Association Between Morning Blood Pressure Surge And Stenosis Degree Of Coronary Artery Atherosclerosis

Objective: A large number of studies showed that Cardiovascular and cerebrovascular events occurring in the morning increased significantly.An exaggerated MBPS may be involved in the increasing incidence of Cardiovascular(CV)events occurring in the morning,as BP and CV events display parallel diurnal variations.The mechanisms of an exaggerated MBPS was caused by the activation of the sympathetic nervous system or the renin-angiotensin(RA)system from sleep to waking time in the morning,and by race,aging,sleep disorder,mood and smoking in the early morning.The most common observational markers were cerebral white matter lesions,Carotid artery intima-media thickness,Carotid femoral pulse wave velocity,left ventricular mass index and urine albumin/creatinine ratio in studies.on MBPS and target organ damag.MBPS triggers advanced vulnerable plaque rupture by mechanical stress of BP and shear stress from exaggerated variability of blood flow,resulting in the onset of CV events.The small arteries branching rectangularly from large arteries are anatomically exposed to high pressure and that must maintain strong vascular tone in order to provide large pressure gradients from the parent vessels to the capillaries.These vascular structures are found in coronary arteries.Therefore,this study was designed to investigate the association between MBPS and the lesions of coronary artery atherosclerosis that derived from ambulatory blood pressure monitoring(ABMP)and coronary artery CT angiography.Methods: 87 patients were selected in the department of our hospital from January 2015 to January 2016,including 43 males,44 females,mean age 56.37±11.82 years old.All patients were taken 24-hour ABMP and CCTA.According to the data derived from 24-hour ambulatory blood pressure,the MBPS was calculated as mean systolic BP during the 2 hours after awaking minus the mean systolic BP during the 1 hour that included the the lowest night-time reading.In accordance with the Li et al.literature,using 20 mmHg as the cut point,MBPS was divided into two groups,the differences of the occurrence of CAD was compared between the two groups.The differences of two groups and correlation of coronary lesions including number of involved branches,lesion involved left main artery,segment involvement score(SIS)and segment stenosis score(SSS)by CCTA were analyzed,and risk factors for the occurrence of CAD were analyzed in main indexs of ABPM and traditional factors,such as age,hypertension,diabetes et a1.by Binary Logistic regression.Results:1 When the cut point was 20 mmHg for MBPS and comparing of the number of involved branches,lesion involved left main artery,SIS and SSS of two groups,there were significant differences in number of involved branch,SIS and SSS,P<0.05.There was nonsignificant difference in lesion involved left main artery.2 Analysis of the correlation of MBPS and SIS,SSS and number of involved branchs showed that r-values were 0.030,0.044,0.042 sequentially,P<0.05.There was correlation between MBPS and SIS,SSS and number of involved branch,the degree of coronary artery stenosis increased with the increase of MBPS.3 Sex,age,smoking,hypertension,diabetes,hyperlipidemia and MBPS(P<0.05)were showed statistical significance and had relation with CAD incidence,but BMI and antihypertensive treatment was not statistically significant in univariate analysis of CAD with the sex,age,smoking,body mass index(BMI),hypertension,diabetes,hyperlipidemia,anti hypertension treatment and MBPS.There was no significant difference in univariate analysis between CAD and 24 hSBP,24hDBP,dSBP,dDBP,nSBP,nDBP.The main indexs such as sex,age,smoking,hypertension,diabetes,hyperlipoidemia,and MBPS as the independent variables,and CAD as the dependent variable,multivariate regression analysis showed that sex,age,smoking,hypertension and MBPS were the risk factors for CAD,MBPS(?=3.452,P=0.016,OR=3.156)and 95% C.I.for OR(2.397,15.569);sex(female)was a protective factor.The other factors of diabetes and hyperlipoidemia,were no statistical significance(P>0.05).Conclusions:1 The stenosis degree of coronary atherosclerosis was significantly higher in patients as MBPS?20 mmHg,and it has aggravated with the increase of MBPS.2 There was significant differences between CAD and sex,age,smoking,hypertension,diabetes,hyperlipidemia and MBPS in univariate analysis of CAD.Multivariate regression analysis of CAD showed that sex,age,smoking,hypertension and MBPS were the risk factors for CAD,and sex(female)was a protective factor.MBPS was associated with incidence of CAD.