高血压和糖尿病患者动态动脉硬化指数与靶器官损害的相关性

目的 探讨高血压和糖尿病患者的动态动脉硬化指数（AASI）与肾脏损害及颈动脉内膜损伤的相关性.方法 筛选原发性高血压患者149例、2型糖尿病患者79例、高血压合并糖尿病患者98例,同期健康体检者48名作为对照组,分别行24h动态血压监测（ABPM）,尿白蛋白、尿肌酐测定及颈动脉内-中膜厚度（IMT）测量,计算出AASI,进行AASI与尿白蛋白/尿肌酐比值（ACR）及IMT等的相关性分析.结果 高血压组、糖尿病组、高血压合并糖尿病组与健康对照组比较,ACR值、微量白蛋白尿发生率、IMT、颈动脉异常发生率以及AASI差异均有统计学意义.两组间两两比较,高血压合并糖尿病组与高血压组、糖尿病组、健康对照组间差异均有统计学意义,高血压组、糖尿病组与健康对照组间差异均有统计学意义.多变量logistic分析显示,ASSI增高的独立相关危险因素是女性、年龄、高血压病史、糖尿病病史.结论 高血压、糖尿病患者的AASI与肾脏损害及颈动脉内膜损伤程度有明显相关性,高血压、糖尿病独立促进动脉硬化的进展.     

老年高血压患者动态动脉硬化指数与颈动脉粥样硬化及微量白蛋白尿的相关性

目的观察老年高血压患者动态动脉硬化指数(AASI)与颈动脉粥样硬化及微量白蛋白尿(MAU)的相关性及AASI在老年高血压患者心血管风险评估中的作用。方法 172例行24 h动态血压监测的住院老年高血压患者,根据文献方法计算AASI,以AASI<0.55或AASI≥0.55分为两组,比较各组颈动脉内中膜厚度(IMT)、颈动脉斑块指数及MAU的差异,以及与AASI的相关性。结果两组比较,在AASI≥0.55组中,其IMT、颈动脉斑块指数及MAU水平显著高于AASI<0.55组(P<0.001);Pearson相关分析显示,AASI与IMT、颈动脉斑块指数及MAU呈显著正相关,其相关系数分别为:IMT(r=0.560,P<0.001)、颈动脉斑块指数(r=0.591,P<0.001)、MAU(r=0.538,P<0.001);控制年龄、平均收缩压、平均舒张压、血肌酐水平、eGFR等因素后,偏相关分析显示,AASI仍与IMT、颈动脉斑块指数及MAU显著相关;多元逐步回归分析显示IMT、颈动脉斑块指数及MAU均与AASI独立相关,其标准化偏回归系数分别为:0.260、0.252、0.337,P<0.001。结论在老年高血压患者,AASI与IMT、颈动脉斑块指数及MAU水平呈显著正相关,AASI可作为老年高血压患者心脑血管事件风险的独立预测因素。     

糖尿病患者动脉硬化指数对靶器官损害的预测价值分析

选取68例糖尿病患者,按照AASI水平均分2组,0. 51以下者为低水平组,0. 51以上者作为高水平组,同时期选取68例健康人员作为参照组。对所有对象的AASI、ACR(尿白蛋白/尿肌酐)、IMT(颈动脉内-中膜厚度)作分析。结果:实验组AASI、ACR、IMT比参照组高(P 0. 05);与低水平组比,高水平组AASI、IMT高,(P 0. 05)。结论:利用糖尿病患者的AASI判定对靶器官损伤情况,具有较高的价值,操作方法简单。     

中老年高血压伴左室肥厚患者周围动脉硬化特点及相关性分析

目的 探讨中老年高血压伴左室肥厚(LVH)患者周围动脉硬化特点及二者的相关性. 方法 149例中老年高血压患者入选本研究,其中高血压伴LVH 67例为LVH组,高血压非左室肥厚(NLVH) 82例为NLVH组,并选择同期健康体检者48例作为正常对照组,应用动态血压检查动态动脉硬化指数(AASI)对全身的动脉硬化程度进行评估;同时应用超声评价颈动脉粥样硬化程度,然后进行组间对比及相关性分析. 结果 LVH组AASI最高,NLVH组次之,均明显高于对照组(P ＜0.01);EH患者与正常组比较,颈动脉内-中膜厚度(CCA-IMT)、颈动脉超声阳性检出率增加,LVH组显著高于NLVH组. 结论 EH患者在出现LVH之前,外周动脉就发生一系列结构和功能上的改变,LVH患者动脉硬化更明显,因此动脉硬化在LVH发生发展中起着重要的作用.     

血压晨峰、动态动脉硬化指数与颈动脉内膜中层厚度相关性分析

目的:探讨血压晨峰、动态动脉硬化指数(AASI)与颈动脉内膜中层厚度(IMT)的相关性。方法:对212例入选高血压病例监测24h动态血压,并行颈动脉超声检查,测量颈总动脉IMT,根据IMT增厚与否分为IMT正常组(84例)和IMT增厚组(128例),计算血压晨峰值及AASI;根据是否存在血压晨峰现象,分为血压晨峰组(120例)和无血压晨峰组(92例),观察血压晨峰、AASI与颈动脉IMT的相关性。结果:与IMT正常组比较,IMT增厚组中AASI[(0.42±0.13)比(0.68±0.14)]及血压晨峰值[(25.94±4.57)mmHg比(36.57±8.41)mmHg]明显升高(P<0.05);与无血压晨峰组比较,血压晨峰组中AASI[(0.43±0.13)比(0.71±0.14)]、IMT[(1.01±0.20)mm比(1.25±0.17)mm]显著增加(P<0.05);直线相关分析结果显示,血压晨峰、AASI与颈动脉IMT呈正相关(r=1.22,0.51,P均<0.05)。结论:血压晨峰和动态动脉硬化指数是颈动脉内膜中层厚度的独立危险因素,且具有预测价值。     

原发性高血压患者动态动脉硬化指数与血压昼夜节律及微量白蛋白尿的相关性

目的探讨原发性高血压(高血压)患者动态动脉硬化指数(ambulatory arterial stiffness index,AASI)与微量白蛋白尿(microalbuminuria,MAU)及血压昼夜节律的相关性,为预防高血压患者发生心血管事件提供依据。方法入选215例高血压患者,监测其24 h动态血压并检测生化指标、MAU等指标,采用Pearson相关分析、多因素Logistic回归进行分析。结果 AASI≥中位数(0.57)组患者的年龄、尿肌配、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)、AASI、内膜中层厚度(intima-media thickness,IMT)、颈动脉指数、MAU、踝动脉收缩压(ankle systolic blood pressures,ASBP)、踝动脉舒张压(ankle diastolic blood pressures,ADBP)等指标明显高于AASI中位数(0.57)组(P0.05)。MAU阳性组AASI水平明显高于MAU阴性组,非构型血压组AASI水平明显高于构型血压组,差异有统计学意义(P0.05)。AASI、颈动脉指数均与尿白蛋白/尿肌酐比值呈正相关关系(r=0.5400,r=0.4254;P0.0001)。年龄、MAU阳性、AASI中位数(0.57)、饮酒史是血压昼夜节律的独立危险因素,引起非构型血压的危险度分别升高3.226、2.202、1.998、1.785倍。结论对于高血压患者应进行AASI评估,有助于了解其血压昼夜节律现象和肾功能损伤情况,一定程度上可以尽早了解其心血管事件的发生危险,预防病情恶化。     

原发性高血压患者微量白蛋白尿与脑小动脉硬化的关系

目的　探讨原发性高血压 (EH)患者微量白蛋白尿 (MCA)与亚临床脑血管损害的关系。方法　 84名EH患者按 2 4小时尿MCA值分为异常微量白蛋白组 (MCA组 )和正常微量白蛋白组 (NMCA组 ) ,应用二维超声测定颈动脉内膜中层厚度 (IMT)及斑块 ,头颅CT或头颅MRI评价腔隙性脑梗死。结果　MCA组颈总动脉内膜—中层厚度 ,斑块的严重程度 ,发生腔隙性脑梗死患者比例均高于NMCA组 (P <0 0 0 1) ,差别有显著性意义。结论　合并有MCA的EH患者脑小动脉硬化更显著。     

高血压病及其并发症与AT1R基因多态性

目的:本研究通过检测一型血管紧张素Ⅱ受体(AT1R)基因的C1166等位基因在正常人和原发性高血压(EH)患者中的频率,探讨AT1R基因多态性与原发性高血压以及与高血压左室肥厚、动脉硬化、微白蛋白尿之间的关系. 方法:EH患者(n=120)和正常对照组(n=86)进行血压、身高、体重及空腹血糖(Glu)、血总胆固醇(Tch)、甘油三脂(TG)浓度测定,并测定78例高血压患者的左室重量指数(LVMI),颈总动脉内膜中层复合体厚度(IMT)、管腔内径(D)、壁/腔比(I/D),及尿微量白蛋白(UA).用饱和盐析法常规提取外周血白细胞DNA,采用多聚酶链式反应(PCR)结合限制性内切酶方法检测基因多态性. 结果:(1)EH患者AT1R基因AC基因型频率高于对照组(0.181 vs 0.058,P＜0.01),C1166等位基因频率高于正常对照组(0.091vs 0.029,P＜0.05);(2)AT1R基因AC基因型EH患者颈总动脉IMT比AA基因型患者厚(1.13±0.13 mm vs 0.89±0.21 mm,P＜0.05),AC型EH患者I/D值大于AA型EH患者(0.14+0.12US0.10+0.02,P<0.01),AA和AC型EH患者颈总动脉内径无差别;(3)AT1R基因AC基因型EH患者LVMI以及尿微量白蛋白与AA基因型EH患者差异不显著. 结论:AT1R基因A1166C多态性与中国人高血压病有关并可能与高血压动脉硬化有关.AT1R基因A1166C多态性可能与高血压LVH,微白蛋白尿无关.     

原发性高血压患者颈动脉内膜-中层厚度与冠状动脉内皮功能的关系

目的:应用超声观察原发性高血压(EH)患者颈动脉内膜-中层厚度(IMT),并探讨其冠状动脉内皮功能及两者的相关性。方法:选择60例EH患者(EH组)、30例健康体检者(正常对照组),测定其颈动脉IMT及冷加压试验前后冠状动脉左主干内径变化百分率。结果:EH患者颈动脉IMT较正常对照组增厚,冷加压试验冠状动脉左主干内径变化百分率明显低于正常对照组。颈动脉IMT与冷加压试验冠状动脉左主干内径变化呈显著负相关。结论:EH患者存在明显的颈动脉IMT增加及冠状动脉内皮功能减低。     

动态动脉硬化指数与高血压患者微量白蛋白尿的关系

目的 探讨住院高血压患者24 h,白天和夜间的动态动脉硬化指数(AASI)与微量白蛋白尿的关系.方法 对入选的444例住院高血压患者行24 h动态血压监测,并检测其血清学指标和尿微量白蛋白,尿肌酐值.AASI定义为1减去24 h舒张压和收缩压的回归系数.微量白蛋白尿定义为男性尿白蛋白肌酐比≥22 mg/g,或者女性尿白...     

Ambulatory blood pressure, target organ damage and left atrial size in never-treated essential hypertensive individuals

OBJECTIVE: To investigate the relationship between ambulatory blood pressure and different markers of target organ damage with left atrial size in never-treated essential hypertensive individuals. METHODS: A total of 519 grade 1 and 2 hypertensive patients (mean age 46 +/- 12 years), referred for the first time to our outpatient clinic, underwent routine examinations: 24-h urine collection for microalbuminuria, ambulatory blood pressure monitoring over two 24-h periods in 4 weeks, echocardiography and carotid ultrasonography. RESULTS: Left atrial diameter was increased in 17.3% of patients. No significant differences were found between subjects with and without increased left atrial size with regard to sex, duration of hypertension, clinic and mean 48-h ambulatory blood pressure, and daytime and night-time values. Compared with 429 patients with normal left atrial size, the 90 patients with enlarged left atria were older, had higher body mass index, were more frequently smokers, and included more individuals with the metabolic syndrome. The prevalence of left ventricular hypertrophy, of intima-media thickening, but not of microalbuminuria was significantly higher in subjects with increased left atrial size. CONCLUSION: Left atrial enlargement is not an early echocardiographic finding in relatively young never-treated hypertensive individuals, as its prevalence is lower than that of well-validated markers of target organ damage, and it is unrelated to ambulatory blood pressure. Overweight, left ventricular hypertrophy, carotid intima-media thickening and metabolic syndrome are independent predictors of left atrial dimension, suggesting that changes in left atrial size represent an adaptive response when high blood pressure is associated with other cardiovascular or metabolic abnormalities.     

Masked hypertension and target organ damage in treated hypertensive patients

BACKGROUND: Recent studies have shown that an elevated ambulatory or home blood pressure (BP) in the absence of office BP-a phenomenon called masked hypertension-is associated with poor cardiovascular prognosis. However, it remains to be elucidated how masked hypertension modifies target organ damage in treated hypertensive patients. METHODS: A total of 332 outpatients with chronically treated essential hypertension were enrolled in the present study. Patients were classified into four groups according to office (<140/90 or >or=140/90 mm Hg) and daytime ambulatory (<135/85 or >or=135/85 mm Hg) BP levels; ie, controlled hypertension (low office and ambulatory BP), white-coat hypertension (high office but low ambulatory BP), masked hypertension (low office but high ambulatory BP), and sustained hypertension (high office and ambulatory BP). Left ventricular mass index, carotid maximal intima-media thickness, and urinary albumin levels were determined in all subjects. RESULTS: Of the patients, 51 (15%), 65 (20%), 74 (22%), and 142 (43%) were identified as having controlled hypertension, white-coat hypertension, masked hypertension, and sustained hypertension, respectively. Left ventricular mass index, maximal intima-media thickness, and urinary albumin level in masked hypertension were significantly higher than in controlled hypertension and white-coat hypertension, and were similar to those in sustained hypertension. Multivariate regression analyses revealed that the presence of masked hypertension was one of the independent determinants of left ventricular hypertrophy, carotid atherosclerosis, and albuminuria. CONCLUSIONS: Our findings indicate that masked hypertension is associated with advanced target organ damage in treated hypertensive patients, comparable to that in cases of sustained hypertension.     

Effects of angiotensin-converting enzyme gene polymorphism and serum vitamin D levels on ambulatory blood pressure measurement and left ventricular mass in Turkish hypertensive population

INTRODUCTION: Regulation of angiotensin converting enzyme (ACE) and angiotensin II (ang-II) levels is under genetic control. 1,25(OH)2 vitamin D3 treatment has been shown to reduce the ang-II level, reduce myocardial hypertrophy and to decrease blood pressure. This study was designed to examine the effect of ACE gene polymorphisms on 24-h ambulatory blood pressure measurement (24 h) values, vitamin D levels and target organ damage in hypertensive patients. METHODS: This study was carried on 118 patients with essential hypertension (female/male: 70/48, mean age: 49.1+/-7.6 years, hypertension duration: 56+/-40.5 months). All patients were assessed for target organ damage; the eye by retinal examination, the heart with echocardiography and the kidney with blood and 24-h urine analysis. 24-h ambulatory blood pressure measurement was performed in all patients. PCR amplification was employed to detect ACE genotypes. RESULTS: ACE genotypes were as follows: DD (n=49) 41.5%; ID (n=37) 31.4% and II (n=32) 27.1%. No difference was present between groups of ACE polymorphism when 24-h ambulatory blood pressure measurement values, retinal vascular changes and microalbuminuria were taken into account. Statistically significant left ventricular mass index levels were obtained in the DD group when compared with the non-DD (ID+II) group (P : 0.009). Positive correlations have been noted between left ventricular mass index and day/night and early morning systolic pressures. A negative correlation exists between serum 25 (OH) vitamin D levels and 24-h ambulatory blood pressure measurement values (P<0.05). CONCLUSIONS: The presence of the D allele is linked with a higher risk for left ventricular mass index in the Turkish hypertensive population.     

动态血压监测参数血压负荷、曲线下面积与左室肥厚的关系

目的　研究高血压患者动态血压监测参数 :血压负荷、曲线下面积与左室肥厚的关系。对象　 75例高血压病人 ,男性 51例 ,女性 2 4例 ,平均年龄 63± 8(46～ 74)岁。方法　动态血压测定 2 4h血压 ,超声心动图测定室间隔、左室后壁厚度 ,左室舒张末直径并按Devereux校正公式计算左心室重量指数 (LVMI)。结果　多元逐步回归分析显示 :收缩压、收缩压负荷 ,收缩压曲线下面积值以及夜间的舒张压、舒张压负荷、舒张压曲线下面积与LVMI有关 (P <0 0 1 )。结论　曲线下面积能较好地反映动脉血压的变化与左心室肥厚的关系。     

Nighttime Home Blood Pressure and the Risk of Hypertensive Target Organ Damage

In ambulatory blood pressure (BP) monitoring, nighttime BP has a superior ability to predict hypertensive target organ damage than awake BP. We evaluated whether nighttime BP, assessed by a home BP monitor, was associated with hypertensive target organ damage. We measured clinic BP, out-of-clinic BP including nighttime home BP, and the urinary albumin:creatinine ratio (UACR) in 854 patients who had cardiovascular risk factors. Nighttime home BP was measured at 2:00, 3:00, and 4:00 am, in addition to clinic, awake ambulatory, nighttime ambulatory, and awake home BP. Nighttime home systolic BP (SBP) was slightly higher than nighttime ambulatory SBP (difference, 2.6 mm Hg; P<0.001). Clinic (r=0.186), awake ambulatory (r=0.173), nighttime ambulatory (r=0.194), awake home (r=0.298), and nighttime home (r=0.311) SBPs were all associated with log-transformed UACR (all P<0.001). The correlation coefficient for the relationship between nighttime home SBP and log-transformed UACR was significantly greater than that for the relationship between nighttime ambulatory SBP and log-transformed UACR (P<0.001). The goodness of fit of the association between SBP and UACR was improved by adding nighttime home SBP to the other SBPs (P<0.001). Nighttime home diastolic BP also improved the goodness-of-fit of the association between diastolic BP and UACR (P=0.001). Similar findings were observed for the left ventricular mass index in the subgroup (N=594). In conclusion, nighttime home BP is slightly different from (but comparable to) nighttime ambulatory BP. The addition of nighttime home BP to other BP measures improves the association of BP with hypertensive target organ damage.     

老年高血压病人血压变异性分析

目的：探讨老年高血压病患血压变异性与靶器官损害及年龄的关系。方法：对478例老年高血压病人及229例非高血压进行了24小时动态血压监测，以测得的血压标准差作为血压变异性指标。结果：高血压病患的24小时血压变异性大于非高血压（P＜0．05），高血压病人中靶器官损害的24小时血压变异性大于无损害的（P＜0．05）；各年龄组间的血压变异性无明显差别。结论：老年高血压病人24小时血压变异性增加，靶器官损害的24小时变异性更高。     

Factors affecting post-exercise hypotension in normotensive and hypertensive humans

BACKGROUND: Post-exercise hypotension has been extensively described under laboratory conditions. However, studies investigating the persistence of this post-exercise decrease in blood pressure for longer periods have produced controversial results. The present investigation was conducted to verify the effect of a single bout of exercise on ambulatory blood pressure and to identify potential factors that might influence this post-exercise ambulatory blood pressure fall. DESIGN: The study was a randomized controlled clinical trial. METHODS: Thirty normotensive and 23 hypertensive subjects were submitted to two ambulatory blood pressure monitorings (using the SpaceLabs 90207, SpaceLabs, Redmond, Washington, USA), which were performed after 45min of seated rest (control session) or cycling exercise at 50% peak oxygen uptake (exercise session). RESULTS: Normotensive subjects demonstrated a lower 24h blood pressure level in the exercise session. Hypertensive patients showed no significant difference in ambulatory blood pressure level between the two experimental sessions. Further data analysis revealed that approximately 65% of the subjects in both groups experienced a fall in blood pressure after exercise. Moreover, in the normotensive subjects, this blood pressure fall was significantly and positively correlated with clinic and ambulatory blood pressure, and negatively correlated with weight and body mass index. The blood pressure response to exercise was also greater in women. In the hypertensive patients, the post-exercise blood pressure decrease was significantly and positively correlated with clinic and ambulatory blood pressure as well as with the peak oxygen uptake, and negatively correlated with age and body mass index. CONCLUSIONS: The post-exercise ambulatory blood pressure fall observed in normotensive and hypertensive humans depends on individual characteristics. Moreover, in both normotensive and hypertensive humans, post-exercise ambulatory hypotension is greater in subjects with a higher initial blood pressure level.     

老年高血压病患者血压昼夜节律与动态的动脉硬化指数的关系

目的 探讨老年高血压病患者血压昼夜节律与动态动脉硬化指数的关系。方法 根据动态血压检测结果将112例老年高血压病患者分为杓形组(n=37)、非杓形组（n=45）和反杓形组（n=30）,并测定及计算动态动脉硬化指数（AASI）。结果 3组年龄,体质量指数,总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、空腹血糖、病程和全天及白天平均收缩压、舒张压和脉压比较均无显著性差异。3组夜间平均收缩压、夜间平均舒张压、AASI比较有显著性差异（P<0.01）。结论 动态血压昼夜节律的改变与动态动脉硬化指数相关。     

Ambulatory blood pressure and left ventricular mass index in hypertensive children

To determine whether ambulatory blood pressure is more predictive of left ventricular hypertrophy than is casual blood pressure in hypertensive children, echocardiography and ambulatory blood pressure data from 37 untreated hypertensive children were analyzed. Left ventricular mass was calculated using the Devereux equation, left ventricular mass index was calculated as left ventricular mass (in grams)/height(2.7) (in meters), and left ventricular hypertrophy was defined as left ventricular mass index >51 g/m(2.7). Average blood pressure, blood pressure load, and blood pressure index (average blood pressure divided by pediatric ambulatory blood pressure 95th percentile) were calculated. Left ventricular mass index was strongly correlated with 24-hour systolic blood pressure index (r=0.43, P=0.008) and was also correlated with 24-hour systolic blood pressure (r=0.34, P=0.037), 24-hour systolic blood pressure load (r=0.38, P=0.020), wake systolic blood pressure load (r=0.37, P=0.025), sleep systolic blood pressure (r=0.33, P=0.048), and sleep systolic blood pressure load (r=0.38, P=0.021). Left ventricular mass index did not correlate with age, weight, clinic blood pressure, or ambulatory diastolic blood pressure. The overall prevalence of left ventricular hypertrophy was 27%. The prevalence of left ventricular hypertrophy was 47% (8 of 17) in patients with both systolic blood pressure load >50% and 24-hour systolic blood pressure index >1.0, compared with 10% (2 of 20) in patients without both criteria (P=0.015). These data suggest ambulatory blood pressure monitoring may be useful for the clinical assessment of hypertensive children by identifying those at high risk for the presence of end organ injury.     

血压变异性与高血压靶器官损害的关系

目的探讨血压变异性与高血压靶器官损害的关系。方法选择６０例高血压病人进行２４ｈ动态血压监测和静息及应激状况下短时血压监测，以各时间段血压的标准差作为血压变异性指标，并测定左心室重量指数（ＬＶＭＩ）和２４ｈ尿微量蛋白（ＭＡＵ）。结果与正常对照组比较，高血压患者长时血压变异增大，静息及心算时的短时血压变异也增大；ＬＶＭＩ，ＭＡＵ与长时血压变异显著相关，但与各状态下短时血压变异不相关。结论提示血压变异性增大是高血压患者的一个重要的临床特征，长时血压变异可能与某些靶器官（心、肾）损害有关