| Background and Objective:In recent years,the morbidity of coronary heart disease which is a common and frequent cardiovascular disease is increasing worldwidely,It's not easy to prevent the occurrence of this disease early because of the multiplicate pathogenic factors,The development and poor prognosis of the disease because of indistinct symptom.The most important method of diagnosising coronary heart disease were Coronary CTA examination and Coronary angiography in clinical,but the most basic level hospital and medical institutions which are far away from cities can not carried out the examinations effectively,so it is necessary to find more convenient examinations methods.Ambulatory Blood Pressure Monitoring(ABPM)is a common Blood Pressure monitoring method,it monitor the blood pressure(BP)of patients(including the sleep time)to obtain the relevant blood pressure parameters and analysis,the ABPM can avoid White Coat Hypertension(WCH)and not misdiagnosis Masked Hypertension(MH).Hypertension is an independent risk factor for coronary heart disease,Plenty of researches have been shown that MBPS was associated with Cardio-cerebro-vascular diseases and target organ damage,and morning blood pressure surge can independently predict the occurrence of cardiovascular events,and a large number of studies have confirmed that with its related mortality,morbidity of microvascular disease were significantly increased in hypertension with diabetes mellitus than patients with simple hypertension,patients both suffering diabetes and hypertension will increase the risk of cardiovascular events in patients who have cardiovascular disease,the study about the impact of the coronary artery in hypertension patients who suffer both diabetes mellitus and MBPS is not much.The purpose of this study is to explore the characteristics of morning blood pressure surge in patients hypertension combined with or without type 2 diabetes disease and its correlation with the severity of coronary artery lesions and analyzed its influencing factors and mechanism,so as to reduce the risk of cardiovascular events and to provide theoretical and clinical basis.Methods:1.A total of 244 inpatients with hypertension in our department from January 2014 to August 2015 were recruited.They were 118 males and 126 females,at an average age of 64.7±11.5.2.Clinical data and laboratory test results were collected on all patients.3.According to the morning blood pressure surge(MBPS)and diabetes the subjects were divided into four groups:diabetes group of MBPS(D-S group,36 cases),diabetes group of non-MBPS(D-nS group,56 cases)and non-diabetic group of MBPS(nD-S group,72 cases)and non-diabetic group of non-MBPS(nD-nS group,80 cases).4.A total of 244 patients were received coronary angiography examination,According to the imaging result record count coronary artery pathological changes,calculated according to each patient's diseased branch stenosis degree coronary total points,As indicators of coronary artery stenosis degree judgment standardfour groups were compared in patients with coronary artery lesion severity.Results:1.The 24-hour mean systolic blood pressure(24 hMSBP),day systolic blood pressure(dSBP)in D-S group,D-nS group and nD-S group was all higher than nD-nS group(P<0.05);The 24-hour mean diastolic blood pressure(24 hMDBP),day diastolic blood pressure(dDBP)in D-S group were higher than D-nS group,nD-S group and nD-nS group(P<0.05);2.MBPS group presented the higher rate of 3-vessel disease,type C lesion and higher total Gensini scores(P<0.01);3.Parson correlation analysis showed that the severity of coronary lesions is positively related to age(r=0.786,P<0.01)?BMI(r=0.284,P<0.05)?FBG(r=0.712,P<0.05)?LDL-C(r=0.765,P<0.05)?MBPS(r=0.852,P<0.01)and 24 hMSBP(r=0.804,P<0.01);4.Mltivariate linear regression analysis showed that FBG,24-hour mean systolic blood pressure and MBPS were the independent risk factors for coronary lesions.Conclusion:1.When essential hypertension with diabetes mellitus or MBPS,the systolic blood pressure was rised as the main performance,but when both disease were existed at the same time,showed that systolic blood pressure and diastolic blood pressure were both increased,such patients should pay more attention to the antihypertensive effect in clinic,which provides some new ideas for hypertension treatment.2.For hypertensive patients with or without diabetes,effectively control blood pressure and stably 24-hour long-term reducing blood pressure in this kind of patients can reduce organ damage and occurrence of the cardiovascular events.3.In clinical work,we should not only pay attention to the standard of blood glucose and blood pressure,but also should be focus on the MBPS,and pay more attention to its influence on coronary artery lesions. |
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