Analysis Of Clinical Characteristics Of Primary Hypertension Combined With Acute Myocardial Infarction

Background: Hypertension is a well known risk for atheroscherosis. Many studies had shoun that primary hypertension complicated with acute myocardial infarction is often performance of massive myocardial infarction,which had high incidence of malignant arrhythmias and badly damaged heart function. The emergency percutaneous coronary intervention(PCI),as the first method to treat AMI, is widely used in clinical application. It can improve myocardial blood supply, but also lead to changes in blood pressure in patients. The impact of the primary hypertension on acute myocardial infarction after PCI is seldom reported, and the influence on prognosis due to the change of the blood pressure of those patients was unclear.Objective : To analysis the clinical characteristics, morphological features of the coronary artery and the change of blood pressure in patients with primary hypertension combined with acute myocardial infarction.Methods : 1.As a retrospective cohort study, we selected 230 patients who had underwent PCI in the first affiliated hospital of Soochow university from June 2013 to June2015. Patients were divided into 2 groups: hypertension group(n=137) and non-hypertension group(n=93).2.The case-control study was to collect clinical data of enrolled patients,such as age,sex,history of smoking,history of drinking,history of hypertension,history of hyperlipidaemia,history of diabete,history of previous myocardial infarction,FBG,LDL-C,HDL-C,TC,TG,creatinine,Hs-CRP and so on. Meanwhile,features of coronary angiography were collected, such as the number of coronary artery lesion branches and the coronary artery lesion site. And also collect the systolic blood pressure values and the diastolic blood pressure values rang from before PCI and within twenty-four hours after PCI.3. The clinical characteristics,morphological features of the coronary artery and the change of blood pressure visualized in angiography were compared between two groups.And analysis of the relevant factors on the prognosis of patients with primary hypetensioncombined with AMI after PCI.Results 1.230 patients were enrolled in the study and divided into two groups.the HT group was positively associated with age,history of diabetes and stroke,FBG,the history of smoking,the incidences of paroxysmal atrial fibrillation, cardiac shock and in-hospital mortality, where the difference between groups is statistically significant(p<0.05).2. There were 137 patients in the HT group, where there were 74 patients with one-vessel lesion and 23 patients with multi-vessel lesion.There were 93 patients in the NHT group, where there were 67 patients with one-vessel lesion and 7 patients with multi-vessel lesion. The difference between the two groups are significant in vessels of coronary artery, There was no significant difference between the two groups in the lesion vessels and the infarct location.3. In the HT group, the incidence of lowering blood pressure was 82.5%, the average lowering systolic pressure in hypertension group was(13±22)mmHg and the average lowering diastolic pressure in hypertension group was(6±14)mmHg.In the NHT group, the incidence of lowering blood pressure was 71.0%, the average lowering systolic pressure in hypertension group was(7±11)mmHg and the average lowering diastolic pressure in hypertension group was(2±11)mmHg.The HT group have significant differences cpmpared with the NHT group. Analysis the blood pressure before PCI and after PCI within 24 hours by repeated measures analysis of variance. The results showed that within 12 hours after PCI in group HT SBP decresed in value(13±2) mmHg, DBP decreased in value(6±1)mmHg, compared with the NHT group,which showed that within 12 hours after PCI decresed in value(8±1) mmHg, DBP decreased in value(2±1) mmHg.There were statistically significant differences between the two group. The SBP and DBP within 24 hours after PCI in the HT group were higher than those in the NHT group, and decreased24 hours each time the value of SBP is higher than that of NHT group, and there were significant difference between the two group.4. Multifactorial logistic regression analysis showed that age is independent predictor of serious adverse cardiovascular events.Conclusion 1.Patients with primary hypertension and AMI were older, higher rates of diatebes and stocks.The incidence increased significantly of multiple vessel discase. And the incidence of cardiac shock and in-hospital mortality were higher,and the short-term prognosis is worse.2.The occurrence rates of lowering blood pressure after PCI in patients with AMI and hypertension was higher, and the decreased blood pressuer values were higher. And the blood pressure fell most rapidly within 12 hours after PCI in patients with AMI and hypertension.3.Age is the risk factor of the serious adverse cardiovascular events in patients with AMI.