无创中心动脉脉压与高血压合并动脉粥样硬化性心血管疾病的相关性研究

背景　动脉粥样硬化性心血管疾病（ASCVD）是心血管疾病致残、致死的主要原因，在高血压患者中应尽早进行诊断和干预。研究发现中心动脉压（CAP）对心血管事件的预测价值高于周围动脉压。但目前对于高血压合并ASCVD患者无创CAP的研究鲜有报道。目的　探讨高血压合并ASCVD患者及不合并ASCVD患者间无创中心动脉收缩压（SBP）、舒张压（DBP）、脉压（PP）与外周肱动脉压的差异。方法　连续选取2019年8-12月于北京大学人民医院门诊就诊的高血压患者239例，根据是否存在ASCVD分为ASCVD组（61例）和非ASCVD组（178例）。比较ASCVD组和非ASCVD组肱动脉及无创中心动脉SBP、DBP、PP的差异；采用多因素Logistic回归分析探讨高血压合并ASCVD的影响因素。结果　ASCVD组较非ASCVD组年龄高、心率慢、吸烟患者比例低，ASCVD组肱动脉DBP、无创中心动脉DBP均低于非ASCVD组，无创中心动脉PP高于非ASCVD组（P<0.05）。总人群、ASCVD组、非ASCVD组无创中心动脉SBP、PP分别低于肱动脉SBP、PP，无创中心动脉DBP高于肱动脉DBP（P<0.05）。年龄与高血压合并ASCVD相关〔OR（95%CI）=1.073（1.040，1.108），P<0.05〕。将患者按年龄分为老年亚组（年龄≥65岁，n=99）和非老年亚组（年龄<65岁，n=140），分别进行单因素分析发现：老年亚组中ASCVD组肱动脉SBP低于非ASCVD组，非老年亚组中ASCVD组年龄大于非ASCVD组、心率慢于非ASCVD组、无创中心动脉PP高于非ASCVD组（P<0.05）。结论　与肱动脉PP相比，无创中心动脉PP与高血压患者合并ASCVD相关；按照年龄分层后，在非老年患者中，无创中心动脉脉压升高与合并ASCVD相关。

Relationship between Noninvasively Measured Central Aortic Pulse Pressure and Hypertensive Atherosclerotic Cardiovascular Disease

Background　As a major cause of disability and primary death worldwide，atherosclerotic cardiovascular disease（ASCVD）in hypertensive patients should be diagnosed and intervened as early as possible.It has been reported that central aortic pressure has a higher predictive value for cardiovascular events than peripheral arterial blood pressure.However，there are few reports on the association of noninvasively measured central aortic pressure with hypertensive ASCVD.Objective　To investigate the differences of noninvasively measured central aortic systolic pressure（CASP），central aortic diastolic pressure（CADP），central aortic pulse pressure（CAPP），and brachial artery pressure in hypertensive patients with and without ASCVD.Methods　Clinical data of 239 hypertensive outpatients were recruited from Peking University People’s Hospital from August to December 2019， including 61 with ASCVD and 178 without. Brachial artery pressure，and noninvasively measured CASP，CADP and CAPP were compared between ASCVD and non-ASCVD groups.Multivariate Logistic regression was performed to identify the factors affecting the occurrence of hypertensive ASCVD．Results　Compared with non-ASCVD group，ASCVD group had greater average age，less average heart rate and lower prevalence of smoking，lower average brachial arterial diastolic pressure and CADP，and higher average CAPP（P<0.05）.In all the participants，ASCVD group or non-ASCVD group，the average CASP was lower than the average brachial arterial systolic pressure（P<0.05），the average CAPP was lower than the average brachial arterial pulse pressure（P<0.05），and the average CADP was higher than the average brachial arterial diastolic pressure（P<0.05）.Age was related to hypertensive ASCVD〔OR（95%CI）=1.073（1.040，1.108），P<0.05﹞.Further univariate analysis revealed that in patients aged 65 and above（n=99），those with ASCVD had lower average brachial arterial systolic pressure than those without（P<0.05）.In patients aged less than 65（n=140），those with ASCVD had greater average age，less average heart rate and higher average CAPP than those without（P<0.05）.Conclusion　Compared with brachial artery pulse pressure，noninvasively measured CAPP is a more sensitive marker of hypertensive ASCVD.In those younger than 65 years，increased noninvasively measured CAPP is related to ASCVD.