Risk Factors and Prediction Model for Cardiovascular Events in Patients with Coronary Heart Disease Complicated by Hypertension and Diabetes Mellitus After Intensive Blood Pressure Reduction Based on 24-Hour Ambulatory Blood Pressure Monitoring
YANG Bing
ZHANG Chenguang
LI Jinjin
Abstract：Objective To investigate the risk factors for cardiovascular events in patients with coronary heart disease complicated by hypertension and diabetes under the guidance of 24-hour ambulatory blood pressure monitoring(ABPM)-guided intensive antihypertensive therapy,and to establish a risk prediction model.Methods A retrospective study was conducted on 200 patients with coronary heart disease complicated by hypertension and diabetes who received standardized intensive antihypertensive management under ABPM guidance at Zhengzhou Public Transport Hospital from January 2023 to January 2024.Based on whether cardiovascular events occurred within one year,the patients were divided into an event group(33 cases)and a non-event group(167 cases).The baseline data,laboratory indicators,ultrasound parameters,and ABPM parameters were compared between the two groups.Multivariate logistic regression analysis was performed to identify independent risk factors,and the predictive efficacy was evaluated using the receiver operating characteristic(ROC)curve.Results The event group exhibited a longer disease duration,higher creatinine levels,lower estimated glomerular filtration rate(eGFR)and high-density lipoprotein cholesterol(HDL-C),increased interventricular septal thickness(IVST)thickness,higher 24-hour average systolic blood pressure(24 h ASBP)and nocturnal blood pressure,a higher proportion of reverse-systolic pattern(30.30％vs 15.57％),and lower daytime systolic blood pressure coefficient of variation(dSCV).Multivariate logistic regression revealed that 24 h ASBP(OR=3.065,95％CI:2.629-3.501),duration of diabetes(OR=2.687,95％CI:2.439-2.935),duration of hypertension(OR=2.432,95％CI:2.117-2.747),and nighttime mean arterial pressure(nMAP)(OR=2.087,95％CI:1.551-2.623)were independent risk factors,while eGFR(OR=0.638,95％CI:0.327-0.949)and dSCV(OR=0.502,95％CI:0.248-0.756)were independent protective factors.The combined model(24 h ASBP+nMAP+dSCV)demonstrated the best predictive performance(AUC=0.883),outperforming individual indicators.Conclusion After intensive antihypertensive therapy guided by ABPM,24 h ASBP,nMAP,and dSCV remained independent predictors of cardiovascular events in patients with coronary heart disease complicated by hypertension and diabetes.The combined model based on ABPM parameters facilitates risk stratification,suggesting that intensive antihypertensive strategies should simultaneously focus on blood pressure rhythm and variability management.
Keywords：coronary heart diseasehypertensiondiabetes mellitusambulatory blood pressure monitoringintensive antihypertensive therapycardiovascular eventsrisk factorspredictive models
Publication Date：2026-06-13
Online Publishing Date：2026-09-12(First online date of this platform, not the publication date of the document)
Pages：8( 1980-1987 )