| Background and objectiveThroughout the history of epidemic situation of disease in China and the whole world,Cardiovascular disease(CVD)has become the single and leading cause of death.In clinical work,coronary heart disease(CHD)is one of the most common types of cardiovascular disease.It has greatly threatened the health and safety of human beings and increased the economic burden of all countries.From a global perspective,with the development of various countries' economies and the changes in people's lifestyles,the incidence and mortality of coronary heart disease have been increasing year by year.It has attracted much attention.In coronary heart disease,acute myocardial infarction(AMI)has a rapid progression,high mortality,severe complications,and poor prognosis.Therefore,reliable clinical monitoring is needed to predict the state of the disease.Hypertension is one of the major risk factors for coronary heart disease.Compared with non-hypertensive people,hypertension is a high-risk group with cardiovascular disease.In order to better monitor blood pressure changes in hypertensive patients,the 24-hour ambulatory blood pressure monitoring(ABPM)is widely used in recent years.It provides us with many valuable information about blood pressure,such as the maximum blood pressure.Value,minimum blood pressure,blood pressure variability,night blood pressure drop rate,etc.Blood pressure variability including systolic blood pressure variability(SBPV)and diastolic blood pressure variability(DBPV).Among them,blood pressure variability(BPV)has been proved to be related to the severity of cardiovascular disease and made damage of important target organ in many studies.The impact of elevated BPV on cardiovascular disease may be no less than that of blood pressure.In addition,BPV may be associated with increased mortality of cardiovascular disease and the incidence of cardiovascular adverse events which is relatived to other risk factors for cardiovascular disease.It appears to have a higher prognosis and predictive value for patients with cardiovascular disease.Therefore,in patients with hypertension combined with acute myocardial infarction,BPV may be considered as an important clinical monitoring indicator to evaluate the degree of coronary artery disease and the short-term prognosis.Therefore,the aim of this study was to analyze the correlation between BPV and the degree of coronary lesion in patients with hypertension complicated with acute myocardial infarction,and to explore the predictive value of BPV in its disease progression and prognosis in the near future(intake within 30 days)so as to guide the clinical treatment plan.MethodWe selected 191 patients who were hospitalized with acute myocardial infarction in the department of cardiology of the First Affiliated Hospital of Zhengzhou University from June 2015 to February 2018.All enrolled patients underwent 24-hour ambulatory blood pressure monitoring and coronary angiography(CAG)under the same conditions.All patients underwent Gensini scores based on coronary angiography.According to whether the patients have hypertension,55 cases were non-hypertension group and 136 cases were hypertension group.The two groups were analyzed in glycosylated hemoglobin,total cholesterol,high density lipoprotein,low density lipoprotein,creatinine,uric acid,coronary artery score,blood pressure variability,history of diabetes,smoking history,family history and other clinical indicators whether have difference between them.According to the Gensini score in the hypertension group,the groups were divided into two groups.We classified them as mild lesion group(score<50,n=47)and severe lesion group(score?50,n=89).All the clinical index and blood pressure variability were compared of two groups to find out differences.Find out the difference in blood pressure variability,and the correlation between blood pressure variability and coronary Gensini score.Explore the incidence of cardiovascular adverse events(death,cardiogenic shock,severe arrhythmia,severe heart failure)within 30 days after admission was compared.Analyze the risk factors for cardiovascular adverse events.Result1.All-day SBPV,all-day DBPV,daytime SBPV,daytime DBPV,nighttime SBPV,nighttime DBPV and Gensini scores in the hypertensive group were higher than those in non-hypertension group.There were only statistical differences in the brain natriuretic peptide,all-day SBPV,all-day DBPV,daytime SBPV,daytime DBPV,nighttime DBPV,and Gensini score between two group(P<0.05).2.With in the hypertensive group,the variability of all-day SBPV,all-day DBPV,daytime SBPV,daytime DBPV,nighttime SBPV and nighttime DBPV in severe lesions group were were higher than those in mild lesion group.There were only statistical differences in sex,age,brain natriuretic peptide,high density lipoprotein,all-day SBPV,all-day DBPV,daytime SBPV,daytime DBPV,nighttime DBPV and Gensini score between two group(P<0.05).3.Correlation analysis of hypertension group showed that there was a significant positive correlation between Gensini score with each one of all-day SBPV,all-day DBPV,daytime SBPV,daytime DBPV,nighttime DBPV in hypertension group(correlation coefficient r=0.284,r=0.221,r=0.320,r=0.235,r=0.245,P<0.05).4.Multivariate logistic analysis showed that elevated all-day SBPV was an independent risk factors for cardiovascular adverse events in patients.Conclusion1.BPV is elevated in patients with hypertension and AMI.2.With the increase of BPV,the severity of coronary artery lesion is more serious.3.All-day SBPV is independent risk factors for recent cardiovascular adverse events in patients with coronary heart disease. |
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