超重对青少年远期血压变化的影响

目的 探索超重对青少年远期血压变化及高血压发生的影响.方法 1987年在陕西汉中农村4623名6～15岁在校学生进行血压等相关因素调查的基础上,根据3次测量初始体质量指数(BMI)在其同年龄、同性别第90百分位(P90)以上者确定为超重肥胖组(42例),BMI在其同年龄、同性别第50百分位(P50)以下者为对照组(218例).2005年对该队列组样本进行随访.随访时间平均18年.结果 总随访率75.8%,其中超重组随访率71.4%,对照组随访率76.6%;无论基线还是随访血压,超重组均显著大于对照组,超重组18年后发生高血压(≥140/90 mm Hg)的几率有高于对照组的趋势但无显著性(30.0% vs 13.8% ,P>0.05);随访期间的BMI增加幅度在最高的4分位者,高血压发生率是最低的2个4分位者的4.5倍(37.9% vs 8.8%,P<0.01).结论 青少年时期BMI增长过快者远期随访血压增幅大,高血压发生率显著增加,是青年高血压发病重要易患因素.     

超重对青少年远期血压变化的影响

目的探索超重对青少年远期血压变化及高血压发生的影响。方法1987年在陕西汉中农村4623名6～15岁在校学生进行血压等相关因素调查的基础上,根据3次测量初始体质量指数(BMI)在其同年龄、同性别第90百分位(P90)以上者确定为超重肥胖组(42例),BMI在其同年龄、同性别第50百分位(P50)以下者为对照组(218例)。2005年对该队列组样本进行随访。随访时间平均18年。结果总随访率75.8%,其中超重组随访率71.4%,对照组随访率76.6%;无论基线还是随访血压,超重组均显著大于对照组,超重组18年后发生高血压(≥140/90mmHg)的几率有高于对照组的趋势但无显著性(30.0%vs13.8%,P>0.05);随访期间的BMI增加幅度在最高的4分位者,高血压发生率是最低的2个4分位者的4.5倍(37.9%vs8.8%,P<0.01)。结论青少年时期BMI增长过快者远期随访血压增幅大,高血压发生率显著增加,是青年高血压发病重要易患因素。     

盐敏感性对青少年远期血压变化及高血压发生的影响

目的 探索盐敏感性对青少年远期血压变化及高血压发生影响.方法 1987年在陕西汉中农村对4623名6～15岁在校学生进行血压等相关因素调查的基础上,选310名儿童经口服盐水负荷与速尿利钠缩溶试验方法,确定盐敏感性,其中盐敏感组101例,盐不敏感组209例,于2005年进行随访.结果 基线样本310例,共随访到223例(盐敏感者71例,盐不敏感者152例),总随访率71.9%,其中盐敏感者随访率70.3%,盐不敏感者随访率72.7%;盐敏感组儿童18年后血压增幅较大,无论收缩压还是舒张压均显著大于盐不敏感者[收缩压:(122.9±13.1)vs(117.3±12.4)mmHg,P相似文献   

社区非糖尿病人群血压水平与稳态模型胰岛素抵抗指数及定量胰岛素敏感性指标的相关性研究

目的 探讨社区非糖尿病人群血压测值与稳态模型胰岛素抵抗指数(HOMA-IR)及定量胰岛素敏感性指标(QUICKI)的相关性.方法 2002年8月至2004年3月,在上海交通大学医学院附属仁济医院内分泌科对上海浦东上钢和塘桥社区居民743名(除外糖尿病和糖耐量受损、继发性高血压及有严重肝、肾功能损害者)进行研究检测.以标准法测量血压、身高、体重、腰围和臀围.根据不同血压测值分为非高血压组和高血压组.非高血压组包括(1)理想血压组,收缩压＜120 mm Hg(1 mm Hg=0.133 kPa),舒张压＜80 mm Hg;(2)正常血压组收缩压120～＜130 mm Hg,舒张压80～＜85 mm Hg;(3)正常高值血压组收缩压130～＜140 mm Hg,舒张压85～＜90 mm Hg.高血压组收缩压≥140 mm Hg和(或)舒张压≥90 mm Hg.放免法测定空腹血浆胰岛素,并计算HOMA-IR及QUICKI.采用SPSS 11.5软件进行统计分析.结果 社区743名非糖尿病人群中,正常高值血压组和高血压组与理想血压组之间HOMA-IR及QUICKI比较差异均有显著性意义(P＜0.01).血压值与年龄、体重指数(BMI)、腰围、WHR、空腹胰岛素、血浆总胆固醇、三酰甘油及HOMA-IR呈正相关,与QUICKI呈负相关.在控制年龄及性别之后,HOMA-IR及QUICKI和血压之间仍明显相关(P＜0.001).结论 HOMA-IR和QUICKI指数均是预测正常高值血压人群胰岛素抵抗的独立影响因子.治疗早期高血压,减轻胰岛素抵抗的因素可能更重要.     

盐敏感性对青少年远期血压变化及高血压发生的影响

目的探索盐敏感性对青少年远期血压变化及高血压发生影响。方法 1987年在陕西汉中农村对4623名6～15岁在校学生进行血压等相关因素调查的基础上,选310名儿童经口服盐水负荷与速尿利钠缩溶试验方法,确定盐敏感性,其中盐敏感组101例,盐不敏感组209例,于2005年进行随访。结果基线样本310例,共随访到223例(盐敏感者71例,盐不敏感者152例),总随访率71.9%,其中盐敏感者随访率70.3%,盐不敏感者随访率72.7%;盐敏感组儿童18年后血压增幅较大,无论收缩压还是舒张压均显著大于盐不敏感者[收缩压:(122.9±13.1)vs(117.3±12.4)mmHg,P<0.01;舒张压:(78.2±10.4)vs(74.7±10.8)mmHg,P<0.05];盐敏感组随访远期高血压(≥140/90 mmHg)患病率显著大于盐不敏感者(15.5%vs 6.3%,RR=2.46,P<0.05)。结论盐敏感儿童远期随访血压增幅大,高血压发生率显著大于盐不敏感者,前者是青少年高血压发病的独立危险因素。     

有效控制血压对高危高血压患者左室肥厚的长期影响

目的对"1999WHO/ISH高血压防治指南"危险分层为高危和极高危组的患者单用或联合使用指南推荐的一线降压药,以血压＜140/90 mm Hg作为目标血压,观察有效控制血压对高危高血压患者左室肥厚的长期影响.方法763例患者确定危险分层入选后,随机进入目标治疗组(n=382)和对照组(n=381).目标治疗组在高血压专科门诊定期随访,按5步法治疗方案,直到达到或接近目标血压为止.对照组在普通门诊治疗.测定基线和治疗后的超声心动图.结果两组患者的基线特征无明显差异.在平均4.4年随访期间,目标治疗组平均收缩压/舒张压为(133.8±6.6/79.7±5.5)mm Hg,明显低于对照组(151.7±12.7/87.7±8.0)mm Hg,P＜0.0001).共有437例患者复查超声心动图1次以上.目标治疗组(n=270)左室重量指数由124.9降至119.7 g/m2,下降4.2%(P=0.007);对照组由131.0增至136.9 g/m2,增加4.5%(P=0.05).233例患者在基线时患有左室肥厚,目标治疗组142例;对照组91例.最后1次测量与基线相比,目标治疗组左室重量指数降低14.8 g/m2(10.1%,P＜0.0001);对照组下降2.9 g/m2(1.8%,P=0.53).目标治疗组66例左室肥厚消失,左心室肥厚逆转率为46.5%,显著高于对照组的31.9%(91例中29例左室肥厚消失,P=0.03).在基线没有左室肥厚的204例患者中,目标治疗组(n=128)左室重量指数增加5.3 g/m2(5.3%,P=0.03);对照组(n=76)增加16.4 g/m2(16.8%,P＜0.0001).复查达到左室肥厚标准者,目标治疗组34例(26.6%);对照组27例(35.5%),两组间无显著差异(P=0.12).结论与一般治疗相比,长期严格控制血压能降低高血压左室肥厚患者的左心室重量,并显著提高左室肥厚逆转率.     

脑梗死患者急性期血压监测与预后的初步研究

目的探讨脑梗死患者急性期动态血压的变化及血压与预后的相关性。方法本研究为前瞻性地对发病48h内入院的53例脑梗死患者进行24 h动态血压监测,持续10天,记录其他影响预后的危险因素,并在21天、3个月做近远期神经功能评分。结果脑梗死患者急性期高血压常见,有自发下降的趋势。在入院4天时,收缩压和舒张压分别下降(8.8±7.9)mm Hg(、4.5±5.0)mm Hg(1 mm Hg=0.133 kPa,P<0.05),4~10天时血压下降趋势趋于平缓。脑梗死患者急性期血压与远期预后单因素分析显示呈U型曲线关系,血压的最适水平为收缩压140~160mm Hg,舒张压75~80 mm Hg。但在多因素分析中仅收缩压≥160 mm Hg与140~159.9 mm Hg比较是近期(P=0.024)和远期(P=0.046)预后不良的独立危险因素,收缩压每升高10 mm Hg,近期和远期预后不良的危险性分别增加368.2%和137.2%。结论脑梗死患者急性期血压显著升高(收缩压≥160 mm Hg)提示预后不良。     

青少年初始血压高者在高血压发生中的预测意义

为探讨初始血压偏高者在高血压发生中的预测意义，对汉中农村４６２３名年龄６～１５岁青少年血压，经过８年随访（末次随访率为８２．０７％）证明，基线调查收缩压百分位与８年后的收缩压相关系数，男为０．３３，女为０．２８，舒张压均为０．２０；基线调查收缩压在第７５百分位（Ｐ７５）以上者，８年后血压≥１８．７／１２．０ｋＰａ（１４０／９０ｍｍＨｇ）的机率是＜Ｐ５０以下的３．９１倍，初始血压百分位愈高相对危险性愈大；如同时初始收缩压≥Ｐ７５、体重指数≥Ｐ９０，并有高血压病家族史者，发生高血压的机率为２７．６％，是收缩压＜Ｐ７５、体重指数＜Ｐ９０和无高血压家族史者的６．５７倍。我们认为，青少年初始血压高者是成年高血压的易感人群，特别当伴有肥胖或超重及高血压家族史者，预测意义更大。     

高血压前期人群血压转归及其影响因素

目的 探讨高血压前期人群血压转归及其影响因素.方法 选择2006-2007年度开滦集团公司职工健康体检中符合JNC-7高血压前期诊断标准的高血压前期人群作为观察队列.于2008-2009年度对观察队列进行第2次健康体检,观察其血压转归情况及其影响因素.结果 (1)纳入最终观察队列的高血压前期者为25 474例,第2次体检时有8361例进展至高血压.男性与女性人群进展至高血压的比例分别为35.3%、23.3%;基线血压水平在120-129/80～84 mm Hg(1 mm Hg=0.133 kPa)、130～139/85～89 mm Hg范围内的人群进展至高血压的比例分别为27.2%、43.8%;有、无危险因素的人群进展至高血压的比例分别为34.3%、19.9%.(2)多因素logistic回归分析影响进展至高血压的危险因素依次是基线收缩压、腰围、年龄、体质指数(BMI)、性别(男性)、舒张压、总胆固醇、空腹血糖、甘油三酯、低密度脂蛋白胆固醇,上述因素每增加一个单位进展至高血压的RR(95%可信区间)分别为1.052(1.048～1.056)、1.009(1.006～1.013)、1.023(1.021～1.026)、1.063(1.052～1.074)、1.554(1.442～1.675)、1.036(1.029～1.043)、1.064(1.037～1.093)、1.043(1.024～1.062)、1.041(1.021～1.062)、1.035(1.000～1.072).结论 2年间有32.8%的高血压前期人群进展至高血压.基线收缩压、腰围、年龄、BMI、性别(男性)、舒张压、总胆固醇、空腹血糖、甘油三酯、低密度脂蛋白胆固醇是进展至高血压的危险因素.     

数字疗法用于中国成人高血压患者进行自我管理的评估

目的 探讨数字疗法用于中国成人高血压患者自我管理的可行性及效果评估。方法 纳入2021年5月1日—12月31日使用数字疗法进行自我管理的高血压患者进行回顾性分析。根据基线收缩压(SBP)值将受试者分为正常血压组(SBP<130 mm Hg)、正常高值血压组(SBP 130～139 mm Hg)、1级高血压组(SBP 140～159 mm Hg)和2级高血压组(SBP 160～179 mm Hg),采用混合效应模型分析血压管理效果。结果 队列共纳入1 131例,最终数据可用于分析者514例,年龄中位数(四分位间距)是51岁(42～60岁)。正常血压组共237例(46.1%),正常高值血压组共118例(23.0%),1级高血压组共96例(18.6%),2级高血压组共63例(12.3%),各组受试者在26周时SBP降幅(均数标准误)分别为2.9(0.9)、14.2(1.5)、25.9(2.1)、35.3(3.2) mm Hg。基线SBP>140 mm Hg者共159例(30.9%),在26周时血压控制率为87.4%。校正了年龄、性别、体重指数、腰围、吸烟、焦虑、高脂血症、糖尿病、...     

出生体重与青少年期单纯性肥胖及血脂、血糖、血压相关关系的队列研究

目的 探讨出生体重与青少年期单纯性肥胖及血脂、血糖、血压的相关关系。方法 采用整群抽样横断面调查与追踪调查的流行病学方法,对北京市193名健康学龄儿童（7～11岁）与9年后同一观察对象（16～20岁）进行出生情况调查、体格检查及实验室检测。结果 出生体重与儿童、青少年期体质指数呈U型相关,低出生体重组（5．6％）及高出生体重组（6．1％）青少年期超重-肥胖发生率较正常出生体重组（2．8％）有增高趋势,但差异无统计学意义（P〉0．05）。高出生及低出生体重组体质指数均显著大于正常出生体重组（P值分别为0．002和0．009）,高出生体重组（33．3％）及低出生体重组（38．9％）青少年期超重-肥胖发生率均显著高于正常出生体重组（16．2％,P值分别为0．025和0．020）。不同出生体重婴儿至儿童及青少年期血糖、血脂及血压水平未发现显著差异。结论 胎儿宫内生长与青少年期体格生长密切相关,加强孕期营养指导有利于预防青少年期单纯性肥胖的发生。     

Left ventricular mass and incident hypertension in individuals with initial optimal blood pressure: the Strong Heart Study

OBJECTIVE: Metabolic abnormalities have been shown to predict 8-year incident arterial hypertension in individuals with optimal blood pressure. As echocardiographic left ventricular mass has also been reported to predict incident hypertension in individuals with baseline blood pressure of less than 140/90 mmHg, we determined whether left ventricular mass predicts 4-year incident hypertension also in individuals with initial optimal blood pressure (<120/80 mmHg), independent of metabolic factors influencing blood pressure. METHODS: We studied 777 of 3257 members of the American Indian population-based Strong Heart Study cohort with optimal blood pressure (34% men, 45% obese, and 35% diabetic), aged 57 +/- 7 years, and without prevalent cardiovascular disease. RESULTS: Over 4 years, 159 individuals (20%, group H) developed hypertension (blood pressure >/=140/90 mmHg). They had a greater baseline BMI, waist girth, and blood pressure (112/69 vs. 109/68 mmHg, all P < 0.03) than those remaining normotensive (group N), with similar lipid profile and renal function. At baseline, left ventricular mass was significantly greater in group H than in group N (P < 0.004). The difference in left ventricular mass was confirmed after controlling for initial BMI, systolic blood pressure, homeostatic model assessment index, and diabetes. The probability of incident hypertension increased by 36% for each standard deviation of left ventricular mass index (P = 0.006), independent of covariates. Participants with left ventricular mass of more than 159 g (75th percentile of distribution) had 2.5-fold (95% confidence interval, 1.4-3.6; P < 0.001) higher adjusted risk of incident hypertension than those below this value. CONCLUSION: Left ventricular mass predicts incident arterial hypertension in individuals with initially optimal blood pressure. This association is independent of body build, prevalent diabetes, and initial blood pressure.     

High-normal blood pressure progression to hypertension in the Framingham Heart Study

This study sought to determine if individuals with high-normal blood pressure (diastolic blood pressure of 85-89 mm Hg) progress to hypertension more frequently than those with normal blood pressure (diastolic blood pressure less than 85 mm Hg), thus advancing to a higher cardiovascular risk category. Individuals from the Framingham Heart Study were placed in normal and high-normal blood pressure categories and followed for 26 years for the development of hypertension. With hypertension defined as a diastolic blood pressure of 95 mm Hg or greater or the initiation of antihypertensive therapy, 23.6% of men and 36.2% of women with normal blood pressure developed hypertension compared with 54.2% of men and 60.6% of women with high-normal blood pressure. The relative risk for the development of hypertension associated with high-normal blood pressure was 2.25 for men (95% confidence interval [CI], 1.8-2.8; p less than 0.0001) and 1.89 for women (95% CI, 1.5-2.3; p less than 0.0001). The age-adjusted relative risks estimated by the proportional hazards model were 3.36 for men and 3.37 for women (p less than 0.001). Among those risk factors examined, baseline systolic and diastolic blood pressure, Metropolitan relative weight, and change in weight over time were significant predictors of future hypertension in men and women whose initial blood pressure was normal. For men with high-normal blood pressure, systolic blood pressure and change in weight were identified as risk factors for future hypertension. These results indicate that the probability of individuals with blood pressure in the high-normal range developing hypertension is twofold to threefold higher than in those with normal blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)     

H型高血压患者动态血压的特点

目的:分析H型高血压患者动态血压的表现及特点。方法:连续入选自2010年1月至2013年3月,于我院住院的高血压患者,根据血清同型半胱氨酸(Hcy)水平将患者分为非H型高血压组(Hcy10μmol/L,A组)和H型高血压组(Hcy≥10μmol/L,B组),其中B组患者又分为B1组(Hcy20μmol/L)和B2组(Hcy≥20μmol/L)。所有患者均接受动态血压监测,对比分析两种类型高血压患者动态血压的特点。结果:本研究共入选高血压患者242例,其中H型高血压组(B组)患者136例(56.2%)。与非H型高血压患者相比,H型高血压患者动态血压,表现为非勺型和反勺型者均明显增多(非勺型:75.7%vs.34.9%,P0.001;反勺型:33.1%vs.18.9%,P=0.017),晨峰血压水平明显升高[(169±10)vs.(160±7)mmHg(1mmHg=0.133kPa),P=0.036]。进一步亚组分析显示,B2组患者反勺型血压明显高于B1组(43.8%vs.23.6%,P=0.013),晨峰血压水平也明显高于B1组[(174±9)vs.(166±9)mmHg,P=0.042]。结论:与非H型高血压患者相比,H型高血压患者的动态血压表现为非勺型及反勺型者明显增多,晨峰血压明显增高。     

Lowering of blood pressure and coronary blood flow in isolated systolic hypertension.

BACKGROUND: In essential hypertension, the lower limit of autoregulation of coronary flow shifts to higher perfusion and the hypertensive ventricle is at a higher than normal risk of ischemia, and less able to tolerate acute reduction of coronary perfusion pressure. Little is known about pattern of coronary flow in isolated systolic hypertension, a pathologic condition in which the elevated systolic blood pressure is associated with a lower than normal vascular compliance and normal or slightly greater than normal mean arterial pressure and vascular resistance. OBJECTIVE: To evaluate the effects of rapid normalization of blood pressure on coronary blood flow in isolated systolic hypertension. METHODS: We subjected 20 patients with isolated systolic hypertension to intraoperative hemodynamic and transesophageal echocardiographic monitoring during peripheral vascular surgery. Coronary flow velocity integrals and diameters in the left anterior descending coronary artery were evaluated under baseline conditions and after normalization of blood pressure, which occurred spontaneously during anesthesia (10 cases; group 1A) or was induced by infusion of nitrate (10 cases, group 1B). RESULTS: After normalization of systolic blood pressure integrals decreased significantly only for patients in group 1A; percentage changes of diameter were significantly greater for patients in group 1B. Therefore, coronary blood flow after normalization of systolic blood pressure increased for patients in group 1B (by 28+/-25%) and decreased for patients in group 1A (by 30+/-21%). Changes in integrals were inversely related to those in diameter (r= -0.72, P < 0.001); for patients in group 1A changes in coronary perfusion pressure and diameter were related to those of integrals (r= 0.94; P < 0.0005). CONCLUSIONS: In isolated systolic hypertension, despite there being similar changes of the systolic blood pressure, administration of nitrates caused a marked increase of coronary flow through direct effects on coronary circulation, whereas spontaneous normotension was associated with a significant reduction of coronary flow.     

Resting blood pressure and cardiovascular response to sympathetic stimulation in adolescents.

The prevalence of significant hypertension in childhood may be higher than expected. We have measured sitting blood pressure in 168 11-yr-old children attending a pre-high school in the Neapolitan area on four occasions over a 3-month period. We have also measured blood pressure and heart rate during a mental arithmetic test and during isometric exercise. Prevalence of significant hypertension (diastolic blood pressure 82-90 mmHg) was 13% at the first visit and decreased to 6.5% at the last visit; prevalence of severe hypertension (diastolic blood pressure greater than or equal to 90 mmHg) decreased from 5.4% to 1.2% from the 1st to the 4th visit. No sex-related difference was observed. A more frequently positive family history of hypertension (50% vs 30% in the fifth and first quintile of blood pressure, respectively) and higher body weight (body mass index = 21.4 vs 19.3 kg/m2) were found in children in the 5th quintile of blood pressure distribution. Blood pressure increased during mental arithmetic by 10/13% of the resting values in the first quintile and by 6/11% in the last one during mental test; during handgrip the increase was of 20/37% and 24/46%, respectively: differences between quintiles did not reach statistical significance. These data show that about 8% of a Neapolitan sample of school population have high blood pressure levels, while no difference in vascular reactivity to sympathetic stimulation was detected in children with higher blood pressure.     

超敏C反应蛋白水平与血压昼夜波动程度的关系

目的 探讨血浆C反应蛋白水平与血压昼夜波动程度的关系. 方法入选高血压患者82例,正常血压者79例.采用免疫荧光色谱法检测血浆超敏C反应蛋白水平,同时用24 h动态血压仪监测入选者血压水平和血压变异性.采用多元线性回归,校正年龄、性别、体质指数、血糖、血脂、吸烟史、基线血压等各影响因素,分析C反心蛋白水平与血压昼夜波动的关系. 结果 (1)高血压组白天、夜间和24 h收缩压变异性均高于对照组(P＜0.01、P＜0.01和P＜0.05),舒张压变异性亦高于对照组(均为P＜0.05),而夜间收缩压、舒张压和平均动脉压下降率均低于对照组(分别为P＜0.01、P＜0.05和P＜0.05);(2)高血压组血浆C反应蛋白高于对照组分别为(5.44±1.78)mg/L与(3.03±0.72)mg/L,差异有统计学意义(P＜0.01);(3)高血压组白天、夜间和24 h 3个时段的舒张压变异性均与C反应蛋白水平呈正相关(分别为r=0.492,P＜0.001;r=0.240,P=0.048;r=0.271,P=0.030).多元线性回归分析结果显示,上述3个时段的舒张压变异性对C反应蛋白水平具有预测作用(r=0.660,决定系数R2=0.436;回归模型F=11.597,P＜0.001).(4)正常血压组各时段的血压变异性与C反应蛋白水平无相关性. 结论高血压患者血压变异性、血浆C反应蛋白水平均显著高于正常血压患者,而夜间血压下降率低于正常血压者,且高血压患者血浆C反应蛋白水平与昼夜血压的波动程度,特别是舒张压的波动程度密切相关.

Abstract：

Objective To explore the association between CRP and circadian variation of blood pressure in both hypertensive and normotensive old population.Methods The 82 patients with essential hypertension (EH) and 79 normotensive adults were enrolled in this study. Serum high sensitive CRP (hsCRP) level was tested by fluorescence immunoassay technology. The 24-hour ambulatory monitor of the level and variability of blood pressure was carried out. Multivariable linear regression models were run to adjust the age, gender, body mass index, blood sugar, blood fat,smoking history and baseline blood pressure for analyzing the association between hsCRP and circadian variation of blood pressure.Results ( 1 ) The variability of systolic blood pressure during daytime,nighttime and 24-h our periods were higher in EH group than in control group (P＜0.01 or P＜0. 05), the variabilities of diastolic blood pressure were also significantly higher than in control group (P＜0. 05), the dipping ratios of nocturnal systolic, diastolic and mean artery pressure were all less than in contrast group (all P＜0.05). (2) The hsCRP was obviously higher in EH group than in control group [(5.44± 1.78)mg/L vs. (3.03±0. 72) mg/L, P＜0. 01]. (3) The hsCRP had positive associations with diastolic blood pressure variability during daytime (r= 0. 492, P＜0. 001 ), nighttime (r=0.240, P=0.048), and 24-hour (r=0.271, P=0.030). The variability in diastolic blood pressure predic ted the level of hs CRP(r=0.660, R2=0.436, P＜0.001). (4) In control group, no significant association was found between CRP and variation of blood pressure.Conclusions The BP variability and serum CRP in EH patients are obviously higher than in normotensive patients,however, the nocturnal BP dipping ratio is less than in normotensive patients. Furthermore, the level of serum hsCRP in EH patients is positively associated with the variation of blood pressure, especially for variation of diastolic blood pressure.     

高血压家族史儿童血压水平的研究

目的：了解有高血压家族史儿童的血压水平。方法：对167例有高血压家族史的儿童测量血压,以175例无高血压家族史的健康儿童作为对照。结果：与对照组比较,有家族史的儿童收缩压和舒张压明显增高,高血压检出率明显增高（2．57％：15．13％,P〈0．01）。有早发高血压家族史的儿童与非早发家族史儿童比较,收缩压和舒张压更高,高血压检出率更高（21．54％：12．94％,P〈0．01）。结论：有高血压家族史儿童血压水平较无高血压家族史儿童高,以有早发高血压家族史儿童更明显,提示成年后发生高血压的危险性显著升高。     

White coat effect, blood pressure and mortality in men: prospective cohort study.

BACKGROUND: Because long-term follow-up studies, which also included normotensive controls, have been lacking, the clinical significance of 'white coat' effect and of 'white coat' hypertension has remained controversial. METHODS AND RESULTS: Twenty-one-year prospective data was gathered in 536 men with cardiovascular risk factors at baseline. Blood pressure was measured both by a nurse and by a physician and 'white coat effect' was defined as the difference between the two measurements (physician minus nurse). In addition, four blood pressure groups were categorized: normotensive (n=259), white coat hypertensive (n=18), mildly hypertensive (n=150) and persistently hypertensive (n=109). Comparison of these groups at baseline showed that men with white coat hypertension had higher levels of metabolic risk factors. Sixty-eight men died during follow-up. The men with a white coat effect >30 mmHg (n=37) had significantly higher mortality than other men (relative risk 2.2, 95% confidence interval 1.1-4.2). Mortality was significantly higher in the white coat hypertensive group (33.3%) than in the normotensive group (9.5%, P=0.0005 between groups). Relative risk adjusted for baseline risk factors in the white coat hypertensive group was 3.3 (1.2-7.6) compared with the normotensive group. The development of drug-treated hypertension was also more common (27.8% vs 13.4% in the normotensive group, P<0.0001 between groups). CONCLUSION: The results suggest that white coat hypertension or a large white coat effect is not an innocent phenomenon. It tends to co-exist with metabolic risk factors and predicts total and cardiovascular mortality during long-term follow-up.     

血清高敏C反应蛋白与血压的关系

目的 探讨自然人群中C反应蛋白与血压的关系.方法 在江苏省高邮市八桥镇随机人选了3889名18～74岁农村居民,使用标准流行病学调查表进行问卷,并测量血压,空腹抽血常规生化检查,免疫比浊法测量高敏C反应蛋白(hCRP).按hCBP四分位间距将男性与女性分别分为4组:Q1组(男性hCRP＜2.04 mg/L;女性hCRP＜1.80 mg/L);Q2组(男性2.04 mg/L≤hCRP＜3.01mg/L;女性1. 80 mg/L≤hCRP＜2.76 mg/L);Q3组(男性3.01 mg/L≤hCRP＜4.14 mg/L;女性2.76mg/L≤hCRP＜3.84 mg/L);Q4组(男性hCRP≥4.14 mg/L;女性hCRP≥3.84 mg/L).结果 男性的收缩压(调整后P=0.016)与脉压(调整后P=0.003)、女性脉压(调整后P=0.002)随CRP浓度增高而增高,而舒张压与CRP无显著相关.多元回归提示logCRP增高与男性收缩压及男女脉压升高独立相关.调整年龄、体质指数、腰臀比、吸烟史、饮酒史等变量,hCRP与男性高血压发病独立相关,男性Q4组高血压患病风险较Q1组增高40.4%(95%可信区间:4.9%～87.9%).结论 hCRP增高与男性与女性脉压增高,及男性收缩压增高与高血压发病的独立相关.