盐酸苯那普利在老年高血压患者中应用的流行病学监测

目的：评价盐酸苯那普利药品在以社区为基础的老年原发性高血压患者人群中使用的降压效果和安全性。方法：连续收集了594例服用盐酸苯那普利药的老年原发性高血压患者的12个月用药记录,包括血压水平,用药和不良反应情况等。结果：研究人群既往服药患者占38．9％,按规定服药和单独服用盐酸苯那普利者占95％以上。盐酸苯那普利的有效率从3个月的68．3％上升到12个月的80．0％,各种特征的患者均有效。12个月的血压下降幅度收缩压／舒张压为13．7／6．7mmHg。143个出现不良反应,发生率为24．1％,主要不良反应类型是咳嗽。首次发生不良反应的高峰出现的服药的前3个月内,结论：长期服用直 那普利的降压效果是肯定的,同时又是安全的。     

盐酸苯那普利药物上市后的流行病学监测

目的 评价盐酸苯那普利药品在以社区为基础的原发性高血压患者人群中使用的降压效果和安全性。方法 连续收集了１８３１例服用盐酸苯那普利药的原发性高血压患者的１８个月用药记录,包括血压水平、用药和不良反应情况等。结果 患者人群既往服药患者占１／３,按规定服药和单独服用盐酸苯那普利者占９６％以上。盐酸苯那普利的有效率从３个月的７３．６％上升到１８个月的８４．７％,各种特征的患者均有效。１８个月的血压下降幅     

复方利血平氨苯喋啶片联合其他抗高血压药物治疗非杓型原发性高血压患者的血压达标情况及其安全性

目的 评价复方利血平氨苯喋啶片联合其他抗高血压药物治疗非杓型原发性高血压患者的血压达标情况和长期用药的安全性.方法 选择符合入组条件的非杓型原发性高血压患者461例为研究对象,随机分为2组,一组为晨起服药组,另一组为晚上服药组.分别给予复方利血平氨苯喋啶片治疗,每次1片,1次/d,连续6个月,治疗过程中如血压未达标可联合除利尿剂外的抗高血压药物,治疗前和结束时进行心电图和实验室检查.结果 治疗后收缩压和舒张压均明显下降,基线收缩压(156.82±11.69) mm Hg,舒张压(92.93±9.31) mm Hg,治疗后收缩压(126.02±9.20) mm Hg,舒张压(79.06±7.56) mm Hg;治疗后收缩压的下降值为(30.82±14.39) mm Hg,舒张压下降值为(14.11±10.32) mm Hg.治疗1个月后总达标率为63.5％,治疗3～6月的血压达标率均保持在87％以上,晨起服药组与晚上服药组比较,达标率差异无统计学意义(P＞0.05).在随访过程中有280例(62.9％)患者联合了其他抗高血压药物.治疗后血常规、血生化和电解质发生异常变化的较少,治疗期间20例(占4.5％)患者发生药物不良反应.结论 复方利血平氨苯喋啶片是一种有效的抗高血压药物,及时联合使用其他种类降压药物可显著降低血压,提高达标率,长期应用安全性较好.     

缬沙坦与苯那普利联合治疗高血压病的疗效观察

目的观察缬沙坦与苯那普利联合治疗重度高血压病的降压效果及耐受性。方法选择重度高血压患者(坐位舒张压≥110mmHg)。所有入选病例停药1周并给予安慰剂服用1周后,仍符合入选条件者服用缬沙坦80mg／d;于4周末坐位舒张压≥90mmHg者加用苯那普利10mg／d,继续用药4周。在治疗前及治疗中监测血压、心率,每周一次并记录出现的不良反应。结果共入选病例82例,完成8周观察者78例。4周末SBP／DBP下降19.2±8.1／13.5±6.3mmHg,总有效率20.5％;8周末联合用药组SBP／DBP下降35.2±12.1／24.5±11.1mmHg,总有效率82.3％。最终单用缬沙坦组16例,联合用药组62例。缬沙坦组治疗前后心率无明显变化,联合用药组治疗后心率较治疗前略有增加。结论缬沙坦与苯那普利联合治疗重度高血压疗效确切。     

苯那普利致咳嗽不良反应的监测及其危险因素研究

目的 研究苯那普利相关咳嗽不良反应的危险因素。方法 对1831例高血压患者进行连续3年的用药观察，随访记录咳嗽不良反应发生情况，并嵌套病例对照研究，进行危险因素分析。结果 服用苯那普利后半年内，咳嗽不良反应的发生率女性为18．35％，男性为12．11％。logistic回归分析显示，女性(OR＝2．193，95％CI：1．500—3．206)、肾功能失代偿的女性(OR＝3．432，95％CI：1．954—6．028)、女性65岁以上(OR＝1．672，95％CI：1．040—2．688)、男性饮白酒100g／日以上(OR＝2．478，95％CI：1．148—5．347)发生咳嗽不良反应的危险性增加。结论 女性、老年、饮白酒、肾功能失代偿是苯那普利致咳嗽不良反应发生的可能危险因素，但不是主要的危险因素。     

氢氯噻嗪与缬沙坦或贝那普利联洽治疗原发性高血压患者疗效比铰

目的：比较联合应用缬沙坦和氢氯噻嗪与贝那普利和氢氯噻嗪治疗原发性高血压患者的疗效和安全性比较。方法：120例原发性高血压患者,血压水平为1—2级,随机分为两组。一组选用每天缬沙坦80mg和氢氯噻嗪12．5mg;另一组选用每天贝那普利10mg与氢氯噻嗪12．5mg。以基线值与用药4周末血压的平均变化作为疗效指标,并记录药物不良反应,结合实验室检查结果作安全性评估。结果：两治疗组第4周平均收缩压及平均舒张压均较治疗前降低,治疗后两组间收缩压及平均舒张压差异无统计学意义（P〉0．05）。与药物相关的不良反应咳嗽发生率缬沙坦和氢氯噻嗪组（3．70％）低于贝那普利与氢氯囔嗪组（12．12％）,但无统计学意义。结论：联合应用缬沙坦和氢氯噻嗪与贝那普利和氢氯噻嗪治疗原发性高血压降压疗效相似．但前者的安全性和耐受性较好。     

联合用药治疗慢性心力衰竭临床疗效分析

[目的]评价美托洛尔、苯那普利和硝酸甘油联用治疗慢性心力衰竭的疗效.[方法]63例慢性充血性心力衰竭患者随机分为对照组30例,联合用药组33例;对照组予苯那普利、利尿剂、硝酸甘油、洋地黄等常规治疗.联合用药组在上述治疗基础上加服美托洛尔,疗程均为1个月.[结果]联合用药组与对照组的心率、收缩压和舒张压与治疗前相比,均有所降低,差异有统计学意义(P<0.05),而联合用药组降低的程度大干对照组;联合用药组有效率为90.9%(14例显效,16例有效,3例无效;对照组总有效率为73.3%(9例显效,13例有效,8例无效);两组总有效率比差异有统计学意义(P<0.05),两组均无严重不良反应.[结论]苯那普利治联合小剂量美托洛尔治疗慢性心力衰竭疗效优于单用苯那普利,且不良反应少,值得推广应用.     

缬沙坦与苯那普利联合治疗高血压病的疗效观察

目的观察缬沙坦与苯那普利联合治疗重度高血压病的降压效果及耐受性.方法选择重度高血压患者(坐位舒张压≥110mmHg).所有入选病例停药1周并给予安慰剂服用1周后,仍符合入选条件者服用缬沙坦80mg/d;于4周末坐位舒张压≥90mmHg者加用苯那普利10mg/d,继续用药4周.在治疗前及治疗中监测血压、心率,每周一次并记录出现的不良反应.结果共入选病例82例,完成8周观察者78例.4周末SBP/DBP下降19.2±8.1/13.5±6.3mmHg,总有效率20.5%;8周末联合用药组SBP/DBP下降35.2±12.1/24.5±11.1mmHg,总有效率82.3%.最终单用缬沙坦组16例,联合用药组62例.缬沙坦组治疗前后心率无明显变化,联合用药组治疗后心率较治疗前略有增加.结论缬沙坦与苯那普利联合治疗重度高血压疗效确切.     

苯那普利抗高血压治疗患者血压长期变化趋势分析

目的 介绍混合线性模型方法在降压治疗中对血压长期变化趋势分析的应用。方法利用在上海市南市区开展的一项以社区为基础的苯那普利上市后3年流行病学监测数据,分析不同年龄、性别的原发性高血压患者用药3年中血压水平的变化趋势。用作拟合的是患者每3个月1次的血压重复测量值。结果 对收缩压和舒张压拟合的较适模型为曲线线性模型。而对脉压进行了分段拟合,即用药后前9个月为曲线线性模型,9个月后为线性模型。服用苯那普利期间,患者的血压水平表现出长期稳定的降压效果。不同年龄和性别的患者在血压水平、降压速度和加速度方面存在一定的变异。患者年龄越大,表现出收缩压越高、舒张压越低、脉压越大。抗高血压治疗表现出最初的血压水平越高,降压速度越快,降压幅度越大。结论 混合线性模型方法在应用于纵向数据的分析时,尤其是在处理缺失数据方面,具有很大的灵活性,能更充分地利用可得信息。     

美托洛尔联合苯那普利硝酸甘油治疗慢性充血性心力衰竭疗效分析

[目的]评价美托洛尔、苯那普利和硝酸甘油联用治疗慢性充血性心力衰竭的疗效. [方法]63例慢性充血性心力衰竭患者随机分为对照组30例,联合用药组33例;对照组予苯那普利、利尿剂、硝酸甘油、洋地黄等常规治疗.联合用药组在上述治疗基础上加服美托洛尔,疗程均为1个月. [结果]联合用药组与对照组的心率、收缩压和舒张压与治疗前相比,均有所降低,差异有统计学意义(P<0.05),而联合用药组降低的程度大于对照组;联合用药组有效率为90.9%(14例显效,16例有效,3例无效;对照组总有效率为73.3%(9例显效,13例有效,8例无效);两组总有效率比差异有统计学意义(P<0.05),两组均无严重不良反应.[结论]苯那普利治联合小剂量美托洛尔治疗慢性充血性心力衰竭疗效优于单用苯那普利,且不良反应少,值得推广应用.     

上海市社区老年高血压患者血压水平影响因素的多水平分析

目的 应用多水平分析模型分析社区老年高血压患者血压水平的影响因素.方法 通过多阶段随机抽样,抽取上海市23个社区的927例老年高血压患者作为研究对象,采用两水平线性多层模型分别分析社区老年高血压患者收缩压(SBP)和舒张压(DBP)的影响因素.结果 研究对象的平均血压水平为SBP(139.2±11.7)mm Hg、DBP(85.6±8.6)mm Hg(I mm Hg=0.133 kPa).在社区水平上,辖区高血压患者/站点医师数(医患比)"高"的社区较医患比"低"的社区患者的SBP低3.86 mm Hg、DBP低2.51 mm Hg.在个体水平上,年龄、性别、超重/肥胖是血压升高的危险因素;规律服药、限盐、疾病管理自我效能的提高可降低血压,特别是在控制其他影响因素后仅限盐1项就可降低SBP 2.44 mm Hg、DBP 2.03 mm Hg.结论 多水平分析模型可以灵活有效地处理具有层次结构的数据,社区因素和个体因素对老年高血压患者的血压水平均有影响.     

Pet ownership and blood pressure in old age

BACKGROUND: It has been proposed that pet ownership improves cardiovascular health. This study examines the relation of pet ownership with systolic and diastolic blood pressure, pulse pressure, mean arterial pressure, and hypertension in a large sample of older men and women. METHODS: Participants were 1179 community-dwelling men (n = 498) and women (n = 681) age 50-95 years. Participants responded to a 1991-1992 mailed questionnaire ascertaining pet ownership, and they attended a 1992-1996 clinic visit at which systolic (SBP) and diastolic (DBP) blood pressures were measured and use of antihypertensive medication was validated. Pulse pressure was calculated as SBP minus DBP. Mean arterial pressure was calculated as (SBP+DBP)/2. Body mass index, waist-hip ratio, and information on other potential confounders were obtained. RESULTS: Average age of participants was 70.4 +/- 10.8 years; 30.0% reported current pet ownership. Mean SBP was 137.5 +/- 21.4 mm Hg, and DBP was 76.1 +/- 9.3 mm Hg; 55.6% were hypertensive (SBP >or= 140, DBP >or= 90 or taking hypertension medication). Pet owners were younger and slightly more overweight and they exercised less than nonowners; owners were somewhat more likely to have diabetes and to use beta-blockers. In unadjusted analyses, pet owners had lower SBP, pulse pressure, and mean arterial pressure, and a reduced risk of hypertension (odds ratio = 0.62; 95% confidence interval = 0.49-0.80). However, after adjustment for age and other confounders, pet ownership was not associated with systolic or diastolic blood pressure, pulse pressure, mean arterial pressure or risk of hypertension. CONCLUSIONS: Results suggest that pet ownership is not independently associated with blood pressure, vascular reactivity, or hypertension.     

Knowledge,treatment and control of hypertension. Results of a multicenter study of patients hospitalized for cardiac ischemia

The study objective was to assess the prevalence, level of treatment, and control of hypertension in CHDs patients. We conducted a cross-sectional survey on 1109 patients hospitalised for a first episode of MI in the main hospitals of the District of Tunis during the period 1999-2000. Hypertension and control level are defined according to the JNC recommendations. HBP is defined as SBP > = 140 and or DBP > = 90 mm Hg and the use of blood pressure-lowering medication for the indication of hypertension. Hypertension is controlled by medication if SBP < 140 and DBP < 90 mm Hg. We conduct analysis by socio demographic variables, medical history and CHDs risk factors. 54.9% men and 72.1% women were hypertensive. The prevalence of hypertension increases with age in both genders. The logistic regression have shown that the age-adjusted odds ratios were statically significant for diabetes, obesity, high cholestrolemia and cigarettes smoking. Only 68.9% of the hypertensive were aware of having hypertension, women were more aware than men (84.6% versus 61.7%, p < 0.001). Awareness increase with age and education level. Among hypertensive, 94.4% were treated but only 41.3% were controlled. The study highlights the problem of the hypertension, and contributes to identify the iceberg of this CHDs risk factor. An effort must be done to involve the health personnel for educating patients, the population for changing their life style and manager for enhancing the availability of drugs. The question is how much will be the cost of HBP and CVDs control for a country which has a limited resources.     

Women, employment status, and hypertension: cross-sectional and prospective findings from the Atherosclerosis Risk in Communities (ARIC) Study.

PURPOSE: This study examined the cross-sectional and prospective associations between employment status and hypertension among middle-aged, African-American (AA) and European-American (EA) women participating in the Atherosclerosis Risk in Communities Study. METHODS: Employed women and homemakers from the baseline examination (1987-89) were included in the cross-sectional study (n = 7351). Associations between employment and the incidence of hypertension ascertained at visit 2 (1990-92) were determined among those who at baseline, had low-normal blood pressure (not hypertensive and systolic blood pressure (SBP) < or = 120 mm Hg systolic and diastolic blood pressure (DBP) < or =80 mm Hg (n = 3194). Logistic regression analysis was used to examine the association between employment status and hypertension by ethnicity, taking into account covariates. RESULTS: At baseline, employed women were less likely to be hypertensive (SBP > or =140 mm Hg or DBP > or =90 mm Hg or current use of antihypertensive drugs) than were homemakers (prevalence odds ratio) (POR) = 0.70; 95% confidence interval (CI) = 0.62-0.79), controlling for age, body mass index, and education. Among the subgroup who had low-normal blood pressure at baseline, employed women were less likely to develop hypertension during the three-year time period than were homemakers (odds ratio (OR) = 0.68; 95% CI = 0.44-1.05). The inverse association was stronger among AA (RR = 0.37; 95% CI = 0.16-0.88) than EA (OR = 0.83; 95% CI = 0.50-1.38) women. CONCLUSIONS: These findings suggest that the inverse association between hypertension and employment status is not due to a healthy worker effect, and that employment may confer protection against incident hypertension in women.     

Assessing Cardiovascular Reactivity in Working Women with the Social Competence Interview

ABSTRACT

The Social Competence Interview (SCI), an interview to induce cardiovascular reactivity through recounting a stressful life experience, was used with a sample of 120 working women employed as childcare providers. Women recounted their most stressful work factor while cardiovascular reactions were monitored at 2-minute intervals (data points included 4 baseline, 6 SCI, and 3 recovery). Increases were found when comparing mean baseline and SCI measures: systolic blood pressure (SBP) increased 10.00 mm Hg; diastolic blood pressure (DBP) increased 10.63 mm Hg; and heart rate increased 4.57 beats per minute. Consistent with the literature SBP and DBP were higher for some subgroups of women (those who were 50 years or older, were obese, or had 4 or more risk factors) across all data points. There were no time by individual difference interactions, indicating that the patterns of change over time were the same across groups. In a logistic regression, comparing women who reached SBP ≥ 140 mm Hg and/or DBP ≥ 90 mm Hg during the SCI versus those who did not, higher BP was associated with being older and obese, having a higher level of acceptance coping, and a lower level of suppression of competing activities coping.     

Multiple risk factor intervention trial (MRFIT).: VI. Intervention on blood pressure

The MRFIT blood pressure data derived from the Special Intervention (SI) group of men over the first 4 years are presented, and the results of the hypertension treatment program are reviewed. A therapeutic goal diastolic blood pressure (DBP) was established for each man determined to be hypertensive which included men with DBP ?90 mm Hg and men who were already taking antihypertensive drugs. A stepped care protocol was used to guide the drug treatment. At the fourth annual examination, 63.8% of the 5,790 SI men seen had been previously declared hypertensive. The mean baseline blood pressure (BP) for the hypertensive group was 140.3 mm Hg, systolic, and 94.5 mm Hg, diastolic, and at the 48-month visit, the mean BP was 120.7 mm Hg, systolic, and 82.5 mm Hg, diastolic. Of the hypertensive men seen at 48 months, 87.3% were taking antihypertensive drugs, 65.4% were at or below their goal pressure, and 83.5% had a DBP <90 mm Hg. Most men on antihypertensive drug therapy were at protocol Step 1 or Step 2, receiving a diuretic agent alone (32.9%), or in combination with an antiadrenergic drug (40.4%). Data for specific drug regimens are presented. Older men and men with higher BP levels at entry had a better response. The MRFIT BP results, achieved within a context of a multiple-risk-factor intervention program, compare favorably with the results from recently reported trials that focused solely on the treatment of mild hypertension.     

Effects of Val-Pro-Pro and Ile-Pro-Pro on nondipper patients: a preliminary study

Much clinical evidence on the antihypertensive effects of the milk-derived antihypertensive peptides Val-Pro-Pro and Ile-Pro-Pro (lactotripeptides) has been reported. However, circadian rhythm effects determined by ambulatory blood pressure monitoring (ABPM) to eliminate the confounding influence of the white-coat effect have not been fully studied. Twelve hypertensive patients not receiving antihypertensive medication (2 men, 10 women; mean age±standard deviation, 63.5±8.3 years) who had been visiting our clinic for more than 1 year participated in this study. Mean (±standard deviation) systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 142.4±2.6 and 83.5±6.4?mm Hg, respectively, at the first office visit. After patients ingested a fermented milk product containing antihypertensive peptides (2.53?mg Val-Pro-Pro; 1.52?mg Ile-Pro-Pro) for more than 4 weeks, both office SBP and DBP were significantly reduced to a mean (±standard deviation) of 133.3±7.0?mm Hg and 76.5±8.4?mm Hg (P<.001 and P<.005 by paired t-test), respectively. The 24-hour SBP and DBP determined by ABPM were reduced from 127.3±2.4 and 78.7±2.3?mm Hg to 120.2±2.4 and 75.0±2.2?mm Hg (P<.001 and P<.05), respectively. Awake-time SBP (08:00-21:00), night-time SBP (0:00-05:00), and early-morning SBP (06:00-07:00) were reduced from 130.9±2.4 to 123.3±2.3?mm Hg, 118.7±2.9 to 113.2±3.4?mm Hg, and 132.8±4.3 to 122.4±3.9?mm Hg (by paired t-test: P<.001, P<.05, and P<.05), respectively. As seen with DBP measured by ABPM, 24-hour DBP and awake-time DBP were significantly reduced from 78.7±2.3 to 75.0±2.2?mm Hg and 82.1±2.5 to 77.3±2.2?mm Hg (P<.05 and P<.01), respectively. Office BP and 24-hour blood pressure did not significantly differ between the dipper and nondipper groups at baseline. However, after treatment, night-time and early-morning blood pressure were significantly reduced from baseline in the nondipper group (-8.5±2.5 and -15.6±3.7?mm Hg; P<.05 and P<.01, respectively) but not in the dipper group (-2.5±3.6 and -1.2±4.7?mm Hg; P not significant), and the reduction in early-morning blood pressure significantly differed between the groups (P<.05). These results suggest that Val-Pro-Pro and Ile-Pro-Pro decrease blood pressure in patients with stage I hypertension and result not only in lower blood pressure at night-time but also in lower early-morning SBP in nondipper patients.     

Coffee intake and incidence of hypertension

BACKGROUND: The long-term longitudinal evidence for a relation between coffee intake and hypertension is relatively scarce. OBJECTIVE: The objective was to assess whether coffee intake is associated with the incidence of hypertension. DESIGN: This study was conducted on a cohort of 2985 men and 3383 women who had a baseline visit and follow-up visits after 6 and 11 y. Baseline coffee intake was ascertained with questionnaires and categorized into 0, >0-3, >3-6, and >6 cups/d. Hypertension was defined as a mean systolic blood pressure (SBP) >or=140 mm Hg over both follow-up measurements, a mean diastolic blood pressure (DBP) >or=90 mm Hg over both follow-up measurements, or the use of antihypertensive medication at any follow-up measurement. RESULTS: Coffee abstainers at baseline had a lower risk of hypertension than did those with a coffee intake of >0-3 cups/d [odds ratio (OR): 0.54; 95% CI: 0.31, 0.92]. Women who drank >6 cups/d had a lower risk than did women who drank >0-3 cups/d (OR: 0.67; 95% CI: 0.46, 0.98). Subjects aged >or=39 y at baseline had 0.35 mm Hg (95% CI: -0.59, -0.11 mm Hg) lower SBP per cup intake/d and 0.11 mm Hg lower DBP (95% CI: -0.26, 0.03 mm Hg) than did those aged <39 y at baseline, although the difference in DBP was not statistically significant. CONCLUSIONS: Coffee abstinence is associated with a lower hypertension risk than is low coffee consumption. An inverse U-shaped relation between coffee intake and risk of hypertension was observed in the women.     

Blood pressure lowering in elderly subjects: a double-blind crossover study of omega-3 and omega-6 fatty acids

In 46 elderly (aged greater than or equal to 60 y) hypertensive subjects with entry systolic blood pressure (SBP) greater than or equal to 160 or diastolic blood pressure (DBP) greater than or equal to 90 mm Hg, our specific aim in a randomized, double-blind, crossover study (two 8-wk treatment periods separated by a 3-wk washout) was to compare blood pressure-lowering effects of 9 g fish oil/d [omega-3 (n-3) fatty acid] vs 9 g corn oil/d [omega-6 (n-6) fatty acid]. After a 4-wk baseline period, 22 subjects were randomly assigned to receive fish oil and 24 to receive corn oil. For both 8-wk treatments there were no between-group differences in the change in blood pressure. There was a treatment difference for standing DBP when baseline values were compared with those after treatment 2; DBP decreased by 5.1 mm Hg in the fish-oil group vs 0.72 mm Hg in the corn-oil group (P = 0.024). Within groups during the first treatment, both fish oil and corn oil lowered all four blood pressure measures (P less than 0.05); blood pressures were not further lowered during the second treatment compared with the washout period. There were no significant between-group differences in laboratory safety tests or categorical side effects. Fish oil lowered triglycerides by 0.47 mmol/L (P less than 0.001). In elderly subjects, diet plus both omega-3 and omega-6 supplements (9 g/d) safely and effectively lower SBP and DBP.