无创血流动力学参数在中年与青年高血压患者中的变化及其与颈动脉病变的关系OA

Aim To explore the changes of non-invasive hemodynamic parameters in young and middle-aged pa-tients with hypertension and their relationship with carotid arterial lesions.Methods A total of 689 hypertensive pa-tients admitted to our hospital from October 2021 to April 2024 were enrolled as the research subjects.Patients were di-vided into hypertension grade 1((systolic blood pressure(SBP):140～159 mmHg;diastolic blood pressure(DBP):90～99 mmHg),hypertension grade 2(SBP:160～179 mmHg;DBP:100～109 mmHg)and hypertension grade 3(SBP:≥180 mmHg;DBP:≥110 mmHg)according to their levels of SBP and DBP.The severity of carotid artery le-sions was evaluated using the Crouse score,with the grading criteria as follows:non-lesion(0 point:intima-media thick-ness(IMT)<1 mm),IMT thickening(1 point:IMT1～1.2 mm),plaque formation(2 points:IMT 1.2～1.5 mm),mild stenosis(3 points:IMT 1.5～2.0 mm)and severe stenosis(4 points:IMT>2.0 mm).In addition,patients were divided into the carotid artery lesion group(IMT≥1 mm,Crouse score≥1 point)and the non-lesion group(IMT<1 mm,Crouse score<1 point)according to IMT values.Multivariate Logistic regression model was used to identify risk factors for carotid artery lesions in hypertensive patients.Multiplicative model and additive model were used to analyze the inter-action between age and non-invasive hemodynamic parameters on carotid arterial lesions.Additionally,restricted cubic spline model was used to examine the dose-response relationship between non-invasive hemodynamic parameters and carotid arterial lesions in hypertensive patients.Results In young and middle-aged hypertensive patients,the proportions of severe coronary artery stenosis(Gensini score≥50 points)and Crouse score≥2 points,as well as thoracic fluid content(TFC),stroke volume variation(SVV),systemic vascular resistance(SVR),systemic vascular resistance index(SVRI),acceleration index(ACI),mean arterial pressure(MAP),24-hour mean systolic blood pressure(24h-mSBP),24-hour mean diastolic blood pressure(24h-mDBP),24-hour systolic blood pressure variability(24hSBPV),and 24-hour diastolic blood pressure variability(24hDBPV)all showed a gradual increase from hypertension grade 1 to grade 3(P<0.05).Compared with the non-lesion group,age and the above-mentioned indicators were significantly increased in the carotid artery lesion group(P<0.05).Middle-age,grade3 hypertension,TFC>32 kΩ-1,SVR>1 534 dyne·s/cm5,ACI>91,24h-mSBP>167 mmHg and 24hSBPV>12.9 mmHg were independent risk factors for carotid arterial lesions.Age exhibited multiplicative interaction(OR>1)and additive interaction(RERI>0,AP>0,SI>1)with TFC,SVR and ACI on carotid arterial lesions.Levels of TFC,SVR,and ACI exhibited a non-linear dose-response relationship with ca-rotid arterial lesions in young hypertensive patients(Pnon-linearity=0.002,0.016,0.028)and middle-aged hypertensive pa-tients(Pnon-linearity=0.003,0.007,0.015).Conclusion In young and middle-aged hypertensive patients,the levels of TFC,SVR and ACI all increase with the elevated blood pressure grade,as well as the elevation of each indicator is an independent risk factor for carotid arterial lesions.