肥胖、2型糖尿病与高血压

<正>肥胖、2型糖尿病与高血压有密切关系。高血压患者半数以上有肥胖或超重,约10％有糖尿病和糖耐量异常。糖尿病患者至少1/3以上合并高血压,并发肾脏损害者高血压患病率达70％～80％,这类患者有明显的代谢紊乱和较严重的靶器官损害,降压药的疗效减低,控制血压的能力受影响,构成一种特殊类型高血压。从心血管病     

成都地区中老年高血压人群糖代谢异常流行状况及其影响因素

目的 探讨成都地区中老年高血压人群糖代谢异常流行状况及影响因素.方法 于2008年采用分层整群抽样的方法,调查成都城乡地区40～79岁中老年人口4685例,进行血压、口服葡萄糖耐量试验(OGTT)等检测,已确诊糖尿病患者只测空腹血糖,开展问卷调查.比较高血压及非高血压人群糖代谢异常患病率,获取中老年高血压人群单纯性糖耐量异常及单纯性负荷后高血糖情况,分析中老年高血压人群糖代谢异常的影响因素.结果 成都地区中老年高血压人群糖代谢异常患病率(53.4%)显著高于非高血压人群(25.1%);若不行OGTT,仅依靠检测空腹血糖,将漏诊中老年高血压人群中72.9%的糖尿病前期患者和54.4%的新诊断糖尿病患者;年龄、一级亲属糖尿病史、超重或肥胖为成都地区中老年男性高血压人群发生糖代谢异常的独立危险因素,体育锻炼、文化程度高为保护因素;年龄、一级亲属糖尿病史、腹型肥胖、高TG血症为成都地区中老年女性高血压人群发生糖代谢异常的独立危险因素.结论 成都地区中老年高血压人群超过半数合并糖代谢异常,需要通过OGTT及时发现这些合并糖代谢异常的患者.适当运动,了解糖尿病相关的保健知识以采取合理的生活方式,干预超重或肥胖、腹型肥胖及高TG血症等代谢性因素,对于减少中老年高血压人群糖代谢异常的发生有着较为重要的作用.     

肥胖、2型糖尿病与高血压

肥胖、2型糖尿病与高血压有密切关系。高血压患者半数以上有肥胖或超重 ,约 10 %有糖尿病和糖耐量异常 ,高血压患者发生糖尿病的可能性是正常血压者的 2 5倍 ;糖尿病患者至少 1/3以上合并高血压 ,并发肾脏损害者高血压患病率达 70 %～ 80 %。这类患者有明显的代谢紊乱和较严重的靶器官损害 ,降压药的疗效减低 ,控制血压的能力受影响 ,构成一种特殊类型高血压[1] 。从心血管病事件链引出的心血管危险新概念角度 ,这类患者属于心血管危险的高危群体。从多重心血管危险因素控制的角度 ,反映肥胖程度的体重指数 (ＢＭＩ)越高 ,平均危险因素数目…     

超重肥胖人群合并高血压情况的调查与护理干预

目的 了解超重肥胖人群合并高血压的发生情况及护理干预对其的影响.方法 在我院周围小区应用系统抽样方法抽取超重肥胖患者452例,依据WHO诊断标准进行筛查,并对符合高血压标准的人群实施护理干预,进行结果测评.结果 本组超重肥胖人群高血压发生率明显增高,为30.8%,通过护理干预可使患者体质量指数降低(2.68±0.07)kg/m2,收缩压平均下降(25.5±5.0)mmHg(1mmHg=0.133kPa),舒张压平均下降(10±5)mmHg,差异均有统计学意义(P＜0.05).结论 超重肥胖是高血压的危险行为因素,通过护理干预可使患者树立正确健康观念,改变不良生活习惯,从而控制血压,减少并发症.     

肥胖性高血压的治疗

近二十年来，我国高血压和肥胖的发病率大幅上升，我国18岁及以上居民高血压患病率为18．8％，全国患病人数1．6亿多；大城市成人超重率与肥胖现患率分别高达30．0％和12．3％。一项中国人群的大样本调查发现，不管采用美国国家胆固醇教育计划（NCEP）成人治疗组第三次报告（ATPⅢ）、国际糖尿病联盟（IDF）或中华医学会糖尿病学分会（CDS）标准，代谢综合征患者中均有70％～100％符合中心性肥胖标准、80％～90％符合血压异常标准。目前，临床上单纯血压升高的患者比例约为10％。高血压更多的是以多重危险因素聚集的方式出现，如代谢综合征、糖尿病合并高血压及肥胖性高血压口。。各种代谢危险因素出现往往先于高血压，血压升高可能是代谢异常的一种后果或重要的中间环节，心肾血管损害则是高血压与代谢异常综合作用的结果。     

血压联合体质量指数与新发慢性肾脏病的关系

目的探讨成人群体中血压联合体质量指数(BMI)对新发慢性肾脏病(CKD)的影响。方法采用回顾性队列研究的方法,以参加2006-2007年健康体检的开滦研究人群作为研究队列,其中符合入选标准的研究对象共84 671人。依据血压[高血压:收缩压≥140和(或)舒张压≥90 mm Hg或有明确诊断的高血压病史或正在服用降压药;正常血压:收缩压140和舒张压90 mm Hg且无明确诊断的高血压病史和未服用降压药]和BMI(超重肥胖:BMI≥24 kg/m~2;非超重肥胖:BMI24 kg/m~2)将观察对象分为4组:正常血压非超重肥胖组、正常血压超重肥胖组、高血压非超重肥胖组和高血压超重肥胖组;CKD定义为:至少2次体检出现估算的肾小球滤过率(eGFR)下降或者蛋白尿;用Kaplan-Meier法计算各组新发CKD的累积发生率,并用Log-rank检验比较不同组别累积发生率的差异;采用Cox比例风险模型探讨不同组别对新发CKD的影响。结果符合入选标准的84 671名基线非CKD人群,在平均随访(8.77±1.41)年期间,共新发CKD 3 625例,累积发生率达4.28%;正常血压非超重肥胖组、正常血压超重肥胖组、高血压非超重肥胖组、高血压超重肥胖组新发CKD的累积发生率分别为2.63%、3.26%、4.47%、6.63%;并且各组间比较差异有统计学意义(P0.05)。多因素Cox回归分析显示,在校正多种混杂因素后,与正常血压非超重肥胖组相比,正常血压超重肥胖组、高血压非超重肥胖组和高血压超重肥胖组新发CKD的风险均增加,对应的HR(95%CI)分别为1.23(1.10～1.37)、1.53(1.35～1.73)、2.23(2.02～2.47)。此外,分别除外糖尿病、吸烟及服用降压药人群后进行了敏感性分析,结果与主要研究结果趋势一致。结论高血压和超重肥胖与新发CKD相关,同时合并高血压及超重肥胖新发CKD风险高于单独高血压或者超重肥胖者。     

良性肥胖对2型糖尿病、心血管事件和死亡的影响——大庆糖尿病预防23年随访研究

目的探讨良性肥胖对2型糖尿病、心血管事件和死亡等长期临床结局的影响。方法1986年纳入大庆市经口服葡萄糖耐量试验诊断的糖耐量正常者519名和新诊断2型糖尿病者630例,之后评估23年随访的长期临床结局。良性肥胖即超重肥胖而无代谢异常(定义为无糖尿病、高血压和高脂血症)。最终纳入682例受试者(糖耐量正常者350名和新诊断2型糖尿病者332例),根据基线状态分为正常体重无代谢异常组(211例)、超重肥胖无代谢异常组(58例)、超重肥胖伴高血压组(81例)、超重肥胖伴2型糖尿病组(109例)、超重肥胖伴高血压和2型糖尿病组(223例)。比较各组2型糖尿病、心血管事件和死亡发病率。结果23年后随访,超重肥胖无代谢异常组心血管事件和死亡发病风险与正常体重无代谢异常组相比无差异,但是其2型糖尿病发病率为正常体重无代谢异常组的2倍(24.1%、12.5/1000人年对10.9%、5.2/1000人年,P=0.01)。多因素回归分析调整了年龄、性别、吸烟史的影响后,这种差别依然存在[风险比(HR)=2.42,95%CI 1.24~4.74,P=0.01]。超重肥胖伴高血压组、超重肥胖伴2型糖尿病组及超重肥胖伴高血压和2型糖尿病组的全因死亡、心血管事件和死亡的发病风险均高于正常体重无代谢异常组,并依次递增(P<0.05)。结论良性肥胖人群长期心血管病风险和死亡与正常组无差异,但其2型糖尿病发病率显著增加。肥胖合并其他代谢紊乱人群的2型糖尿病、心血管事件和死亡的发病风险增加更甚。     

2型糖尿病合并高血压与超重、肥胖关系的研究

目的探究2型糖尿病合并高血压与患者的超重、肥胖的关系。方法选取2014年1月—2015年1月50例2型糖尿病合并高血压的患者,作为实验组,对这50例2型糖尿病合并高血压患者的临床资料进行调查分析,同时选取50例糖尿病患者为对照组,分析实验组与对照组患者之间的差异,探究其与患者超重、肥胖的关系。结果实验组50例2型糖尿病合并高血压的患者在体重指数中,肥胖与超重的患者共计47例,占实验组总患者例数的94%,而对照组50例糖尿病患者的肥胖与超重人数为5例,仅占对照组总例数的10%,验组与对照组相比,差异有统计学意义(P0.05)。实验组与对照组患者中,肥胖共计10例,其患高血压的发生率为90.00%,超重患者共计42例,其患高血压的发生率为88.10%,超重与肥胖导致患者出现高血压的发生率明显大于健康以及偏瘦患者出现高血压的发生率,差异有统计学意义(P0.05)。结论超重以及肥胖是引发2型糖尿病和高血压的重要因素,对2型糖尿病以及高血压进行预防的最好方法就是积极的参与健身,保持健康的体重。     

南京市城区40岁以上人群超重、肥胖流行特点调查分析

目的 了解南京市城区年龄≥40岁的中老年人超重、肥胖的流行特点,并分析肥胖人群多种代谢性疾病患病率情况.方法 采用随机抽样方法,对南京市城区6个社区40～79岁的居民进行问卷调查、体格检查及生化检测.共调查9696人,剔除信息不全334人,最终共9362人纳入统计分析,男性3204人(占34.2％),女性6158人(占65.8％).按照《中国成人超重和肥胖预防控制指南》标准,体重指数≥28.0 kg/m2为肥胖,24.0～27.9 kg/m2为超重.对不同性别、年龄组人群超重、肥胖率进行比较分析.结果 总的超重率41.0％,男性高于女性(43.91％vs.39.48％,x2=17.01,P＜0.001).总的肥胖率16.79％,其中男性为16.73％,女性为16.82％,差异无统计学意义(P＞0.05).受教育程度较低的人群肥胖率高于受教育程度较高人群(x2=47.95,P＜0.001).与正常体重人群比较,肥胖人群糖尿病、高血压、高胆固醇血症、高甘油三酯血症、低密度脂蛋白-胆固醇升高、高密度脂蛋白-胆固醇降低发生率明显增加(x2值分别为42.02,641.88,9.58,236.08,13.24,138.82,P均＜0.001).结论 南京市城区40岁以上人群超重和肥胖发生率高,肥胖人群糖尿病、高血压、血脂异常的发生率明显增加.     

糖尿病合并高血压现状及其影响-成都7 288例人群分析

目的糖尿病与高血压二者均为最常见心血管危险因素且常同时并存,导致大量心血管病事件与死亡,受到日益广泛关注,国内尚少大系列有关调查报告,本研究观察人群中二者现状及其影响因素.方法自99年元月到2000年4月采用整群抽样对成都市18～80岁有代表性人群7 288人的重要心血管危险因素进行综合调查.本文为系列研究中有关糖尿病合并高血压部分,高血压按1999WHO/ISH诊断标准,糖尿病按ADA诊断标准.本组患病率指18～80岁人群.结果本组血压正常人群,空腹血糖平均5.12 mmol/L,高血压者5.47 mmol/L(P<0.01),血糖正常者与糖尿病人群平均血压分别为117/77 mmHg,128/79 mmHg.总人群血糖增高者7.97%,血压增高者15.45%.不论男女均有显著差别(P<0.01).血糖正常者高血压患病率为14.11%,空腹血糖升高者高血压患病率为32.1%,糖尿病为39.2%.正常血压与高血压者之糖尿病患病率分别为2.88%及8.82%,糖尿病合并高血压者占总人群的1.82%.高血压及糖尿病患者常见危险因素TG、TC、尿酸、心率均高于正常人,糖尿病合并高血压时TG水平不高于糖尿病,血尿酸不高于高血压,HDL不低于普通人群及单独高血压或糖尿病.糖尿病与高血压单独存在较一般人具有更高的高血脂症(但糖尿病未影响 HDL),高尿酸及慢性阻塞肺疾病.结论研究证明糖尿病及高血压二者经常并存,高血压者较正常人伴有更多糖代谢障碍,糖代谢障碍者更多伴有高血压.     

Undiagnosed obesity in hypertension: clinical and therapeutic implications

OBJECTIVES: The aim of this study was to determine the prevalence of obesity in patients with hypertension and to evaluate the relationship between obesity, metabolic syndrome (MetS) and blood pressure (BP) control. MATERIALS AND METHODS: We conducted an epidemiological survey in a sample of 19,039 patients with hypertension who consecutively attended a primary healthcare center. Patients were considered to have hypertension if the BP was > or =140/90 mmHg or > or =130/80 mmHg in diabetic patients or if they were undergoing pharmacological treatment for hypertension. The obesity was based on body mass index (BMI). Overweight was if the BMI was > or =25 kg/m2, obese > or =30 kg/m2 and severe obesity (SO) if BMI was > or =40 kg/m2. Abdominal obesity (AO) was considered when the waist circumference was greater than 102 cm in men and 88 cm in women. RESULTS: The prevalence of obesity in our hypertensive patients was 51.6% and among these 3.8% had SO. Furthermore, 38.7% were overweight. AO was observed in 66.1% of the whole. Both obesity and AO were significantly more prevalent in women. When evaluating the patients according to categories of BMI, we observed greater levels of BP (from 145.5/84.5 to 149.5/89 mmHg, p<0.0001), worse control over BP (from 29.6% to 15.4%, p<0.0001) and a greater prevalence of MetS (from 20.8% to 66.9%, p<0.0001) as weight increased. Likewise, an increase in both BMI and AO was associated with worse control of BP (obesity, OR = 1.343 (95% confidence interval, CI, 1.251-1.442); AO, OR = 1.292 (95% CI 1.201-1.389). CONCLUSIONS: There is a high prevalence in Spain of obesity and AO in patients with hypertension. These conditions are associated with metabolic alterations and worse BP control.     

Women and hypertension: what did we learn from the Women's Health Initiative?

The Women's Health Initiative (WHI) provides valuable data on blood pressure (BP) and on the prevalence, treatment, and control of hypertension in the largest multiethnic, best characterized cohort of postmenopausal women ever studied, including 98,705 women aged 50 to 79 years. Hypertension prevalence was high (38% overall) and directly related to age. Major determinants of hypertension prevalence included black race, history of cardiovascular disease (CVD), and concomitant CVD risk factors of physical inactivity, overweight/obesity, and excess alcohol consumption. Menopausal hormone treatment had little effect on BP. BP control rates declined dramatically with age. Interestingly, participants who were insured by Medicaid had significantly higher treatment rates and tended to have better BP control than those with Medicare only, perhaps reflecting differences in drug coverage and/or age. Inadequate intensity of antihypertensive treatment contributed to poor BP control: approximately 60% of participants were treated with a single drug; 30% with 2 drugs; <10% with 3 or more drugs, and the number of medications used was similar across age groups despite the age-related increase in the severity of hypertension. This treatment pattern is inconsistent with current treatment guidelines, which stress the need for 2 or more antihypertensive medications to control BP in most older hypertensive patients. The take-home message from WHI is that more effective strategies, including more efficient and cost-effective systems of healthcare delivery, are needed to control BP and prevent CVD morbidity and mortality in older women, a group characterized by severe, treatment-resistant hypertension and high risk for CVD events.     

Prevalence of hypertension in schoolchildren based on repeated measurements and association with overweight

OBJECTIVE: Most studies assess the prevalence of hypertension in pediatric populations based on blood pressure (BP) readings taken on a single visit. We determined the prevalence of hypertension measured on up to three visits in a Swiss pediatric population and examined the association between hypertension and overweight and selected other factors. METHODS: Anthropometric data and BP were measured in all children of the sixth school grade of the Vaud canton (Switzerland) in 2005-2006. 'Elevated BP' was defined according to sex-specific, age-specific and height-specific US reference data. BP was measured on up to two additional visits in children with elevated BP. 'Hypertension' was defined as 'elevated BP' on all three visits. RESULTS: Out of 6873 children, 5207 (76%) participated [2621 boys, 2586 girls; mean (SD) age, 12.3 (0.5) years]. The prevalence of elevated BP was 11.4, 3.8 and 2.2% on first, second and thirds visits, respectively; hence 2.2% had hypertension. Among hypertensive children, 81% had isolated systolic hypertension. Hypertension was associated with excess body weight, elevated heart rate and parents' history of hypertension. Of the children, 16.1% of boys and 12.4% of girls were overweight or obese (CDC criteria, body mass index >or= 85th percentile). Thirty-seven percent of cases of hypertension could be attributed to overweight or obesity. CONCLUSIONS: The proportion of children with elevated BP based on one visit was five times higher than based on three measurements taken at few-week intervals. Our data re-emphasize the need for prevention and control of overweight in children to curb the global hypertension burden.     

糖尿病合并动脉粥样硬化性心血管病患者血压控制现状调查

目的了解中国糖尿病合并动脉粥样硬化性心血管病患者血压控制及降压药物使用情况,分析影响血压控制的因素。方法对参加“第二项心脏保护研究”临床试验筛选门诊的糖尿病合并动脉粥样硬化性心血管病患者进行调查,记录病史和用药情况,测量血压、BMI和腰围。结果2007年6月至2009年10月期间,在14个城市共调查6522例患者,平均年龄64岁。70％有高血压病史,其中12％未服任何降压药物,仅18％血压达标。缺血性脑卒中病史（OR0．70,95％CI 0．58～0．84）和向心性肥胖（OR0．64,95％C10．46～0．89）与血压达标呈负相关。无高血压病史的患者中,64％血压高于130／80mmHg。结论我国糖尿病合并心血管病患者血压控制情况距指南要求仍存在很大差距,应注意加强对此类患者的血压控制。     

Hypertension in overweight and obese primary care patients is highly prevalent and poorly controlled

BACKGROUND: Although the relationship between body weight and blood pressure (BP) is well established, there is a lack of data regarding the impact of obesity on the prevalence of hypertension in primary care practice. The objective of this study was to assess the prevalence of hypertension and the diagnosis, treatment status, and control rates of hypertension in obese patients as compared to patients with normal weight. METHODS: A cross-sectional point prevalence study of 45,125 unselected consecutive primary care attendees was conducted in a representative nationwide sample of 1912 primary care physicians in Germany (HYDRA). RESULTS: Blood pressure levels were consistently higher in obese patients. Overall prevalence of hypertension (blood pressure >/=140/90 mm Hg or on antihypertensive medication) in normal weight patients was 34.3%, in overweight participants 60.6%, in grade 1 obesity 72.9%, in grade 2 obesity 77.1%, and in grade 3 obesity 74.1%. The odds ratio (OR) for good BP control (<140/90 mm Hg) in diagnosed and treated patients was 0.8 (95% confidence interval [CI] 0.7-0.9) in overweight patients, 0.6 (95% CI 0.6-0.7) in grade 1, 0.5 (95% CI 0.4-0.6) in grade 2, and 0.7 (95% CI 0.5-0.9) in grade 3 obese patients. CONCLUSIONS: The increasing prevalence of hypertension in obese patients and the low control rates in overweight and obese patients document the challenge that hypertension control in obese patients imposes on the primary care physician. These results highlight the need for specific evidence-based guidelines for the pharmacologic management of obesity-related hypertension in primary practice.     

Treatment and blood pressure control in isolated systolic hypertension vs diastolic hypertension in primary care

Cross-sectional surveys on prevalence, treatment and control of hypertension could not satisfactorily distinguish between diastolic hypertension and isolated systolic hypertension because the definition of hypertension included patients under pharmacological treatment. We assessed the situation in the two types of hypertension in general practice in Belgium, based on current blood pressure (BP) measurements and on BP prior to the initiation of drug therapy. Participating physicians enrolled the first 15 at least 55-year-old men visiting the surgery, measured their BP and recorded data on medical history including pretreatment BP, drug utilization, cardiovascular risk factors and target organ damage. Diastolic hypertension was defined as diastolic BP> or =90 mmHg, irrespective of systolic BP, and isolated systolic hypertension as systolic BP > or =140 mmHg and diastolic BP < 90 mmHg. Among 3761 evaluable patients, 74% were hypertensive. Among the 1533 hypertensive patients in whom blood pressure was known prior to treatment (n=965) or who were untreated at the study visit (n=568), 1164 had diastolic hypertension and 369 isolated systolic hypertension. The prevalence of antihypertensive treatment was, respectively, 75 and 25% (P<0.001) in these two types of hypertension. The odds of being treated were independently determined by type of hypertension, severity of hypertension and level of risk (P<0.001). BP was controlled in 25% of all patients with diastolic hypertension and in 13% of all patients with isolated systolic hypertension (P<0.001). About half of the treated patients with systolic hypertension were on a diuretic and/or a calcium-channel blocker. In conclusion, isolated systolic hypertension is less frequently treated than diastolic hypertension, overall BP control is poor and actual drug therapy diverges from recommendations based on placebo-controlled intervention trials.     

Increased masked hypertension prevalence in patients with obesity

ABSTRACT

Objectives: Masked hypertension is associated with an increased risk for cardiovascular conditions. The aim of the study was to evaluate the relationship obesity parameters, including body weight, waist circumference, and body mass index.

Methods: The study group consisted of 251 consecutive outpatient subjects without overt hypertension. Subjects were classified according to BMI. After a complete medical history and laboratory examination, patients’ height, weight, waist circumference heart rate, and office blood pressure were recorded. All subjects underwent ambulatory blood pressure monitoring. Masked hypertension is defined as normal office blood pressure measurement and high ambulatory blood pressure level.

Results: Baseline characteristics in patients and controls were similar. Prevalence of Masked hypertension was significantly higher in patients with obesity than controls (30.9% vs 5.7%, p < 0.001). Body mass index (33.2 ± 4.3 vs 25.1 ± 2.7 p < 0.001), waist circumference (98.5 ± 11.7 vs 86.8 ± 8.8, p < 0.001), and weight (86.5 ± 11.8 vs. 69 ± 9.1, p < 0.001) in patients with obesity were significantly higher than in patients with normal weight. Office Systolic BP (121.8 ± 4.4 vs 120.5 ± 4.78, p = 0.035), ambulatory daytime systolic BP (128.8 ± 8.9 vs 124.5 ± 7.4, p < 0.001), ambulatory daytime diastolic BP (73.9 ± 9.5 vs 71.5 ± 7.0, p = 0.019), ambulatory night-time systolic BP in patients with obesity was significantly higher than in patients with normal weight.

Conclusion: This study demonstrated that masked hypertension prevalence is higher in patients with obesity than control patients. It can be suggested that predefining obesity might be helpful in early detection of masked hypertension.     

北京农村老年高血压患者降压药物使用及血压控制情况调查

目的了解北京农村地区老年高血压患者降压药物使用及高血压控制情况。方法对北京大兴区长子营地区1240例60岁以上正在治疗的高血压患者降压药物使用及血压控制情况进行调查。降压药分为三类:推荐制剂、传统制剂、中药制剂。推荐制剂:包括血管紧张素转换酶抑制剂(ACEI)、血管紧张素Ⅱ受体拮抗剂(ARB)、β受体阻滞剂(βRB)、钙通道阻滞剂(CCB)和噻嗪类利尿剂(HCTZ);传统制剂:包括降压0号、复方降压片、复方利血平等;中药制剂:包括罗布麻片、珍菊降压片、牛黄降压丸等。降压药物使用后血压≤140/90 mmHg为血压达标。结果 1240例调查对象中710例(57.2%)使用推荐制剂,499例(40.2%)使用传统制剂,9例(0.7%)使用中药制剂,22例(1.7%)使用推荐制剂+传统制剂;血压达标率分别为43.1%、40.7%、33.3%和54.5%;总体达标率为42.3%。使用推荐制剂患者中选用单种及两种或三种降压药联合治疗的患者分别占66.9%、31.0%和2.1%,血压达标率分别为34.1%、60.0%和80.0%。使用单种推荐制剂的患者中使用CCB、ACEI/ARB,βRB和HCTZ比例分别为62.1%、29.9%、6.3%和5.6%。使用两种推荐制剂联合治疗的患者中CCB+ACEI/ARB占83.2%,HCTZ+其他推荐制剂患者仅为2.3%。结论北京局部农村地区老年高血压治疗药物使用尚不够规范,推荐制剂使用不足60%;推荐制剂组达标率高于传统制剂组和中药制剂组。40%以上的患者使用传统制剂和中药制剂,有必要进一步探讨其降压效果和是否减少心脑血管疾病发生的循证医学证据。     

安徽中部地区人群高血压状况及用药分析

目的:了解安徽中部地区企事业单位高血压患者的血压控制状况及用药情况.方法:采用随机整群抽样的方法,选取2008-08月在安徽省立医院健康体检中心体检的41家企事业单位职工2 019例,现场测量血压,并进行高血压患病及用药情况问卷调查.结果:高血压患者共计599例,患病率为29.7%.85例血压＜140/90 mmHg(1 mmHg=0.133 kPa),控制率为14.2%;血压≥140/90 mmHg中青年职工人群以舒张压未控制以及舒张压和收缩压均未控制为主.高血压患者中服药184例,48例血压＜140/90 mmHg,服药率和服药控制率分别为30.7%、26.1%;服药患者中64.5%使用单一降压药物治疗,24.4%使用复方制剂,11.1%使用联合治疗;服用率较高降压药物为钙拮抗剂(53.5%)和复方制剂(27.3%),β受体阻滞剂(3.5%)和利尿剂(1.7%)服用率较低.结论:安徽中部地区单位职工高血压发病率较高而服药率和控制率较低,且用药方案与<中国高血压防治指南>要求存在一定差距,建议加强这一人群的健康干预以及基层医师的继续教育.     

Blood pressure, antihypertensive treatment and factors associated with good blood pressure control in hypertensive diabetics: the Tarmidas study

Numerous population studies confirm the high prevalence of hypertension in type II diabetic (DM2) subjects and that intensive antihypertensive treatment is more beneficial to diabetic than to nondiabetic hypertensive subjects, yet not many of these are specific to Spain. To assess the degree of blood pressure (BP) control and the effects of antihypertensive drugs in the medical management of hypertension in diabetic patients in specialist care centres throughout Spain, we studied the socio-demographic, clinical and relevant laboratory parameters of 796 hypertensive patients with DM2 (mean age 66.09 (95% confidence interval (CI): 64.08-68.10). The percentage of diabetic patients responding positively to BP control measures was lower when compared to the nondiabetic population in both Spain and Europe. The degree of control was poorer for systolic than for diastolic BP, yet 40.6% of the patients were only on monotherapy. The fact that antihypertensive treatment was modified in only 40% of the poorly controlled patients was also highly significant and could be attributed to a nonstringent use of clinical guidelines. Among the other differences between well-controlled and poorly controlled patients, we found that well-controlled patients presented with lower levels of cholesterol and triglycerides, a lower prevalence of excess weight/obesity, and a greater prevalence of cardiovascular and/or cerebrovascular disease despite having a greater percentage of patients on antiplatelet therapy. Better application of therapeutic guidelines and the prevention and treatment of compounding factors could improve the response rate to BP control measures in poorly controlled patients.