The Study Of The Relationship Between Central Blood Pressure And The Number Of Diseased Coronary Vessels In Coronary Heart Disease(CHD)

Objective: This was designed to compare peripheral and central blood pressure (BP) in CHD, and investigate the relationship between central BP and the number of diseased coronary vessels in CHD.Methods:1 204 patients with angiographically confirmed CHD and ejection fraction >50% were enrolled. Of them, there were 103 male and 101 female, age 36~88 years old, mean age 64.37±11.03 years old. Of them, there were 85 patients with diabetes mellitus (DM), 137 patients with hypercholesterolemia, 101 patients with hypertension, 102 smoking patients. According to the coronary angiography, the patients were divided into three groups: one-, two-,three-vessel coronary artery disease group.2 Before coronary angiography, age and gender were recorded, body mass index (BMI, Kg/m2) was calculated, total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), fasting blood glucose (FBG), renal function and liver function were measured in fasting.3 Central BP including systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean blood pressure (MAP) was measured during the period of coronary angiography. Simultaneously, peripheral BP (brachial SBP, DBP and MAP) was measured by cuff method, then compared central and peripheral BP.4 Pulse pressure (PP), fractional systolic pressure (FSP) and fractional diastolic pressure (FDP) were calculated with the following formula:①PP = SBP-DBP;②MAP=DBP+1/3PP;③FSP =SBP/MAP; FDP=DBP/MAP.5 All data was analyzed using SPSS 11.5 software. Categorical variables were reported as percentages and continuous variables as mean±SD. Normally distributed continuous variables were compared using analysis of variance (ANOVA), three-vessel coronary artery disease group was compared with one-, two-vessel coronary artery disease group using Dunnet-t test. The Chi-square test was applied to all categorical variables. A multivariate logistic regression analysis was performed to evaluate the independent effects of hemodynamic variables on the risk of having three-vessel in CHD. Central and peripheral BP was compared using paired t-test. P<0 .05 was considered to indicate statistical difference.Results:1 Clinical basic characteristics of the study population in relation to the number of diseased coronary vessels were compared. Sex, hypertension, hypercholesterolemia, BMI, EF smoking, history of myocardial infarction and history of medication among the three groups were not significantly different(P>0.05). Patients with three-vessel CHD were older and more often had DM when compared with the other patient groups(age:59.35±11.43, 62.56±10.33, 67.77±10.53; the percentage of DM: 36.23%, 38.10%, 51.67%;P<0.05).2 Peripheral SBP, PP and central SBP, PP, FSP were significantly higher when compared with the other groups (Peripheral SBP:122.81±17.86, 126.32±18.08, 131.74±19.08; PP: 38.05±17.33, 43.90±15.89, 48.16±15.18; central SBP: 128.26±18.33, 133.81±18.11, 138.98±19.05; PP: 42.56±17.86, 49.56±16.45, 52.22±17.78; FSP: 1.33±0.11, 1.34±0.10, 1.37±0.12; P <0.05). Central FDP was significantly lower when compared with the other groups (central FDP: 0.84±0.05, 0.83±0.04, 0.82±0.03; P <0.05).3 After multivariate logistic regression, Central PP, FSP, FDP, age and DM were independently related to the risk of having three-vessel coronary artery disease in CHD (PP per 10 mm Hg, OR = 1.18, 95% CI=0.13 to 1.42; FSP per 0.1, OR= 1.21, 95% CI=1.14 to 1.65; FDP per 0.1, OR=0.75, 95% CI=0.35 to 0.92; age per 10 year-old, OR= 1.30, 95% CI=1.22 to 1.68; DM: OR= 1.32, 95% CI=1.20~1.74,P<0.05).4 Non-invasive brachial SBP, DBP and PP were underestimated to invasive central SBP, DBP and PP in CHD (SBP:120.4±18.9,127.8±19.8;DBP:77.3±11.2,80.2±12.2;PP:44.1±12.1,47.2±15.1;P <0.05;).Conclusions:1 Of patients in CHD, central PP, FSP and FDP were related to the three-vessel disease in patients with CHD, central PP and FSP were risk factors of the three-vessel disease in patients with CHD,central FDP was protective factor of the three-vessel disease in patients with CHD. Non-invasive peripheral blood pressure indices were not significantly related to the three-vessel disease in patients with CHD.2 Non-invasive brachial SBP, DBP and PP were underestimated to invasive central SBP, DBP and PP in patients with CHD. Non-invasive brachial BP was not accurately evaluated central BP in patients with CHD.