Characteristics of coronary arterial lesions in patients with coronary heart disease and hypertension
Hypertension is known as a strong risk factor of coronary atherosclerosis. However, whether hypertension is a risk factor of complexity and severity of coronary atherosclerosis remains to be elucidated. In some studies, authors investigated the relationship between the prevalence, severity, and plaque characteristics of coronary atherosclerosis and blood pressure grade. The results of their studies strongly suggest that the incidence of coronary calcification was similarly high in hypertension and diabetes mellitus, and that coronary atherosclerosis shows a grade-response relationship according to hypertension grade (Graham et al. 2012; Grossman et al. 2013; Im et al. 2014; Tomizawa et al. 2015). In this study, the mean SS in the CHD-HT group was higher than that in the CHD group. The analysis of the characteristics of PCI target-vessel lesions revealed that the prevalences of complex, calcified, and diffused long lesions were significantly higher in the CHD-HT group than in the CHD group. The mean number of stent implantations was also significantly higher in the CHD-HT group than in the CHD group, suggesting that the CHD-HT patients had more-complex CAL.
Tanaka et al. (2013) found that among the risk factors of CHD, aging, male sex, and diabetes mellitus were identified as significant independent risk factors of the complexity of CAL. Other coronary risk factors such as hypertension, hypercholesterolemia, and smoking were not identified as significant independent risk factors. While the results of this study were not consistent with the results of their study, this study found that within the general population and the CHD-HT group, not only age, male sex, and diabetes exhibited significantly positive correlations with the SS, but also hypertension, hyperlipidemia, and previous history of myocardial infarction, indicating that hypertension, hyperlipidemia, and previous history of myocardial infarction, as well as age, sex, and diabetes, were independent predictors of the complexity of CAL.
Although the pathogeneses of CHD and hypertension were independent from each other, there existed mutual reinforcing interaction between the two diseases, the atherosclerosis process in CHD patients could be significantly accelerated owing to the presence of hypertension and the reduction in coronary reserve caused by hypertensive microvascular disease could aggravate the coronary arterial stenosis (Delles et al. 2012; Erbel et al. 2012; Juhola et al. 2013; Moges et al. 2014).
Studies have confirmed that hypertension was an independent risk factor of the occurrence and prognosis of CHD events (Makridakis and DiNicolantonio 2014; Nilsson and Cederholm, 2011; Zambon et al. 2014; Zanchetti 2014). In this study, the post-PCI 2-year follow-up results revealed that compared with the CHD group, although the incidence of MACCE (cardiac death, nonfatal myocardial infarction, re-revascularization, and stroke) between the two groups had no statistical significance, the incidence of overall MACCE was still significantly higher in the CHD-HT group than in the CHD group.
Some papers showed an association between coexistence of hypertension and diabetes and negative synergistic effect on SYNTAX score. It may be the diabetes and the hypertension were in the same stage, but there were not the serious symptom. Then the hypertension and diabetes were coexistence. Instead either of hypertension without diabetes or diabetes without hypertension were not associated with high SYNTAX score. These differences may be caused by: First, as mentioned above, different ethnic groups have different lifestyles, eating habits, geographical and cultural differences and other extrinsic factors. Secondly, CHD is multiple factor disease. In addition to the risk factors, the differences existed in gene in different ethnic. The Kaplan–Meier survival analysis revealed that the long-term event-free survival rates between the two groups had no significant difference, indicating that in addition to hypertension, blood glucose and blood lipid levels were also important factors of coronary events and prognosis and that the more-systematic medications of the post-PCI patients might play certain roles in improving the prognosis.