高血压病各期与纤溶活性的关系

观察５０例各期高血压病病人的纤溶活性，发现高血压病Ⅲ期病人组织型纤溶酶原激活物活性低于Ⅰ，Ⅱ期病人，提示疾病的严重程度与纤溶活性有关。     

老年高血压病患者纤溶、内皮系统功能状态的研究

[目的]研究老年高血压病患者纤溶、内皮系统功能状态的改变。[方法]采用SYSMEX CA-7000血液凝固仪测定组织型纤溶酶原激活物（t-PA）、纤溶酶原激活物抑制物-1活性（PAI-1）、D-二聚体（D-dimer）、yon Willebrand因子（vwF）。[结果]老年高血压病患者纤溶系统功能下降和血管内皮损伤的程度，Ⅲ级组〉Ⅰ／级组〉Ⅰ级组，但各组部分指标水平之间没有显著性差异（P〉0．05），提示尚存在其它机制对纤溶、内皮系统产生影响。根据危险因素对患者进行低危、中危、高危、很高危分组并进行统计学处理，纤溶系统功能下降和血管内皮损伤的程度，很高危组〉高危组〉中危组〉低危组，且各组指标之间存在显著性差异（P〈0．01）。[结论]老年高血压病患者纤溶、内皮系统功能状态严重受损，并且随着危险因素的增加而进一步加重。     

纤溶激活系统改变在有氧训练影响apoE缺陷鼠动脉粥样硬化斑块面积中的作用

目的：探讨长期有氧运动对apoE缺陷小鼠（apoE0)动脉粥样硬化斑块面积的影响及纤溶激活系统变化在其中的作用。方法：apoE0鼠和C57BL／6J鼠各20只随机分为对照组和游泳组,120min/次,6次／周,12周后测定apoE0鼠动脉粥样硬化斑块面积及纤溶激活活性。结果：①有氧训练使apoE0鼠的动脉粥样硬化斑块面积减少了35％;②apoE0鼠的纤溶和凝血系统均处于一种较高的水平;③有氧训练使apoE0鼠和C57BL／6J鼠血浆组织纤溶酶原激活剂（tPA)活性和tPA／纤溶酶原激活抑制剂（PAI）比值均明显升高,但C57BL／6J鼠PAI活性降低,apoE0鼠PAI活性保持不变;④有氧训练使apoE0鼠的纤溶酶原水平较之训练前显著升高,但纤溶酶、凝血酶原和凝血酶均未发生明显改变。结论：apoE缺陷鼠有着明显的凝血功能亢进和纤溶活性增强,长期有氧训练可缩小动脉粥样硬化病变面积,其过程中有纤溶机制的参与。     

原发性高血压患者纤溶系统功能的变化

目的 观察未经治疗的原发性高血压患者的纤溶指标的变化及临床意义。方法 选取36例初次就诊的原发性高血压患者[男17例。女19例，平均年龄(52&;#177;7)岁]及3l例血压正常者[男16例，女15例，平均年龄(5l&;#177;7)岁]。两组受试者的临床特点无明显差别。用发色底物法测定他们的血浆组织型纤溶酶原激活物(t-PA)及其抑制剂(PAI—1)的活性和a2-PI活性。结果 原发性高血压患者血浆t-PA和a2-PI活性明显低于对照者，P&;lt;0．05。PAI-1，活性明显高于对照组，P&;lt;0．05。结论 原发性高血压患者存在内源性纤溶功能低下。     

老年原发性高血压患者纤溶活性和D-二聚体的变化及其意义

目的 了解纤溶活性和D－二聚体变化在老年原发性高血压中的作用。方法 采用ELISA法测定血、尿D－二聚体,用发色底物法测定组织型纤溶酶原激活剂（t-PA)及纤溶酶原激活剂抑制剂－1（PAI－1）活性。结果 老年原发性高血压及老年高血压肾病组的PAI－1,D－二聚体纤溶酶原明显高于正常对照组t-PA纤溶酶活性水平低于正常对照组。结论 纤溶活性和D－二聚体在老年高血压、老年高血压肾病中具有重要作用,可作为老年高血压合并肾病早期诊断依据。     

一种新的纤溶活性测定法及在心肌梗死中的应用

目的 建立新的纤维蛋白溶解活性（Ｆｉｂｒｉｎｏｌｙｔｉｃａｃｔｉｖｉｔｙ,ＦＬＡ）测定方法,并初步应用于心肌梗死（ＡＭＩ）患者的观察,方法 将定量受检血浆加于含有纤溶酶原（ＰＬＧ）和标准纤维蛋白的小试管中,同时加入定量的组织纤溶酶原激活剂（ｔ－ＰＡ）硅粒,３７℃温育一小时,检测生成Ｄ－二聚体的量,结果 ４０例正常人的ＦＬＡ分级在Ⅱ,Ⅲ级（占７０％）,６０例ＡＭＩ患者ＦＬＡ分级在０,Ｉ和Ⅳ级（占７３     

Medical care expenditures for hypertension, its complications, and its comorbidities

OBJECTIVES: Medical expenditures attributed to hypertension were estimated, including expenditures for cardiovascular complications, other conditions for which hypertensives are at higher risk, and comorbidities (secondary diagnoses) that raise the cost of medical care. This article presents total, per capita, and per condition US expenditures in 1998 according to sex, age, and type of health service. METHODS: A variety of national data sources were used to disaggregate national health expenditures in 1998 by diagnosis. Expenditures for cardiovascular complications and other conditions for which hypertensives had higher rates of utilization were determined by analysis of attributable risks. Additional expenditures generated by extra hospital inpatient days and higher charges for nursing home and home health care for comorbidities were estimated by regression analyses. RESULTS: In 1998, $108.8 billion in health care spending was attributed to hypertension, 12.6% of total national spending that could be allocated to diagnoses, including $22.8 billion for hypertension, $29.7 billion for cardiovascular complications, and $56.4 billion for other diagnoses. Per capita expenditures increased with age from $249 for those younger than 65 years to $3,007 for those 85 years and older. The average amount spent per hypertensive condition was $3,787. Expenditures were generally higher for females. CONCLUSIONS: The economic burden of hypertension is large, but health services directly related to hypertension account for only a fraction of attributed expenditures. Comprehensive accounting of expenditures more accurately assesses the cost of hypertension and potential savings from prevention and treatment. Alteration of lifestyles and medical intervention provide opportunities to reduce national health expenditures.     

Current possibilities of ACE inhibitor and ARB combination in arterial hypertension and its complications

The renin–angiotensin–aldosterone system (RAAS) plays a crucial role in blood pressure regulation and hypertension-related complications. Angiotensin-converting enzyme inhibitors (ACEIs) were the first to be used to block the RAAS and now have many compelling indications in the treatment of hypertension and its cardiovascular and renal complications. Angiotensin II receptor blockers (ARBs), introduced 20 years later, have been shown to be equally as effective as antihypertensive treatment and are also associated with a lower number of side effects. Furthermore, in clinical trials ARBs and ACEIs were associated with comparable benefits for their most typical indications. This was confirmed in the 2007 New European Society of Hypertension/European Society of Cardiology (ESH/ESC) guidelines for the management of hypertension by comparable specific recommendations for ARB and ACEI treatment. There is sufficient theoretical background and, in some cases, also clinical evidence that combination therapy with ACEIs and ARBs may be more beneficial than monotherapy with either of the groups alone, both in uncomplicated hypertension and with concomitant heart failure or renal dysfunction. However, the combination of ACEI and ARB was not recommended in the ESH/ESC 2007 Guidelines. This may change after the publication of the Ongoing Telmisartan Alone and in Combination with Ramipril Global End point Trial (ONTARGET) study, the preliminary results of which have just been presented. In heart failure, recent studies have shown that the combination of ACEI and ARB decreases cardiovascular mortality and the number of hospitalizations due to aggravation of heart failure. These results have been reflected in the newest ESC guidelines of the heart failure treatment. Nephroprotective properties of the combination of ACEs and ARBs have been proved both in studies on nondiabetic and diabetic nephropathy. The potential benefits, indications in prespecified groups of patients, the most recent data from clinical trials and latest research regarding dual blockade of RAAS will be reviewed in this article.     

Current possibilities of ACE inhibitor and ARB combination in arterial hypertension and its complications

The renin-angiotensin-aldosterone system (RAAS) plays a crucial role in blood pressure regulation and hypertension-related complications. Angiotensin-converting enzyme inhibitors (ACEIs) were the first to be used to block the RAAS and now have many compelling indications in the treatment of hypertension and its cardiovascular and renal complications. Angiotensin II receptor blockers (ARBs), introduced 20 years later, have been shown to be equally as effective as antihypertensive treatment and are also associated with a lower number of side effects. Furthermore, in clinical trials ARBs and ACEIs were associated with comparable benefits for their most typical indications. This was confirmed in the 2007 New European Society of Hypertension/European Society of Cardiology (ESH/ESC) guidelines for the management of hypertension by comparable specific recommendations for ARB and ACEI treatment. There is sufficient theoretical background and, in some cases, also clinical evidence that combination therapy with ACEIs and ARBs may be more beneficial than monotherapy with either of the groups alone, both in uncomplicated hypertension and with concomitant heart failure or renal dysfunction. However, the combination of ACEI and ARB was not recommended in the ESH/ESC 2007 Guidelines. This may change after the publication of the Ongoing Telmisartan Alone and in Combination with Ramipril Global End point Trial (ONTARGET) study, the preliminary results of which have just been presented. In heart failure, recent studies have shown that the combination of ACEI and ARB decreases cardiovascular mortality and the number of hospitalizations due to aggravation of heart failure. These results have been reflected in the newest ESC guidelines of the heart failure treatment. Nephroprotective properties of the combination of ACEs and ARBs have been proved both in studies on nondiabetic and diabetic nephropathy. The potential benefits, indications in prespecified groups of patients, the most recent data from clinical trials and latest research regarding dual blockade of RAAS will be reviewed in this article.     

Plasma concentration of coagulation and fibrinolysis factors and platelet function in hypertension

Fifty-one patients with mild hypertension were evaluated in relation to the plasma concentrations of coagulation and fibrinolysis factors as well as for the aggregability of their platelets. In a considerable number of the patients (18/51), a significantly enhanced in vitro ADP (2 mumol/l)-induced aggregation was found. In the coagulation line significant increases could be demonstrated in fibrinogen, fibrin monomers and thrombin-antithrombin III. The fibrinolysis system showed significant increases for D-dimers, tissue plasminogen activator antigen and plasminogen activator inhibitor, whereas the tissue plasminogen activator activity was significantly diminished. Remarkably, there seems to be a discrepancy between the (low) tissue plasminogen activator activity and the (higher) plasminogen activator antigen concentration. Alterations in the plasma concentrations of the investigated coagulation and fibrinolysis factors and in the aggregability of the platelets are indicative of an involvement of coagulation, fibrinolysis and platelets in hypertension, which can be considered as partial risk factors for thrombophilia.