昼夜动态血压变化与脑白质疏松症的关系

目的探讨昼夜动态血压变化与脑白质疏松症(LA)的相关性。方法回顾性分析脑血管病危险因素筛查研究中的144例患者,根据头部MRI结果分为LA组(80例)和非LA组(64例)。采用美国DP5000型动态血压监测仪监测患者的血压水平,包括昼夜收缩压(24 hSBP)、昼夜舒张压(24 hDBP)、白昼收缩压(DSBP)、白昼舒张压(DDBP)、夜晚收缩压(NSBP)、夜晚舒张压(NDBP);血压变异性(BPV)参数包括白昼收缩压标准差(DSBP-SD)和舒张压标准差(DDBP-SD)、夜晚收缩压标准差(NSBP-SD)和舒张压标准差(NDBP-SD)。根据DSBP和NSBP判定血压昼夜节律,同时比较两组动态血压参数以及血压昼夜节律分型的差异。结果①LA组昼夜SBP、DSBP、DDBP、NSBP、DSBP-SD高于非LA组,差异有统计学意义(P<0.05)。②非杓型和超杓型患者的LA发生率高于杓型患者(63.0%和68.4%比38.5%),差异有统计学意义(P<0.05)。③Binary Logistic回归分析显示,DSBP(OR=1.070;95%CI:1.024～1.117)和DSBP-SD(OR=1.324;95%CI:1.129～1.552)增高是LA的独立危险因素。结论血压水平、血压变异性及血压昼夜节律是LA的重要影响因素,其中DSBP、DSBP-SD增高是LA的独立危险因素。     

药物联合气道正压通气治疗OSAS并高血压52例临床观察

选取阻塞性睡眠呼吸暂停综合征(OSAS)并高血压患者52例(OSAS组)及非OSAS高血压患者48例,入院后同步进行24 h动态血压监测.两组均予低盐饮食及培哚普利和(或)苯磺酸氨氯地平口服治疗2周,其后OSAS组降压效果差者接受气道正压通气(CPAP)治疗2周,观察两组治疗前后全天平均血压变化.结果 两组日间平均收缩压(DSBP)、舒张压(DDBP)及夜间平均舒张压(NDBP)均无明显差异,OSAS组的夜间平均收缩压(NSBP)明显高于对照组(P<0.05);药物治疗2周后,OSAS组全天平均血压无明显变化,对照组明显低于治疗前(P<0.05);OSAS组30例药物降压效果欠佳者行CPAP治疗2周后血压显著下降(P<0.05).认为对OSAS并高血压患者单纯药物降压疗效欠佳,辅助CPAP治疗可提高疗效.     

急性缺血性脑梗死病人血压变化节律与预后及靶器官损伤的相关性研究

目的研究急性缺血性脑梗死病人血压变化节律与预后及靶器官损伤的相关性。方法采用前瞻性研究,使用S/NB19086动态血压监测系统,对我院2015年1月—2016年12月住院的213例急性缺血性脑梗死病人血压进行24 h监测,根据血压节律类型分为3组,勺型组63例、非勺型组72例和反勺型组78例,比较各组入院7 d血压节律变化和靶器官损伤情况;入院时和治疗3个月后采用美国国立卫生研究院卒中量表(NIHSS)评分、生活质量评分(Barthel指数)评价预后。结果各组间夜间脉压(NPP)、夜间收缩压(NSBP)、夜间舒张压(NDBP)和24 h平均动脉压(24 hMAP)差异有统计学意义(P0.05),日间脉压(DPP)、日间收缩压(DSBP)、日间舒张压(DDBP)差异无统计学意义(P0.05)。勺型组脑损伤、脑+心损伤、脑+心+肾损伤的比例为84.13%、15.87%、0.00%;非勺型组分别为8.33%、68.06%、23.61%,反勺型组分别为10.26%、47.44%、42.31%;非勺型组、反勺型组脑+心损伤、脑+心+肾损伤的比例明显高于勺型组(P0.05),非勺型组脑+心损伤比例高于反勺型组(P0.05),反勺型组脑+心+肾损伤比例高于非勺型组(P0.05)。入院时和3个月后非勺型组、反勺型组NIHSS评分均高于勺型组,Barthel指数均低于勺型组(P0.05)。勺型与预后和靶器官损伤无相关性(r=0.067,P=0.937;r=0.042,P=0.949);非勺型与预后和靶器官损伤呈正相关(r=0.714,P=0.008;r=0.608,P=0.011);反勺型与预后和靶器官损伤呈正相关(r=0.737,P=0.007;r=0.812,P=0.000)。结论急性缺血性脑梗死病人血压变化节律异常预示靶器官损伤和预后较差,调整异常血压节律、合理控制血压可改善病人预后。     

非洛地平缓释片对原发性高血压患者动态血压的影响及与细胞内胞浆游离钙浓度的关系

目的 观察非洛地平对高血压患者动态血压的影响及与细胞内胞浆游离钙浓度的关系。方法 检测28例原发性高血压患者及相应对照组之血压及淋巴细胞胞浆游离钙浓度及非洛地平缓释片治疗四周后血压及淋巴细胞胞浆游离钙浓度的变化,并观察其治疗前后24h动态血压的变化。结果 原发性高血压患者淋巴细胞胞浆游离钙浓度显著高于对照组,非洛地平缓释片治疗后淋巴细胞胞浆游离钙浓度和血压显著下降(P<0.01),淋巴细胞胞浆游离钙浓度的下降幅度与收缩压及舒张压下降幅度呈正相关(r=O.866,P<0.001及r=0.734,P<0.001)。治疗后24h平均收缩压、24h平均舒张压、日间平均收缩压、日间平均舒张压、夜间平均收缩压、夜间平均舒张压、日间收缩压负荷、日间舒张压负荷、夜间收缩压负荷、夜间舒张压负荷均较治疗前明显降低(P<0.05-P<0.01)。结论非洛地平是平稳有效的抗高血压药物,其降压作用可能是通过降低细胞内胞浆游离钙浓度而发挥作用。     

原发性高血压患者血压变异性与糖尿病的相关性

目的探讨合并2型糖尿病(T2DM)的高血压患者与单纯原发性高血压患者动态血压水平及血压变异性的相关性。方法以800例合并T2DM的原发性高血压患者及800例单纯原发性高血压患者为研究对象,监测研究对象日间、夜间及24 h收缩压及舒张压变异性,并进行对比分析,研究原发性高血压患者血压变异性与糖尿病的相关性。结果高血压合并T2DM组24 h平均收缩压、夜间平均收缩压均明显高于高血压组(均P0.05),高血压合并T2DM组收缩压昼夜差值、舒张压昼夜差值均明显低于高血压组(均P0.05);高血压合并T2DM组24 h收缩压标准差、日间收缩压标准差、日间收缩压变异系数、夜间收缩压标准差、夜间收缩压变异系数、夜间舒张标准差、血压晨峰均明显高于高血压组(均P0.05);经相关分析发现,患者血糖水平与24 h收缩压标准差、24 h收缩压变异系数、日间收缩压标准差、日间收缩压变异系数、日间舒张标准差、日间舒张压变异系数、夜间舒张标准差、血压晨峰呈正相关(均P0.05)。结论原发性高血压合并T2DM患者血压变异性较单纯原发性高血压患者增大,提示糖尿病合并原发性高血压时对患者昼夜血压调节损害较大并可能与血糖水平有关。     

原发性高血压患者血压变异性与早期肾功能损害的相关性研究

目的：观察原发性高血压（EH）患者血压变异性与尿微量白蛋白/尿肌酐比值的相关性。方法：随机选择60例EH患者作为EH组,按照24h平均动脉压均值高度又分为3个亚组,即EH1组（90.2～106.6mmHg）、EH2组（106.6～118.3mmHg）及EH3组（118.3～143.7mmHg）,各亚组均20例,另选择15例健康正常人作为健康对照组。监测所有研究对象在日间、夜间及24h收缩压变异性和舒张压变异性,以晨尿微量白蛋白/尿肌酐比值作为早期肾功能损害的指标,研究其相关性。结果：两组均存在血压变异性,与健康对照组比较,EH组日间、夜间及24h收缩压变异性[日间：（12.62±2.96）比（17.62±3.27）,夜间：（8.32±2.14）比（11.63±2.35）,24h：（11.23±2.25）比（18.35±2.94）]和舒张压变异性[日间：（10.32±2.41）比（12.48±2.85）,夜间：（9.52±2.00）比（11.59±3.12）,24h：（10.68±2.16）比（13.45±3.00）]均明显增大（P均〈0.01）。双变量相关分析显示EH组及EH各个亚组的日间、夜间及24h收缩压和舒张压的血压变异性均与尿微量白蛋白/尿肌酐比值均呈正相关（r=0.217～0.485,P〈0.05）。结论：原发性高血压患者血压变异性与早期肾脏损伤密切相关,改善血压变异性对预防早期肾功能损害有益。     

原发性高血压患者醛固酮与肾素活性比值和夜间血压及靶器官损害的关系

目的探讨原发性高血压患者中醛固酮与肾素活性比值(ARR)与夜间血压及高血压靶器官损害的相关性。方法选择2014年11月1日至2015年11月30日,大连医科大学附属第一医院高血压科住院的单纯原发性高血压患者237例,按ARR高低等分为3组,每组79例:ARR5.8、5.8～12.6、≥12.6 (ng/dL)/[μg/(L·h)]组。分析ARR与夜间血压、高敏C反应蛋白(hsCRP)、脑钠尿肽、肱踝动脉脉搏波传导速度(baPWV)、踝臂指数、左心室质量指数(LVMI)的关系。结果随着ARR升高,hsCRP、踝臂指数、脑钠尿肽、LVMI、夜间收缩压(nSBP)及夜间舒张压(nDBP)随之升高,而nSBP和nDBP下降百分比降低(P0.05);Pearson相关分析显示,ARR与踝臂指数、脑钠尿肽、LVMI、nSBP呈正相关(r=0.161、0.270、0.190、0.225);与nSBP及nDBP下降百分比呈负相关(r=-0.360、-0.285,均P0.05)。多元线性回归显示,ARR是nSBP及nDBP下降百分比的独立影响因素(β=-0.360,-0.264,均P0.05)。结论 ARR是原发性高血压患者nSBP及nDBP下降百分比的独立危险因素。     

老老年高血压患者伴慢性心衰患者心功能分级与动态血压参数相关性研究

【摘要】目的：研究老老年原发性高血压伴慢性心力衰竭患者,心功能分级与动态血压参数之间的相关性。方法：选取2013年5月至2014年4月广安门医院心内科住院的老老年高血压患者147例,根据纽约心功能分级标准将患者分成心功能Ⅰ级48例,Ⅱ级31例,Ⅲ级38例,Ⅳ级30例,比较各组间动态血压参数的数值,并进行相关性分析。结果：不同心功能分级各组间行Spearman相关性分析显示：心功能分级与全天收缩压（r=-0.253,p=0.004）、全天舒张压（r=-0.247,p=0.005）、白天收缩压（r=-0.309,p=0.000）、白天舒张压（r=-0.293,p=0.001）、白天脉压（r=-0.179,p=0.044）、全天平均动脉压（r=-0.282,p=0.001）、白天平均动脉压（r=-0.309,p=0.000）、夜间收缩压下降率（r=-0.375,p=0.000）、24小时收缩压负荷（r=-0.262,p=0.003）、24小时舒张压负荷（r=-0.275,p=0.002）、白天收缩压负荷（r=-0.246,p=0.005）、白天舒张压负荷（r=-0.275,p=0.002）、夜间舒张压负荷（r=-0.229,p=0.01）均呈负相关,p值均＜0.05,有统计学意义。经多元线性回归分析显示,白天平均收缩压、夜间平均收缩压为老老年高血压伴随慢性心力衰竭患者的最终影响因素。结论：在老老年原发性高血压伴慢性心衰患者中,心功能与动态血压关系密切,尤其是白天、夜间平均收缩压,故应密切观察患者的动态血压参数,并进行合理的临床干预,从而有利于患者心功能的改善,预防心功能的进一步恶化,改善老老年高血压患者的生活质量及预后。     

上皮钠通道基因变异与高血压及氢氯噻嗪降压效果和药物不良反应的相关性研究

目的上皮钠通道在调节机体血压方面起到重要作用,其基因变异可影响血压的变化。本研究拟验证上皮钠通道基因变异与高血压、高血压人群服用氢氯噻嗪后的降压效果,及与氢氯噻嗪低血钾及高血糖不良反应的相关性。方法本研究前瞻性纳入两组高血压病例对照人群(分别为1 642例及609例)检测上皮钠通道基因型。并对542例高血压患者给予2周的氢氯噻嗪单药降压治疗,测量基线血钾、血糖等生化指标。经过长期随访,共获得456例患者的随访资料,平均随访31个月,再次测量血钾、血糖等生化指标。结果 SCNN1Ars2071244的G等位基因在两组高血压病例对照人群中均与高血压显著相关(OR:1.528,95%CI:1.138~2.051,P=0.005及OR:2.032,95%CI:1.292~3.194,P=0.002)。矫正年龄、性别等因素后在两组人群中相关性仍显著(OR:1.429,95%CI:1.042~1.960,P=0.027及OR:1.779,95%CI:1.098~2.884,P=0.019)。氢氯噻嗪服药两周后,携带rs2071244G等位基因的患者无论是收缩压还是舒张压均比携带CC基因型的患者具有更显著的降压效果。携带rs2071244G等位基因的患者收缩压下降26.7 mm Hg,携带CC基因型的患者收缩压下降20.1 mm Hg(P=0.026)。携带G等位基因的患者舒张压下降13.2 mm Hg,携带CC基因型的患者舒张压下降9.8 mm Hg(P=0.014)。在高血压人群中,服用氢氯噻嗪之前及服用后随访时,SCNN1Ars2071244不同基因型之间血钾及血糖水平、血钾及血糖变化幅度均差异无统计学意义(P0.05)。结论上皮钠通道SCNN1A基因变异rs2071244是高血压的危险因素,对氢氯噻嗪的降压效果更敏感,但与氢氯噻嗪对血钾、血糖的不良反应无关。     

老年原发性高血压患者血脂异常与血压变异性的相关研究

目的观察血脂异常对老年原发性高血压患者动态血压（ABP）及血压变异性（BPV）的影响。方法选择67例老年原发性高血压患者,根据总胆固醇（TC）水平分为两组：高胆固醇组34例和非高胆固醇组33例,进行24hABP监测,对两组患者的ABP及BPV进行对比分析。结果与非高胆固醇组相比,高胆固醇组的24h收缩压（24hSBP）、日间收缩压（dSBP）、24h脉压均值（24hPP）、日间脉压均值（dPP）均增高（P〈0.05）。高胆固醇组24h收缩压标准差（24hSBPSD）、日间收缩压标准差（dSBPSD）高于非高胆固醇组（P〈0.01）,夜间收缩压标准差（nSBPSD）、夜间舒张压标准差（24hDBPSD）、日间舒张压标准差（dDBPSD）高于非高胆固醇组（P〈0.05）。而两组之间其他参数差异无统计学意义。结论BPV与血脂异常具有正相关性,高血压和血脂异常都是心脑血管疾病的重要危险因素。     

高血压病患者动态血压与左心功能相关关系的研究

目的观察收缩压、舒张压分别对左室收缩及舒张功能的不同影响。方法应用诊所血压、２４小时动态血压监测及超声心动图，观察３８例Ⅰ、Ⅱ期高血压病患者血压与左室心肌质量、左室收缩及舒张功能的相关关系。结果２４小时及白天平均收缩压及诊所收缩压均与舒张早期充盈峰值流速（ＥＰＦＶ）呈负相关（Ｐ值均＜００５），２４小时、白天及夜间平均舒张压均与年龄呈负相关（Ｐ值均＜０．０５），与舒张功能各参数之间无相关关系，诊所收缩压与年龄、心房收缩期充盈峰值流速（ＡＰＦＶ）呈正相关（Ｐ＜０．００１及０．０５），夜间平均收缩压及诊所收缩压与左室心肌质量指数呈正相关（Ｐ＜０．０１及０．０５）。而２４小时平均收缩压、白天平均收缩压、２４小时平均舒张压、白天及夜间平均舒张压则均与左室心肌质量指数无明显相关关系。结论２４小时平均收缩压是影响左室舒张功能的重要因素之一，２４小时平均舒张压与左室舒张功能无相关关系。夜间平均收缩压增高是导致左心室肥厚的重要因素之一。随年龄增长，收缩压增高，舒张压下降     

Relation of electrolytes to blood pressure in men. The Yi people study

The relations of sodium, potassium, calcium, and magnesium to blood pressure were investigated in four groups of men (119 high-mountain Yi farmers, 114 mountainside Yi farmers, 89 Yi migrants, and 97 Han people) with a wide range of electrolyte intake in Puge County, Sichuan Province, People's Republic of China. Electrolytes were measured in diet, serum, and urine. Sodium excretion was 73.9 mmol/24 hr in high-mountain Yi farmers, 117.9 mmol/24 hr in mountainside Yi farmers, 159.4 mmol/24 hr in Yi migrants, and 186.0 mmol/24 hr in the Han people. In ecological correlation analysis, dietary and urinary sodium were significantly and positively correlated with both systolic and diastolic pressure, whereas serum sodium showed no relation with blood pressure. In diet, serum, and urine, potassium was negatively related to systolic and diastolic pressure, whereas the sodium/potassium ratio showed a positive association. With regard to calcium, only urinary excretion was significantly and positively related to blood pressure. No relation was found between magnesium and blood pressure. Analyses at the individual level confirmed the results for sodium and potassium seen at the ecological level, but in addition, dietary calcium and magnesium were significantly and negatively correlated to both systolic and diastolic pressure, and urinary magnesium was inversely related to diastolic pressure. These relations persisted after controlling for age, body mass index (kg/m2), heart rate, alcohol, and total energy intake in multiple regression analysis performed separately for electrolytes in diet, serum, and urine. In multiple regression analysis, an increase in sodium intake of 100 mmol/day corresponded to an increase of 2.3 mm Hg systolic blood pressure and 1/8 mm Hg diastolic pressure.(ABSTRACT TRUNCATED AT 250 WORDS)     

Impaired reduction of nocturnal systolic blood pressure and severity of diabetic retinopathy

The aim of the present study was to evaluate the influence of elevated levels of nocturnal blood pressure (BP) on diabetic retinopathy (DR). A total of 88 diabetic hypertensive patients were divided according to the stage of DR. They underwent 24 h ambulatory BP monitoring and ophthalmological evaluation, and their average level of fasting blood glucose as well as their glycemic control index (percentage of fasting blood glucose higher than 11.2 mmol/L over the previous four years) were calculated. When diabetic patients with retinopathy (n=29) (group 1) were compared with patients without retinopathy (n=59) (group 2), a significant difference was observed in diabetes duration (124 months [range six to 460 months] versus 43 months [range six to 365 months], respectively; P<0.05). In addition, group 1 showed higher levels of nocturnal systolic BP (NSBP) (141 +/- 22 mmHg versus 132+/-18 mmHg; P<0.05). However, no significant differences were found between the two groups (group 1 and group 2) when diurnal pressoric levels were compared (diurnal systolic BP, 153+/-19 mmHg versus 146+/-19 mmHg, P not significant; and diurnal diastolic BP, 91+/-9 mmHg versus 91+/-13 mmHg, P not significant). DR correlated with diabetes duration (r=0.26; P<0.05) and with glycemic control index (r=0.24; P<0.01). Multivariate regression analysis showed NSBP to be an independent predictor of DR (r(2)=0.12; P<0.01). Moreover, patients with severe stages of DR (preproliferative, proliferative or macular edema) showed a lower decrease of NSBP than the other patients (3.9+/-6.0 mmHg versus 9.2+/-6.0 mmHg; P<0.05). The present study suggests that the absence of 24 h normal pressoric rhythm can interfere with the prevalence and severity of DR.     

持续气道正压通气对重度阻塞性睡眠呼吸暂停低通气综合征合并高血压患者血压及血清瘦素水平的影响研究

目的探讨持续气道正压通气(CPAP)对重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并高血压患者血压及血清瘦素水平的影响。方法选取我院2011年3月—2014年3月收治的资料完整的重度OSAHS合并高血压患者98例,采用随机数字表法分为对照组40例和治疗组58例。对照组患者给予常规降压药物治疗,治疗组患者在常规降压药物治疗基础上给予CPAP。观察两组患者治疗前、治疗6个月后夜间收缩压、夜间舒张压、24 h平均收缩压、24 h平均舒张压、呼吸暂停低通气指数(AHI)、最低动脉血氧饱和度(SaO2)、最长呼吸暂停时间、血清瘦素水平。结果组间比较:两组患者治疗前夜间收缩压、夜间舒张压、24 h平均收缩压、24 h平均舒张压、AHI、最低SaO2、最长呼吸暂停时间及血清瘦素水平比较,差异均无统计学意义(P0.05);治疗组患者治疗后夜间收缩压、夜间舒张压、24 h平均收缩压、24 h平均舒张压、AHI及血清瘦素水平低于对照组,最低SaO2高于对照组,最长呼吸暂停时间短于对照组(P0.05)。组内比较:对照组患者治疗后24 h平均收缩压、24 h平均舒张压较治疗前降低(P0.05),而治疗前后夜间收缩压、夜间舒张压、AHI、最低SaO2、最长呼吸暂停时间及血清瘦素水平比较,差异均无统计学意义(P0.05);治疗组患者治疗后夜间收缩压、夜间舒张压、24 h平均收缩压、24 h平均舒张压、AHI及血清瘦素水平均较治疗前降低,最低SaO2较治疗前升高,最长呼吸暂停时间较治疗前缩短(P0.05)。直线相关分析结果显示,重度OSAHS合并高血压患者治疗后24 h平均收缩压与AHI呈正相关(r=0.587,P0.05),与最低SaO2呈负相关(r=-0.519,P0.05),与血清瘦素水平呈正相关(r=0.497,P0.05)。结论在常规降压药物治疗基础上联合CAPA治疗可有效减少重度OSAHS合并高血压患者夜间间歇性低氧血症,降低交感神经兴奋性及血清瘦素水平,进而使其血压降低,有利于更好地控制血压。     

血清PTX-3、PGRN与合并OSAHS的高血压病患者血压变异性的关系

目的探讨血清正五聚蛋白3(PTX-3)、颗粒蛋白前体(PGRN)与合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的高血压病患者血压变异性的关系。方法选取241例高血压病合并OSAHS患者,根据呼吸暂停低通气指数(AHI),将患者分成轻度组(n=136)、中度组(n=45)和重度组(n=60)。比较三组患者血清指标和血压变异性的差异,应用Pearson分析血清PTX-3和PGRN水平与血压变异性的相关性,线性回归分析血压变异的危险因素。结果合并不同程度OSAHS患者夜间血压变异性各指标差异有统计学意义(P<0.05);三组患者血清PTX-3和PGRN水平差异有统计学意义(P<0.05);血清PTX-3与夜间收缩压标准差(nSSD)(r=0.484,P<0.001)和夜间舒张压标准差(nDSD)呈正相关(r=0.349,P<0.001);血清PGRN与nSSD(r=0.361,P<0.001)和nDSD呈正相关(r=0.301,P<0.001)。PTX-3和PGRN增加是nSSD、nDSD升高的危险因素(P<0.05)。结论血清PTX-3和PGRN与高血压病合并OSAHS患者夜间血压变异性呈正相关,并且二者表达升高是夜间血压变异增加的危险因素。     

代谢综合征与前列腺体积的相关性

目的 探讨代谢综合征(metabolic syndrome,MS)与前列腺体积的相关性. 方法 选择年龄36～90岁男性1098人,采用2004年中华医学会糖尿病学分会提出的MS建议诊断标准.分为MS组和对照组.测量血压、身高、体质量,计算体质指数(BMI).生化分析包括血糖、总胆固醇、三酰甘油、低密度脂蛋白胆固醇(LDI-C)、高密度脂蛋白胆固醇(HDL-C)和前列腺特异性抗原(PSA).采用经腹部超声测量前列腺体积. 结果 (1)与对照组比较.MS组的BMI、收缩压、舒张压、空腹血糖、三酰甘油、总胆固醇、前列腺体积和PSA水平较高,但HDL-C水平较低(均P<0.05);(2)MS组前列腺体积较对照组增大,分别为(31.0±11.1)ml和(37.8±21.3)ml,两组差异有统计学意义(P<0.01);(3)前列腺体积与血清PSA水平(r=0.350,P<0.01)、年龄(r=0.429,P<0.01)、BMl(r=0.145,P<0.01)、收缩压(r=0.133,P<0.05)呈正相关,与舒张压(r=0.193,P<0.01)呈负相关. 结论 MS与前列腺体积增大有关.     

Salt,endogenous ouabain and blood pressure interactions in the general population

OBJECTIVE: Experimental data show that ouabain is a modulator of the sodium-potassium pump, which plays an important role in sodium homeostasis and blood pressure regulation. We investigated the distribution of plasma ouabain in the general population in relation to blood pressure and other determinants of sodium homeostasis. METHODS: In 379 subjects enrolled in a Belgian population study, we measured plasma ouabain, clinical characteristics including blood pressure, serum and urinary electrolytes, urinary aldosterone excretion, various lifestyle factors, and the Gly460Trp polymorphism of the alpha-adducin gene. Our statistical methods included analysis of covariance and multiple linear regression. RESULTS: Plasma ouabain (median, 140 pmol/l) correlated independently and positively with male gender (n = 182, P = 0.002), smoking (n = 116, P = 0.05), urinary potassium excretion (mean 69 mmol/day, P < 0.0001), and mutation of the alpha-adducin gene (n = 161, P < 0.0001). Both before and after adjustment for covariables, continuous as well as categorical analyses revealed a significant interaction (P < or = 0.02) between plasma ouabain and urinary sodium excretion (mean 194 mmol/day) in relation to blood pressure (mean systolic blood pressure/diastolic blood pressure, 123/76 mmHg). In individuals with plasma ouabain values below the median, blood pressure increased by 2.2 mmHg systolic and 1.4 mmHg diastolic for each 50 mmol/day increment in urinary sodium excretion (P < or = 0.01). No association between blood pressure and urinary sodium excretion was found when plasma ouabain exceeded the median. CONCLUSIONS: Plasma ouabain behaves as a blood pressure modulating factor, possibly released in response to potassium, either inhibiting the pressor effect of an excessive salt intake or counteracting the depressor action of sodium depletion.     

The relationship between both sodium and potassium intake and blood pressure in London Civil Servants. A report from the Whitehall Department of Environment Study

The relationship was examined in 459 male London Civil Servants between the casual lying systolic and diastolic (phase V) blood pressures measured in the clinic, and 24-hr urinary sodium and potassium excretion collected an average of 6 weeks later. Systolic and diastolic pressures, after adjusting for age and weight, were both negatively associated with the 24 hr potassium excretion (r = -0.17 [p less than 0.001, 95% confidence limits -0.07, -0.27) and r = -0.11 (p less than 0.05, 95% CL 0.00, -0.21) for systolic and diastolic pressure respectively]. Adjusted systolic but not diastolic pressure was also negatively associated with plasma potassium estimated at the time of blood pressure measurement (r = -0.15, p less than 0.001, 95% CL -0.06, -0.24). In 159 female London Civil Servants both systolic and diastolic pressures were negatively correlated with plasma potassium. However, there was no evidence for a negative relationship between urinary potassium excretion and blood pressure in women. Urinary sodium excretion was not related to blood pressure either in men or women. Blood pressure was also measured by the subjects at home over a one week period during which time the urine collection was made. There was no evidence for an association between blood pressure measured at home 6 weeks after the time of drawing blood, and plasma sodium. On the other hand, in men, the negative relationship between blood pressure and urinary potassium excretion was consistent and independent of the time and place of measuring blood pressure. This is consistent with a true effect of diet, a low potassium intake being associated with an increased blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)     

收缩性和舒张性心力衰竭患者脑利钠肽水平的对比分析

目的：探讨收缩性和舒张性心力衰竭患者血浆脑利钠肽（BNP）水平的差异和收缩性心力衰竭患者脉压与BNP水平的关系。方法：2005年10月至2006年7月在天津医科大学总医院心内科住院患者34例分为两组：收缩性心力衰竭组患者22例，舒张性心力衰竭组患者12例。采取静脉血测定血浆BNP浓度，行超声心动图检查，测量血压，计算脉压。结果：收缩性心力衰竭组的血浆BNP水平、左心室舒张末期内径（LVEDd）比舒张性心力衰竭组的高（p〈0．05～0．001）。收缩性心力衰竭患者BNP水平与脉压、收缩压、左室射血分数（LVEF）呈显著负相关（分别r=-0．58，P〈0．01；r=-0．50，P〈0．05；r=-0．62，P〈0．01），与LVEDd、右心室舒张末期内径（RVEDd）呈正相关（分别r=0．55，P〈0．05；r=0．57，P〈0．05）。结论：收缩性心力衰竭患者血浆BNP水平高于舒张性心力衰竭患者，其血浆BNP水平升高与脉压降低有关。     

Relationship of serum sodium, potassium, calcium, and phosphorus with blood pressure. Belgian Interuniversity Research on Nutrition and Health

During an epidemiological survey on the relationship between diet and cardiovascular risk factors, serum sodium, potassium, calcium, phosphorus, and total protein were measured in 4167 men and 3891 women with a mean age of 49 years. Several consistent and highly significant correlations were found between serum cation and phosphorus levels and blood pressure. The analysis was performed separately in the total group and in the group not receiving treatment for hypertension. A highly significant negative correlation existed between serum sodium and both systolic and diastolic blood pressure. Serum potassium correlated negatively with blood pressure only in men. Serum phosphorus correlated negatively in men and women with systolic blood pressure. Serum calcium correlated positively with systolic and diastolic blood pressure in men, but only with diastolic blood pressure in women. All these correlations were independent of serum total protein. A significant negative correlation between serum phosphorus and heart rate and a significant positive correlation between the serum calcium/phosphorus ratio and heart rate were demonstrated.