血压昼夜节律与冠状动脉慢血流现象的临床相关性分析

doi:10.3969/j.issn.1006-5725.2026.11.005

Abstract

Abstract:

Objective This study was aimed at investigating the clinical characteristics of diverse blood pressure circadian rhythms and exploring the correlation among blood pressure circadian rhythm， nocturnal blood pressure decline rate， and coronary slow flow phenomenon （CSFP）. Methods A total of 275 patients who presented with chest tightness or chest pain and underwent coronary angiography （CAG） showing no significant stenosis （≤ 40%） at the Department of Cardiology， the Second Hospital of Lanzhou University from 2019 to 2024 were included in the study. The cohort was composed of hypertensive patients， CSFP patients， and patients with both conditions. According to the nocturnal blood pressure decline rate， all patients were classified into four groups： dipper， reverse-dipper， non-dipper， and extreme-dipper. General clinical data， CAG findings， and ambulatory blood pressure monitoring （ABPM） data were collected. Comparisons were carried out on the 24-hour， daytime， and nighttime mean blood pressure （BP）， morning BP surge， and nocturnal BP decline rate. Linear correlation analysis and linear regression analysis were employed to investigate the correlation between CSFP and the nocturnal BP decline rate. Results Correlation analysis indicated that the corrected TIMI frame count （cTFC） was significantly and negatively correlated with the nocturnal systolic blood pressure （SBP） decline rate （r = -0.186， P < 0.001） and the diastolic blood pressure （DBP） decline rate （r = -0.206， P < 0.001）. Multiple linear regression analysis verified that the nocturnal BP decline rate was an independent influencing factor for CSFP （P < 0.05）， and this correlation remained significant after adjusting for confounding factors such as gender， age， body mass index， smoking， diabetes， and cerebral infarction. Conclusions Both the decline rates of systolic and diastolic nocturnal blood pressure are independently correlated with the coronary slow flow phenomenon. Ambulatory blood pressure monitoring in hypertensive patients can assist in the detection of CSFP.

Key words: coronary slow flow, nocturnal blood pressure decline rate, blood pressure circadian rhythm

CLC Number:

R544.1

Xiaofan DI,Kefan ZHANG,Fangjing ZHANG,Yong ZHANG,Mingze LI,Qiongying WANG. Clinical correlation analysis of blood pressure circadian rhythm and coronary slow flow phenomenon[J]. The Journal of Practical Medicine, 2026, 42(11): 1923-1932.

Figures/Tables 7

Tab.1

Tab.2

Laboratory test data of the study subjects"

项目	杓形组（n = 72）	反杓形组（n = 67）	非杓形组（n = 118）	深杓形组（n = 18）	F值	P值
WBC/（×10⁹/L）	5.92 ± 1.48	6.38 ± 1.31	6.42 ± 1.81	6.4 ± 2.88	0.830	0.479
RBC/（×10¹²/L）	4.90 ± 0.52	4.68 ± 0.52^*	4.94 ± 0.58	4.91 ± 0.57	1.818	0.146
PLT/（×10⁹/l）	194.41 ± 51.25	199.33 ± 54.72	188.52 ± 51.5	179.64 ± 45.64	0.578	0.630
空腹血糖/（mmol/L）	5.15 ± 1.03	5.15 ± 1.22	5.58 ± 1.84	4.68 ± 0.67	1.189	0.317
餐后2 h血糖/（mmol/L）	7.80 ± 3.32	7.80 ± 2.85	8.36 ± 3.36	7.37 ± 1.97	0.383	0.765
BUN/（mmol/L）	5.18 ± 1.50^*△	6.49 ± 1.79^#	5.96 ± 1.79	6.78 ± 1.28	5.302	0.002
SCr/（μmol/L）	70.46 ± 11.69	67.84 ± 12.59^△	68.54 ± 16.63	84.66 ± 16.96^*#	4.279	0.006
UA/（μmol/L）	357.53 ± 79.81^*	320.98 ± 94.95	315.07 ± 87.47	345.29 ± 75.27	2.439	0.066
K/（mmol/L）	3.80 ± 0.29	3.81 ± 0.31	3.73 ± 0.44	3.77 ± 0.43	0.471	0.703
NA/（mmol/L）	139.58 ± 2.32	139.64 ± 2.74	139.16 ± 2.45	139.95 ± 2.42	0.589	0.623
CA/（mmol/L）	4.59 ± 15.34	2.31 ± 0.11	6.46 ± 19.97	2.33 ± 0.09	0.739	0.530
TC/（mmol/L）	3.9 ± 0.85	3.86 ± 1.08	3.89 ± 0.91	3.96 ± 0.59	0.033	0.992
TG/（mmol/L）	1.6 ± 1.13	1.77 ± 0.77	2.06 ± 1.6	2.15 ± 1.4	1.38	0.251
HDL/（mmol/L）	1.14 ± 0.28	1.15 ± 0.26	1.13 ± 0.33	1.18 ± 0.36	0.111	0.953
LDL/（mmol/L）	2.53 ± 0.79	2.49 ± 1.05	2.41 ± 0.81	2.47 ± 0.35	0.194	0.900
CK/（U/L）	101.39 ± 76.75	95.93 ± 74.10	128.28 ± 185.92	84.18 ± 28.46	0.795	0.498
CKMB/（U/L）	12.3 ± 3.67	10.8 ± 6.03^*	15.14 ± 10.45	13.55 ± 3.14	3.002	0.032
DDIM/（μg/mL）	0.43 ± 0.66	0.46 ± 0.33	0.30 ± 0.25	0.48 ± 0.41	1.759	0.157
TT3/（nmol/L）	1.55 ± 0.35	1.53 ± 0.28	1.50 ± 0.48	1.57 ± 0.14	0.158	0.924
TT4/（nmol/L）	103.76 ± 24.75^*	104.52 ± 27.67^*	92.53 ± 27.31	105.65 ± 14.42	2.768	0.044
FT3/（pmol/L）	5.06 ± 0.58	4.90 ± 0.58	5.03 ± 1.16	5.43 ± 0.42	1.066	0.365
FT4/（pmol/L）	15.85 ± 3.07^*	15.06 ± 1.86	14.14 ± 2.97	15.91 ± 2.69^*	4.048	0.008
TSH/（mIU/L）	2.97 ± 1.98	78.89 ± 483.94	3.37 ± 3.18	2.27 ± 1.22	1.005	0.392

Tab.2

Tab.3

Tab.4

Tab.5

Tab.6

Fig.1

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项目	杓形组（n = 72）	反杓形组（n = 67）	非杓形组（n = 118）	深杓形组（n = 18）	F/χ²值	P值
性别/例					7.361	0.061
男	44	28	79	10
女	28	39	39	8
年龄（x ± s）/岁	58.84 ± 8.035	61.61 ± 8.22	58.47 ± 10.16	61.73 ± 11.59	1.289	0.280
体质量指数（x ± s）/（kg/m²）	25.55 ± 3.27	25.53 ± 3.50	25.34 ± 5.02	23.98 ± 1.64	0.469	0.704
高血压	46（63.89）	56（83.58）	70（59.32）	11（61.11）	7.032	0.071
CSPF	49（68.06）	51（76.12）	95（80.51）	8（44.44）	7.247	0.064
T2DM	13（19.40）	13（19.40）	23（19.49）	0（0.00）	2.595	0.046
脑梗	5（6.94）	15（22.39）	18（15.25）	2（11.11）	4.276	0.233
吸烟	26（36.36）	3（4.48）^*#△	26（22.03）	7（38.89）	13.316	0.004

项目	杓形组（n = 72）	反杓形组（n = 67）	非杓形组（n = 118）	深杓形组（n = 18）	F值	P值
LA/mm	32.11 ± 3.83	32.76 ± 3.54	32.05 ± 5.56	30.84 ± 3.13	0.523	0.667
LV/cm	4.68 ± 0.37^△	4.51 ± 0.82	4.41 ± 0.89	4.09 ± 1.44	1.841	0.142
IVST/cm	0.87 ± 0.12	0.84 ± 0.21^△	0.83 ± 0.20	0.69 ± 0.26^*#	2.679	0.049
LVPWT/cm	0.87 ± 0.10^△	0.83 ± 0.18^△	0.82 ± 0.18	0.72 ± 0.26	2.419	0.068
SV/mL	69.98 ± 14.16^*	67.83 ± 15.61	63.86 ± 15.16	60.22 ± 16.2	2.113	0.101
LVEF/%	68.70 ± 6.32^△	69.72 ± 5.59^*△	67.01 ± 6.65	63.8 ± 4.44	3.327	0.021
CO/（L/min）	4.94 ± 1.09^*△	4.86 ± 1.06^*△	4.34 ± 1.14	3.68 ± 0.93	5.633	0.001
CI/［L/（min·m²）］	3.20 ± 2.79^*	2.83 ± 0.57	2.51 ± 0.61	2.15 ± 0.34	2.343	0.075
E/（m/s）	0.61 ± 0.16^△	0.68 ± 0.18	0.64 ± 0.16^△	0.78 ± 0.11	3.284	0.022
A/（m/s）	0.74 ± 0.15	0.73 ± 0.13	0.73 ± 0.18	0.79 ± 0.17	0.519	0.670
E/A	0.85 ± 0.24	0.96 ± 0.35	0.93 ± 0.33	1.01 ± 0.23	1.321	0.269
E/e′	11.19 ± 3.59^△	12.52 ± 4.75	11.93 ± 3.42	14.71 ± 8.50	1.995	0.117

项目	杓形组（n = 72）	反杓形组（n = 67）	非杓形组（n = 118）	深杓形组（n = 18）	F值	P值
白天SBP/mmHg	124.98 ± 14.82	126.95 ± 12.69^*	121.04 ± 13.91^△	130.18 ± 15.54	2.487	0.062
白天DBP/mmHg	73.41 ± 7.33	74.93 ± 8.35	73.11 ± 9.82	77.55 ± 12.09	1.000	0.394
白天P/（次/min）	69.73 ± 7.62	67.10 ± 9.70	68.36 ± 8.24	71.27 ± 9.02	1.064	0.366
夜间SBP/mmHg	109.34 ± 13.23^*	133.41 ± 13.43^*#△	116.03 ± 13.98^#△	100.27 ± 13.67^*	30.015	< 0.001
夜间DBP/mmHg	64.70 ± 7.32^*	77.63 ± 9.18^*#△	69.45 ± 9.77^#△	61.45 ± 10.60^*	17.827	< 0.001
夜间P/（次/min）	60.43 ± 8.72	61.39 ± 9.50	62.53 ± 8.83	59.09 ± 7.38	0.812	0.489
清晨SBP/mmHg	129.07 ± 18.80	131.34 ± 14.89	124.37 ± 20.89	119.82 ± 20.04	1.880	0.135
清晨DBP/mmHg	71.95 ± 7.84	78.46 ± 9.47^#	76.73 ± 16.37	76.45 ± 18.00	1.927	0.127
清晨P/（次/min）	68.09 ± 8.69	66.54 ± 11.32	67.82 ± 10.52	70.00 ± 14.50	0.362	0.78
24 h SBP/mmHg	120.68 ± 14.27	128.66 ± 12.79^*#△	119.70 ± 13.81	112.27 ± 36.47	4.288	0.006
24 h DBP/mmHg	70.93 ± 7.13	75.88 ± 8.78^*#	72.21 ± 9.60	72.64 ± 11.78	2.351	0.074
24 h P/（次/min）	67.30 ± 7.72	65.59 ± 9.46	66.75 ± 7.96	67.82 ± 9.04	0.384	0.765
SBP夜间下降率/%	12.50 ± 2.59^*△	-5.07 ± 2.78^*#△	4.22 ± 3.07^#△	23.18 ± 2.68^*#	419.445	< 0.001
DBP夜间下降率/%	11.84 ± 5.01^*△	-3.32 ± 5.69^*#△	4.92 ± 5.33^#△	20.91 ± 2.39^*#	93.258	< 0.001
SBP血压晨峰/mmHg	28.82 ± 14.53^*	6.59 ± 12.57^*#△	16.96 ± 17.01^#	25.00 ± 13.91	16.012	< 0.001
DBP血压晨峰/mmHg	14.59 ± 7.34	7.44 ± 8.24^*#△	13.82 ± 13.29	20.09 ± 14.00	5.526	0.001
动脉硬化指数	0.59 ± 0.14	0.64 ± 0.11^*△	0.58 ± 0.15	0.54 ± 0.07	2.746	0.045

项目	LAD CTFC		LCX TFC		RCA TFC		平均TFC
项目	r值	P值	r值	P值	r值	P值	r值	P值
白天SBP	-0.069	0.329	-0.065	0.357	-0.087	0.220	-0.084	0.238
白天DBP	-0.057	0.418	-0.038	0.591	-0.065	0.358	-0.060	0.395
白天P	-0.159	0.024	-0.159	0.024	-0.138	0.051	-0.170	0.016
白天SBP血压负荷	-0.084	0.237	-0.076	0.286	-0.084	0.233	-0.091	0.197
白天DBP血压负荷	-0.015	0.838	-0.008	0.910	0.016	0.826	-0.001	0.986
夜间SBP	0.075	0.291	0.025	0.726	0.041	0.559	0.051	0.472
夜间DBP	0.108	0.128	0.076	0.284	0.076	0.285	0.095	0.177
夜间P	-0.010	0.889	-0.014	0.845	0.025	0.720	0.002	0.977
夜间SBP血压负荷	0.097	0.170	0.064	0.369	0.039	0.580	0.072	0.308
夜间DBP血压负荷	0.069	0.329	0.077	0.275	0.033	0.645	0.074	0.299
清晨SBP	0.079	0.267	0.034	0.628	0.055	0.435	0.062	0.385
清晨DBP	0.020	0.782	-0.008	0.915	-0.008	0.914	0.001	0.998
清晨P	-0.025	0.728	-0.043	0.541	-0.032	0.651	-0.038	0.591
24 h SBP	-0.028	0.688	-0.042	0.553	-0.05	0.480	-0.046	0.514
24 h DBP	0.006	0.936	0.01	0.893	-0.015	0.838	-0.001	0.994
24 h P	-0.125	0.077	-0.126	0.074	-0.097	0.170	-0.130	0.067
24 h SBP血压负荷	-0.014	0.846	-0.024	0.740	-0.039	0.585	-0.030	0.676
24 h DBP血压负荷	0.026	0.713	0.020	0.773	0.023	0.747	0.026	0.716
SBP夜间血压下降率	-0.206^**	< 0.001	-0.123^*	0.033	-0.175^*	0.013	-0.186^**	< 0.001
DBP夜间血压下降率	-0.216^**	< 0.001	-0.145^*	0.040	-0.192^**	< 0.001	-0.206^**	< 0.001
SBP血压晨峰	0.022	0.757	0.056	0.429	0.039	0.581	0.045	0.525
DBP血压晨峰	-0.061	0.390	-0.019	0.794	-0.077	0.275	-0.059	0.406
动脉硬化指数	0.170^*	0.016	0.179^*	0.011	0.082^*	0.014	0.158^*	0.025

项目	SBP夜间血压下降率			DBP夜间血压下降率
项目	β	95%CI	P值	β	95%CI	P值
LAD CTFC	-0.214	-0.360 ~ -0.067	< 0.01	-0.171	-0.311 ~ -0.031	< 0.01
LCX TFC	-0.151	-0.326 ~ 0.023	< 0.05	-0.114	-0.280 ~ 0.052	< 0.05
RCA TFC	-0.243	-0.435 ~ -0.051	< 0.05	-0.205	-0.388 ~ -0.022	< 0.01
平均TFC	-0.203	-0.351 ~ -0.054	< 0.01	-0.163	-0.305 ~ -0.022	< 0.01

Clinical correlation analysis of blood pressure circadian rhythm and coronary slow flow phenomenon

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