| [Objective]To analyze the characteristics of ambulatory blood pressure in patients with coronary atherosclerotic heart disease(CHD)aged 65 years and older.[Methods]A total of 960 consecutive CHD patients aged 65 years and older were included in this study.The office and ambulatory blood pressure characteristics were analyzed in all patients and patients with different blood pressure circadian rhythm.960 patients with CHD were divided into hypertension group and non-hypertension group.The ambulatory blood pressure characteristics were compared between the two groups.After a 1:2 propensity score matching,a total of 159 elderly non-CHD patients and 307 CHD patients who met the inclusion criteria during the same period were included in the study.The characteristics of clinical and ambulatory blood pressure were compared between the two groups.[Results]The mean(±SD)age of 960 CHD patients was 72.3±5.9 years(range 65-97years).293 cases were female(30.5%),.The systolic blood pressure(SBP)rhythm:169 cases(17.6%)of dipping,411 cases(42.8%)of non-dipping,363(37.8%)cases of reverse dipping and 17cases(1.8%)of extreme dipping.Patients with different patterns of SBP circadian rhythm showed statistically significant differences in age,gender,N-terminal pro-brain natriuretic peptide(NT-proBNP)levels,urine albumin-to-creatinine ratio(UACR)levels,and highly sensitive c-reactive protein(hsCRP)levels(P<0.01 for all).The reverse dipping group had older age.The non-dipping and reverse dipping groups had a higher proportion of female patients and higher levels of NT-proBNP,UACR,and hsCRP.There was no significant difference in circadian rhythm between CHD with hypertension group and non-hypertension group.When comparing the CHD group with the non-CHD group,the CHD group showed significantly lower levels of 24-hour diastolic blood pressure(DBP),daytime DBP,and nighttime DBP compared to the non-CHD group(P<0.01,P<0.01,P<0.05).The CHD group also had a lower degree of nighttime SBP drop compared to the non-CHD group(P<0.01).Additionally,the proportion of patients with a reverse dipping pattern in SBP was higher in the CHD group compared to the non-CHD group(P=0.01),and the proportion of patients with a extreme dipping pattern in DBP was higher in the CHD group(P<0.05).[Conclusion]This study found that in the elderly population with CHD,the proportion of patients with a non-dipping or reverse dipping pattern in SBP was significantly higher than the proportion of patients with a dipping pattern.The non-dipping and reverse dipping groups had a higher proportion of female patients and higher levels of NT-proBNP,UACR and hsCRP compared to the dipping and non-dipping groups.The reverse dipping group had an older age compared to the other groups.Furthermore,in elderly patients with CHD,the levels of 24-hour,daytime,and nighttime DBP were lower compared to non-CHD patients.The proportion of patients with a reverse dipping pattern in SBP and a extreme dipping pattern in DBP was higher in the CHD group compared to the non-CHD group.[Objective]To analyze the factors influencing the blood pressure circadian rhythm in coronary atherosclerotic heart disease(CHD)patients aged 65 and older.[Methods]A total of aforementioned 960 elderly patients aged 65 and older with CHD were included.Systolic blood pressure(SBP)and diastolic blood pressure(DBP)circadian rhythm were taken as dependent variables,gender,age,body mass index(BMI),history of heart failure,history of chronic kidney disease,history of hypertension,persistent atrial fibrillation(AF),diabetes mellitus and medication affecting blood pressure were included as independent variables in a binary logistic regression model to analyze the impact of these factors on the blood pressure circadian rhythm in elderly patients with CHD.Among the 960 CHD patients,155 patients underwent sleep breathing monitoring.SBP and DBP were taken as dependent variables,gender,age,BMI,medication affecting blood pressure,and moderate to severe obstructive sleep apnea(OSA)were included as independent variables in a binary logistic regression model to analyze the impact of moderate to severe OSA on the blood pressure circadian rhythm in patients with CHD Subgroup analyses were conducted for AF patients:using a 1:2 propensity score matching,105 patients with non-valvular AF(31 with persistent AF and 74 with paroxysmal AF)were included from the first group of 960 elderly CHD,along with 210 non-AF patients.Clinical characteristics of the three groups(persistent AF,paroxysmal AF,and non-AF)were compared,as well as the ambulatory blood pressure(ABPM)characteristics between the two groups(persistent AF and non-AF).Subgroup analysis for OSA:among the aforementioned elderly CHD patients who underwent sleep monitoring,155 patients were included,and after 1:1 propensity score matching,there were 62 patients with moderate to severe OSA and 61 patients without/with mild OSA.Clinical and ambulatory blood pressure characteristics between the two groups were compared.[Results]The results of the study indicate that there is a higher risk of non-dipping and reverse dipping patterns in SBP for females,older individuals,and those taking blood pressure-affecting medications(P<0.01,P<0.01,P<0.05).Similarly,being female is associated with a higher risk of non-dipping and reverse-dipping patterns in DBP(P<0.01).On the other hand,persistent atrial fibrillation is linked to a lower risk of non-dipping and reverse dipping patterns in SBP(P<0.01).Moderate to severe OSA does not show a significant association with non-dipping/reverse-dipping patterns in SBP and DBP(all P>0.05).Subgroup analysis of AF,it was observed that CHD patients with coexisting persistent AF had lower nighttime SBP compared to non-AF patients(P<0.05).There were no statistically significant differences in office SBP,24-hour SBP,and daytime SBP between the two groups(all P>0.05).Among patients with persistent AF,the proportion of dipper in SBP was higher(P<0.01).Subgroup analysis for OSA patients:there were no significant differences in office blood pressure,24-hour blood pressure,daytime blood pressure,nighttime blood pressure,and the proportion of non-dipper and reverse dippier between the moderate to severe OSA group and the without/mild OSA group(all P>0.05).[Conclusion]Females,older age,and the use of blood pressure-affecting medications are associated with a higher risk of non-dipping and reverse dipping patterns in SBP.The patients with persistent AF is linked to a lower risk of non-dipping and reverse dipping patterns in SBP.Moderate to severe OSA does not show a significant association with non-dipping/reverse-dipping patterns in SBP and DBP.[Objective]To analyze the significance of blood pressure circadian rhythm on the prognosis of elderly patients with coronary atherosclerotic heart disease(CHD).[Methods]Among 960 patients with CHD,421 patients had complete follow-up records.The primary endpoint of the follow-up was composite endpoint,which included all-cause mortality,non-fatal myocardial infarction,non-fatal stroke,revascularization,and hospitalization due to heart failure.The occurrence of events related to different blood pressure circadian rhythms was compared using Kaplan-Meier curves.Adjustments were made for patient demographic characteristics and confounding factors using the Cox proportional hazards model in multivariate regression,obtaining hazard ratios(HR)for different blood pressure circadian rhythms.[Results]The mean follow-up time was 59.3±27.0 months.Kaplan-Meier analysis showed that patients with non-dipping and reverse dipping SBP pattern had increased incidence of hospitalization due to heart failure events compared to those with extreme dipping and dipping pattern(P<0.05).However,there were no statistically significant differences in composite events or all-cause mortality between the two groups.Cox regression analysis was performed using age,gender,body mass index,smoking history,diabetes history,hyperlipidemia history,and antihypertensive medication as independent variables,with composite endpoint,all-cause mortality,and hospitalization due to heart failure as dependent variables.Different Cox regression models were constructed by adding variables such as non-dipping and reverse dipping,SBP patterns、office SBP,24-hour SBP,nighttime SBP,non-dipping and reverse dipping,SBP patterns+office SBP,non-dipping and reverse dipping,SBP patterns+24-hour SBP,and non-dipping and reverse dipping,SBP patterns+nighttime SBP.The baseline model showed that increasing age and smoking were associated with increased risk of all-cause mortality(P<0.01,P<0.05).Non-dipping and reverse dipping SBP patterns,office SBP,24-hour SBP,and nighttime SBP did not have statistically significant predictive value for composite events or all-cause mortality in all models.There was a trend towards increased risk of hospitalization due to heart failure associated with non-dipping and reverse dipping patterns(P=0.065),and this association was not weakened after adjusting for nighttime SBP(P=0.061).[Conclusion]The Kaplan-Meier analysis showed that patients with non-dipping and reverse dipping SBP patterns had no statistically significant difference in composite events or all-cause mortality compared to the extreme dipper and dipper group,but showed an increase in hospitalization due to heart failure events.Cox regression analysis showed that the non-dipping and reverse dipping SBP patterns had no statistically significant impact on the prognosis of composite events or all-cause mortality,but there was a trend towards increased risk of heart failure. |
