Overview of Coronary Artery Disease
Coronary artery disease is a part of systemic vascular disease caused by hypertension. Hypertension plays an extremely important role in the development of coronary heart disease, and the hemodynamic changes produced by persistently high blood pressure can activate platelets in the blood, promote atherosclerotic lesions, and then lead to myocardial ischemia, hypoxia, or necrosis, resulting in coronary heart disease. At present, hypertensive patients do not have enough awareness of the risk of combined coronary heart disease, and the blood pressure control rate of patients with combined coronary heart disease and hypertension is less than 70%. Therefore, it is important to emphasize the management of blood pressure and overall cardiovascular risk factors in such patients to avoid reoccurrence.
Etiology
Coronary atherosclerosis is a disease of multiple causes, of which hypertension is an extremely important factor. Studies have shown that for every 10 mmHg increase in systolic blood pressure, the risk of myocardial infarction increases by 31%. 60% to 70% of people with coronary atherosclerosis suffer from hypertension, and coronary atherosclerosis occurs three to four times more often in hypertensive patients than in those with normal blood pressure. Hypertension can accelerate and worsen the coronary artery atherosclerosis lesions, resulting in increased myocardial oxygen consumption and exacerbate the development of coronary heart disease, angina pectoris can occur, the heavy can lead to acute myocardial infarction, sudden cardiac death occurs. In addition, due to the early morning is the highest blood pressure in the day, sudden death and myocardial infarction and other peaks in the wake up before and after 4 to 6 hours, early morning blood pressure and coronary heart disease is more closely related.
Other risk factors for coronary heart disease include dyslipidemia, smoking, abnormal glucose metabolism, overweight and obesity, lack of exercise and psychological stress, etc. The risk of coronary heart disease is different for people of different ages and genders; in addition to the above mentioned factors, there is also a clear genetic influence on the development of hypertension.
Symptoms
Coronary heart disease is the most common type of organ disease caused by atherosclerosis. Due to different anatomical and pathophysiological changes, it can have different clinical manifestations, the most common of which include angina pectoris and myocardial infarction.
Stable angina pectoris is characterized by episodic chest pain as the main clinical manifestation, which is usually characterized by pressure, dullness or constrictive pain that occurs after physical work or emotional excitement, mainly in the middle and upper part of the sternal body, often radiating to the left shoulder and within the left shoulder. Angina is often progressively aggravated after the onset of angina and gradually disappears within 3 to 5 minutes, and can be relieved within a few minutes by sublingual nitroglycerin. The site and nature of unstable angina are similar to that of stable angina, but it can also occur at rest, and the relieving effect of nitric acid drugs is weakened. The clinical manifestations of myocardial infarction are related to the size and location, etc. Pain is the first symptom, which occurs early in the morning, and the location and nature are similar to angina pectoris, but it often occurs during quiet time, and the degree of severity is more severe.
As a comorbidity, hypertension usually has a slow onset and no specific clinical manifestations, but plays an important role in the development of the disease.
Screening
The examination for hypertension is the same as usual, but in view of the high incidence of cardiovascular and cerebrovascular events in the early morning hours, emphasis should be placed on monitoring blood pressure values between 6:00 and 10:00 am in the early morning.
In the examination of coronary heart disease, electrocardiogram is the most commonly used examination method to detect myocardial ischemia and diagnose angina pectoris, including electrocardiogram at rest, electrocardiogram during angina pectoris attack and electrocardiogram loading test, in addition to coronary arteriography, ultrasonic electrocardiogram and radionuclide examination. Myocardial infarction can also be measured by myocardial necrosis markers.
Diagnosis
Hypertension is diagnosed by a systolic blood pressure of ≥140 mmHg and/or a diastolic blood pressure of ≥90 mmHg, and is further diagnosed if the home blood pressure is ≥135/85 mmHg and/or the office blood pressure is ≥140/90 mmHg during the early morning hours.
Angina pectoris is usually diagnosed based on typical attack characteristics and signs, and is relieved by nitroglycerin. For atypical attacks, the diagnosis depends on observing the efficacy of nitroglycerin and the changes in the ECG during the attack, or continuous monitoring of 24-hour ambulatory electrocardiogram. The diagnosis of myocardial infarction is not difficult to make based on typical clinical manifestations, characteristic electrocardiographic changes and laboratory tests.
Questions you may be concerned about
What are the tests for coronary artery disease combined with hypertension?
Patients with coronary heart disease combined with hypertension need to have regular blood pressure, blood sugar and blood lipid examinations.
1. Blood pressure: Hypertension is a major independent risk factor for coronary heart disease. Since hypertensive patients are often accompanied by left ventricular hypertrophy, resulting in increased myocardial oxygen consumption and impaired coronary microcirculation, when combined with coronary heart disease, coronary blood supply is reduced and myocardial ischemia is likely to occur. Therefore, it is necessary to check the blood pressure regularly to ensure that the target value of blood pressure in patients with coronary artery disease and hypertension is <140/90mmHg.
2. Blood glucose: patients with coronary artery disease combined with hypertension should pay attention to monitoring blood glucose changes at any time. If fasting blood glucose ≥7 mol/L or 2h postprandial blood glucose >11.1 mmol/L, after a clear diagnosis of diabetes mellitus, adjust the target value of blood pressure <130/80 mmHg in time, and at the same time, control glycated hemoglobin <7%.
3. Lipids: For patients with coronary artery disease combined with hypertension, their LDL control should be <1.8mmol/L to reduce the probability of cardiovascular events.
If you have coronary artery disease combined with hypertension, it is recommended to go to a regular hospital to avoid delaying your condition.
Differential Diagnosis
Care should be taken to differentiate acute myocarditis, pericarditis, myocardial infarction and precordial pain caused by other diseases, and elevated blood pressure to exclude secondary hypertension caused by renal disease, renal artery stenosis, primary aldosteronism, and so on.
Treatment
(I) Antihypertensive treatment
The benefits of antihypertensive therapy for coronary heart disease are well recognized, and large-scale clinical studies have demonstrated that a decrease in systolic blood pressure of 10-20 mmHg or a decrease in diastolic blood pressure of 5-6 mmHg reduces the number of strokes, deaths from cardiovascular and cerebrovascular diseases, and coronary heart disease events within 3-5 years by 38%, 20%, and 16%, respectively, and reduces heart failure by more than 50%. The management of blood pressure mainly includes drug treatment and lifestyle intervention:
1. At present, the commonly used antihypertensive drugs in clinical practice are divided into five categories: calcium antagonist drugs, with anti-angina and anti-atherosclerosis effects, can significantly improve symptoms and improve the prognosis of patients with coronary artery disease combined with hypertension has a very good therapeutic effect, and it is the most commonly used and important drugs for the treatment of this disease at present, of which amlodipine benzenesulfonate has the most extensive coronary artery disease indication; in addition, angiotensin-converting enzyme inhibitors and angiotensin receptor antagonist drugs, beta-blockers and diuretics. Care should be taken in treatment to select truly long-acting agents as much as possible, to reduce blood pressure fluctuations, to smoothly control 24-hour blood pressure, especially early morning blood pressure from 6:00 a.m. to 10:00 a.m., and to adhere to long-term medication.
The target of blood pressure reduction, synthesizing a large amount of existing information, it is suggested that the target blood pressure level of hypertensive patients with stable coronary heart disease, unstable angina, non-ST-segment elevation and ST-segment elevation myocardial infarction can generally be <130/80 mm Hg. Attention should be paid to the individualization of the treatment and the contraindications of the drugs, to avoid aggravation of the condition due to irrational use of the medication.
2. Lifestyle intervention, including rational diet, restriction of smoking and alcohol, and moderate exercise.
(ii) Interventional therapy
To solve myocardial ischemia and dilate coronary artery to eliminate angina symptoms as soon as possible, of which revascularization PCI is an important interventional therapy. As most of the patients are in serious condition, attention should be paid to long-term vasodilatation, combined with statin drugs to control blood lipids, adjust blood sugar, improve coronary artery obstruction, and reverse or delay the progression of atherosclerosis during treatment.
Prevention
It is mainly to prevent the occurrence of atherosclerosis and treat the existing atherosclerosis. Control of hypertension can prevent morbidity and mortality from cardiovascular and cerebrovascular diseases. Control of blood pressure at night and in the early morning with long-acting medications that can last for 24 hours of antihypertensive effect when administered once daily can be more effective in preventing the occurrence of cardiovascular and cerebrovascular complications. At the same time, comprehensive consideration should be given to the management of other risk factors, such as rational diet, physical exercise, tobacco control and intensive lipid regulation, antiplatelet and other drug therapy.