高血压并发症及其预防和治疗研究

目的对高血压并发症的预防和治疗方法进行研究和探讨。方法对高血压并发症采用流行病的方法进行调查,并根据并发症进行相应的预防和治疗措施。结果在高血压患者的并发症中,并发冠心病和视网膜病变的年龄之间存在着差异,并且两者之间差异明显,具有统计学意义(P0.05),高血压有着较高的并发症发生率,需要加强对并发症的治疗和预防。结论为了更好的降低高血压并发症的发生率,需要对高血压及其并发症的预防加强重视,同时对已经患有高血压疾病的患者进行必要的治疗。     

高血压并发症及其预防和治疗研究

目的对高血压并发症的预防和治疗方法进行研究和探讨。方法对高血压并发症采用流行病的方法进行调查,并根据并发症进行相应的预防和治疗措施。结果在高血压患者的并发症中,并发冠心病和视网膜病变的年龄之间存在着差异,并且两者之间差异明显,具有统计学意义(P0.05),高血压有着较高的并发症发生率,需要加强对并发症的治疗和预防。结论为了更好的降低高血压并发症的发生率,需要对高血压及其并发症的预防加强重视,同时对已经患有高血压疾病的患者进行必要的治疗。     

经导管主动脉瓣植入术后抗血栓治疗中国专家共识

经导管主动脉瓣植入术(TAVI)现已成为治疗有症状重度主动脉瓣狭窄患者的有效措施,且适用人群也从老年高风险患者逐步扩展到中、低风险及较年轻患者,但其术后缺血性及出血性并发症仍不少见,并有一定的致死率和致残率。该专家共识复习了相关资料及研究进展,结合我国具体情况及国际指南,给出了TAVI术后抗血栓治疗的建议,以期提高我国TAVI术后患者生存率及生存质量,减少缺血及出血并发症。该共识从TAVI术后血栓形成及出血的危险因素和机制、缺血及出血风险评估、抗凝与抗血小板治疗的选择、抗血小板治疗的方案、抗血栓时程、瓣叶血栓及出血并发症的处理等方面进行了详尽的阐述。强调TAVI术后应综合评估患者缺血及出血事件发生的风险,方案的制定应个体化,进而改善患者预后。     

缺血性脑卒中患者二级预防中抗血栓药物使用现况调查

目的调查缺血性脑卒中患者二级预防中抗血栓药物的使用情况,并分析其影响因素。方法本研究为现况调查,其对象为在北京天坛医院神经内科门诊就诊既往诊断明确的脑梗死或短暂性脑缺血发作患者(发病后4周~5年),调查其近两周内的抗血栓药物使用情况及相关影响因素。依据患者是否使用抗血栓药物,将入选患者分为两组:即治疗组与未治疗组。结果符合入选标准的缺血性脑卒中患者共计669例,最后共有607例缺血性脑卒中患者进入本研究结果分析中。其中未接受抗血栓药物治疗者163例(26.9%)。使用阿司匹林的患者中438例,其中剂量25~40 mg/d的患者152例(34.7%)。在抗血栓药物的影响因素方面,较好的日常生活能力OR=1.009,95%CI:1.002~1.017、医疗保险OR=1.822,95%CI:1.123~2.956、高血压OR=1.533,95%CI:1.030~2.282是脑卒中患者接受药物治疗的促进因素。结论缺血性脑卒中幸存者均应给予抗血小板药物或抗凝药物,除非预计患者不久将死亡或有严重的禁忌证,其用药剂量应遵循临床指南。     

经导管主动脉瓣植入术后抗血栓治疗中国专家共识

经导管主动脉瓣植入术(TAVI)现已成为治疗有症状重度主动脉瓣狭窄患者的有效措施,且适用人群也从老年高风险患者逐步扩展到中、低风险及较年轻患者,但其术后缺血性及出血性并发症仍不少见,并有一定的致死率和致残率。该专家共识复习了相关资料及研究进展,结合我国具体情况及国际指南,给出了TAVI术后抗血栓治疗的建议,以期提高我国TAVI术后患者生存率及生存质量,减少缺血及出血并发症。该共识从TAVI术后血栓形成及出血的危险因素和机制、缺血及出血风险评估、抗凝与抗血小板治疗的选择、抗血小板治疗的方案、抗血栓时程、瓣叶血栓及出血并发症的处理等方面进行了详尽的阐述。强调TAVI术后应综合评估患者缺血及出血事件发生的风险,方案的制定应个体化,进而改善患者预后。     

急性缺血性脑卒中病人处理指南

美国心脏学会(AHA)根据心肺复苏准则,制定了缺血性卒中病人急诊处理准则,就急性脑卒中病人的早期识别、紧急支持治疗和急性并发症的处理、抗血栓或抗血小板药物的早期治疗、溶栓治疗、血液稀释疗法、细胞保护治疗和外科治疗等提出了原则性意见,供广大临床工作者参考。     

急性缺血性脑卒中病人处理指南

美国心脏学会根据心肺复苏准则，制定了缺血性卒病人急诊处理准则，就急性脑卒中病人的早期识别，紧急支持治疗和急性并发症的处理，抗血栓或抗血小板药物的早期治疗，溶栓治疗、血液稀释疗法、细胞保护治疗和外科治疗等提出了原则性意见供广大临床工作者参考。     

重视老年心血管疾病患者抗血栓策略的选择

抗血栓治疗是防止动静脉血栓形成、也是冠心病和房颤等心血管疾病的主要治疗措施之一,对于减少血栓性事件的发生具有重要意义。然而,抗血栓治疗常会导致出血。老年患者由于其自身的生理特点,常伴发多系统疾病,血栓及出血风险都明显增加,在抗血栓治疗时宜根据患者自身病情,慎重选择抗栓策略,平衡血栓及出血风险,使患者获益最大化。     

高血压伴糖尿病及心、脑、肾合并症的治疗对策

治疗高血压的目的不仅是为了控制血压,更重要的是防止并发症,保护靶器官.但当已出现并发症时,高血压治疗须注意什么,这是值得临床医生思考的问题.高血压的常见并发症发生于心、脑、肾等重要脏器,如何保护这些器官在高血压治疗中占有重要地位.     

高血压与冠状动脉、主动脉及髂股动脉粥样硬化的关系

近20年来,降压药的应用不断增加,这说明了降低动脉血压在控制高血压的小动脉并发症方面的重要性,以及治疗高血压有可能减少伴有动脉粥样硬化时的并发症。这是当前特别强调治疗高血压的理由之一。此外     

Pharmacologic treatment of portal hypertension.

Variceal formation and rupture are dreaded complications of chronic liver disease and portal hypertension. The pharmacologic treatment of portal hypertension should be able to stop as well as to prevent variceal hemorrhage. There are two principal types of vasoactive drugs in the treatment of portal hypertension: vasoconstrictors and vasodilators. Vasoconstrictors reduce the splanchnic blood flow, thereby decreasing the portal blood flow and portal pressure. Vasodilators act by different mechanisms, including by relaxation of myofibroblasts in the fibrous septa and presinusoidal areas of the liver and by direct vasodilation of the collateral circulation. In addition, paradoxically, they could decrease portal flow and pressure by inducing a baroreflex-mediated mesenteric arterial vasoconstriction. A miscellaneous group of drugs is also available. These drugs reduce the blood flow and pressure in the gastroesophageal variceal system by mechanisms other than vasoconstriction or vasodilation. The success of these pharmacologic agents is limited once the varices have ruptured. The use of beta-blockers in the prophylaxis of the first variceal bleeding has been proven of benefit in this respect. Future research should be aimed at elucidating the role that humoral and endothelial factors play in development of the hyperdynamic circulatory state that characterizes patients with portal hypertension. Once these etiologic factors have been identified and new knowledge is acquired about their role in the complications of chronic liver disease, the challenge will rest on developing novel pharmacologic therapies specifically targeting these factors.     

450例佤族高血压住院病例分析

目的对佤族高血压住院病例进行探讨,以了解佤族高血压患者的影响因素。方法随机抽取我院在2008年1月-2013年12月治疗的450例佤族高血压住院病例,通过回顾性分析法对患者的临床资料进行探讨与分析。结果 450例佤族高血压住院患者中以年龄较大或者是文化水平低的为主,其中51.1%(230例)的患者属于3级高血压,并发症发生率为62.2%(280例),合并症发生率为42.2%(190例)。450例佤族高血压住院患者中,60例患者死亡,死亡率为13.33%,在住院期间死亡的主要原因是脑出血,其余患者经过我院治疗后,均已好转出院。结论佤族由于其所在区域多为偏远农村,且文化水平偏低,对高血压不了解,因此高血压的防治难度较高,需要当地医院加大对高血压防治的宣传,提倡健康教育,帮助当地居民养成健康生活的方式,并对高血压患者进行治疗指导,以提高佤族居民对高血压的了解,从而降低高血压的患病率,有效控制并发症与合并症的发生率。     

Restructuring of the vascular bed in response to hemodynamic disturbances in portal hypertension

In recent years, defined progress has been made in understanding the mechanisms of hemodynamic disturbances occurring in liver cirrhosis, which are based on portal hypertension. In addition to pathophysiological disorders related to endothelial dysfunction, it was revealed: There is the restructuring of the vasculature, which includes vascular remodeling and angiogenesis. In spite of the fact that these changes are the compensatory-adaptive response to the deteriorating conditions of blood circulation, taken together, they contribute to the development and progression of portal hypertension causing severe complications such as bleeding from esophageal varices. Disruption of systemic and organ hemodynamics and the formation of portosystemic collaterals in portal hypertension commence with neovascularization and splanchnic vasodilation due to the hypoxia of the small intestine mucosa. In this regard, the goal of comprehensive treatment may be to influence on the chemokines, proinflammatory cytokines, and angiogenic factors(vascular endothelial growth factor, placental growth factor, platelet-derived growth factor and others) that lead to the development of these disorders. This review is to describe the mechanisms of restructuring of the vascular bed in response to hemodynamic disturbances in portal hypertension. Development of pathogenetic methods, which allow correcting portal hypertension, will improve the efficiency of conservative therapy aimed at prevention and treatment of its inherent complications.     

Pathogenetic background for treatment of ascites and hepatorenal syndrome

Ascites and hepatorenal syndrome (HRS) are the major and challenging complications of cirrhosis and portal hypertension that significantly affect the course of the disease. Liver insufficiency, portal hypertension, arterial vasodilatation, and systemic cardiovascular dysfunction are major pathophysiological hallmarks. Modern treatment of ascites is based on this recognition and includes modest salt restriction and stepwise diuretic therapy with spironolactone and loop diuretics. Tense and refractory ascites should be treated with a large volume paracentesis, followed by volume expansion or transjugular intrahepatic portosystemic shunt. New treatment strategies include the use of vasopressin V₂-receptor antagonists and vasoconstrictors. The HRS denotes a functional and reversible impairment of renal function in patients with severe cirrhosis with a poor prognosis. Attempts of treatment should seek to improve liver function, ameliorate arterial hypotension and central hypovolemia, and reduce renal vasoconstriction. Ample treatment of ascites and HRS is important to improve the quality of life and prevent further complications, but since treatment of fluid retention does not significantly improve survival, these patients should always be considered for liver transplantation.     

儿童门静脉高压症研究进展

儿童门静脉高压症是指在多种病因作用下,门静脉系统的血流受阻和（或）血流量增加、血管舒缩功能障碍,引起门静脉及其属支的压力持续增高,门静脉压力＞5 mmHg（1 mmHg=0.133 kPa）,或门静脉、肝静脉压力梯度＞10 mmHg,最终导致脾大、门腔侧支循环形成和开放、腹水等临床表现,是一种血流动力学异常综合征。儿童门静脉高压症根据病因不同分为肝硬化性门静脉高压症和非肝硬化性门静脉高压症;根据压力来源的解剖部位,可将门静脉高压症分为肝前性、肝内性（窦前性、窦性、窦后性）及肝后性。治疗方法有药物治疗、曲张静脉套扎或硬化、手术治疗等。虽然儿童门静脉高压症发病率较低,但可以引起胃食管静脉曲张破裂出血、肝性脑病等严重并发症。为加强对本病的认识,减少并发症,提高治愈率,现将其病因分类、发病机制、诊断和治疗方面的研究进展作一综述。     

Hypertension Canada’s 2018 Guidelines for the Management of Hypertension in Pregnancy

We present Hypertension Canada’s inaugural evidence-based Canadian recommendations for the management of hypertension in pregnancy. Hypertension in pregnancy is common, affecting approximately 7% of pregnancies in Canada, and requires effective management to reduce maternal, fetal, and newborn complications. Because of this importance, these guidelines were developed in partnership with the Society of Obstetricians and Gynaecologists of Canada with the main common objective of improving the management of women with hypertension in pregnancy. Guidelines for the diagnosis, assessment, prevention, and treatment of hypertension in adults and children are published separately. In this first Hypertension Canada guidelines for hypertension in pregnancy, 7 recommendations for the management of nonsevere and severe hypertension in pregnancy are presented. For nonsevere hypertension in pregnancy (systolic blood pressure 140-159 mm Hg and/or diastolic blood pressure 80-109 mm Hg), we provide guidance for the threshold for initiation of antihypertensive therapy, blood pressure targets, as well as first- and second-line antihypertensive medications. Severe hypertension (systolic blood pressure ≥ 160 mm Hg and/or diastolic blood pressure ≥ 110 mm Hg) requires urgent antihypertensive therapy to reduce maternal, fetal, and newborn adverse outcomes. The specific evidence and rationale underlying each of these guidelines are discussed.     

Thiazolidinediones-benefits on microvascular complications of type 2 diabetes

Type 2 diabetes is associated with serious microvascular complications, such as nephropathy, retinopathy, and neuropathy, which have a significant impact on patients' quality of life, morbidity, and mortality. Type 2 diabetes management strategies to reduce the risk of microvascular complications include treatment of hyperglycaemia, hypertension, and other vascular risk factors. The importance of glycaemic control in reducing the risk of microvascular complications of diabetes is well established. However, many antihyperglycaemic therapies fail to provide adequate glycaemic control and do not prevent complications in the long term. The thiazolidinediones (TZDs) are a class of agents that provide sustained glycaemic control, mediated primarily by reductions in insulin resistance. Evidence reviewed suggests that the TZDs may have the potential to reduce microvascular complications through benefits that go beyond glycaemic control. Insulin resistance underlies a range of metabolic abnormalities, collectively known as the metabolic syndrome (MS), which are cardiovascular (CV) risk factors. Components include visceral obesity, hyperglycaemia, hypertension, dyslipidaemia, low-grade inflammation and microalbuminuria (an early manifestation of target organ damage). Reducing insulin resistance, therefore, has the potential to reduce both microvascular and macrovascular complications.     

高血压健康教育在社区慢性病防治中的应用探讨

目的探索研究高血压健康教育在社区慢性病防治中的应用。方法选取本社区的高血压患者总共82例,将选取的82例患者随机平均分成观察组和对照组两组。观察组与对照组的所有患者均采用常规药物治疗方法进行降压治疗,在常规治疗的基础上给予观察组患者健康教育活动。在进行3个月的治疗以及健康教育后,测试观察组患者与对照组患者对高血压相关知识的掌握程度。监测两组患者的血压情况,比较两组患者的降压效果。观察两组患者的并发症发生情况。结果观察组患者治疗后的知晓率比对照组患者的知晓率高,差异显著(P0.05),具有统计学意义。观察组患者降低血压的总有效率与对照组相比较有显著差异(P0.05),具有统计学意义。观察组患者的并发症发生率比对照组低,差异显著(P0.05),具有统计学意义。结论通过对社区的高血压患者进行高血压健康教育能够加深患者对高血压的认识,有效降低和控制患者的血压,降低并发症的发生率。     

Contemporary concepts of the medical therapy of portal hypertension under liver cirrhosis

Severe complications of liver cirrhosis are mostly related to portal hypertension. At the base of the pathogenesis of portal hypertension is the increase in hepatic vascular resistance to portal blood flow with subsequent development of hyperdynamic circulation, which, despite of the formation of collateral circulation, promotes progression of portal hypertension. An important role in its pathogenesis is played by the rearrangement of vascular bed and angiogenesis. As a result, strategic directions of the therapy of portal hypertension under liver cirrhosis include selectively decreasing hepatic vascular resistance with preserving or increasing portal blood flow, and correcting hyperdynamic circulation and pathological angiogenesis, while striving to reduce the hepatic venous pressure gradient to less than 12 mmHg or 20% of the baseline. Over the last years, substantial progress in understanding the pathophysiological mechanisms of hemodynamic disorders under liver cirrhosis has resulted in the development of new drugs for their correction. Although the majority of them have so far been investigated only in animal experiments, as well as at the molecular and cellular level, it might be expected that the introduction of the new methods in clinical practice will increase the efficacy of the conservative approach to the prophylaxis and treatment of portal hypertension complications. The purpose of the review is to describe the known methods of portal hypertension pharmacotherapy and discuss the drugs that may affect the basic pathogenetic mechanisms of its development.     

Hypertension artérielle et cancer : les liaisons dangereuses

Hypertension is a very common comorbidity in patients suffering from cancer, due to common risk factors. In addition, many oncology drugs, including the new tyrosine kinase-targeting drugs, may induce hypertension or unbalance a pre-existing hypertension. Severe hypertension may lead to cardiac, renal or vascular complications and require the discontinuation or modification of anticancer treatment. It is therefore necessary to be aware of the molecules at risk. The management of hypertension in cancer is the subject of expert consensus and is based on the usual antihypertensive drugs. Adequate cardiac monitoring should be organised before, during and after treatment to allow early management and avoid possible complications. The aim is to provide optimal oncological treatment and improve short-term survival, but also to reduce the long-term cardiovascular risk of cancer survivors.