Relationship between coronary atherosclerosis and aortic pulse pressure in patients with primary hypertension

Lisong LIU; Qi HUA; Beilei PANG

ABSTRACT

BACKGROUND:

Both pulse pressure (PP) and aortic stiffness are the predictors of coronary artery disease (CAD). The relationship between aortic PP and atherosclerosis may be bi-directional. Some investigations have tested the relationship between coronary arteriongraphy-diagnosed coronary heart disease and aorta pulse pressure (APP).

OBJECTIVE:

To observe the relationship between coronary atherosclerosis and APP in patients with primary hypertension.

DESIGN:

Case control observation.

SETTING:

Department of Cardiology, Xuanwu Hospital, Capital University of Medical Sciences

PARTICIPANTS:

A total of 300 patients with primary hypertension who received the treatment in the Department of Cardiology, Xuanwu Hospital, Capital University of Medical Science between July 2002 and January 2005. The patients were all untreated hypertensive patients who were referred for a first diagnostic coronary angiography. All of them met the diagnostic criteria of international hypertensive association. Secondary hypertension, myocardial disease, valvular disease of the heart (VDH), heart failure, liver and renal insufficiency and so on were excluded. The patients, 170 male and 130 female, were aged (61±11 )years. Informed consents were obtained from all the patients.

METHODS:

A total of 300 untreated hypertensive patients were recruited for a first diagnostic coronary angiography. According to whether having coronary artery disease (CAD), the patients were divided into CAD group (143 in total, 92 male, 64%) and non-CAD group (157 in total, 82 male, 52%). Informed consents were obtained from all the patients.The following data were collected invasive intra-aortic systolic blood pressure (ASBP) and intra-aortic diastolic blood pressure (ADBP), extent of coronary artery disease, and basic clinical materials of the patients. All the observed index were expressed as Mean±SD. Independent sample t test was used in the comparison between two groups, and P ＜ 0.05was set as significant difference.MAIN OUTCOME

MEASURES:

ASBP, ADBP and BP, ratio of stroke volume (SV), which reflects aortic stiffness, to aortic pulse pressure (APP); The number of branch and stegnotic extent of coronary artery disease (Cases with stegnotic extent ＜ 50% were included in non-CAD group; Basic clinical indexes and routine biochemical indexes of patients after admission (including fasting blood glucose, serum creatinine, blood lipid and so on).

RESULTS:

The enrolled 300 patients with hypertension all participated in the result analysis. In the whole population, ASBP and PP were significantly higher in CAD group than non-CAD group [(150.3±26.5) vs. (145.6±23.3) mm Hg, P ＜ 0.05;(77.1±22.7) vs. (70.4±19.3) mm Hg, P ＜ 0.05)]. The ratio of APP to SV in CAD group was markedly higher than that in non-CAD group(1.20±0.44) vs. (0.96±0.33), P ＜ 0.05]. Fasting blood glucose of patients in the CAD group was significantly higher than that in the non-CAD group [(1.38±0.27) vs. (1.08±0.28) mmol/L, P ＜ 0.01]. Serum creatinine of patients in the CAD group was significantly higher than that of non-CAD group [(11.98±2.15) vs. (11.19±1.58) μ mol/L, P ＜0.01]. High-density lipoprotein cholesterol of patients in the CAD group was significantly lower than that in the non-CAD group [(0.54±0.13) vs. (0.62±0.18) mmol/L, P＜ 0.01].

CONCLUSION:

Atherosclerosis may further aggravate the aortic stiffness and then cause the increase of APP in patients with primary hypertension.