健康支持性环境对四川农村人群的不同血压水平的影响分析

目的 探讨健康支持性环境中的不同特征变量对四川省农村人群的不同血压水平的影响。方法 采用多阶段整群抽样的方法，随机抽取四川省7个县（区）8400名的18岁以上常住居民为调查对象。问卷调查一般人口学特征、身体活动行为特征和环境等信息。采用标准方法测量身高、体重、腰围和血压。采用无序多分类logistic回归分析。结果 本调查人群中共检出正常高值血压者4270例，检出率为50.83%，标化率为37.02%，平均年龄（56.22±14.89）岁；高血压患者1498例，检出率为17.83%，标化率为7.92%，平均年龄（65.26±11.28）岁。无序多分类logistic回归结果显示，住宿环境好、获得运动方面的健康信息和参与中等强度活动150Symbol~A@300min/周是正常高值血压和高血压人群的共同保护因素；住宿便利（OR=0.789, 95%CI:0.649~0.958, P=0.017）、医疗服务可及性便利（OR=0.686, 95%CI:0.509~0.924, P=0.013）、对健身步道和健身广场满意为高血压人群的保护因素。结论 多途径合理构建健康支持性环境，对农村正常高值血压者和高血压患者具有保护作用，对遏制农村高血压的流行现状起到一定作用。     

运动训练激活中枢ACE2-Ang(1-7)-MAS轴延缓高血压进展

目的:观察运动训练对高血压前期的血压进展、血压调节以及中枢血管紧张素转换酶2(ACE2)-血管紧张素(Ang)(1-7)-MAS轴的影响,探讨运动训练延缓高血压进展的中枢机制。方法:5周龄雄性自发性高血压大鼠(SHR)和正常血压WKY大鼠各20只,随机分成安静组和运动训练组,每组10只。运动组大鼠进行20周中低强度跑台运动。采用尾套法测定大鼠尾动脉收缩压,药物法检测动脉压力反射敏感性(BRS)。Real-time PCR和Western blot分别检测压力反射中枢ACE2和MAS的mRNA和蛋白表达。侧脑室注射MAS受体激动剂Ang(1-7)及拮抗剂A779,检测注药前后的BRS变化。结果:始于高血压前期的运动训练可推迟高血压发生、延缓高血压进展,明显降低SHR和WKY大鼠血压(P0.05),并改善SHR血压调节功能,提高其BRS(P0.01);此处,运动训练可上调SHR压力反射中枢(孤束核、延髓头端腹外侧区和室旁核中)ACE2和MAS的mRNA和蛋白表达(P0.05);中枢给予A779抵消了运动对SHR BRS的改善作用(P0.01),相反,注射Ang(1-7)则增强安静组和运动组SHR的BRS(P0.05)。结论:运动训练延缓高血压前期进展到高血压的进程及改善血压调节作用可能与运动增强中枢ACE2-Ang(1-7)-MAS轴功能有关。     

探究自拟清肝降压饮早期干预高血压前期和原发性1级高血压

目的观察分析自拟清肝降压饮早期干预高血压前期和原发性1级高血压的疗效。方法选取我院于2010年1月至2012年12月收治的高血压前期和原发性1级高血压患者100例进行临床研究。结果治疗后,辅助清肝降压饮治疗的观察组患者的血压控制有效率为93.3%,明显优于对照组(P<0.05);观察组患者的证候有效率为98.1%,明显高于对照组(P<0.05)。结论自拟清肝降压饮早期干预高血压前期和原发性1级高血压有着良好的治疗效果,可以在临床上广泛推广。     

Effects of normal blood pressure, prehypertension, and hypertension on autonomic nervous system function

Background

Autonomic nervous system plays an important role in blood pressure (BP) regulation, and large proportion of patients with hypertension have increased sympathetic and decreased parasympathetic activity. Heart rate recovery (HRR) is a simple non-invasive measurement for investigating autonomic nervous system influence on the cardiovascular system; however, this methodology has not been used to evaluate autonomic nervous system in subjects with prehypertension (PHT). Accordingly, the present study was designed to evaluate HRR in subjects with PHT.

Methods and results

We measured HRR of 91 subjects with PHT, 44 patients with hypertension, and 53 normotensive healthy volunteers. HRR was significantly lower in the HT and PHT groups as compared to the control group (24.4 ± 5.7, 26.0 ± 8.4, 30.0 ± 8.7; hypertension, PHT, and control groups, respectively), but it did not significantly differ between HT and PHT groups. HRR was significantly and inversely correlated with age, systolic and diastolic BP, fasting and postprandial glucose level, waist circumference, total cholesterol, LDL cholesterol and non-HDL cholesterol, whereas exercise duration and METs were positively correlated with HRR. In multivariable analysis, we found that systolic BP, postprandial glucose level and exercise duration were independent predictors of lower HRR.

Conclusions

HRR, a non-invasive measurement analyzing the dysfunction in autonomic nervous system, was reduced in subjects with PHT as compared to normotensives, and the subjects with PHT had HRR as lower as patients with HT did. Our findings are supportive for the hypothesis that autonomic dysregulation is present in an early stage of essential hypertension.     

血脂水平对血压正常高值人群脉搏波传导速度的影响

目的 探讨血脂和脂蛋白比值对血压正常高值人群脉搏波传导速度的影响.方法 选择11 611名血压正常的健康体检者,分为正常血压值组(血压＜ 120/80 mmHg)和血压正常高值组(血压为120 ～ 139/80 ～ 89 mmHg).应用全自动动脉硬化仪测定人选者肱踝脉搏波传导速度(baPWV),同时测量身高、体重、FPG、TC、TG、HDL-C、LDL-C等指标,并计算HDL-C和TC/HDL-C比值、LDL-C/HDL-C比值.分析血脂和脂蛋白比值异常情况对不同血压组脉搏波传导速度的影响.结果 血压正常高值组的baPWV异常率均高于血压正常组.血压正常组中除HDL-C外,TC、TG、LDL-C、TC/HDL-C、LDL-C/HDL-C的升高均使baPWV的异常率显著增加(P＜0.001).血压正常高值组中,TC和LDL-C的升高使baPWV的异常率显著增加(P＜0.001).多元logistic回归分析显示,除年龄、BMI、FPG外,TC/HDL-C异常是血压正常组动脉僵硬度增高的独立危险因子(OR=1.732),TG异常是血压正常高值组的独立危险因素(OR=1.301).结论 在正常血压不同水平下,血脂和脂蛋白比值的异常是动脉僵硬度增高的独立危险因素.     

基于疾病风险分层的健康管理模式在中青年高血压前期患者中的应用效果

目的：探讨基于疾病风险分层的健康管理模式在中青年高血压前期患者中的应用效果。方法：选取中青年高血压前期患者256例,随机分为观察组和对照组各128例。对照组采用常规健康教育,观察组采用疾病风险分层的健康管理模式。结果：干预6个月后,观察组超重与肥胖、摄入盐过量、运动量不足、不合理膳食、饮酒情况均低于对照组,差异有统计学意义（P<0.05）;吸烟、心理问题情况比较差异无统计学意义（P>0.05）;在趋势性检验中,膳食不合理、饮酒比较差异有统计学意义（P<0.05）。干预3、6个月后,观察组自我健康管理行为各维度得分均高于对照组,且随时间改变呈增高趋势（P<0.001）;收缩压、舒张压均低于对照组,差异有统计学意义（P<0.05）,且随时间改变呈降低趋势（P<0.001）。结论：基于疾病风险分层的健康管理模式可有效改善中青年高血压前期患者的健康危险因素,促进自我健康管理行为的建立,从而降低血压水平。     

三维斑点追踪技术对高血压前期患者左心室亚临床收缩功能受损的评价

【摘要】目的：探讨三维斑点追踪技术评估高血压前期患者左心室收缩功能的改变以及与血压变异性的关系。方法：连续性选择高血压前期患者58例（高血压前期组）以及性别和年龄匹配的健康对照者56例（对照组）纳入研究。所有受试者均行常规超声心动图以及三维超声心动图检查,测量所有受试者左心室整体纵向应变(global longitudinal strain ,GLS) 整体圆周应变(global circumferential strain ,GCS) 整体面积应变(global area strain, GAS) 以及整体径向应变(global radial strain, GRS)。所有的高血压前期患者行动态血压监测并计算收缩压变异度（SBPV）和舒张压变异度（DBPV）。结果：与对照组比较,高血压前期组患者左心室GLS显著减低(P＜0.05),GRS、GAS以及GCS无显著改变(P＞0.05)。 相关性分析显示：高血压前期组GLS与SBPV以及 DBPV 线性相关（r=0.540,0.526, P均 < 0.001）。结论：高血压前期患者左心室三维纵向应变显著减低,三维斑点追踪技术是新的评估高血压前期患者心脏功能以及轻微左心室功能受损的可行方法。     

Determinants of Brachial-Ankle Pulse Wave Velocity and Carotid-Femoral Pulse Wave Velocity in Healthy Koreans

The aim of this study was to determine the normal value of brachial-ankle pulse wave velocity (baPWV) and carotid-femoral pulse wave velocity (cfPWV) according to age group, gender, and the presence of cardiovascular risk factors in healthy Koreans, and to investigate the association between PWV and risk factors such as prehypertension, dyslipidemia, smoking, and obesity. We measured an arterial stiffness in 110 normal subjects who were 20 to 69 yr-old with no evidence of cardiovascular disease, cerebrovascular accident or diabetes mellitus. The mean values of baPWV and cfPWV were 12.6 (±2.27) m/sec (13.1±1.85 in men, 12.1±2.51 in women; P=0.019) and 8.70 (±1.99) m/sec (9.34±2.13 in men, 8.15±1.69 in women; P=0.001), respectively. The distribution of baPWV (P<0.001) and cfPWV (P=0.006) by age group and gender showed an increase in the mean value with age. Men had higher baPWV and cfPWV than women (P<0.001). There was a difference in baPWV and cfPWV by age group on prehypertension, dyslipidemia, current smoking, or obesity (P<0.001). In multiple linear regression, age and prehypertension were highly associated with baPWV and cfPWV after adjustment for confounding factors (P<0.001). The present study showed that baPWV and cfPWV are associated with age, gender, and prehypertension in healthy Koreans.

Graphical Abstract

相似文献   

Prehypertension: an opportunity for a new public health paradigm

From 2005 to 2006, approximately 3 of 8 adults in the United States had blood pressure (BP) in the prehypertensive range of 120 to 139/80 to 89 mm Hg and roughly 1 in 8 adults had BP in the range of 130 to 139/85 to 89 mm Hg, which is referred to as high normal BP or stage 2 prehypertension. Adults with stage 2 prehypertension are also roughly twice as likely as adults with normotension to suffer cardiovascular disease. The Seventh Report of the Joint National Committee on Hypertension recommended only lifestyle changes for most prehypertensive patients. BP in the range of 120 to 129/80 to 84 mm Hg is also associated with increased risk but roughly half of that of stage 2 prehypertension.     

Left ventricular mass in normotensive,prehypertensive and hypertensive children and adolescents

The purpose of this study was to investigate differences in left ventricular mass index (LVMI) and the prevalence of left ventricular hypertrophy (LVH) in children and adolescents classified as normotensives, prehypertensives and hypertensives by ambulatory blood pressure (BP) levels. A total of 124 consecutive children and adolescents aged 5 to 18 years were analysed. Patients underwent 24 h ambulatory blood pressure monitoring (ABPM) and echocardiography. Hypertensive and prehypertensive subjects had significantly higher LVMI than normotensives (36.8 ± 8.4 g/m^2.7 and 34.1 ± 3.4 g/m^2.7 vs. 29.5 ± 8.3 g/m^2.7, P < 0.01 and P < 0.05, respectively). In multivariate analysis predictors for LVMI were body mass index (BMI) z score and hypertension (R-squared = 0.31). LVMI values in hypertensive subjects were significantly higher than those of normotensives even after adjustment for age, sex and BMI z score. The prevalence of LVH was significantly higher in the prehypertensive compared to normotensive subjects, and was equal to that of the hypertensive subjects. Hypertension and prehypertension in children and adolescents were associated with pathologically elevated LVMI values. If confirmed in a larger group prehypertensive children may be at risk for target organ damage similar to the condition of established hypertension.