隐蔽性高血压对冠心病合并代谢综合征患者心脑血管事件的影响

目的探讨隐蔽性高血压(MH)对冠心病合并代谢综合征患者心脑血管事件的影响。方法选择2015-08～2017-08在该院经冠脉造影确诊的冠心病合并代谢综合征患者66例,根据24 h动态血压监测结果将其分为正常血压组(n=32)和MH组(n=34),分析两组动态血压参数的差异,随访并比较两组患者主要心脑血管事件(MACCE)的发生情况。结果 MH组体质量指数(BMI)、腰围水平高于正常血压组(P 0. 05)。MH组24 h平均收缩压(24hSBP)、白天平均收缩压(d SBP)、夜间平均收缩压(n SBP)、白天收缩压平台、夜间收缩压平台、清晨收缩压上升速度水平均高于正常血压组(P 0. 05)。单因素相关分析显示,24hSBP与腰围及BMI呈正相关(P 0. 05)。Logistic回归分析显示,较大的腰围和BMI是MH的危险因素(P 0. 05)。Kaplan-Meier生存分析显示,MH患者发生MACCE风险增加(P 0. 05)。Cox回归分析显示,较高水平的24hSBP和患有MH是MACCE发生的危险因素(P 0. 05)。结论超重和肥胖会升高血压水平和加剧清晨血压波动,24hSBP水平升高是冠心病合并代谢综合征患者发生MACCE的危险因素。     

隐蔽性高血压清晨血压波动与心脑血管事件的关系

目的探讨隐蔽性高血压(MH)与清晨血压波动及心脑血管事件的关系。方法入选2016年2月至2017年7月烟台市莱阳中心医院心内科住院及门诊诊室血压140/90 mm Hg的非高血压受试者320例,年龄40～79岁,由同一研究小组完成24 h动态血压监测,根据24 h平均收缩压≥130和(或)24 h平均舒张压≥80 mm Hg与否分为正常血压组(n=194)和MH组(n=126),分析两组动态血压参数的差异,随访并比较两组患者主要心脑血管事件(MACCE)的发生情况,随访终止时间为2018年6月,随访终点事件为新发心肌梗死、脑卒中或心源性死亡。结果 MH组体质量指数、吸烟及糖尿病比例、空腹血糖及糖化血红蛋白(HbA1c)水平高于正常血压组(均P0.05)。MH组24 h平均收缩压(24hSBP)、白天平均收缩压(dSBP)、夜间平均收缩压(nSBP)、白天收缩压平台、夜间收缩压平台、清晨收缩压上升速度[(14.9±9.3)比(11.2±9.2) mm Hg/h]高于正常血压组(均P0.01),MH组平均动脉压(MAP)、舒张压各参数水平也高于正常血压组(均P0.05)。MH组MACCE发生率高于正常血压组(7.14%比2.06%,P0.05)。Kaplan-Meier生存分析显示:MH患者发生MACCE风险明显增加(P=0.009),糖尿病患者MACCE发生风险高于非糖尿病患者(P=0.025)。多变量Cox回归分析显示:MH组清晨收缩压上升速度(HR=1.589,95%CI 1.161～2.175,P=0.004)、白天收缩压平台水平(HR=1.155,95%CI 1.005～1.327,P=0.042)是MACCE发生的危险因素。结论 MH患者白天收缩压平台水平升高和清晨收缩压上升速度加快可能是MACCE的危险因素。     

代谢综合征患者血压变异性和心率变异性的临床研究

目的 通过观察代谢综合征(MS)患者血压变异性(BPV)和心率变异性(HRV),探讨MS对心血管系统自主神经功能的影响.方法 入选MS患者(MS组)110例及对照组46例,分别进行24h动态血压和动态心电图监测,对比分析两组的BPV和HRV的指标.结果 (1)MS组的一般资料(性别比、年龄)及HDL-C与对照组比较,差异均无统计学意义(P＞0.05);MS组的体质指数(BMI)、腰围(WC)、腰臀比(WHR)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FBG)、体脂含量(FATc)及体脂比例(FATp)与对照组比较,差异均有统计学意义(P＜0.05).(2)MS组BPV中9项指标均较对照组显著性增高(P＜0.05);其余3项(dDBPSD、nSBPSD及nDBPSD)指标升高,但无统计学意义(P＞0.05).(3)MS组HRV各项指标与对照组比较,差异均有统计学意义(P＜0.05).(4)MS与性别、吸烟、心血管病早发家族史、高血压、糖尿病、TG、FBG及MBI具有相关性(P＜0.05);与饮酒、TC、HDL-C及LDL-C无相关性(P＞0.05).结论 MS患者存在心血管系统自主神经功能紊乱,表现为BPV的显著升高和HRV的显著降低,其与性别、吸烟、心血管病早发家族史、高血压病、糖尿病、TG、FBG及MBI相关.     

老年高血压患者24h动态血压变异特点及与心脑血管事件发生的关系

目的探究老年高血压患者24h动态血压变异特点及与心脑血管事件的关联性。方法选取我院自2010年1月至2015年2月收治的210例老年高血压患者,按照高血压级数分为Ⅰ级、Ⅱ级、Ⅲ级高血压三组,每组70例,使用动态心电血压记录仪分别记录每组患者24h动态血压,观察其变异特点及其与心脑血管事件的关系。结果三组高血压患者平均收缩压和收缩压差值依次减小(P0.05)。三组高血压患者舒张压-SD,舒张压-CV和收缩压-SD,收缩压-CV差值依次减小(P0.05)。三组患者脑血栓、脑出血和心肌梗死的发生率均依次增加(P0.05)。结论Ⅰ级、Ⅱ级和Ⅲ级高血压,其收缩压和舒张压的最高值和最低值随着血压分级的增高而减小。血压级别越高,心脑血管事件的发生率越大。     

老年原发性高血压患者心脑血管事件与动态血压的关系

目的 :探讨动态血压及偶测血压与高血压预后的关系。　　方法 :随访的 12 9例老年原发性高血压患者入选时分别测量基础状态下动态血压及诊室血压 ,并根据白昼舒张压水平分为高、中、低、3组 (HL组 36例、ML组 5 1例、L L组 42例 ) ,然后在平均 38个月随访观察与原发性高血压相关的心脑血管事件。　　结果 :12 9例中发生心、脑、肾各类事件者 2 2例。单因素分析表明事件患者各项动态血压参数明显高于非事件患者(P<0 .0 5～ 0 .0 1) ,而两者诊室血压间无显著差异 (P>0 .0 5 )。L L、ML、HL 3组中事件发生率分别为 2例 / 10 0人年、5 .1例 / 10 0人年及 9.5例 / 10 0人年。多因素分析显示 :收缩压节律、夜间收缩压水平及总胆固醇水平为高血压患者事件发生的独立危险因素 ,分别为 RR=3.0 5、RR=1.2 7、RR=1.48(P<0 .0 5～ 0 .0 1)。　　结论 :动态血压在判断高血压预后方面较诊室血压更具有临床意义 ,较高的动态血压水平 (白昼舒张压水平 )提示不良的预后 ,收缩压节律、夜间收缩压水平是预测高血压患者心脑血管事件及肾脏受损的独立危险因素。     

合并代谢综合征的原发性高血压患者血压变异性特征的研究

代谢综合征（MS）最直接的后果就是心血管疾病的患病率和病死率显著增加。我们旨在对合并MS的原发性高血压（EH）患者的各血压指标进行观察分析，以探讨此类患者的血压变异性（BPV）特征。     

不同代谢综合征诊断标准对上海市华阳社区40岁以上代谢综合征人群心脑血管事件发生风险的评估

目的比较WHO(1999)、NCEP-ATPⅢ(2001)两种工作定义诊断的代谢综合征(MS)对于心脑血管事件发生的风险预测作用。探讨适合于中国人群的MS诊断定义，分析其对于心脑血管事件发生的预测价值。方法对1998～1999年上海华阳社区40岁以上人群，具有完整的代谢综合征基线调查资料和心脑血管疾病的5年随访资料共971例进行分析。分别应用WHO(1999)、NCEF-ATPⅢ(2001)、中国建议Ⅰ和中国建议Ⅱ诊断MS，比较MS对于心脑血管事件发生的风险预测。结果WHO(1999)与NCEP-ATPⅢ(2001)定义的MS对于心血管事件的相对风险率分别为3．92和2．66；中国建议定义Ⅰ与Ⅱ对心血管事件的相对风险率分别为6．59和5．43，脑血管事件为2．61和2．44。结论四种定义的MS(1999WHO、2001NCEP-ATPⅢ、中国建议定义Ⅰ和中国建议定义Ⅱ)均能预测心脑血管事件的发生，而中国建议定义Ⅰ的MS预测作用最强；中国建议定义Ⅰ方便易行，具有较大的实用性和较好的可推广价值。     

代谢综合征伴靶器官损害与动态血压变异性的关系

对165例代谢综合征（MS）患者（MS组）及70例健康者（对照组）进行24h动态血压监测,以血压标准差作为血压变异性（BPV）指标。结果两组BPV比较有显著统计学差异（P〈0．05）;MS组伴与不伴靶器官损害者比较p〈0．05,且肾损害者BPV最大。BPV随血压升高、动态血压负荷值增大而逐渐增大;≤60岁者的BPV随年龄增加而增大。提示BPV与MS患者的靶器官损害、血压负荷值可能互为因果。     

代谢综合征患者脉压与心脑血管疾病的相关性

目的：探讨脉压（PP）、脉压指数（PPI）与代谢综合征（MS）患者心脑血管疾病的相关性。方法：选择近5年我院门诊和住院MS患者204例（男138例．女66例）,按PPI≤0．40、0．41～0．50、0．51～0．60、〉0．60分为4组,按PP≤40mmHg、41～60mmHg、61～80mmHg、〉80mmHg（1mmHg=0．133kPa）分为4组．分析各组间PP、PPI与心脑血管疾病发生率的相关性。结果：①不同组的PP、PPI在吸烟、饮酒、体重指数（BMI）、血糖、腹围、舒张压（DBP）、甘油三脂（TG）、高密度脂蛋白-胆固醇（HDL-C）、及低密度脂蛋白-胆固醇（LDL—C）方面无显著差别（P〉0．05）,在年龄、收缩压（SBP）方面差异有显著性（P〈0．05～〈0．01）;不同组的PP及PPI的左室肥厚、冠心病、心功能不全、脑卒中发生率有显著性差异（P均〈0．05）;左室肥厚、冠心病、心功能不全、脑卒中的发生率与患者年龄、收缩压、脉压、脉压指数有显著相关性[EXP（B）=1．614～3．340,P均〈0．05]。结论：MS患者心脑血管疾病与年龄、SBP、PP、PPI等因素有关,与PPI的关系更为密切。     

抗高血压药物对正常血压冠心病患者心血管事件的影响

疾 病 冠心病 目 的 比较氨氯地平或依那普 利与安慰剂治疗冠心病人对心血管事 件的影响。 研究 设 计 双 盲、随 机 、多 中 心 、 安慰剂对照。 随 访 24个月。 病 人 1991例病人,经心血管造 影诊断冠心病(冠脉狭窄>20%),舒张压 低于 100m m H g (1m m H g=0.133kPa)。 亚组研究对 274例患者用血管内超声 (intravascularultra鄄sound,IVUS)检查动 脉粥样硬化斑块进展情况。 观察指标 主要的有效指标是心 血管事件的发生率,氨氯地平与安慰 剂进行比较;其次是氨氯地平与依那 普 利 或 依 那 普 利 与 安 慰 剂 进 行 比 较 。 心血管事件…     

Ambulatory blood pressure is a better marker than clinic blood pressure in predicting cardiovascular events in patients with/without type 2 diabetes

BACKGROUND: The prognostic significance of ambulatory blood pressure (ABP) has not been established in patients with type 2 diabetes (T2DM). METHODS: In order to clarify the impact of ABP on cardiovascular prognosis in patients with or without T2DM, we performed ABP monitoring (ABPM) in 1,268 subjects recruited from nine sites in Japan, who were being evaluated for hypertension. The mean age of the patients was 70.4 +/- 9.9 years, and 301 of them had diabetes. The patients were followed up for 50 +/- 23 months. We investigated the relation between incidence of cardiovascular diseases (CVDs) and different measures of ABP, including three categories of awake systolic blood pressure (SBP <135, 135-150, and >150 mm Hg), sleep SBP (<120, 120-135, and >135 mm Hg), and dipping trends in nocturnal blood pressure (BP) (dippers, nondippers, and risers). Cox regression models were used in order to control for classic risk factors. RESULTS: Higher awake and sleep SBPs predicted higher incidence of CVD in patients with and without diabetes. In multivariable analyses, elevated SBPs while awake and asleep predicted increased risk of CVD more accurately than clinic BP did, in both groups of patients. The relationships between ABP level and CVD were similar in both groups. In Kaplan-Meier analyses, the incidence of CVD in nondippers was similar to that in dippers, but risers experienced the highest risk of CVD in both groups (P < 0.01). The riser pattern was associated with a approximately 150% increase in risk of CVD, in both groups. CONCLUSIONS: These findings suggest that ABPM is a better predictor of cardiovascular risk than clinic BP, and that this holds true for patients with or without T2DM.     

Preventing coronary events by optimal control of blood pressure and lipids in patients with the metabolic syndrome

We estimated the coronary heart disease (CHD) events that are preventable by treatment of lipids and blood pressure in patients with metabolic syndrome (MetS), a contributor to coronary heart disease (CHD). Among patients aged 30 to 74 years (without diabetes or CHD) in the United States, MetS was defined by National Cholesterol Education Program criteria. CHD events over a period of 10 years were estimated by Framingham algorithms. Events that could be prevented by statistically “controlling” blood pressure, low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol to either normal or optimal levels according to national guidelines were calculated. Of 7.5 million men and 9.0 million women aged 30 to 74 years with MetS, approximately 1.5 million men and 0.45 million women, if untreated, developed CHD events in 10 years. In men and women, blood pressure control to normal levels “prevented” 28.1% and 12.5% of CHD events, respectively (p <0.01); control to optimal levels resulted in preventing 28.2% and 45.2% of events, respectively (p <0.01). Control of HDL cholesterol to normal levels resulted in preventing 25.3% of events in men and 27.3% in women; optimal control prevented 51.2% and 50.6% of events, respectively. Control of LDL cholesterol to normal levels prevented 9.3% of events in men and 9.8% of events in women; control to optimal levels prevented 46.2% and 38.1% of events (p <0.05), respectively. Control of all 3 risk factors to normal levels resulted in preventing 51.3% of events for men and 42.6% for women; control to optimal levels resulted in preventing 80.5% and 82.1% of events, respectively. Thus, many CHD events in patients with MetS may be preventable by nominal or optimal control of lipids and/or blood pressure.     

80岁及以上高血压患者血压与心脑事件和季节性变化研究

目的 观察80岁及以上老年高血压患者血压和心脑血管事件的季节性变化. 方法监测67例年龄80～92岁的高血压患者2年间的家庭自测血压、诊室测血压和每季度1次的24 h时动态血压,记录期间发生的心脑血管事件. 结果高血压患者夏季的收缩压、舒张压最低(P＜0.01).冬季的收缩压最高(P＜0.01),冬季舒张压高于夏季(P＜0.01).春季和秋季的收缩压、舒张压差异无统计学意义.心脑血管事件的发病率在夏季和冬季明显高于春季和秋季(P＜0.05).发生心血管事件的相关因素为:季节(OR=1.525,P=0.001)、体质指数(OR=1.145,P=0.018)、心功能(OR=2.037,P=0.01),发生缺血性脑血管事件的相关因素为季节(OR=1. 604,P=0.001)、脑血管病史(OR=1.598,P=0.034)、诊室测收缩压(OR=0.960,P=0.013)、动态血压的舒张压(OR=0.936,P=0.008). 结论 80岁及以上老人通过3种方式测得的血压结果显示,夏季的收缩压、舒张压为全年最低;冬季的收缩压全年最高,舒张压高于夏季;春季和秋季的血压水平无明显差异.心脑血管事件的发生率在冬季和夏季明显高于春季和秋季.

Abstract：

Objective To investigate the effect of seasonal variation of blood pressure (BP) on the incidence of cardiovascular and cerebrovascular events in the elderly aged 80 years and over.Methods The 67 patients (aged 80-86 years) with essential hypertension were enrolled, the BP were measured at home, in consulting room, and by 24-h ambulatory BP monitor in every season for 2 years. The incidences of cardiovascular and cerebrovascular events were recorded in the meantime.Results Both systolic BP (SBP) and diastolic BP (DBP) were lower in summer than in any other season (P＜0. 01 ). SBP was higher in winter than in any other season. (P＜0.01), DBP was higher in winter than in summer(P＜0. 01). There were no significant differences in SBP and DBP between spring and autumn. The incidence of cardiovascular and cerebrovascular events were higher in winter and summer than in spring and autumn (P＜0.05). The season (OR= 1. 525, P=0. 001), BMI (OR =1.145, P=0.018) and heart function (OR= 2. 037, P=0.01) were related to the incidence of cardiovascular events. And the season (OR = 1. 604, P= 0. 001 ), history of cerebrovascular disease (OR= 1. 598, P=0. 034), office-measured SBP (OR=0.960, P=0.013) and ambulatory DBP (OR =0. 936, P = 0. 008) were related to the incidence of cerebrovascular events.Conclusions The blood pressure measured by three methods in the elderly aged 80 and over shows that both SBP and DBP are at the lowest in summer; SBP is at the highest in winter, DBP is higher in winter than in summer. There are no significant differences in BP between spring and autumn. The incidences of cardiovascular and cerebrovascular events are significantly higher in winter and summer than in spring and autumn.     

老年人代谢综合征与心脑血管事件

代谢综合征(MS)是一组以肥胖、高血糖、血脂异常以及高血压等聚集发病、严重影响人类健康的临床症候群.代谢综合征在老年人群中具有较高的患病率,其所引发的多种代谢异常都是老年人心脑血管事件的重要危险因子,严重影响老年人的身心健康.