Study Of Relationship Between Microalbuminuria, Different Ambulatory Blood Pressure Monitoring Parameters And Severity Of Coronary Artery Stenosis

ObjectiveTo evaluate the relationship between microalbuminuria (mAlb), different ambulatory blood pressure monitoring (ABPM ) parameters and the severity of coronary artery stenosis. Methodstwo hundred and fifty–two patients were randomly assigned . All patients( mean age57.75±11.26years, 168 males and 84females) underwent coronary angiography. mAlb was determined with radioimmunoassay(RIA). Aortic systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured during the period of coronary angiography . All subjects underwent 24-h ABPM after coronary angiography . Brachial SBP and DBP were measured before and after coronary angiography. The severity of coronary artery stenosis was evaluated by the number of impaired arteries and Gensini score.Results1 Patients with essential hypertension(EH) had higher mAlb(P=0.000)than those without EH.2 Patients with EH had higher incidence of coronary heart disease(CHD)(81.1% vs 53.4%,P = 0.000)than those without EH. Patients with EH had higher incidence of 2 and 3 coronary artery lesions (28.7% vs 5.7%,P=0.000;29.3% vs 9.1%,P=0.000) than those without EH.3 They were all significantly higher in patients with 1,2 or 3 artery lesions among CHD than those in the normal subjects for either mAlb ,morning surge or 24-h systolic blood pressure load(24hSBPload)(p=0.000).4 They were all significantly higher in patients with CHD than those in the normal subjects for either brachial, aortic or 24h ambulatory SBP ,pulse pressure( PP)( P < 0. 05).Ambulatory SBP,PP were all prior to either brachial or aortic SBP , PP.Among those ,nighttime SBP , PP was the best. And among ambulatory SBP or PP , PP were all prior to SBP.5 There were all a significant correlation between mALB and either brachial, aortic, 24-h,daytime or nighttime SBP,PP. And PP were all more closely related to mALB than SBP. 24-h SBP, 24-h PP, nighttime SBP and nighttime PP ,compared with brachial SBP, brachial PP, aortic SBP and aortic PP, were all more closely related to mALB . Among those, nighttime SBP was more closely related to mALB than 24-h SBP.6 Logistic multivariate analysis indicated that age[beta(β)=0.078, P=0.006, odds ratio (OR)=1.081], mAlb [β=0.325, P=0.000, OR = 1.385], morning surge[β=0.255, P=0.000, OR = 1.291 ], daytime SBP [β=1.690, P=0.001, OR = 5.420] , nighttime SBP [β=1.856,P=0.001,OR = 6.410], nighttime SBPload[β=0.093, P=0.000,OR = 1.098] and rate of SBP decline during nighttime [β=2.220,P=0.000,OR = 9.174 ] were closely related to the severity of coronary artery lesions. And rate of SBP decline during nighttime,compared with other factors, was more closely related to the severity of coronary artery lesions. ConclusionmAlb is closely related to ABPM parameters , which might be a marker of the predictors of severity of coronary artery disease . Age, morning surge,daytime SBP, nighttime SBP, nighttime SBPload and rate of SBP decline during nighttime are all the independent risk factors of the severity of coronary artery stenosis,and the rate of SBP decline during nighttime is the better predictor of severity of CHD.