非阻塞性冠状动脉疾病患者动态血压升高与运动性高血压相关性研究

Association between elevated ambulatory blood pressure and hypertensive response to exercise in patients with non-obstructive coronary artery disease

摘要:

目的 运动性高血压（hypertensive response to exercise，HRE）与不良心血管事件有关，早期识别和适当干预HRE对预防心血管事件非常重要。本研究旨在探讨非阻塞性冠状动脉疾病（non-obstructive coronary artery disease，NOCAD）患者动态血压升高与HRE之间的潜在联系。方法 纳入517名疑似冠心病的患者，行冠状动脉造影术判断冠状动脉的狭窄程度。选取其中的NOCAD患者，根据心肺运动试验（cardiopulmonary exercise testing，CPET）期间的血压情况诊断HRE。使用logistic回归模型分析动态血压升高和HRE之间的关系。结果 最终共有347名NOCAD患者纳入统计分析。患者的平均年龄为（61.15±9.14）岁，其中42.4%为男性。约51.3%的患者有高血压，13.8%的患者有糖尿病。logistic分析结果显示，动态血压升高是HRE的危险因素（OR=2.163，95%CI=1.094~4.275，P=0.026）。在按性别分层进行亚组分析后，发现在女性NOCAD患者中，动态血压升高是发生HRE的危险因素（OR=3.310，95%CI=1.387~7.902，P=0.007），而在男性NOCAD患者中，没有发现动态血压升高与HRE相关（OR=1.154，95%CI=0.370~3.603，P=0.805）。结论 在NOCAD患者特别是女性NOCAD患者中，动态血压升高与发生HRE相关。这一发现可能有助于早期诊断HRE，并进一步指导这些患者在心脏康复时进行适当的有氧运动。

Abstract:

Objective Hypertensive response to exercise（HRE） is associated with adverse cardiovascular events，and early identification and proper intervention of HRE is of great importance for the prevention of cardiovascular events. This study aims to investigate the potential association between elevated ambulatory blood pressure（BP） and HRE in patients with non-obstructive coronary artery disease（NOCAD）.Methods A total of 517 patients with suspected coronary heart disease were enrolled in this study，and coronary angiography was performed to observe the degree of coronary artery stenosis. Cardiopulmonary exercise testing（CPET） was performed for the patients with NOCAD，and HRE was diagnosed based on BP records during CPET. The logistic regression model was used to analyze the association between elevated ambulatory BP and HRE.Results Finally，a total of 347 patients with NOCAD were included in the statistical analysis，with a mean age of （61.15±9.14） years，and male patients accounted for 42.4%. Among these patients，51.30% had hypertension and 13.8% suffered from diabetes. The logistic regression analysis showed that elevated ambulatory BP［odds ratio（OR）=2.163，95%CI=1.094-4.275，P=0.026］ was a risk factor for HRE. The subgroup analysis based on sex showed that in the female patients with NOCAD，elevated ambulatory BP（OR=3.310，95%CI=1.387-7.902，P=0.007） was a risk factor for HRE，while in the male patients with NOCAD，elevated ambulatory BP was not found to be associated with HRE （OR=1.154，95%CI=0.370-3.603，P=0.805）.Conclusion Elevated ambulatory BP is associated with HRE in patients with NOCAD，especially in female patients with NOCAD. This finding may help with the early diagnosis of HRE and guide such patients to take proper aerobic exercise during cardiac rehabilitation.