| Background and objective:Pseudo-hypertension?Pseudohypertension PHT?is easily misdiagnosed as essential hypertension.PHT patients with routine antihypertensive treatment will lead to low blood pressure and thus damage the pressure receptor,followed by low perfusion will also damage the brain,heart,kidneys and other important organs,in addition to PHT also interfere with the clinical and epidemiological study of hypertension,so that we can not accurately estimate the intensity of cardiovascular risk factors.At present,endovascular blood pressure is still the gold standard for the diagnosis of PHT,because of its invasive,many complications and other characteristics,it is difficult for patients to accept.Non-invasive methods such as pulse wave conduction velocity?pulse wave Velocity PWV?and blood flow mediated vasodilation?flow mediated dilatation FMD?have diagnostic value for PHT,but require higher requirements for instrumentation and testing personnel,Not suitable for extensive screening of PHT patients.The 2014 Hu et difference[1]study found that the difference in diastolic pressure between the arms induced by ischemia?Interarm of Diastolic blood pressure dIAD?was lower in patients with high arterial stiffness?coronary heart disease,diabetes,hypertension,etc.?,And the correlation with FMD is better.We speculate on whether there is also a lower brachial dIAD in PHT patients,so this study explores the significance of ischemic induced dIAD for PHT diagnosis by measuring the dIAD of ischemic induction.Methods:From June 2018 to December 2018,100 patients underwent coronary angiography in Department of Cardiology,Second Affiliated Hospital of Nanchang University.According to the inclusion criteria and exclusion criteria,51 patients were included.The patients were given brachial bundle ischemia test on the night before operation,and the related indexes such as pulse pressure difference?PP?,ankle brachial index?ABI?,dIAD before and after the bundle arm were calculated.General data of patients,such as age and sex,blood biochemical indicators?such as blood lipid,homocysteine,fasting blood sugar,glomerular filtration rate,uric acid,etc.?and related imaging indicators?such as carotid artery media thickness,left ventricular end-systolic diameter,left ventricular end-diastolic diameter,interventricular septal thickness,diastolic function,coronary artery plaque,etc.?were collected.Intracavity blood pressure of brachial artery was measured three times during operation,and cuff blood pressure was measured three times with electronic sphygmomanometer.After the operation,the blood samples were taken from patients before and after the operation,and the plasma endothelin?ET?,nitric oxide?NO?and peroxynitrite anion?ONOO-?were measured.According to the direct and indirect measured systolic and diastolic pressure difference?S-S or D-D>10mmHg?,the patients were divided into PHT group and non-PHT group.Results:In this study,the PHT group amounted to 26 cases,and the non-PHT group amounted to 25 cases.General data of two groups of patients:age,sex,smoking history,history of diabetes mellitus,stroke history,coronary artery plaque,history of coronary heart disease,hypertension,cholesterol,triglycerides,low density lipoprotein,homocysteine,fasting blood glucose,left ventricular systolic end diameter,left ventricular diastolic end diameter,ventricular septal thickness,carotid medial membrane thickness?IMT?,The diastolic pressure of cuff band was not statistically significant?P>0.05?with the difference of diastolic pressure in the cavity?D-D?,before and after sIAD,ABI and front before and after the bundle arm,and the ET concentration,the number of left ventricular diastolic dysfunction in the PHT group,PP,The difference between cuff systolic pressure and intra-cavity systolic pressure?S-S?was significantly higher than that in non-PHT group?p<0.05?,the glomerular filtration rate in PHT group,NO concentration before and after the beam,and the dIAD of the bundle arm were significantly lower than that of the non-PHT group?p<0.05?.In this paper,two Yuan logistic regression analysis was carried out on the index of PHT,and it was found that the ET concentration before and after PP,dIAD and beam arm were included in the regression equation,which was statistically different?p<0.05?,and the area was analyzed by using ROC curve,dIAD,The role of ET concentration in the diagnosis of PHT,the area under the curve?AUC?was 0.837,0.786,0.683,0.665,P<0.05,respectively,the effect of different nodes after the bundle arm on the diagnosis PHT was analyzed,and the Joden index was found to be0.45,dIAD<3.5mmHg?sensitivity is 77%and specificity is 68%?,it is the best diagnostic value for PHT.Conclusion:Ischemic induced dIAD has a high sensitivity and specificity in the diagnosis of PHT,so the lower brachial dIAD can indicate that the patient has the possibility of PHT. |
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