高血压患者动态脉压及脉压指数与冠心病的关系  

Relationship Between Ambulatory Pulse Pressure, Pulse Pressure Index and Coronary Artery Disease in Hypertension Patients

作　　者：罗富健 张丁丁[1] 张云[1] 李卫[1] 黄建凤[1] 

机构地区：[1]北京协和医学院中国医学科学院国家心血管病中心阜外医院心血管疾病国家重点实验室流行病研究部,北京市100037

出　　处：《中国循环杂志》2017年第5期447-451,共5页Chinese Circulation Journal

基　　金：国家自然科学基金(81570386)

摘　　要：目的:探讨高血压患者24 h动态脉压(24hPP)、24 h动态脉压指数(24hPPI)和夜间动态脉压指数(NPPI)与冠心病的相关性。方法:共入选305例于2016-05至2016-07在阜外医院进行动态血压监测(ABPM)的受试者,根据ABPM数据计算受试者的24hPP、24hPPI和NPPI,并分析这些指标与冠心病的相关性。24hPP为24 h平均收缩压(24hSBP)与24 h平均舒张压(24hDBP)之差,24hPPI为24hPP与24hSBP的比值,NPPI为夜间(22:00~06:00)平均PP与平均SBP的比值。结果:305例受试者中,222例(72.8%)为高血压患者。高血压患者的24hPP、24hPPI、NPPI均高于血压正常者[24hPP:(49.0±11.6)mmHg(1 mmHg=0.133 kPa)vs.(42.2±7.4)mmHg,P<0.001;24hPPI:0.39±0.06 vs.0.37±0.05,P=0.004;NPPI:0.40±0.07 vs.0.38±0.05,P=0.009]。222例高血压患者中,116例(52.3%)冠心病患者的24hPP、24hPPI和NPPI均高于106例(47.7%)无冠心病者[24hPP:(50.9±12.2)mmHg vs.(47.0±10.6)mmHg,P=0.013;24hPPI:0.41±0.06 vs.0.38±0.06,P<0.001;NPPI:0.42±0.07 vs.0.38±0.06,P<0.001];而在83例(27.2%)血压正常的受试者中,冠心病患者和无冠心病者上述指标之间的差异均无统计学意义。Logistic回归模型分析显示,调整年龄、性别、体重指数、降压药服用情况等因素后,高血压患者的24hPPI和NPPI与冠心病相关[24hPPI:比值比(OR)=1.95,95%可信区间(CI):1.11~3.44,P=0.020;NPPI:OR=2.21,95%CI:1.28~3.82,P<0.001]。受试者工作特征(ROC)曲线分析结果显示,高血压患者的24hPPI和NPPI对冠心病的筛查和预测价值均优于24hPP。结论:高血压患者的24hPPI和NPPI与冠心病密切相关,有助于高血压患者冠心病的筛查和预测,且效果优于24hPP。Objective： To investigate the relationship between 24-hour ambulatory pulse pressure （24hPP）, 24-hour ambulatory pulse pressure index （24hPPI）, night-time ambulatory pulse pressure index （NPPI） and coronary artery disease （CAD） occurrence in hypertension patients. Methods： A total of 305 subjects received ambulatory blood pressure monitoring （ABPM） in our hospital from 2016-05 to 2016-07 were enrolled. Base on ABPM information, 24hPP, 24hPPI and NPPI were calculated to analyze their relationship to CAD occurrence. 24hPP was defined by 24-hour mean systolic blood pressure （24hSBP） minus 24hDBP, 24hPPI by the ratio of 24hPP/24hSBP and NPPI by the ratio of night （22：00-6：00） PP/SBP. Results： There were 222/305 （72.8%） subjects with hypertension. Compared with normotension subjects, hypertension patients had increased 24hPP： （49.0±11.6） mmHg vs （42.2±7.4） mmHg, P〈0.001, 24hPPI： （0.39±0.06） vs （0.37±0.05）, P=0.004 and NPPI： （0.40±0.07） vs. （0.38±0.06）, P=0.009 respectively. 116/222 （52.3%） hypertension patients suffered from CAD. Compared with non-CAD patients, CAD patients presented elevated 24hPP： （50.9±12.2） mmHg vs （47.0±10.6） mmHg, P=0.013, 24hPPI： （0.41±0.07） vs. （0.38±0.06）, P〈0.001 and NPPI： （0.42±0.07） vs. （0.38±0.06）, P〈0.001 respectively. Among 83/305 （27.2%） normotension subjects, the above indexes were similar between CAD patients and non-CAD subjects. Logistic regression analysis demonstrated that with adjusted age, gender, body mass index （BMI） and antihypertensive medication, 24hPPI [OR=1.95, 95% CI 1.11-3.44, P=0.020] and NPPI [OR=2.21, 95% CI 1.28-3.82, P〈0.01] were related to CAD occurrence. ROC curve analysis showed that 24hPPI and NPPI were superior to 24hPP for CAD screening and prediction in hypertension patients. Conclusion： 24hPPI and NPPI were closely related to CAD occurrence in hypertension patients, they were both helpful for CAD screening and predictio

关 键 词：高血压 冠状动脉疾病 血压监测 便携式 

分 类 号：R54[医药卫生—心血管疾病]