血压达标高血压病患者脉压差与冠心病关系的研究

目的研究血压达标(收缩压＜140 mmHg、舒张压＜90 mmHg)高血压病患者的脉压差(收缩压和舒张压的差值)与冠心病(包括急性心肌梗死和不稳定性心绞痛)的关系.方法661例血压达标高血压病患者分为冠心病组(184例)和非冠心病组(477例),对2组的性别、年龄、体重指数等一般情况进行比较,采用Logistic 回归方法对冠心病的混杂因素如年龄、心率、体重指数、高血压病程、收缩压、舒张压、平均动脉压、高脂血症、糖尿病等进行分析.结果经单因素分析脉压差、收缩压、舒张压、年龄与冠心病的发生密切相关(P＜0.05).经多因素逐步筛选变量分析脉压差与冠心病呈正相关关系,脉压差每增加5 mmHg,其发病风险平均增加4.20倍.舒张压与冠心病呈负相关,舒张压每增加5 mmHg,其发病风险平均减少1.07倍.收缩压每增加5 mmHg,其发病风险平均增加1.51倍.年龄每增加10岁, 其发病风险平均增加1.04倍.其他混杂因素如饮酒、高脂血症、糖尿病、高血压病程、心率、体重指数等与冠心病均无明显关系(P＞0.05).结论血压达标高血压病患者随着脉压差增加,发生冠心病的危险性也相应增加,随着舒张压的增加,发生冠心病的危险性相应降低.对高血压病患者,治疗上不仅仅要将血压降至靶目标水平,而且要综合干预,注意监测脉压差,为冠心病一级预防和高血压药物选择提供临床依据.

Relationship between pulse pressure and incidence of coronary artery disease in essential hypertensive patients

Objective: To study the relationship between pulse pressure (PP) (the difference of systolic blood pressure and diastolic blood pressure) and coronary artery disease (CAD, including acute myocardial infarction and unstable angina pectoris) in essential hypertensive (EH) patients (systolic blood pressure <140 mmHg, diastolic blood pressure <90 mmHg). Methods: Six hundred and sixty-one essential hypertensive patients were divided into two groups: 184 patients had CAD and 477 patients had no CAD, then made comparision to sex, age, BMI (body mass index) and so on. Logistic regression analysis was used to analyze the interference factors of CAD, such as age, heart rate, BMI, duration of hypertention, systolic blood pressure, diastolic blood pressure, hyperlipemia, mean artery pressure, and diabetes. Results: Univariate analysis showed that CAD was strongly correlated with PP, systolic blood pressure, diastolic blood pressure and age (P<0.05). Multivariate regression analysis showed that PP was strongly correlated with CAD, every 5 mmHg increment in PP,OR was 4.2; Diastolic blood pressure was negative correlated with CAD, every 5 mmHg increment in diastolic blood pressure, OR was 1.07; Every 5 mmHg increment in systolic blood pressure, OR was 1.52; Every 10 years old increment in age, OR was 1.04. Other interference factors, such as drinking, hyperlipemia, diabetes, duration of hypertension, heart rate, BMI, had not statistical significance (P>0.05). Conclusions: With the increment in PP of EH patients, the incidence of CAD increased accordingly. With the increment in systolic blood pressure, the incidence of CAD decreased accordingly. It suggests that therapy principle in EH patients is not only to decrease BP into objective target level, but also to provide comprehensive interference. PP may be conductive to the primary prevention of CAD and provide clinical base in selection of anti-hypertension drugs.