Jiang Cui-Ping, Liu Yuan-Kang, Cheng Pan-Pan, Dong Yue, Wang Xiang, Wu Fan-Yu, Xia Yu-Xuan, Wang Peng-Yun, Xu Xiang-Yang
Department of Radiology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430060, Hubei Province, China.
Department of Radiology, Taihe Hospital, Hubei University of Medicine, Wuhan 442700, Hubei Province, China.
World J Diabetes. 2025 Apr 15;16(4):102751. doi: 10.4239/wjd.v16.i4.102751.
Inadequately controlled hypertension often leads to an increased cardiovascular death rate in type 2 diabetes mellitus (T2DM). It remains unclear whether systolic blood pressure (SBP) status of hypertension is related to coronary inflammation and plaques in T2DM.
To evaluate whether SBP variability (SBPV) and levels of hypertension are related to coronary inflammation and plaques in T2DM patients using coronary computed tomography angiography (CCTA).
This retrospective study involved 881 T2DM patients with CCTA images, including 668 hypertension and 213 normotension patients. Hypertension patients were subgroup based on SBP status: (1) SBPV: Low (< 8.96 mmHg) and high (≥ 8.96 mmHg) groups; and (2) SBP levels: Controlled (< 140 mmHg) and uncontrolled (≥ 140 mmHg) groups. Pericoronary adipose tissue (PCAT) attenuation, high-risk plaques (HRPs) and obstructive stenosis (OS) were evaluated by CCTA. Propensity score matching was utilized to compare these CCTA findings for these groups. The impact of SBPV and SBP levels of hypertension on these CCTA findings in T2DM patients were evaluated by multivariate logistic regression and multivariable linear regression.
PCAT attenuation of the left anterior descending artery (LAD), any low attenuation plaque (LAP), any spotty calcification (SC), any positive remodeling (PR), and OS had significant differences between the hypertension group and the normotension group, as well as between the high SBPV or uncontrolled SBP group and the low SBPV or controlled SBP group (all < 0.05). Hypertension was independently positively correlated with LAD-PCAT attenuation ( = 1.815, = 0.010), LAP (OR = 1.612, = 0.019), SC (OR = 1.665, = 0.013), PR (OR = 1.549, = 0.033), and OS (OR = 1.928, = 0.036) in all T2DM patients. Additionally, high SBPV and uncontrolled SBP were independently positively correlated with LAD-PCAT attenuation (high SBPV: = 1.673, = 0.048; uncontrolled SBP: = 2.370, = 0.004) and PR (high SBPV: OR = 1.903, = 0.048; uncontrolled SBP: OR = 2.230, = 0.013) in T2DM patients with hypertension.
Inadequately controlled hypertension, including high SBPV and/or uncontrolled SBP levels, may be related to increased coronary artery inflammation, HRPs, and OS in T2DM, leading to increased cardiovascular risk. Achieving both low SBPV and controlled SBP levels simultaneously, especially in individuals with T2DM and hypertension, warrants clinical attention.
血压控制不佳常导致2型糖尿病（T2DM）患者心血管死亡率增加。目前尚不清楚高血压的收缩压（SBP）状态是否与T2DM患者的冠状动脉炎症及斑块有关。
采用冠状动脉计算机断层扫描血管造影（CCTA）评估T2DM患者的SBP变异性（SBPV）和高血压水平是否与冠状动脉炎症及斑块有关。
这项回顾性研究纳入了881例有CCTA图像的T2DM患者，其中包括668例高血压患者和213例血压正常患者。高血压患者根据SBP状态分为亚组：（1）SBPV：低（<8.96 mmHg）和高（≥8.96 mmHg）组；（2）SBP水平：控制良好（<140 mmHg）和控制不佳（≥140 mmHg）组。通过CCTA评估冠状动脉周围脂肪组织（PCAT）衰减、高危斑块（HRP）和阻塞性狭窄（OS）。采用倾向评分匹配法比较这些组的CCTA结果。通过多因素逻辑回归和多变量线性回归评估高血压的SBPV和SBP水平对T2DM患者这些CCTA结果的影响。
高血压组与血压正常组之间，以及高SBPV或SBP控制不佳组与低SBPV或SBP控制良好组之间，左前降支（LAD）的PCAT衰减、任何低密度斑块（LAP）、任何点状钙化（SC）、任何阳性重塑（PR）和OS均有显著差异（均P<0.05）。在所有T2DM患者中，高血压与LAD-PCAT衰减（β=1.815，P=0.010）、LAP（OR=1.612，P=0.019）、SC（OR=1.665，P=0.013）、PR（OR=1.549，P=0.033）和OS（OR=1.928，P=0.036）独立正相关。此外，在高血压T2DM患者中，高SBPV和SBP控制不佳与LAD-PCAT衰减（高SBPV：β=1.673，P=0.048；SBP控制不佳：β=2.370，P=0.004）和PR（高SBPV：OR=1.903，P=0.048；SBP控制不佳：OR=2.230，P=0.013）独立正相关。
血压控制不佳，包括高SBPV和/或SBP水平控制不佳，可能与T2DM患者冠状动脉炎症增加、HRP和OS有关，导致心血管风险增加。同时实现低SBPV和SBP水平控制良好，尤其是在T2DM和高血压患者中，值得临床关注。
