第一部分 北京市成人高血压患者脉压及脉压指数与冠心病的关系

研究目的

探讨北京市成人高血压患者的脉压（Pulse Pressure，PP）和脉压指数（Pulse Pressure Index，PPI）与冠心病的关系。

研究方法

本研究选取2011年“北京市心脑肾及糖尿病慢性病流行病学综合调查研究”中的高血压患者为研究对象。收集研究对象的性别、年龄、地区、受教育水平等基本资料。血压测量选用统一的欧姆龙HEM/770A电子血压计，收缩压（Systolic Blood Pressure，SBP）≥140 mmHg（1 mmHg=0.133 kPa）和(或)舒张压（Diastolic Blood Pressure，DBP）≥90 mmHg和(或)近两周内服用过降压药者定义为高血压患者。PP为SBP与DBP之差，PPI为PP与SBP的比值。了解北京市成人高血压患者PP和PPI的水平和特点，采用Logistic回归模型探讨PP和PPI与冠心病的关系。

研究结果

共有7 563例北京市成人高血压患者纳入本次研究。研究对象的平均年龄为（51.7±12.4）岁，其中有4 102例（54.2%）男性，年龄在18～59岁之间的研究对象有5 806例（76.8%），冠心病患者有799例（10.6%）。老年（60～79岁）高血压患者的PP和PPI均高于青、中年（18～59岁）高血压患者（PP：68.1 mmHg vs. 52.4 mmHg，P＜0.001；PPI：0.44 vs. 0.36，P＜0.001）。高血压合并冠心病患者的PP和PPI均高于高血压未合并冠心病者（PP：61.0 mmHg vs. 55.5 mmHg，P＜0.001；PPI：0.41 vs. 0.37，P＜0.001），且不同性别、地区等研究对象中均存在此现象。Logistic回归分析结果显示，单因素分析中高血压患者的PP和PPI均与冠心病相关[PP：比值比（Odds Ratio，OR）=1.25，95%置信区间（Confidence Interval，CI）:1.20～1.31，P＜0.001；PPI：OR=1.93，95%CI:1.75～2.13，P＜0.001]；调整年龄、性别、体质指数、地区、受教育水平、当前吸烟和饮酒后的多因素分析结果显示，高血压患者的PP与冠心病的相关性无统计学意义，而PPI仍与冠心病相关（OR=1.18，95%CI:1.04～1.33，P=0.008）；进一步调整是否服用降压药后，高血压患者的PP和PPI与冠心病的相关性均无统计学意义。

研究结论

北京市成人高血压患者中，合并冠心病者的PP和PPI均高于未合并冠心病者。调整年龄、性别、体质指数、地区、受教育水平、当前吸烟和饮酒后，高血压患者的PPI仍与冠心病相关；进一步调整是否服用降压药后，上述相关性无统计学意义。

关键词 冠心病；高血压；脉压；脉压指数；北京市

第二部分 高血压患者动态脉压及脉压指数与冠心病的关系

研究目的

探讨高血压患者的24小时动态脉压（24-hour Ambulatory Pulse Pressure，24hPP）、24小时动态脉压指数（24-hour Ambulatory Pulse Pressure Index，24hPPI）和夜间动态脉压指数（Night-time Ambulatory Pulse Pressure Index，NPPI）与冠心病的关系，为高血压患者的动态脉压及脉压指数的临床应用提供参考。

研究方法

研究对象均选自2016年5月至2016年7月在中国医学科学院阜外医院进行动态血压监测（Ambulatory Blood Pressure Monitoring，ABPM）者，ABPM有效读数需≥75%。详细询问研究对象的一般资料，记录年龄、性别、身高、体重、近两周内是否服用降压药等基本信息。24小时平均收缩压（24-hour Mean Systolic Blood Pressure，24hSBP）≥130mmHg（1 mmHg=0.133 kPa）和(或)24小时平均舒张压（24-hour Mean Diastolic Blood Pressure，24hDBP）≥80mmHg和(或)近两周内服用降压药的研究对象定义为高血压患者。根据ABPM数据计算研究对象的24hPP、24hPPI和NPPI，并分析它们与冠心病的相关性，比较各指标对冠心病的风险评估和预测价值的优劣。24hPP为24hSBP与24hDBP之差，24hPPI为24hPP与24hSBP的比值，NPPI为夜间（22:00～次日06:00）平均PP与平均SBP的比值。

研究结果

共有305例在中国医学科学院阜外医院进行ABPM者纳入本次研究。研究对象平均年龄为（58.2±14.4）岁，其中男性172例（56.4%），高血压患者222例（72.8%）。高血压患者的24hPP、24hPPI和NPPI均高于血压正常者（24hPP：49.0 mmHg vs. 42.2 mmHg，P＜0.001；24hPPI：0.39 vs. 0.37，P=0.004；NPPI：0.40 vs. 0.38，P=0.009）。高血压患者中，共有116例（52.3%）冠心病患者，冠心病患者的24hPP、24hPPI和NPPI均高于无冠心病者（24hPP：50.9 mmHg vs. 47.0 mmHg，P=0.013；24hPPI：0.41 vs. 0.38，P＜0.001；NPPI：0.42 vs. 0.38，P＜0.001）；而在血压正常者中，冠心病患者和无冠心病者上述指标之间的差异均无统计学意义。Logistic回归模型结果显示，单因素分析中高血压患者的24hPP、24hPPI和NPPI均与冠心病相关[24hPP：比值比（Odds Ratio，OR）=1.35，95%置信区间（Confidence Interval，CI）:1.06～1.72，P=0.014；24hPPI：OR=2.46，95%CI:1.57～3.86，P＜0.001；NPPI：OR=2.56，95%CI:1.66～3.95，P＜0.001]；调整年龄、性别、体质指数、是否服用降压药后只有24hPPI和NPPI与冠心病相关（24hPPI：OR=1.98，95%CI:1.11～3.52，P=0.021；NPPI：OR=2.26，95%CI:1.29～3.97，P=0.004）。受试者工作特征曲线（Receiver Operator Characteristic Curve，ROC曲线）分析结果显示高血压患者的24hPPI和NPPI对冠心病预测价值的ROC曲线下面积均大于24hPP。

研究结论

高血压患者的24hPPI和NPPI与冠心病密切相关，有助于临床上高血压患者合并冠心病的预测和诊断，且效果优于24hPP。

关键词 冠心病；高血压；动态血压监测；脉压；脉压指数；夜间血压

The first part: The relationship between pulse pressure, pulse pressure indexes and coronary heart disease in hypertensive patients among Beijing adults

Objective

To investigate the relationship between pulse pressure (PP), pulse pressure index (PPI) and coronary heart disease (CHD) in hypertensive patients among Beijing adults.

Methods

Beijing Chronic Diseases Survey 2011 used a multiple stage, random cluster process to yield a representative sample of Beijing adults aged 18 to 79 years. Pulse pressure (PP) was defined by systolic blood pressure (SBP) minus diastolic blood pressure (DBP) and pulse pressure index (PPI) by the ratio of PP/SBP. Logistic regression analysis was used to analyze the the relationship between PP, PPI and coronary heart disease (CHD) in hypertensive patients.

Results

A total of 7 563 hypertensive patients from Beijing Chronic Diseases Survey 2011 were enrolled in this study. The average age of all participants was (51.7±12.4) years old. Among 7 563 hypertensive patients, 4 120 (54.2%) were males, and 799 (10.6%) were CHD patients. The PP and PPI were higher in hypertensive patients aged 60 to 79 years compared with those aged 18 to 59 years [PP: 68.1 mmHg (1 mmHg=0.133 kPa) vs. 52.4 mmHg, P<0.001; PPI: 0.44 vs. 0.36, P<0.001]. They were also higher in CHD patients than those without CHD (PP: 61.0 mmHg vs. 55.5 mmHg, P<0.001; PPI: 0.41 vs. 0.37, P<0.001). Logistic regression analysis demonstrated that after adjustment of age, gender, body mass index, district, education level, current smoking and alcohol drinking, PPI was independently related to CHD in hypertensive patients [odds ratio (OR)=1.18, 95% confidence interval (CI): 1.04~1.33, P=0.008]; After adjustment of age, gender, body mass index, place of residence, education level, current smoking, alcohol drinking and antihypertensive drug therapy, the relationship between PPI and coronary heart disease is no statistically significant.

Conclusion

PPI is related to CHD in hypertensive patients among Beijing adults after adjustment of age, gender, body mass index, district, education level, current smoking and alcohol drinking and this correlation is no statistically significant after adjustment of antihypertensive drug therapy.

Key words Coronary heart disease; Hypertension; Pulse pressure; Pulse pressure index; Beijing

The second part: The relationship between ambulatory pulse pressure, ambulatory pulse pressure indexes and coronary heart disease in hypertensive patients

Objective

To investigate the relationship between 24-hour ambulatory pulse pressure (24hPP), 24-hour ambulatory pulse pressure index (24hPPI), night-time ambulatory pulse pressure index (NPPI) and coronary heart disease (CHD) in hypertensive patients.

Methods

All participates underwent ambulatory blood pressure monitoring (ABPM) in Fuwai Hospital from May 2016 to July 2016, 24hPP, 24hPPI and NPPI were calculated to analyse their relationship with CHD occurrence. 24hPP was defined by 24-hour mean systolic blood pressure (24hSBP) minus 24-hour mean diastolic blood pressure (24hDBP), 24hPPI by the ratio of 24hPP/24hSBP and NPPI by the ratio of night-time (22:00~06:00) PP/SBP.

Results

A total of 305 participates were enrolled in this study. There were 222 (72.8%) hypertensive patients. The 24hPP, 24hPPI and NPPI were higher in hypertensive participants than normotensive participants [24hPP: 49.0mmHg (1mm Hg=0.133 kPa) vs. 42.2mmHg, P<0.001; 24hPPI: 0.39 vs. 0.37, P=0.004; NPPI: 0.40 vs. 0.38, P=0.009]. Among all hypertensive participants, the 24hPP, 24hPPI and NPPI were higher in participants with CHD than those without (24hPP: 50.9mmHg vs. 47.0mmHg, P=0.013; 24hPPI: 0.41 vs. 0.38, P<0.001; NPPI: 0.42 vs. 0.38, P<0.001). Logistic regression analysis demonstrated that after adjustment of age, gender, body mass index and antihypertensive drug therapy, 24hPPI and NPPI were independently related to CHD in hypertensive patients [24hPPI: odds ratio (OR)=1.98, 95% confidence interval (CI): 1.11~3.52, P=0.021; NPPI: OR=2.26, 95%CI: 1.29~3.97, P=0.004]. The receiver operator characteristic (ROC) curve analysis showed that 24hPPI and NPPI were superior to 24hPP in the screening and prediction of CHD in hypertensive patients.

Conclusion

24hPPI and NPPI are closely related to CHD in hypertensive patients and they are superior to 24hPP in the prediction of CHD.

Key words Coronary heart disease; Hypertension; Ambulatory blood pressure monitoring; Pulse pressure; Pulse pressure index; Night-time blood pressure