胰岛素抗性与高血压关系的研究进展

高血压是国际上最受重视的研究领域之一,随着对高血压基础、临床和流行病学的研究不断深入,人们对高血压的认识有两个较大的飞跃:①高血压不单纯是血压升高,而且伴有其它方面的异常;②高血压的治疗不应是单纯的控制血压,而且要降低并发症的发生率和死亡率。近年来,人们对高血压的代谢异常兴趣大增,而胰岛素抗性(insulin resistance)在这些代谢异常     

老年人群血压水平与多代谢异常的关系

目的探讨老年人群血压水平与多代谢异常的关系。方法对648名年龄为60～78岁的老年人进行健康查体,对不同血压水平老年人体重指数(BMI)、血清总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)和空腹血糖(FPG)平均水平及超重肥胖、高血压、高血糖、血脂异常等代谢异常的检出率进行分析,对多代谢异常的危险性进行分析。结果血脂异常、高血压、超重肥胖是老年人群出现较早的、最常见的代谢异常。随着血压水平的升高,老年人BMI、TC、TG、LDL-C、FPG平均水平明显升高,HDL-C平均水平明显降低,老年人群合并二种、三种代谢异常的检出率明显升高,合并二种、三种代谢异常的危险性明显升高。血压水平为120～129/80～84 mmHg和130～139/85～89 mmHg时,老年人群合并二种代谢异常的检出率为29.81%、32.26%,合并二种代谢异常的危险性是理想血压人群的2.73、3.06倍。高血压人群比血压正常人群更易合并多种代谢异常,高血压人群合并二种、三种代谢异常的检出率为45.65%、10.33%,合并二种、三种代谢异常的危险性是血压正常人群的2.18、2.57倍。结论血压水平达到和超过120～139/80～89 mmHg时,老年人群多代谢异常的检出率和危险性明显升高。     

高血压患者糖类和脂蛋白代谢异常与肥胖的关系

未经治疗的高血压患者,糖、胰岛素和脂蛋白代谢异常比血压正常对照更为常见,其原因尚不清楚。一种可能是高血压与代谢异常二者偶然伴随;另一种可能认为糖、胰岛素和脂蛋白代谢的异常改变在高血压患者     

代谢相关性高血压：代谢性心血管病的重要驱动力

代谢相关性高血压是指代谢紊乱与血压升高之间存在因果关系, 排除了其他继发性高血压, 干预代谢紊乱可降低血压的一类高血压, 也是代谢性心血管疾病的重要驱动因素。代谢相关性高血压的心血管风险高低既取决于血压水平, 也与合并代谢危险因素的多少有关。胃肠道和能量失衡介导的代谢紊乱在其发病中起重要作用。代谢相关性高血压需控制血压及改善代谢紊乱并重, 内分泌代谢与心血管学科的交叉融合有助于代谢性相关性高血压的防治。     

代谢性高血压的手术治疗进展

代谢性高血压的干预策略应当兼顾血压控制和改善代谢紊乱, 全面降低心血管病风险。从20 世纪50 年代减 重手术用于治疗肥胖, 到今天已发展为一系列代谢手术用于糖尿病等代谢相关疾病的治疗。目前临床研究已证实 代谢手术能有效降低血压, 同时可改善多种代谢性心血管危险因素, 是治疗代谢性高血压的有效方法。建立多学科 协作团队, 深入开展代谢手术治疗高血压的机制探索、适应征选择、远期效果评价等研究, 将有助于代谢性高血压的 综合控制。     

代谢性高血压:一个值得探索的问题

近20年来随着对高血压研究的逐步深入,现巳认识到高血压是一个由多重危险因素所致,能产生多种心血管损害的临床综合征,血压升高只是其中表现之一。为此,美国高血压学会(ASH)、美国心脏协会(AHA)、美国心肺血研究所(NHBLI)和国际高血压学会(ISH)均提出对高血压的研究不应局限于血压的调节和高血压的控制,而应更广泛地关注导致高血压的诸多心血管和代谢危险因素。另外,近10年的分子生物学研究也显示高血压是一个多基因疾病,某些高血压相关基因也是肥胖、糖脂代谢紊乱和动脉粥样病变的易感基因,如撇开糖脂代谢异常,肥胖和代谢综合征这些…     

某些高血压急症的诊断与处理

高血压急症系指血压突然或极度升高损害了脑、心、肾功能并威胁生命的情况。须立即采取降压措施。决定发生高血压急症的因素主要是血压升高的程度而不是产生高血压的原因,且血压上升的速率较血压的绝对值更重要。伴有急性左心衰竭、急性夹层动脉瘤或颅内出血者,即使血压只有中度升高也是危险的。因此,对高血压急症的处理须及时果断,切忌忙于进行各种检查而延误治疗。高血压急症中的急进性     

艾灸疗法治疗原发性高血压的研究进展

高血压是心脑血管疾病发生的首要危险因素,艾灸对血压的调控作用已经得到临床证实,但相关作用机制还未完全阐明,需进一步深入研究。本文通过对近年来艾灸疗法治疗原发性高血压的作用特点及起效机制进行归纳总结。艾灸疗法常单独或联合其他疗法使用,辨证施灸调控血压水平。高血压前期应用艾灸疗法可改善体质偏颇,并具有一定远期疗效,其作用机制大多是通过调节神经-内分泌系统、改善内皮细胞功能、调节血流变、抗氧化应激实现,并与人体代谢异常互为因果。     

动态血压监测在糖尿病高血压患者的应用

糖尿病合并高血压的发病率很高，可是高血压控制现状不理想，其中一个重要原因是血压评估方法尚有一定误区。动态血压监测应该成为评估糖尿病高血压患者血压控制与指导抗高血压药物治疗的主要方法。     

宁夏社区人群代谢异常与心电图异常的关系

目的探讨人群代谢异常与心电图异常的关系。方法选取卫生部疾病控制项目"全国高血压规范化管理"和卫生部行业基金项目"心血管病危险因素监测和高血压规范化管理"中宁夏分中心的基线资料2 524例进行分析。调查内容包括问卷调查、体格检查、血压测量、实验室检查、心电图检查。结果心电图异常的检出率为15.2%,其中男10.2%,女19.7%,女性心电图异常检出率超过男性(P<0.001)。代谢异常的数量越多,心电图异常的检出率越高(P<0.05)。不同代谢异常数目下,代谢异常的组成存在差别,但统计学无显著差异。Logistic回归分析统计结果显示4种代谢异常的风险最大〔OR=4.19,95%CI(2.62⁶.70)〕,一种代谢异常的人群,血糖异常对心电图异常的检出风险最大;两种代谢异常的人群,血压升高合并血脂异常对心电图异常的检出风险最大;3种代谢异常的人群,血压升高合并中心性肥胖与血脂异常对心电图异常的检出风险最大。结论随着代谢异常的数量增多,心电图异常的检出率增高。一种代谢异常的人群,应重点干预血糖异常;两种代谢异常的人群,应重点干预血压升高合并血脂异常;3种代谢异常的人群,应重点干预血压升高合并中心性肥胖与血脂异常。     

Metabolic disorders predict development of hypertension in normotensive Japanese subjects

Each component of the metabolic syndrome is not necessarily clustered coincidentally. Thus, subjects who have obesity, dyslipidemia or impaired glucose tolerance may be at high risk for the development of hypertension. We studied the predictive value of the following for the development of hypertension: obesity (body mass index > or =25.0 kg/m2), dyslipidemia (high-density lipoprotein-cholesterol <40 mg/dL, triglyceride > or =150 mg/dL, or use of anti-dyslipidemic drugs), high normal blood pressure (130 mmHg < or = systolic <140 mmHg, or 85 mmHg < or = diastolic <90 mmHg), and impaired glucose tolerance (fasting plasma glucose > or =110 mg/dL or use of anti-diabetic agents). This observational study included 5,785 subjects without hypertension recruited from participants in our health checkup program. They were followed up for 1,097+/-365 d, with the endpoint being the development of hypertension. During the follow-up, hypertension developed in 1,168 subjects (74.1 per 1,000 person-years). The incidence of hypertension was higher in subjects who had obesity (106.2 vs. 67.8), dyslipidemia (96.1 vs. 69.0), high normal blood pressure (166.0 vs. 40.1), or impaired glucose tolerance (130.5 vs. 65.3 per 1,000 person-years) than in those without these disorders at baseline. The risk of hypertension was increased as the number of metabolic disorders in an individual increased. Multiple regression analysis indicated that obesity, high normal blood pressure, and impaired glucose tolerance remained independent predictors of the onset of hypertension. Thus, the presence of individual components of the metabolic syndrome predicts the development of hypertension. Prediction of the development of hypertension may lead to effective prevention of both hypertension and resulting cardiovascular diseases.     

Enhanced sodium sensitivity and disturbed circadian rhythm of blood pressure in essential hypertension

OBJECTIVE: To assess whether an association between sodium-sensitive hypertension and metabolic syndrome exists; and whether, in patients with metabolic syndrome, the nocturnal fall of blood pressure decreases and salt restriction affects the circadian blood pressure rhythm. METHODS: Japanese patients with essential hypertension, who were treated without any antihypertensive agent, were maintained on a high-sodium diet and a low-sodium diet for 1 week each. On the last day of each diet, the 24-h blood pressures were measured. A diagnosis of metabolic syndrome was made according to the International Diabetes Foundation definition RESULTS: Among the 56 patients with essential hypertension, 15 patients were complicated with metabolic syndrome while 41 patients were not. The nocturnal blood pressure fall was significant in patients without metabolic syndrome, while it was not so in patients with metabolic syndrome. Only in patients with metabolic syndrome was the nocturnal blood pressure fall enhanced by sodium restriction. The prevalence of sodium-sensitive hypertension in patients with metabolic syndrome was significantly higher than in those without metabolic syndrome (70.6 versus 36.0%, respectively; P = 0.017). A multiple logistic regression analysis revealed central obesity to be an independent risk factor for sodium-sensitive hypertension (odds ratio, 1.41; 95% confidence interval, 1.04-1.91). CONCLUSIONS: In patients with essential hypertension, an inter-relationship exists among metabolic syndrome, enhanced sodium sensitivity of the blood pressure and non-dipping. The elevated risk of cardiovascular diseases in patients with metabolic syndrome may be related to sodium-sensitive hypertension and non-dipping.     

Pleiotropic effects of angiotensin receptor blockers: addressing comorbidities by optimizing hypertension therapy

The efficacy of angiotensin receptor blockers (ARBs) in the management of hypertension is well established. Whether these agents induce pleiotropic effects that promote the amelioration of vascular disorders independent of blood pressure reduction remains controversial. This review examines preclinical and clinical data that highlight a potentially important role for ARBs in several common vascular disorders, including cardiovascular, cerebrovascular, renal, and metabolic disorders. The preponderance of evidence suggests that some of the benefits derived from ARBs might improve outcomes in these disorders by actions that extend beyond blood pressure reduction. This review also identifies some potentially important differences in the mechanism of action between ARBs and angiotensin-converting enzyme inhibitors that may have clinical significance in the management of vascular diseases.     

Pulse wave velocity in patients with obesity and hypertension

Pulse wave velocity was measured in 27 obese and 25 nonobese patients with sustained essential hypertension. Pulse wave velocity was significantly increased in obese patients in comparison with nonobese patients. The result was independent of age, sex, and level of blood pressure. In the overall population, a significant positive correlation (r = 0.85; p less than 0.001) was observed between the degree of obesity and pulse wave velocity. A study of partial correlation coefficients indicated that the levels of glycemia, cholesterolemia, and triglyceridemia did not influence the relationship. After body weight was reduced, blood pressure decreased and arterial compliance increased. The results show that in patients with sustained essential hypertension: pulse wave velocity and obesity are strongly related independent of age, sex, blood pressure, and associated metabolic disorders and body weight reduction is associated with an improvement of arterial distensibility and compliance.     

Borderline hypertension.

Borderline hypertension is a widespread condition and because of its large prevalence, it has a major impact on the cardiovascular mortality of the population. A modest elevation of blood pressure in borderline hypertension is closely associated with multiple rheologic, hemodynamic, humoral and metabolic abnormalities. Many of these abnormalities, independently of the blood pressure, increase the coronary risk in patients with borderline hypertension. There is no sufficient evidence in the literature to propose a well structured algorithm of management and treatment of borderline hypertension. Establishing a reliable baseline blood pressure (by ambulatory or home blood pressure monitoring) is the first step in the management of borderline hypertension. One year of intensive nonpharmacologic treatment is recommended as the first therapeutic modality. If this fails to decrease the blood pressure, pharmacologic treatment with small doses of antihypertensive medication is recommended in patients with dyslipidemia or in patients whose out of office blood pressure remains elevated.     

Management of hypertension in children and adolescents with the metabolic syndrome

Because elevated blood pressure is one of the defining criteria of the metabolic syndrome, treatment of hypertension will be required in many, if not most, children and adolescents diagnosed with the metabolic syndrome. This review highlights several aspects of the approach to treatment of hypertension in young patients with the metabolic syndrome, including the definition of hypertension, use of nonpharmacologic measures, indications for instituting antihypertensive medications, and the potential adjunctive role that insulin-sensitizing agents may play in blood pressure reduction. The choice of antihypertensive agent is also discussed, along with consideration of the diabetogenic effects of various classes of antihypertensive agents. Consideration of all of these issues is important in achieving blood pressure control in children and adolescents with the metabolic syndrome, as appropriate treatment may help to forestall the development not only of type 2 diabetes but also of the cardiovascular disease that is frequently already present at the time of diagnosis of type 2 diabetes in adults.     

Obesity and hypertension

Substantial evidence from epidemiological data supports a link between obesity and hypertension. However, the relationship between the two disorders is not straightforward and most likely represents an interaction of demographic, genetic, hormonal, renal, and hemodynamic factors. Age, race, and sex also modulate the strength of the association between obesity and hypertension. Hyperinsulinemia, which is characteristic of obesity, can contribute to the probability of developing hypertension by activating the sympathetic nervous system (SNS) and by causing sodium retention. The pressor effect of insulin in obesity may be further enhanced by the observation that its vasodilator action can be blunted in obese subjects. Preliminary data have shown that leptin, whose levels are increased in most obese individuals, can contribute to hypertension in obesity through its effects on insulin, SNS, and sodium excretion. The kidney may also have a role in the pathophysiology of hypertension in obesity. Abnormal renal sodium handling coupled with structural changes in the kidney of an obese patient can raise blood pressure. In addition, obesity is associated with distinct cardiovascular hemodynamic alterations and development of eccentric myocardial hypertrophy. Most of these obesity-associated abnormalities, as well as hypertension itself, can be reversed by weight loss. Furthermore, weight loss can prevent, or at least delay, the development of hypertension in patients with high-normal blood pressure. Weight reduction should be the first-line treatment in every obese hypertensive patient. However, the majority of patients will need pharmacologic intervention in conjunction with weight loss. Selection of antihypertensive agents in the overweight patient should take into account the mechanisms leading to hypertension and the metabolic abnormalities that characterize the obese patient.     

The kidney and hypertension: lessons from mouse models

The pathogenesis of hypertension is multi-factorial, involving many of the systems contributing to blood pressure homeostasis including the vasculature, kidneys, central, and sympathetic nervous systems, along with various hormonal regulators. However, over the years, many studies have indicated a predominant importance of the kidney in blood pressure homeostasis and hypertension. This work has established the notion that the kidney is a key determinant of the chronic level of intra-arterial pressure playing a major role in the pathogenesis of hypertension. Therefore, this review will focus on recent work using genetically modified mouse models addressing the role of the kidney in hypertension. In particular, human genetic studies of Mendelian disorders with major impact on blood pressure homeostasis have provided powerful evidence for a role of the kidney in hypertension. Of the approximately 20 genes identified as causal in these disorders, virtually all have an effect on the control of solute transport in the kidney. As such, we have especially focused on generation of mouse models addressing the nature of these specific molecular defects in nephron function that produce an alteration in blood pressure.     

老年高血压合并代谢异常特征及其对靶器官的影响

目的分析老年原发性高血压患者合并不同代谢异常的临床特征及其对靶器官的影响。方法选择老年高血压患者460例,根据合并代谢异常情况分为6组:A组(单纯高血压,21例),高血压合并腹型肥胖、血脂异常、糖尿病、高尿酸血症及代谢综合征分别为B组(32例)、C组(73例)、D组(54例)、E组(27例)和F组(253例),行相关生化指标检测和超声等检查,综合评估其靶器官损害和并发症情况。结果单纯高血压患者仅占4.6%,95.4%的患者合并1项以上代谢异常。与A组比较,F组体重指数、腰围、空腹血糖、餐后2 h血糖、糖化血红蛋白、TG、尿酸及血肌酐明显升高(P<0.05),HDI-C明显下降(P<0.05);各组高血压病程和血压控制水平相当,但F组较其他组需要多种的抗高血压药物(P<0.05);D组与F组颈动脉内膜中层厚度、尿微量白蛋白/肌酐以及合并冠心病和脑血管病差异有统计学意义(P<0.05)。结论老年高血压患者以多重代谢性危险因素聚集为特征,该特征使靶器官损害和心脑血管病的发生明显增加,且需要多种抗高血压药物联用以控制血压。