| Objective:Discussion the relationship between the parameters of central aortic pressure (CAP) and in patients with coronary artery disease and the extent of pulse pressure (PP) on the predictive value of cardiovascular events for the monitoring of coronary heart disease risk factors to predict the occurrence of cardiovascular events and Blocking the incidence of clinical aspects of theory.Method:1, 252 cases of patients were selected with standard Judkins method of selective coronary angiography, according to the results,were devided into two group, coronary artery stenosis group (156 cases) and non-coronary artery stenosis group(CASG) (96 cases). The severity of coronary artery in CASG were expressed by the number of branch points and Gensini integral method. According to the lesion involving one of the left anterior descending artery, left circumflex and right coronary artery branch as single-vessel group (46 cases), two for double-vessel group (69 cases), three for three lesion group (71 cases ). The degree of coronary artery stenosis using Gensini integral method, eight main blood vessel were selected (left main, left anterior descending artery near, middle anterior descending artery, the first diagonal branch, the branch near the roundabout, the roundabout in the middle branch, right coronary artery near , right coronary artery in the middle, septal branch and the second diagonal branch, obtuse marginal branch and the distal left anterior descending artery in any of the above vessel,if the diameter of blood vessels wider than any 8 vessel mentioned above, that is used to replace the diameter of small blood vessels), Selected blood vessel according to their narrow the score Department: 0: stenosis <25; 1: The narrow 25 to 49; 2: narrow 50 to 74; 3 : narrow 75 to 99; 4: 100 (total occlusion); Finally, a total of 8 vessels of the total score, if a vessel has many narrow section, that is, the blood vessels paragraph narrowest point scoring. comparison in groups.2, according to the availability of essential hypertension in patients,they were divided into hypertension groups and non-hypertension group, and then according to pulse pressure, divided into two sub-groups, that is, PP≥60mmHg and PP <60mmHg group, and Comparison. 3, all patients under go coronary angiography were measured central aortic pressure, systolic blood pressure of the aorta (SBP), diastolic blood pressure (DBP), at the same time measurement of the peripheral brachial artery systolic blood pressure (SBP), diastolic blood pressure (DBP), and calculate pulse pressure (PP) = SBP-DBP, comparison in groups.4, records of patients with age and risk factors for coronary heart disease (weight, blood fat), one week before angiography all patients check echocardiography to measure left ventricular ejection fraction (EF). All the selected patients were excluded from secondary hypertension, acute myocardial infarction, heart disease, diabetes, cancer, infection, dysfunction of liver and kidney.5, 156 cases of coronary artery stenosis group were follow-up to determine whether cardiovascular events occured. Follow-up 1-2 times a follow-up time of 14 days to 30 months, with an average follow-up (19.1±5.4) months, a detailed understanding of the following:⑴-year results of the investigation, including: history taking, physical examination of detailed, three conventional , Liver and kidney function, blood sugar, blood lipid, ECG, X-ray and echocardiography tests.⑵in the follow-up period to determine whether the incidence of cardiovascular events occurs. Cardiovascular events, including refractory heart failure, acute myocardial infarction, sustained ventricular tachycardia and ventricular fibrillation, cardiac death (including sudden cardiac death).⑶This group of patients were in strict accordance with the secondary prevention of coronary heart disease drugs, conventional oral aspirin, nitrates, ACEI,β-receptor blockers, calcium antagonists, such as statins.6, all parameters into SPSS10.0 software for statistical analysis, P <0.05 for the difference was significant.Results:1, coronary artery stenosis group: aorta, peripheral arterial systolic blood pressure (SBP), pulse pressure (PP) was significantly higher than normal coronary group, the difference was significant (P <0.05).2, SBP and PP increased with the narrow increase in the number of branches (P <0.05).3, multi-factor analysis revealed that aortic PP, peripheral arterial PP, age and degree of coronary artery stenosis is most closely related to, and the aorta PP relate to coronary disease more than the peripheral arterial PP. 4, when the PP≥60mmHg, regardless of hypertension group or non- hypertension group, with the PP increased, the increase in coronary artery score (P <0.05); when PP <60mmHg, regardless of hypertension group or non- hypertension group. There was no correlation (P> 0.05) between PP and coronary artery score.5,23 cases of CHD patients occurred cardiovascular events, PP≥60mmHg group (18 cases) were significantly higher than PP <60mmHg group (5 cases), there was a significant difference (P <0.05). Retrospective analysis of these 23 patients, all patients with hypertension. Taking blood pressure medicine in,β-receptor blocker (metoprolol tartrate) in 19 cases, the calcium antagonist (nifedipine), 4 cases. Peripheral arterial pressure have decreased, there was no significant difference.Discussion:Coronary heart disease is a disease caused by many factors, coronary atherosclerosis lead to coronary lumen stenosis is important pathophysiological foundation for coronary heart disease in patients with myocardial ischemia. Selective coronary angiography is an important method to determine coronary artery stenosis coronary Integral systems can be more accurate for quantitative analysis of coronary artery stenosis. The results of this study showed that coronary artery stenosis group SBP, PP higher than non-coronary artery stenosis group. SBP and PP gradually increased significantly with the number of narrow branch,there is a significantly cant difference.The results are same in central arterial pressure and peripheral arterial pressure groups. At the same time, PP≥60mmHg, regardless of whether the merger of high blood pressure, patients with coronary artery stenosis rate and the incidence of cardiovascular events were significantly higher than PP <60mmHg group, the difference was statistically significant, and further illustrates the pulse pressure is an independent risk factor outside-hypertension. We know that increased pulse pressure caused by the aortic stenosis, in turn, increased pulse pressure speed up the development of atherosclerosis. Coronary blood flow velocity and myocardial perfusion mainly depended on the aortic pressure and left ventricular diastolic pressure gradient, DBP decline cause coronary blood insufficiency, leading to myocardial ischemia. In the elderly population, PP is an independent risk factor, either SBP, or DBP, in the prediction of coronary heart disease are not the role of the PP, with the results of this research, and aortic PP related to coronary disease more than Peripheral arterial PP. Different drugs on the brachial artery blood pressure and arterial pressure Center for the impact of different drugs to lower blood pressure of the top-five brachial artery pressure was no significant difference, however, calcium channel blockers, angiotensin-converting enzyme inhibitors / angiotensin receptor Antagonist, diuretics lower arterial pressure than Centerβ-receptor blocker significantly.In light of the findings, the drop in the peripheral arterial pressure similar to the case,β-blockers reduce central arterial pressure significantly less than the drop peripheral arterial pressure level. This suggests that in clinical work, not only to control peripheral arterial pressure, but also pay more attention control central aortic pressure in order to reduce the incidence of coronary events.Conclusion:1, the center's blood pressure SBP, PP and coronary artery stenosis and the number of teams was positively related to the degree of stenosis.2, Pulse pressure is a independent risk factor in coronary stenosis of coronary heart disease outside hypertension .3, Central aortic pressure≥60mmHg has more predictive value for the occurrence of cardiovascular events .4, On the basis of the experimental observations, suggesting that peripheral arterial blood pressure was no significant difference in conditions,β-blockers may not be the center for treatment or prevention of arterial pressure drug of choice, and its mechanism of action to be further studied.
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