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目的探讨高血压伴或不伴2型糖尿病患者血压晨峰的患病特点及其与冠脉病变严重程度的相关性。方法选择2014年1月至2015年8月我科住院的高血压患者244例,其中男性118例,女性126例,年龄(64.7±11.5)岁,根据是否合并糖尿病及其动态血压监测结果将其分为4组:糖尿病晨峰组(D-S,36例)、糖尿病非晨峰组(D-n S,56例)、非糖尿病晨峰组(n D-S,72例)、非糖尿病非晨峰组(n D-n S,80例),入选的244例患者全部进行冠状动脉造影检查,分别比较4组患者冠状动脉病变程度。结果糖尿病晨峰组、糖尿病非晨峰组和非糖尿病晨峰组24 h平均收缩压、白天平均收缩压均高于非糖尿病非晨峰组(P<0.05);糖尿病晨峰组24 h平均舒张压、白天平均舒张压高于糖尿病非晨峰组、非糖尿病晨峰组和非糖尿病非晨峰组(P<0.05);晨峰组三支病变率、C型病变率及晨峰组Gensini总积分显著高于非晨峰组(P<0.01);Pearson相关分析显示,冠状动脉病变严重程度与年龄(r=0.786,P<0.01)、BMI(r=0.284,P<0.05)、空腹血糖(r=0.712,P<0.05)、LDL-C(r=0.765,P<0.05)、晨峰程度(r=0.852,P<0.01)及24 h MSBP(r=0.804,P<0.01)呈正相关;多元线性回归分析显示,年龄、空腹血糖、24 h平均收缩压及血压晨峰为冠状动脉病变严重程度独立危险因素。结论原发性高血压合并糖尿病患者血压晨峰是预测冠状动脉病变严重程度的独立危险因素,有效控制该类患者的晨峰血压及24 h长效平稳的降压可减少对靶器官的损害,降低心血管事件发生。
Objective To investigate the prevalence of peak morning blood pressure in patients with or without type 2 diabetes mellitus (T2DM) and its correlation with the severity of coronary artery disease. Methods A total of 244 hypertensive patients admitted to our department between January 2014 and August 2015 were enrolled, including 118 males and 126 females, with an average age of 64.7 ± 11.5 years. According to the results of diabetes mellitus and ambulatory blood pressure monitoring, The patients were divided into four groups: diabetes mellitus group (DS, 36 cases), diabetes mellitus group (56 cases), non-diabetes mellitus group (n DS, 72 cases) DnS, 80 cases). All 244 patients were selected for coronary angiography. The degree of coronary artery lesion was compared between the four groups. Results The average systolic blood pressure at 24 h and the mean systolic blood pressure at daytime in diabetes mellitus group, non-diabetes mellitus group and non-diabetes mellitus group were higher than those in non-diabetes mellitus group (P <0.05) The average diastolic blood pressure during daytime was higher than that of non-diabetes morning climax group, non-diabetes morning climax group and non-diabetes non-morning climax group (P <0.05). The three lesions, C-type lesion rate and Gensini group Pearson correlation analysis showed that the severity of coronary artery disease and age (r = 0.786, P0.01), BMI (r = 0.284, P0.05), fasting plasma glucose (r = 0.712, P <0.05), LDL-C (r = 0.765, P <0.05) Multivariate linear regression analysis showed that age, fasting blood glucose, 24-hour average systolic blood pressure and morning blood pressure were independent risk factors for the severity of coronary artery disease. Conclusion The peak morning blood pressure in patients with essential hypertension complicated with diabetes mellitus is an independent risk factor for predicting the severity of coronary artery disease. Effective control of morning-peak blood pressure and long-term stable antihypertensive therapy in these patients can reduce the damage to target organs, Reduce cardiovascular events.