Correlation Of Pulse Pressure And Pulse Pressure Index With Coronary Artery Lesions In Middle-Aged Patients With Essential Hypertension

Objective:1.To investigate the correlation between pulse pressure(PP)and pulse pressure index(PPI)and coronary artery lesions in middle-aged patients with essential hypertension.2.To clarify the predictive value of PP and PPI on the severity of coronary artery lesions by gender.Methods:180 middle-aged(45-59 years old)patients with essential hypertension attending the People’s Hospital of Inner Mongolia Autonomous Region from December 2021 to December 2022 were selected and divided into 101 patients with hypertension combined with positive coronary angiography group and 79 patients with hypertension combined with negative coronary angiography group according to the coronary angiography results.Age,gender,BMI,smoking history,SBP,DBP,24 h PP,24 h PPI,TC,TG,LDL-C,HDL-C,SUA,CRP,Lp(a),Cys-C and coronary angiography results were collected from all enrolled patients and Gensini score was performed.SPSS 21.0 software was used for statistical analysis of the data.Results: 1.Comparison of general clinical data between the hypertension combined with coronary angiography positive group and the hypertension combined with coronary angiography negative group: 24 h PP,24 h PPI,BMI and CRP in the hypertension combined with coronary angiography positive group were significantly higher than those in the hypertension combined with coronary angiography negative group,and HDL was significantly lower than that in the hypertension combined with coronary angiography negative group,all differences were statistically significant(P<0.05).2.Logistic regression showed that the four indicators of 24 h PP,24 h PPI,BMI and CRP were independent risk factors for positive coronary angiography(OR>1)and that for every 7.89 mm Hg increase in 24 h PP,the risk of positive coronary angiography increased 1.465 times(OR=2.465);for every 0.056 increase in 24 h PPI,the risk of positive coronary angiography increased 1.465 times(OR=2.465).For every 0.056 increase in 24 h PPI,patients had a 1.575-fold increased risk of positive coronary angiography(OR=2.575);for every 2.82 kg/m2 increase in BMI,patients had a 0.548-fold increased risk of positive coronary angiography(OR=1.548);for every 4.91 mmol/L increase in CRP,patients had a 1.520-fold increased risk of positive coronary angiography(OR=2.520).3.Area under the ROC curve for 24 h PP0.706,standard error 0.040,P < 0.01,95% confidence interval(0.629-0.783);area under the ROC curve for 24 h PPI 0.724,standard error 0.039,P < 0.01,95%confidence interval(0.647-0.801);area under the ROC curve for BMI 0.630,standard error 0.042,P=0.003,95% confidence interval(0.548-0.713);area under the ROC curve for CRP 0.545,standard error 0.043,P=0.305,95% confidence interval(0.460-0.629),combined indicators(24h PP,24 h PPI,BMI,and CRP)ROC Area under the curve 0.832,standard error 0.030,P<0.01,95% confidence interval(0.773-0.892).4.Correlation between 24 h PP,24 h PPI,Gensini score and number of involved coronary arteries in patients with hypertension combined with positive coronary angiography.The correlation between 24 h PP and Gensini score and the number of involved coronary arteries was significant and positive(r>0,P<0.05);24h PPI and Gensini score and the number of involved coronary arteries were significant and positive(r>0,P<0.05).The area under the ROC curve for 24 h PP was 0.679,standard error 0.079,P=0.027,95% confidence interval(0.524-0.835);the area under the ROC curve for 24 h PPI was 0.635,standard error 0.082,P=0.095,95% confidence interval(0.475-0.796);the area under the ROC curve for the combined index was 0.781,standard error 0.060,P=0.001,95% confidence interval(0.662-0.899);the comparison of 24 h PP and 24 h PPI between the two groups in men was higher in the group with positive hypertension combined with coronary angiography,and all differences were statistically significant(P<0.05).The area under the ROC curve for24 h PP was 0.709,standard error 0.047,P<0.01,95% confidence interval(0.617-0.801);the area under the ROC curve for 24 h PPI was 0.754,standard error0.045,P<0.01,95% confidence interval(0.666-0.842);the area under the ROC curve for the combined index 0.847,standard error 0.036,P < 0.01,95% confidence interval(0.777-0.917);thus,elevated 24 h PP and 24 h PPI in middle-aged men with hypertension had better diagnostic predictive value than in middle-aged women(area under the ROC curve for 24 h PP in women 0.679 vs.(0.709 for 24 h PPI in women;0.635 vs.0.754 for 24 h PPI in men).6 For hypertensive patients with positive coronary angiography,there was a significant positive correlation between 24 h PP and number of involved coronary arteries in women(r>0,P<0.05);24h PPI index was associated with Gensini score,number of involved coronary arteries in both sexes.There was a significant positive correlation between the 24 h PPI index and Gensini score and the number of involved coronary arteries in both sexes(r>0,P<0.05).Conclusions:1.24 h PP and 24 h PPI were higher in middle-aged primary hypertension combined with positive coronary angiography than in middle-aged primary hypertension combined with negative coronary angiography.2.Gensini score of coronary lesions increased as 24 h PPI increased and the number of coronary branches involved in lesions increased in the middle-aged primary hypertension combined with positive coronary angiography group;Gensini score of coronary lesions increased as24 h PP increased.3.The combined index of 24 h PP,24 h PPI,BMI and CRP was a better predictor of positive coronary angiography.4.24 h PP and 24 h PPI elevation in middle-aged male hypertensive patients had better diagnostic predictive value than in middle-aged female patients.