating that central hypertension is an important risk factor for coronary atherosclerosis.
中心动脉压（BP）超过臂部 BP 的临床意义尚不清楚。在接受冠状动脉造影的患者中，作者探讨了无论臂部高血压的状态如何，升高的中心 BP 是否与冠状动脉疾病（CAD）相关。在一项正在进行的试验中，从 2021 年 3 月至 2022 年 4 月，筛选了 335 名因疑似 CAD 或不稳定型心绞痛住院的患者（平均年龄 64.9 岁，69.9%为男性）。如果冠状动脉狭窄≥50%，则定义为 CAD。根据臂部（无创袖带收缩压≥140mmHg 或舒张压≥90mmHg）和中心（有创收缩压≥130mmHg）高血压的存在情况，将患者交叉分类为孤立性臂部高血压（n=23）、孤立性中心高血压（n=93）、一致性正常血压（n=100）或高血压（n=119）。在连续分析中，臂部和中心收缩压均与 CAD 显著相关，标准化比值比（OR）相似（1.47 和 1.45，p<0.05）。而分类分析显示，孤立性中心高血压或一致性高血压患者的 CAD 患病率和 Gensini 评分明显高于一致性正常血压患者。多变量调整后的 OR（95%置信区间[CI]）显示，与一致性正常血压相比，孤立性中心高血压（2.24[1.16 至 4.33，p=0.009]）和一致性高血压（3.02[1.58 至 5.78，p<0.001]）的 CAD 比值分别为 2.24（1.16 至 4.33，p=0.009）和 3.02（1.58 至 5.78，p<0.001）。高 Gensini 评分的相应 OR（95%CI）分别为 2.40（1.26-4.58）和 2.17（1.19-3.96）。总之，无论臂部高血压的存在与否，升高的中心 BP 与 CAD 的存在和严重程度相关，表明中心高血压是冠状动脉粥样硬化的一个重要危险因素。
