| Background and objectiveThe latest data on the world disease burden has shown that Cardiovascular Disease has been the primary cause of diseases and global death.Among them,Coronary atherosclerotic heart disease,or the Coronary Heart Disease(CHD)for short,as one of the most common type of cardiovascular diseases,ranks first in the global burden of diseases.In recent years,with the accelerating process of social aging and urbanization,and the continuous improvement of people’s living standards,the prevalence and mortality of coronary heart disease also show an increasing trend year by year,and gradually tend to be younger,which brings huge economic burden to China and the world,and has become the most prominent major public health problems.As one of the important risk factors of coronary heart disease,hypertension can significantly increase the risk of coronary heart disease compared with normal blood pressure.Always,In most cases,people define Blood Pressure status through Office Blood Pressure(OBP).With 24-hour Ambulatory Blood Pressure Monitoring(ABPM)is widely used in clinical work,24-hour Ambulatory Blood Pressure Monitoring has evolved into an accurate and reproducible tool for the assessment and management of hypertension.Various out-of-office measurements can be obtained using ABPM data,including morning,daytime,night-time,average 24-hour blood pressure and blood pressure variability."White Coat Hypertension(WCH)" and "Masked Hypertension(MH)as" special types of high blood pressure are gradually been recognized and well known,but most of MH in the daily has no obvious clinical symptoms,and ABPM cannot be popularized at present.MH is easy to be missed and misdiagnosed.A large number of studies at home and abroad have shown that compared with patients with normal blood pressure,MH patients have higher risk of cardiovascular diseases and all-cause mortality,MH is a strong predictor of cardiovascular diseases morbidity and mortality,and is associated with poor cardiovascular prognosis,which is equivalent to persistent hypertension.Therefore,more attention should be paid to MH in clinical practice to achieve "early detection,early diagnosis and early treatment",so as to reduce MH related target organ functional impairment and cardiovascular adverse events,and to improve the prognosis of patients.This article studies the correlation between MH and CHD,so as to provide a theoretical basis for the early prevention and intervention of masked hypertension and its cardiovascular complications.Methods388 inpatients admitted to the department of cardiology,the first Affiliated Hospital of Zhengzhou University from January 2016 to January 2018 were selected as the study objects who underwent office blood pressure,ambulatory Blood Pressure monitoring(ABPM)and coronary angiography.According to the blood pressure monitoring results,the patients were divided into normal control group(n=154 cases),MH group(n=112 cases)and hypertension group(n=122 cases).Gensini scores were also performed for coronary angiography results of all subjects.To analyze whether there are differences among the three groups in clinical indicators such as gender composition,age,smoking,diabetes history,family history of coronary heart disease,glycosylated hemoglobin,homocysteine,total cholesterol,high-density lipoprotein,low-density lipoprotein,triglyceride,creatine kinase,creatine kinase isozyme,creatinine level and so on.Then included in the normal control sample and masked hypertension sample,according to whether the group with CHD,including 154 patients in the coronary heart disease group,112 patients in the non-coronary heart disease group.Whether to have CHD as dependent variable,gender,age,diabetes,MH,smoking,glycosylated hemoglobin,family history of CHD,total cholesterol,high-density lipoprotein cholesterol,low density lipoprotein cholesterol,triglycerides,creatinine,homocysteine,creatine kinase,creatine kinase isoenzyme as independent variables such as single factor Logistic regression analysis.Then screened risk factors were included in the multivariate Logistic regression analysis of CHD.Through the analysis of these factors,the independent risk factors of CHD were obtained,which could increase the risk of CHD.Results1.Age,triglyceride,diabetes mellitus,glycosylated hemoglobin and homocysteine levels of the three groups showed statistically significant differences(P<0.05);Then the comparison between the 2 groups,the levels of age,triglyceride,diabetes mellitus,glycosylated hemoglobin and homocysteine in the hypertension group were higher than those in the normal control group,and the differences were statistically significant(P<0.05);The level of glycosylated hemoglobin in the hypertension group was higher than that in MH group,the differences were statistically significant(P<0.05);There were no statistically significant differences in all the general clinical indicators between the MH group and the normal blood pressure group(P>0.05).2.Comparison of coronary Gensini score among the three groups showed statistically significant differences(P<0.05);The comparison between the 2 groups,the Gensini scores of the hypertension group were higher than that of the MH group(P=0.025)and the normal control group(P=0.000),and the Gensini scores of MH group were higher than that of the normal control group(P=0.040),with statistically significant differences(P<0.05).3.Univariate Logistic regression analysis of CHD showed that age,smoking,diabetes mellitus,gender,family history of CHD,triglyceride,MH,homocysteine,creatinine and glycosylated hemoglobin were risk factors of CHD.4.Multivariate Logistic regression analysis of CHD showed that MH(OR=2.622,95%CI:1.505-4.570,P=0.001),age(OR=1.033,95%CI:1.004-1.063,P=0.026),smoking(OR=2.477,95%CI:1.179-5.204,P=0.017)and diabetes(OR=3.299,95%CI:1.012-10.757,P=0.048)were independent risk factors for CHD.Conclusions1.The degree of coronary artery lesions in patients with MH is more serious than that in patients with normal blood pressure.2.MH,age,smoking and diabetes history are independent risk factors for coronary heart disease. |
