Characteristics of coronary arterial lesions in elderly patients with hypertension
Authors: Nguyen Huu Manh Duc , Hoang Anh Tien , Tran Quoc Bao 
Published: April 2024

Background: Aging is a physiological progress in everyone’s life, combined with a decrease in many functions and comorbidities. Coronary heart disease is a common condition because of cumulative age and risk factors: hypertension, diabetes, dyslipidemia... Hypertension is also a new problem, the main and independent coronary disease risk factor. Large trials that describe a characteristic of coronary lesions by conventional coronary angiography often collect fewer very older patients.

Objectives: 1. To dDescribe the clinical and subclinical coronary lesions characteristic of older patients with hypertension who are indicated conventional coronary angiography. 2. Finding an association between the characteristics of coronary lesions and cardiovascular risk factors in elderly patients with primary hypertension (Vietnam Society of Hypertension guidelines 2022).

Subjects and method: 159 patients older than 60 who have primary hypertension combined with acute coronary syndrome or chronic coronary syndrome are indicated for conventional coronary angiography at Hue Central Hospital from 05/2021 to 05/2022. They are divided into 2 groups: elderly (60 - 79 years old) and very elderly (≥ 80 years old) with cross-sectional method.

Results: Different hypertension grades, pulse pressure, mean blood pressure and cardiovascular risk factors such as diabetes with control HbA1C well, chronic kidney disease, dyslipidemia, and previous coronary diseases are not significant. Contrast this, LDL-C, TG/HDL-C ratio, LDL-C/HDL-C ratio, obesity, arrhythmia, and dilating cardiac chamber on echocardiography is significantly different between 2 groups. Severe coronary stenosis LAD>RCA>LCx>LM. One or two severe coronary diseases is higher in very elderly patient than elderly patient, but three or non-severe coronary diseases is higher in elderly patient. The type of lesion that ACC/AHA classifies is almost type B and type C at three vessels but the only difference at RCA is significant. Severe coronary stenosis is higher in very elderly patients than elderly patients and is significantly different in grade 2 hypertension, systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, pulse pressure ≥ 50 mmHg. Complexity coronary lesion or type C ACC/AHA significantly correlates with systolic blood pressure and HbA1C at medium level. SYNTAX II score correlates positively with systolic blood pressure, pulse pressure, age, and LDL-C/HDL-C ratio and significantly correlates with negative glomerular filtration. Severe tortuosity coronary disease significantly correlates with positive diastolic and mean blood pressure. Chronic total occlusion coronary diseases significantly correlate at a medium level with the TG/HDL-C ratio.

Conclusions: Coronary lesions of elderly patients are more complex and have a higher ratio, especially uncontrol cardiovascular risk factors such as hypertension, dyslipidemia, and diabetes.

Key words: characteristic of coronary lesions, elderly, conventional coronary angiography, elderly and hypertension.