| ObjectiveIn this study, through the monitoring of acute coronary syndrome with hypertension in patients undergoing percutaneous coronary intervention(percutaneous coronary, intervention, PCI) after the dynamic changes in blood pressure, heart rate, specific changes, the incidence of perioperative serum biochemical indexes and adverse cardiovascular events, revealing the non-dipper blood pressure changes and morning blood pressure surge phenomenon of acute coronary syndrome in patients undergoing primary PCI with hypertension. Method217 cases of acute coronary syndrome patients with hypertension after PCI in a hospital in Shenyang were selected. Based on ambulatory blood pressure monitoring for nighttime mean blood pressure decline rate(<10% and more than or equal to 10%) and morning peak systolic pressure(more than or equal to 35 mm Hg and <35mm Hg) divided into non dipper type group, dipper type group, morning peak group and non-morning peak group.The clinical data of the patients in each group were observed.(1)Basic data: the proportion, age, sex, smoking rate, dyslipidemia, diabetes mellitus, hypertension, clinical types.(2)Ambulatory blood pressure monitoring index: SBP, DBP, MAP, blood pressure reduction rate, morning systolic blood pressure(diastolic blood pressure) peak.(3)Heart rate variability index: SDNN, SDANN, r MSSD.(4)Hypersensitive C reaction protein(hs-CRP, as a marker of inflammatory injury).(5)Cardiac troponin I and creatine kinase(c Tn I and CK-MB), myocardial injury markers, the upper limit of the normal reference value is considered as the incidence of myocardial injury and the upper limit of the normal reference value of c Tn I higher than 3 times(c Tn I_A) was regarded as PCI related myocardial infarction).(6)30 days of major adverse cardiovascular events and 1 year heart vascular events. Result1. In terms of age, between non-dipper hypertension group(64.35±8.94) and dipper hypertension group(64.46±8.18) were no significant difference(t=-0.082, P=0.934). Between non-dipper blood pressure group and dipper type group, in the course of hypertension(c2=10.211, P=0.001), the dyslipidemia(c2=4.868, P=0.027) there were statistically significant differences and in sex(c2=0.858, P=0.354), smoking history(c2=0.037, P=0.847), diabetes(c2=3.728, P=0.054), clinical type(c2=0.261, P=0.609) there were no significant difference.In terms of age, between the morning peak hypertension group(63.76±8.49) and the non-morning peak hypertension group(65.18±9.03) were no significant difference(t=-1.184, P=0.238). Between morning peak blood pressure group and non-morning peak blood pressure group basic the clinical data in sex(c2=1.677, P=0.195), smoking history(c2=0.015, P=0.901), dyslipidemia(c2=0.046, P=0.830), diabetes(c2=0.005, P=0.946), the course of hypertension(c2=0.067, P=0.796), clinical type(c2=0.009, P=0.924) had no significant difference.2. After PCI, within one week, between non-dipper blood pressure group and dipper type group, in daytime SBP(t=-1.721, P=0.087), daytime DBP(t=1.052, P=0.296) morning peak SBP(t=0.483, P=0.630), morning peak DBP(t=-0.509, P=0.628) there were no significant difference, but in nigh time SBP(t=5.425, P<0.001), nigh time DBP(t=4.365, P<0.001), decrease rate of night time SBP(z=-4.979, P<0.001) and DBP(z=-2.469, P=0.014) there were statistically significant differences.Between morning peak blood pressure group and non-morning peak blood pressure group, in night time SBP(t=0.148, P=0.882), night time DBP(t=1.068, P=0.286), morning peak DBP(t=-0.007, P=0.994), decrease rate of night time SBP(z=-1.868, P=0.062) and DBP(z=-1.727, P=0.084) there were no significant difference, but in daytime SBP(t=3.564, P<0.001), daytime DBP(t=3.608, P<0.001), morning peak SBP(t=21.778, P<0.001) there were statistically significant differences.3. After PCI, within one week, between non-dipper blood pressure group and dipper type group, in r MSSD(t=-1.759, P=0.080) there were no significant difference, but in SDNN(t=-2.105, P=0.036) and SDANN(t=-2.054, P=0.041) there were statistically significant difference. Between morning peak blood pressure group and non-morning peak blood pressure group, in SDNN(t=-0.321, P=0.749) and SDANN(t=-0.480, P=0.632) there were no significant difference, but in r MSSD(t=2.610, P=0.010) there were statistically significant difference.4. Hs-CRP(t=2.069, P=0.040), c Tn I(c2=5.442, P=0.020), CK-MB(c2=13.332, P<0.001) and c Tn I_A(c2=5.794, P=0.016) of non-dipper type blood pressure patients were significantly higher than that in dipper type blood pressure group. CK-MB(c2=8.847, P=0.003) and c Tn I_A(c2=21.671, P<0.001) of morning peak groups of were higher than that of non-morning peak group, but between morning peak blood pressure group and non-morning peak blood pressure group, hs-CRP(t=1.461, P=0.145) and c Tn I(c2=0.001, P=0.982) had no significant difference.5. Within a year follow-up, incidence of adverse cardiovascular events in the morning peak patients was higher than that of non-morning peak group(c2=24.693, P<0.001), but between non dipper blood pressure group and dipper type group, cardiovascular events occurrence rate(c2=0.503, P=0.478) had no significant difference. Conclusion1. Acute coronary syndrome patients with hypertension after PCI who disappeared circadian blood pressure rhythm showed higher night time blood pressure and decreased night blood pressure drop rate, and patients in morning peak blood pressure showed elevated daytime blood pressure.2. The disappearance of circadian blood pressure rhythm can obviously affect heart rate variability, and the effect of morning peak blood pressure on heart rate variability is small.3. The disappearance of circadian blood pressure rhythm can increase the probability of perioperative inflammatory injury, myocardial injury and myocardial infarction in patients after PCI, morning peak blood pressure can increase the probability of perioperative myocardial injury and myocardial infarction in patients with PCI.4. Morning peak blood pressure can increase the rise of adverse cardiovascular events in patients with hypertension complicated with acute coronary syndrome after PCI. |
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