| Background and ObjectiveHypertension is one of the most important risk factors of cardiovascular disease in the world.At present,there are 245 million people with hypertension in China.There are many risk factors for cardiovascular events in patients with hypertension.Among them,high homocysteine(HHcy)in patients with essential hypertension in China is also defined as high as 75%of the patients with H-type hypertension,which is a major disease leading to the damage of target organs of hypertension.Coronary heart disease(CHD)is one of the most common target organ damage in patients with hypertension.The more serious the coronary artery disease(CAD),the worse the prognosis and the higher the mortality.Therefore,it is very important to judge the severity of CAD in patients with H-type hypertension and CHD in the early stage,and to intervene the treatment in time to improve the prognosis.Coronary angiography is the gold standard to evaluate the severity of CAD at present.However,because of its invasive and demanding equipment and operator,some hospitals have not yet carried out clinical application.Coronary angiography is currently the gold standard for assessing the severity of CAD,but because of its invasiveness and high requirements for equipment and operators,some hospitals have not yet carried out,and clinical applications are relatively limited.The ambulatory arterial stiffness index(AASI),a quantitative index calculated using 24h ambulatory blood pressure monitoring,which is non-invasive,economical and highly repetitive and an important supplement to assess the severity of arteriosclerosis(AS)and CAD,has a wide range of clinical applications.Studies have shown that HHcy is related to the severity of CAD[3]Studies have shown that AASI has independent predictive value for cardiovascular events in patients with hypertension[2].HHcy is also considered as an independent risk factor for AS and thromboembolic disease[3],but previous studies rarely explored the potential interaction between the two in the assessment of CAD development in patients with hypertension and coronary heart disease.This study included AASI to evaluate the AS of patients with H-type hypertension and CHD,to explore the degree of CAD with H-type hypertension and the correlation between AASI and CAD and to explore the correlation between AASI and CAD in patients with H-type hypertension and cornary heart disease,and to further explore the role of AASI and Hcy in the evaluation of CAD in patients with hypertension and coronary heart disease,so as to provide the basis for the early clinical intervention and treatment and prognosis of patients with hypertension and coronary heart disease.MethodFrom April 2018 to April 2019,A total of 327 patients(145 males and 182 females)were enrolled who were admitted to the Department of Cardiology of the Second Affiliated Hospital of Zhengzhou University and diagnosed as essential hypertension with coronary heart disease and underwent coronary angiography.All patients were included in the exclusion criteria and the clinical data were complete and qualified.The general clinical data,biochemical indexes,the results of ambulatory blood pressure monitoring and coronary angiography of the selected patients were collected,and the AASI and Gensini scores were calculated.According to the level of Hcy measured by blood biochemistry,the patients were divided into two groups:H-type hypertension coronary heart disease group(Hcy?15umo l/L,n=152)(HH group)and non-h-type hypertension coronary heart disease group(Hcy<15umol/L,n=175)(NHH group).According to Gensini score,the degree of coronary lesions in patients with coronary heart disease was divided into mild stenosis group,moderate stenosis group and severe stenosis group.Spss21.0 software was used for statistical analysis to compare the general clinical data,biochemical indicators,AASI and the degree of coronary stenosis of HH group and NHH group;to analyze the correlation between AASI and Gensini scores of the two groups;to use multiple linear regression to analyze the relationship between AASI and Gensini scores of coronary lesions and each factor.Results(1)There was no significant difference in the general basic data between the HH group and the NHH group(all P>0.05).Compared with the NHH group,the level of Hcy in the HH group was significantly increased(19.73 ± 3.91 vs 9.86 ± 3.63),and the difference was statistically significant(P<0.001).(2)There was no significant difference in 24hSBP(134.04±11.87 vs 132.44±12.78)and 24HR(68.29 ± 6.29 vs 66.82±6.69)between the HH group and the NHH group(P>0.05);24hDBP of the HH group was significantly lower than that of the NHH group(76.06±7.20 vs 79.18±9.11),and AASI was significantly higher than that of the NHH group(0.57±0.14 vs 0.45±0.17)(P<0.01).(3)The number of patients with mild stenosis in the HH group was significantly lower than that in the NHH group(21.1%vs 46.9%)(P<0.001),and the number of patients with severe stenosis in the HH group was significantly higher than that in the NHH group(45.4%vs 21.7%)(P<0.01),there was no significant difference in the number of patients with moderate stenosis between the two groups(33.5%vs 31.4%)(P>0.05).(4)There was a significant positive correlation between AASI and Gensini Score(r=0.387,P<0.001).There was a significant positive correlation between AASI and Gensini score in the HH group(r=0.324,P<0.001),while there was no significant correlation between AASI and Gensini score in the NHH group(r=0.131,P>0.05).(5)The course of hypertension(?=0.168),the history of diabetes(?=0.236),24hSDP(?=0.122),24hDBP(?=-0.13.1),LDL-C(?=0.134)and Hcy(?=0.233)were the influencing factors of AASI(P<0.05).(6)Diabetes history(?=0.129),Hcy(?=0.515)and AASI(?=0.174)were the influencing factors of Gensini score(P<0.05);And Hcy*AASI(?=0.356)and Hcy*24hHR ?=0.331)have influence on Gensini score Synergistic effect(P<0.05),the effect of Hcy*AASI on Gensini score was more significant(P<0.001).Conclusion(1)there is a certain relationship between HHcy and atherosclerosis,which may accelerate the injury of coronary artery in patients with hypertension.(2)H-type hypertension may accelerate the occurrence and development of atherosclerosis,and it is an independent risk factor of coronary artery aggravation in patients with coronary heart disease.(3)Hcy and AASI have synergistic effect on the assessment of severity of coronary artery disease in patients with hypertension and coronary heart disease. |
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