缺血性脑卒中伴高血压患者血压控制状况调查

目的了解缺血性脑卒中患者血压控制及降血压药物使用情况,分析影响降压药物使用的因素。方法选择2014年1~12月连续收住我院神经内科病房的住院且确诊为缺血性脑卒中和短暂性脑缺血发作患者总计740例,将360例复发性脑卒中纳入分析,高血压314例(87.2%),糖尿病142例,对入选患者血压控制及降血压药物使用情况进行调查。结果 314例高血压患者中,血压达标率为28.3%;142例糖尿病患者中,血压达标率为9.2%。314例高血压患者,服用任1种抗高血压药物248例,药物治疗率79.0%,有21.0%未服用任何降压药物。2型糖尿病、冠心病、吸烟、饮酒、服用抗血小板药物与降压药物治疗有关(P0.05)。冠心病(OR=0.275,95%CI:0.094~0.804,P=0.018)及服用抗血小板药物(OR=0.547,95%CI:0.310~0.966,P=0.038)是影响患者降压治疗的独立危险因素。结论缺血性脑卒中患者血压控制达标率与指南要求存在差距,伴糖尿病患者血压控制达标率更不理想,应加强脑卒中患者血压控制。     

单中心高血压患者血压达标影响因素的探讨

目的了解二级医院门诊高血压患者血压控制达标状况并探讨影响因素。方法采用单纯随机抽样方法,从2011年1月至12月在我院门诊就诊,年龄为18岁及以上的高血压患者中抽取660例,进行流行病学调查,收集研究对象的一般人口学资料、患者的高血压病史、血压控制率、降压药物使用情况。结果全体研究对象中2和3级高血压分别占28.03%和30.00%;调查人群血压达标率为25.91%;全体研究对象中,平均服用1.99种降压药物。对血压达标产生影响的因素中:服用1种药物与服用多种药物,低收入与高收入人群相比,对血压达标影响差异有统计学意义(均为P<0.01)。患者高血压的分级、每月至少复诊1次与每月复诊不足1次,规律服药与间隔服药对血压达标影响差异有统计学意义(均为P<0.05)。结论本中心血压总达标率仅为25.91%,患者高血压的严重程度、经济收入、服药的数量、规律性服药、规律性复诊是影响血压达标的因素。     

老年高血压患者诊室血压和动态血压达标情况分析

目的探讨老年高血压患者诊室血压和动态血压达标情况及影响因素。方法在参加2010-2011年度健康体检的开滦离退休员工中整群抽取年龄≥60岁的2814人进行动态血压监测,符合入选标准者2464人,分析其中754例服用抗高血压药物的老年高血压患者诊室血压达标(诊室血压140/90mm Hg)和24h动态血压达标(24h平均血压130/80mm Hg)情况。采用Logistic回归分析影响老年高血压患者动态血压不达标的相关因素。结果老年高血压患者754例中,诊室血压达标率19.2%(95%CI16.4%~22.0%),24h动态血压达标率33.6%(95%CI30.2%~37.0%)。诊室血压达标的145例老年高血压患者中,24h动态血压达标率为51.0%(95%CI42.9%~59.1%),男性、体质量指数(BMI)是24h动态血压不达标的危险因素,OR值(95%CI)分别为2.942(1.155~7.498),1.195(1.031~1.386)。诊室血压不达标的609例老年高血压患者中,24h动态血压达标率为29.4%(95%CI25.8%~33.0%),男性、诊室收缩压、BMI是24h动态血压不达标的危险因素,OR值(95%CI)分别为1.679(1.125~2.506),1.030(1.019~1.042),1.067(1.007~1.130)。结论老年高血压患者诊室血压和动态血压达标率低,男性、BMI、诊室收缩压是影响24h动态血压不达标的危险因素。     

ѪҺ͸����ظ�Ѫѹ����Ѫѹ�����ƶԲ�

1血液透析相关高血压血液透析相关高血压是指在血液透析充分的状态下,患者透析前平均动脉压(MAP)>106mm Hg(血压>140/90mm Hg,1mm Hg=0.133kPa)。据HEMO研究报道,维持性血液透析(MHD)患者高血压的发生率大于70%,服用降压药物占75%,其中72%以上的患者服用降压药后血压未能降至正常。部分患者经合理联合应用3种或3种以上降压药物,血压仍不能控制在正常水平,临床上称之为“难治性高血压”(5%)[1-3]。1.1血液透析相关高血压发病机制1.1.1水钠潴留MHD患者几乎无残余肾功能,如果不能控制水钠摄入,透析不能有效清除体内多余水分致使水钠失衡…     

综合干预对老年高血压患者血压达标的影响

目的 规范化管理高血压患者,综合干预危险因素,提高老年高血压患者的血压控制达标率.方法 在辖区内离退休老干部中进行心血管病危险因素流行病学调查;对其中老年高血压患者873例的危险因素进行危险评估;强化健康教育,倡导高血压病的非药物治疗;对吸烟、超重、摄盐过多、血脂异常等进行综合干预;为患者制定个体化治疗方案;定期监测血压及危险因素.结果 1)该人群的高血压患病率为68.2%,其中65.1%为单纯收缩期高血压;危险因素≥3种的高危患者占78.2%.2)通过近5年综合干预,吸烟率下降了55.4%,低钠盐摄入者提高了39.4%(P＜0.01);体质量指数转为正常者增加了27.5%(P＜0.05).3)总胆固醇、低密度脂蛋白胆固醇控制达标率分别由28.5%、21.9%提高到64.3%与64.2%(P＜0.01),三酰甘油达标率由65.8%提高到73.9%(P＜0.05).4)高血压的治疗率由89.4%提高到97.0%;高血压患者的收缩压与舒张压均值分别下降了2.2、3.9 mm Hg(P＜0.01);血压控制达标率由71.3%上升至79.7%(P＜0.01).5)多数患者采用钙离子拮抗剂及转换酶抑制剂为基础的联合降压治疗,服用传统复方降压制剂者下降了35.3%.结论 对老年高血压患者进行综合干预和规范化管理,可显著提高血压控制达标率.     

社区缺血性脑卒中患者降压药物使用及血压控制情况

目的:评价社区缺血性脑卒中患者降压药物使用情况和血压达标率。方法:2003年1月至2006年12月,在北京市5个区各选一家二级医院,对在上述医院所属的社区卫生服务中心(站)就诊的缺血性卒中患者进行一次横断面调查,登记高血压患病及治疗情况。结果:共调查1 087例缺血性脑卒中患者,合并高血压者874例,接受降压治疗者736例,其中357例(48.5%)患者使用常用五类降压药,215例(29.2%)患者使用其他降压药,164例(22.3%)患者同时使用常用和其他类药物。接受降压治疗患者的血压达标率为30.8%。无合并症患者、合并不同心血管危险因素患者选择不同常用降压药时的血压达标率差异无统计学意义(P>0.05);选择常用药物单药降压或联合降压时,以及选择常用药物或其他药物时的血压达标率同样差异无统计学意义(均P>0.05)。结论:社区缺血性脑卒中患者的血压达标率有待提高,伴糖尿病的患者血压控制更不理想。对于合并多种心脑血管危险因素的患者,应遵循指南优化降压治疗。     

高血压患者收缩压控制率

目的了解目前接受药物治疗的高血压患者收缩压达标率,医师对收缩压达标的认识及临床高血压用药情况.方法采用调查问卷进行横断面调查,内容包括医师(2 291人)和患者(8 952人)两部分.医师填写患者收缩压达标的比例,干预收缩压最有效的降压药物.患者部分也由医师填写,包括患者的高血压及相关病史,家族史等,检查结果,治疗情况.结果患者的收缩压达标率57%,而主观认为达标率大于50%的医生约占30%.经过高血压药物治疗,患者的收缩压幅度下降.随年龄、血压水平和危险分层的增加,收缩压降压幅度也相应增加,但是收缩压的达标率相对较低.心肌梗死、心力衰竭和脑卒中患者的收缩压降压幅度较大,控制率也较高.而糖尿病患者,降压幅度较小,控制率也较低.联合用药的患者降压幅度高于单一用药.收缩压下降的同时舒张压也相应下降,血压水平和危险分层高的患者舒张压下降幅度较大.患者平时使用最多的和医师主观上认为的最有效的降压药物都是钙拮抗剂.结论高血压患者经治疗后收缩压下降,高危患者的治疗需要高度重视,且开始治疗即可联合用药.临床高血压用药以钙拮抗剂为主.     

北京市丰台区部分社区脑卒中高危人群高血压患者血压达标现状及影响因素分析

目的调查北京市丰台区脑卒中高危人群中高血压患者的血压达标现状及其影响因素。方法采用横断面临床流行病学调查方法对北京市丰台区蒲黄榆社区、王佐镇、花乡、方庄街道40岁以上的脑卒中高危人群进行调查,以登记符合脑卒中高危人群入选标准的高血压患者为研究对象,共收集有效高血压患者资料5 834例,记录其人口学特征、血压控制情况及相关伴发疾病的患病率(高血压患者伴发疾病的患病情况)。结果 5 834例高血压患者的血压总体达标率为52.72%(3 076/5 834),单因素分析时,血压达标组与未达标组间差异有统计学意义的因素包括年龄、体质指数、腰围、年龄构成、体质指数构成、性别、职业、文化程度、饮酒和吸烟。高血压患者伴发疾病中,血脂异常、糖尿病、脑卒中的患病率最高,分别为62.22%(3 630/5 834)、31.35%(1 829/5 834)和15.79%(920/5 834)。多因素Logistic回归分析显示,女性、正常体质指数为血压控制的保护性因素,高龄、脑力劳动为影响血压控制的不利因素。结论北京市丰台区部分社区脑卒中高危人群中高血压患者血压总体达标率为52.72%。血压达标的保护因素为女性和正常体质指数。     

住院2型糖尿病患者血压控制的影响因素

目的探讨住院2型糖尿病(type2diabetes mellitus,T2DM)患者血压控制的影响因素。方法 169例合并原发性高血压(高血压)的T2DM患者给予降压等综合治疗,以出院时血压130/80mm Hg(1mm Hg=0.133kPa)为界限分为达标组(n=97)及未达标组(n=72),比较两组入院时临床及实验室指标,并通过回归分析观察各种因素对出院时平均动脉压水平的影响。结果全组T2DM入院时收缩压为(143±15)mm Hg,舒张压为(78±8)mm Hg,控制达标率仅17.8%;出院时血压达标率57.4%,降压药物种类平均增加1种。未达标组患者入院时收缩压[(151±15)mm Hg vs.(137±12)mm Hg,P0.05)、舒张压[(80±9)mm Hg vs.(77±7)mm Hg,P0.05]均高于达标组,且血清总胆固醇浓度及24h尿白蛋白排泄率显著升高。回归分析显示,平均动脉压与入院时收缩压、舒张压、血清总胆固醇及高血压病程显著正相关,与年龄负相关;平均动脉压与尿白蛋白排泄率显著正相关(r=0.303,P0.01)。合并糖尿病肾病患者随尿白蛋白排泄率增多而收缩压显著升高,大量蛋白尿者需要多种降压药物联合治疗且血压难以控制。结论 T2DM患者门诊血压控制达标率低;住院T2DM患者血压控制受入院时血压水平、高血压病程、高胆固醇血症、高尿白蛋白排泄率等因素影响;尿白蛋白排泄率增加可能是合并糖尿病肾病患者血压难以控制的直接原因。     

未控制高血压患者833例随访3年的观察研究

目的 分析血压控制率低的具体原因,以提高高血压的控制率.方法 门诊就诊病人随访资料完整的1083例中血压未控制的833例作为随访对象,平均年龄(53.5±10.5);给予增加原药物剂量和(或)加服另一种降压药物.结果 随访治疗后平均血压从(163.2±23.1/103.2±10.5)mm Hg,下降到(141.9±15.4/90.7±11.2)mm Hg,下降了21.3/12.5 mm Hg(P＜0.005),血压达标者有382例,达标率45.9%.增加药物剂量有246例(29.5%),增加药物品种587人(70.5%).不遵守、部分遵守医嘱的有548例(65.8%),其原因有降低血压治疗的认识不足、经济困难、疗效差、用药不方便、医生方面因素.结论 针对上述不遵守、部分遵守医嘱的原因作出相应的对策将明显的提高高血压患者的控制率.     

Review of blood pressure control rates and outcomes

Despite the high prevalence of hypertension and documented benefits of blood pressure (BP) control, >40% of patients with hypertension are not controlled. A majority of uncontrolled hypertensive patients receive two or more antihypertensive drugs. The current review examined the relationship between antihypertensive combination drug therapy, achievement of goal BP, and cardiovascular (CV) outcomes. Articles were selected from a PubMed search using a prespecified search strategy. Randomized, controlled clinical trials of adult human subjects published in English between January 1991 and January 2013 were included. From 2319 identified articles, 28 met inclusion criteria and contained a total of 226,877 subjects. There were seven placebo-controlled studies and 21 treatment comparator and combination therapy studies. The studies included in this review reported a positive association between the degree of BP lowering, number of medications, and CV outcomes. As combination therapy became available, it was increasingly utilized in clinical trials and enabled an increased proportion of patients to achieve a prespecified BP target. Adverse events with monotherapy and combination therapy were as anticipated for the specific classes of antihypertensive therapy. Although many patients reach BP goal, combination antihypertensive therapy is often needed to reach BP goal. Effective BP lowering has been shown to result in improvements in CV outcomes.     

Current status and characteristics of hypertension control in community resident elderly Korean people: data from a Korean longitudinal study on health and aging (KLoSHa study).

Hypertension is a common disease that greatly impacts the health of the elderly. However, the status of blood pressure (BP) control in the elderly Korean population has not yet been investigated. Subjects aged 65 years or older living in Seongnam city, a suburb of Seoul, Korea, were included in this study. All subjects were evaluated by a physician, and medication was reviewed by a nurse. Seated BPs were measured by a trained nurse using standard methods. A total of 995 subjects were included in the current analysis (mean age: 76.3+/-8.7 years). The prevalence of hypertension was 68.7% in the study population, and this value increased with age, peaked in the 75-84 age group, and decreased thereafter. Only 66.1% of hypertensive patients had taken any antihypertensive medication, among which calcium channel blockers (64.2%) were most commonly used. Among the patients on antihypertensive medication, 46% were on combination drug therapy. BP was controlled in 38.5% of hypertensive patients, with systolic BP less controlled than diastolic BP, especially in the oldest-old population. The BP control rate was lower in high-risk patients of diabetes and renal disease. In conclusion, in community resident elderly populations, the BP control rate remains unsatisfactory, especially in high-risk patients. The benefit and optimal level of BP control in oldest-old population must be investigated because a lot of elderly hypertensive patients are currently being managed without definite evidence of related benefits.     

Efficacy of fixed combination amlodipine/valsartan in hospitalized patients with hypertensive disease

Efficacy and tolerability of fixed amlodipine/valsartan combination was studied in 86 patients with hypertensive disease hospitalized in departments of general internal medicine or cardiology. All patients had indications for antihypertensive therapy and were randomized either to fixed combination amlodipine/valsartan (n=43) or to therapy which corresponded to the hospital formulary (n=43). Correction of antihypertensive therapy was performed by treating physician at daily rounds. Self-control of blood pressure (BP) was performed by patients with the use of UA767PC apparatus. Results of BP self-control were compared with clinical measurements in order to detect concealed inefficacy of treatment. Results. Rate of achievement of target BP with fixed combination amlodipine/valsartan (93%) was comparable with that on traditional therapy (90%). But the use of fixed combination amlodipine/valsartan compared with traditional therapy was associated with lower clinical and self measured BP, quicker achievement of target BP (5.8+/-2.3 and 9.2+/-1.8 days, respectively, p<0.05), lesser number of antihypertensive drugs (2.5+/-0.6 and 3.0+/-0.9 days, respectively), lower rate of concealed inefficacy of treatment (12 and 31%, respectively, p<0.05). Conclusions. We have demonstrated appropriateness of inhospital administration of fixed amlodipine/valsartan combination as an approach allowing to achieve target BP in shorter time, with the use of fewer antihypertensive drugs, and diminishing concealed inefficacy of treatment.     

Beta-blockade mitigates exercise blood pressure in hypertensive male patients.

OBJECTIVES: The purpose of this study was to determine the antihypertensive agent(s) more likely to mitigate an exaggerated rise in exercise blood pressure (BP) in hypertensive patients. BACKGROUND: An exaggerated rise in exercise BP is associated with increased cardiovascular risk. There are no recommendations for treating such response. METHODS: Participants were hypertensive men (n = 2,318; age 60 +/- 10 years), undergoing a routine exercise test at the Veterans Affairs Medical Center, Washington, DC. Antihypertensive therapy included angiotensin-converting enzyme inhibitors (n = 437), calcium-channel blockers (n = 223), diuretics (n = 226), and combinations (n = 1,442), beta-blockers alone (n = 201) or in combination with other antihypertensive agents (n = 467), and none (n = 208). Exercise BP, heart rate (HR) and rate-pressure product (RPP) at maximal and submaximal workloads were assessed. RESULTS: After adjusting for covariates, patients treated with beta-blockers or beta-blocker-based therapy had significantly lower BP, HR, and RPP at 5 and 7 metabolic equivalents (METs) and peak exercise than those treated with any other antihypertensive agent or combination (p < 0.05). The likelihood of achieving an exercise systolic BP of >/=210 mm Hg was 68% lower (odds ratio = 0.32, 96% confidence interval 0.2 to 0.53) in the beta-blocker-based therapy versus other medications. African Americans exhibited higher BP and HR than Caucasians at all exercise workloads regardless of antihypertensive therapy and had over a 90% higher likelihood for an abnormal exercise BP response. This risk was attenuated by 35% with a beta-blocker-based therapy. CONCLUSIONS: Significantly lower exercise BP, HR, and RPP levels are achieved with beta-blocker-based therapy than with other antihypertensive agents regardless of race. However, BP was better controlled in Caucasians than in African Americans regardless of antihypertensive therapy.     

Antihypertensive drug reduction for treated hypertensive patients during the summer

Seasonal winter–summer variation in blood pressure (BP) has been reported, but there are few reports on the reduction of antihypertensive medication during the summer. We aimed to investigate the prevalence and details of drug reduction during the summer among outpatients. Among 667 patients, 90 patients (13.5%) had their medication reduced during the summer. The highest rate of drug reduction was for diuretics (17.5%). The patients whose medications were reduced (Group R) took a larger number of drugs and more frequently took diuretics compared with the subjects whose medications were unchanged (N = 559; with no reduction or increase in drugs, Group UC). Moreover, both the office BP and morning home BP of the patients in Group R were significantly lower compared with those of the patients in Group UC. These results suggest that doctors tend to reduce antihypertensive drugs to avoid an excessive decrease in BP especially in patients receiving combination therapy including diuretics.     

Reasons for Switching Antihypertensive Medication in General Practice: A Cross-Sectional Czech Nationwide Survey

To improve blood pressure (BP) control of their patients, physicians either adjust or switch antihypertensive medication. Currently, there is only limited information available on why physicians decide to switch antihypertensive medications.A questionnaire-based survey was performed between November 2011 and March 2012 in the Czech Republic. General practitioners were asked to fill in questionnaires about their hypertensive patients whose antihypertensive medication they were planning to change. These questionnaires recorded data about patient demographic information, cardiovascular risk factors, BP values, and reasons for switching antihypertensive medication.Two hundred eight-six general practitioners surveyed a total of 4341 hypertensive patients. The mean age of the patients was 59.8 years, 68.9% of patients were overweight or obese. Uncontrolled office systolic and diastolic BP >140/90 mm Hg was present in 89.6% and 81.5% of patients, respectively, despite the fact that 49.4% of patients used a combination of 2 or more antihypertensive drugs. The most common reasons for switching medication were insufficient BP control (73.7%), followed by aiming for a better 24-hour effect (38.4%) and increased cardiovascular risk of the patients (37.7%).The major reason for switching antihypertensive treatment in general practice was insufficient BP control. Switching medication because of adverse drug effects is less frequent than reported a decade ago.     

Patients with uncontrolled hypertension or concomitant hypertension and benign prostatic hyperplasia

At optimal doses, individual antihypertensive agents lower blood pressure (BP) by an average of 10 mmHg. Many patients with hypertension, including those with stage 3 hypertension, target organ damage, or those at high risk for cardiovascular events and/or adverse effects of high-dose monotherapy, are likely to require combination antihypertensive drug treatment to achieve the recommended systolic/diastolic BP (< 140/90 mmHg). Two studies, a placebo-controlled, double-blind trial (n = 70) and a community-based, open-label trial (n = 491) investigated the antihypertensive efficacy of doxazosin, a long-acting selective alpha1-adrenoceptor blocker, as add-on therapy for uncontrolled hypertension with other antihypertensive medications and in patients with concomitant benign prostatic hyperplasia (BPH) and treated but inadequately controlled hypertension, respectively. The addition of doxazosin to baseline antihypertensive medication(s) significantly lowered BP and had a significantly positive effect on the serum lipid profile. In patients with concomitant BPH, doxazosin significantly improved all BPH symptom scores, regardless of initial symptom severity. Add-on doxazosin sufficiently reduced systolic/diastolic BP such that many patients whose hypertension was previously uncontrolled by other antihypertensive medications were able to reach goal BP (< 140/90 mmHg). Doxazosin as add-on therapy was well tolerated. In conclusion, doxazosin as add-on therapy improves BP control in hypertensive patients not at goal BP and improves lower urinary tract symptoms in patients with concomitant BPH.