A Case-control Study On The Relationship Between Blood Pressure Variability And Severity Of Coronary Artery Disease In Patients With Essential Hypertension

Objective: To investigate the relationship between blood pressure variability(BPV)and the severity of coronary artery disease in patients with essential hypertension.Methods: From January 2016 to December 2017,307 patients were diagnosed as essential hypertension in cardiovascular department of Chengdu Second People’s Hospital and underwent coronary angiography(CAG)in Cardiac Catheterization Laboratory.According to the CAG condition,patients were divided into coronary heart disease(CHD)group(n=186 cases)and non CHD group(n=121 cases).The general clinical data,serum biochemical indicators and 24-hour ambulatory blood pressure of two groups were compared.The relationship between the data of ambulatory blood pressure,especially the variability of blood pressure and the degree of coronary artery disease was analyzed.SYNTAX score was used to evaluate the severity of coronary artery disease.Coronary heart disease was divided into mild group(n=69 cases),moderate group(n=64 cases)and severe group(n=53 cases).The relationship between different coronary artery lesions and blood pressure variability was observed through comparison between two groups.Results:(1)Two groups(CHD group and non CHD group)with body mass index(BMI),alcohol,peripheral arteriosclerosis,arrhythmia,cerebral stroke,hyperuricemia,total bilirubin(TBi L),urea(UREA),uric acid(UA),triglyceride(TG)total cholesterol(TC)and low density lipoprotein cholesterol(LDL-C),the difference was not statistically significant(P>0.05);Sex,age,smoking,high cholesterol,high density lipoprotein cholesterol(HDL-C),creatinine(CREA),the difference was statistically significant(P<0.05).(2)CHD group and non CHD group of ambulatory blood pressure in patients with 24 h mean arterial pressure(24h MAP),the mean arterial pressure(d MAP),nocturnal mean arterial pressure(n MAP),morning peak systolic blood pressure,diastolic blood pressure morning peak,there was no statistically significant difference(P>0.05);24 hour systolic blood pressure variability(24h SCV),diastolic blood pressure variability(24h DCV),daytime systolic blood pressure variability(d SCV),daytime diastolic blood pressure variability(d DCV),nighttime systolic blood pressure variability(n SCV),nocturnal diastolic blood pressure variability(n DCV),the difference was statistically significant(P<0.05).(3)multivariate two element Logistic regression analysis showed the influence of age(OR:1.046,95%CI: 1.014 to 1.078,P=0.004),smoking(OR: 1.046,95%CI: 1.372 to 5.794,P=0.005),hyperlipidemia(OR: 1.046,95%CI: 1.461 to 6.637,P=0.003),24 h SCV(OR:1.146,95%CI:1.199 to 1.784,P=0.000)and d SCV(OR: 1.274,95%CI: 1.084 to 1.497,P=0.003)on coronary heart disease were statistically significant(p<0.05).(4)The blood pressure variability(24h SCV,d SCV)has obviously difference by multi-factor analysis(P<0.05),there also was a statistically significant difference(P<0.05)of it by variance analysis among the three coronary artery disease groups,and between every two groups,the difference of 24 h SCV and d SCV levels were statistically significant(P <0.05),that mild group were evidently lower than the moderate and severe group,moderate group were evidently lower than the severe group.Conclusion: Age,smoking,hyperlipidemia is the risk factors of hypertensive patients with coronary heart disease;the higher blood pressure variability is,the severer the coronary artery lesion is found;24h SCV,d SCV are independent risk factors of coronary heart disease.The level of 24 h SCV and d SCV is positively correlated with the degree of coronary artery lesions.