老年收缩期高血压伴低舒张压对冠状动脉的影响及相关因素分析

摘要

Objective To investigate the correlation of diastolic blood pressure(DBP)<60 mmHg and isolated systolic hyper-tension(ISH)with coronary atherosclerosis(CAS)and coronary heart disease(CHD)in elderly patients and to analyze the independent risk factors for low DBP.Methods A total of 111 elderly patients with untreated ISH who underwent coronary angiography were di-vided into the low DBP group (n=46) and the non-low DBP group (n=65) according to DBP level. All clinical and angiographic data were collected and the retrospective analysis was performed to assess the risk of CAS and CHD in patients with low DBP and to analyze the risk factors for low DBP. Results In the low DBP group the incidence of CAS and CHD was 64.6%(42/65) and 52.3%(34/65), in the non-low DBP group was 73.9%(34/46) and 63.0%(29/46), the incidence of low diastolic pressure group was ob-viously higher, more similar between the two groups have statistical significance (P<0.05). Stepwise logistic analysis showed that age, diabetes and smoking were independent risk factors for low DBP. After adjustment for age, gender and other common risk fac-tors,low DBP was independently associated with CAS and CHD (P<0.05). Conclusion Low DBP is independently associated with CAS and CHD in elderly patients with untreated ISH.Age, diabetes and smoking are the independent risk factors for low DBP.%目的：探讨收缩期高血压（ISH）老年患者伴低舒张压的危险因素及对冠状动脉的影响。方法收集怀疑冠心病而进行冠状动脉造影检查的111例老年收缩期高血压患者，分为低舒张压组（＜60 mmHg）和非低舒张压组（60～89 mmHg），比较两组冠状动脉粥样硬化和冠心病的发生率，并分析发生低舒张压的危险因素。结果111例研究对象中，低舒张压组46例，占41.4%；非低舒张压组65例，占58.6%。非低舒张压组冠状动脉粥样硬化和冠心病的发生率为64.6%（42/65）和52.3%（34/65），低舒张压组为73.9%（34/46）和63.0%（29/46），低舒张压组的发生率明显更高，两组比较差异均有统计学意义（P＜0.05）。低舒张压是冠心病和冠状动脉粥样硬化的独立危险因素。多因素Logistic回归分析结果显示，低舒张压患者中年龄增长、糖尿病和吸烟是独立相关因素。结论对于老年ISH患者而言，低舒张压与心血管疾病独立相关，良好控制血糖和戒烟可减少低舒张压的发生率。