高血压患者颈动脉内膜中层厚度与血压昼夜节律的关系

目的探讨高血压患者颈动脉内膜中层厚度(IMT)与血压昼夜节律的关系。方法选择2016年2月—2017年5月收治的高血压患者130例,根据动态血压监测分为勺型组68例与非勺型组62例。测量BMI、血脂、颈动脉IMT、SBP、DBP、24 h动态血压。计量资料比较采用t检验,P0.05为差异有统计学意义。结果两组BMI及血脂水平比较,差异无统计学意义(均P0.05)。非勺型组IMT高于勺型组,比较差异有统计学意义(P0.05);两组24 h SBP、DBP比较差异无统计学意义(均P0.05)。两组白SBP、DBP比较比较差异无统计学意义(P0.05);非勺型组夜间SBP、DBP高于勺型组,比较差异有统计学意义(均P0.05)。结论高血压患者血压昼夜节律异常与颈动脉IMT关系密切。     

抗高血压药物在慢性脑血管病患者中的血压变异性影响

目的探讨不同类的降压药物和不同钙拮抗剂对慢性脑血管病患者中血压变异性的影响。方法入选373例有慢性脑血管病的高血压患者,分别给予钙拮抗剂(CCBs)、(受体阻断剂(BBs)、血管紧张素转换酶抑制剂(ACEIs)和血管紧张素Ⅱ受体拮抗剂(ARBs)治疗后,行24h动态血压计算血压变异性,并进行统计分析。结果 BBs的日间血压变异性明显高于ARB或CCB(P<0.05),相比于其他CCB药物,西尼地平的日间血压变异性最低。结论 ARB和CCB相比于BBs更有利于脑血管疾病患者的高血压管理和治疗。而CCB中,由于较小的血压变异性,优选西尼地平。     

原发性高血压患者伴焦虑抑郁症状的临床分析

目的探讨原发性高血压患者伴焦虑抑郁症状的临床特征及治疗。方法对86例原发性高血压(EH)患者行焦虑、抑郁评定(SAS、SDS),分为EH+AD组及EH+nonAD组,比较两组相关临床资料,动态血压及血压昼夜节律及治疗效果。结果 (1)EH+AD组24小时平均血压、白昼平均血压、夜间平均血压明显高于EH+nonAD组(P均<0.01),尤以夜间血压增高更为明显(P均<0.001),血压昼夜节律消失、非勺型的血压昼夜节律明显高于EH+nonAD组(72.18%比30.57%,P<0.01)。(2)EH+AD组对血压升高的耐受性差,单纯用降压药物治疗效果差,合并使用抗焦虑抑郁药物疗效显著。结论高血压伴焦虑抑郁患者,24 h平均血压、白昼平均血压、夜间平均血压均高,以夜间血压升高更明显,昼夜节律曲线以非勺型多见。在原发性高血压治疗的同时加用抗焦虑抑郁药物治疗是安全有效的。     

多系统萎缩患者血压昼夜节律变化及夜间高血压相关因素分析

目的研究多系统萎缩(MSA)患者的血压昼夜节律特征和夜间高血压的相关因素。方法研究2016年1月至2019年1月我院收治的114例MSA患者的24小时动态血压参数,分析血压昼夜节律情况及夜间高血压相关因素。结果 114例MSA患者血压昼夜节律主要表现为反勺型(68.4%)和非勺型(27.2%),夜间高血压患者94例(82.5%)。与不伴夜间高血压组相比,夜间高血压组MSA患者出现直立性低血压(OH)和服用降压药物的比例更高(P0.05)、HDL-C水平更低(P0.05)。Logistic回归分析显示服用降压药物是MSA患者夜间高血压的保护因素,HDL-C水平减低则是其危险因素。结论 MSA患者血压昼夜节律消失,普遍存在夜间高血压,降压治疗有助于减少夜间高血压发生,HDL-C水平减低可能与MSA发病相关。     

体位性低血压的H型高血压患者24h动态血压特点探讨

目的:分析体位性低血压(orthostatic hypotension,OH)的H型高血压患者24h动态血压变化特点及心血管事件发生情况。方法:选择405例H型高血压患者进行卧位及立位3分钟血压测量,诊断为OH73例,选取非OH76例作为对照组,对两组患者均进行24h动态血压监测,观察两组平均血压、血压负荷值、血压变异性、动态动脉硬化指数、心血管事件等指标。结果:OH组年龄明显高于非OH组(P0.05);OH组24h及日间平均收缩压、平均舒张压差异均无统计学意义(P0.05);OH组的日间舒张压比非OH组低(P0.05);OH组夜间平均收缩压、平均舒张压均高于非OH组(P0.01);OH组患者收缩压变异性、血压晨峰数值均明显高于非OH组(P0.05);OH组血压昼夜节律以反勺型比较为主,与非OH组比较差异有统计学意义(P0.05);OH组心血管事件与非OH组比较差异有统计学意义(P0.05)。结论:OH组患者易发生于高龄患者,存在夜间高血压,且具有血压变异性增高,血压昼夜节律呈反杓型的特点,且心血管事件发生增多。     

老年高血压患者血压昼夜节律变化分析

目的 分析老年原发性高血压患者动态血压的昼夜节律特征及其临床意义,探讨老年高血压患者的血压控制策略.方法 选择476名老年原发性高血压患者进行24 h动态血压监测,分析其24 h、白天、夜间平均血压和平均脉压及血压变异性.结果 老年高血压患者血压均值收缩压(SBP)和血压均值舒张压(DBP)的波动曲线均呈“双峰双谷”状,血压节律呈非杓型者382例,杓型者94例.老年组和高龄组的非杓型高血压检出率分别为73.47％和91.21％,非杓型高血压检出率在不同年龄组间的差异有统计学意义,但在不同性别间的差异无统计学意义.老年高血压患者的24h动态血压监测(ABPM)参数在男女间无显著性差异,高龄组的24 hSBP、dSBP、24 hAPP高于老年组的24 hSBP、dSBP、24 hAPP,组间差异有统计学意义.结论 老年高血压患者血压昼夜节律呈现非杓型高血压表现为主的异常改变,表现为以单纯收缩压增高为主、舒张压不高甚至降低、脉压增大;且随年龄增高,这些血压异常改变的特征更趋显著.24h动态血压监测可为不同血压波动类型的老年高血压患者实施更精细的个体化防治方案提供更有效指导.     

阻塞型睡眠呼吸暂停低通气综合征与动态血压的临床观察

目的 探讨阻塞型睡眠呼吸暂停低通气综合征(OSAHS)与动态血压的内在联系.方法 应用美国Spacelabs90207型动态血压记录仪测定50例OSAHS患者24 h动态血压,并与健康体检者157例比较.结果 OSAHS患者夜间血压较自昼血压下降不明显(P>0.05),血压呈非杓型改变者39例(78.0%),杓型改变者11例(22.0%).在OSAHS患者中,发现原发性高血压患者21例,占42.0%.在健康体检者中,发现原发性高血压患者20例,占12.7%.OSAHS患者24 h动态血压整体血压水平、白昼血压水平及夜间血压水平均较健康体检者增高,差异有统计学意义(P<0.05或<0.01).结论 OSAHS患者24 h动态血压整体水平较正常为高,夜间增高更明显,昼夜节律消失.OSAHS是高血压发生的因素之一.     

老年2型糖尿病患者认知功能与血压昼夜节律变化特点

目的 探讨老年2型糖尿病(T2DM)患者认知功能与24h动态血压昼夜节律变化特点.方法 选择270例老年T2DM患者为糖尿病组,另选择同期健康体检者100例为对照组.对两组行24 h动态血压监测,根据夜间血压下降率(△MBP)分为杓型(△MBP 10%～20%,n=95)、非杓型(△MBP 0%～＜10%,n=86)、超杓型(△MBP＞20%,n=47)和反杓型(△MBP＜0%,n=42);用中文版简易智能状态检查表(MMSE)对所有受试者进行认知功能调查,比较各组间MMSE得分的差异.结果 糖尿病组患者MMSE得分[(24.34±2.51)分]低于对照组[(28.88±3.02)分],差异有统计学意义(P＜0.05).糖尿病组中非杓型[(24.77±2.53)分]、超杓型[(23.34±2.41)分]和反杓型[(23.03±2.26)分]患者的MMSE得分均低于杓型[(26.03±2.68)分]患者,超杓型和反杓型又低于非杓型患者,差异有统计学意义(P＜0.05),但超杓型和反杓型之间的差异无统计学意义.Pearson相关分析显示,糖尿病患者MMSE得分与24hSBP(r=-0.73)、24hDBP(r=-0.60)、24hPP(r=-0.54)、24hMBP(r=-0.56)呈负相关(P＜0.05).结论 24 h动态血压昼夜节律的减弱或消失可能是老年T2DM患者认知功能受损的相关因素.     

宜兴市居民2型糖尿病危险因素分析

目的 探讨影响2型糖尿病患病危险因素.方法 随机整群抽取宜兴市1 862人问卷调查,对2型糖尿病相关因素进行单因素和多因素非条件Logistic回归分析.结果 单因素Logistic回归分析显示,抽样地区与2型糖尿病患病有密切关系的因素为:年龄、饮酒、BMI、腰臀比、血清甘油三酯、高血压家族史、体力活动及主食等.多因素Logistic回归分析显示,年龄(OR=1.43,P＜0.01)、BMI(OR=1.07,P＜0.01)、腰臀比(OR=13.11,P=0.04)、血清甘油三酯(OR=1.16,P＜0.01)、高血压家族史(OR=2.75,P＜0.01)、体力活动(OR=0.47,P＜0.01)及主食(OR=1.25,P＜0.01)对糖尿病患者有影响.结论 2型糖尿病与年龄,饮酒、BMI、腰臀比、血清甘油三酯、高血压家族史、体力活动及主食等因素相关.     

勺型形态高龄高血压患者的动态动脉硬化指数与靶器官损伤关系

[目的]亚临床靶器官损伤代表着心血管疾病发展的中间阶段。本研究通过测试动态动脉硬化指数(ambulatory arterial stiffness index,AASI),在高龄高血压患者中,探讨靶器官损伤和AASI相关性。[方法]收集本院老年科住院96例高龄(≥80岁)高血压患者资料,根据24 h动态血压勺型形态分为勺型曲线组(40例)和非勺型曲线组(56例),进行AASI测定,评估AASI、平均脉压与内生肌酐清除率、颈动脉内膜厚度、左室重量、左室重量指数之间的关系。[结果]通过测试AASI发现:①在所有高龄高血压患者中,24 h尿蛋白定量与AASI呈独立正相关(P<0.05)。②在勺型曲线高血压患者中,IMT与AASI呈独立正相关(P<0.01)。[结论]考虑高血压患者血压昼夜变化、勺型曲线的影响,AASI在评估靶器官损伤中具有一定的诊断价值。     

A prospective evaluation of persistence on antihypertensive treatment with different antihypertensive drugs in clinical practice

Persistence on treatment affects the efficacy of antihypertensive treatment. We prospectively investigated the persistence on therapy and the extent of blood pressure (BP) control in 347 hypertensive patients (age 59.4 +/- 6 years) randomly allocated to a first-line treatment with: angiotensin-converting enzyme (ACE) inhibitors, calcium-channel blockers (CCBs), beta-blockers, angiotensin-II receptor blockers (ARBs), or diuretics and followed-up for 24-months. Persistence on treatment was higher in patients treated with ARBs (68.5%) and ACE inhibitors (64.5%) vs CCBs (51.6%; p < 0.05), beta-blockers (44.8%, p < 0.05), and diuretics (34.4%, p < 0.01). No ARB, ACE inhibitor, beta-blocker, or diuretic was associated with a higher persistence in therapy compared with the other molecules used in each therapeutic class. The rate of persistence was significantly higher in patients treated with lercanidipine vs others CCBs (59.3% vs 46.6%, p < 0.05). Systolic and diastolic BP was decreased more successfully in patients treated with ARBs (-11.2/-5.8 mmHg), ACE inhibitors (-10.5/-5.1 mmHg), and CCBs (-8.5/-4.6 mmHg) compared with beta-blockers (-4.0/-2.3 mmHg p < 0.05) and diuretics (-2.3/-2.1 mmHg, p < 0.05). No ARB, ACE inhibitor, beta-blocker, or diuretic was associated with a higher BP control compared with the other molecules used in each therapeutic class. A trend toward a better BP control was observed in response to lercanidipine vs other CCBs (p = 0.059). The present results confirm the importance of persistence on treatment for the management of hypertension in clinical practice.     

Calcium channel blockers, angiotensin receptor blockers, and angiotensin-converting enzyme inhibitors: effectiveness in combination with diuretics or beta-blockers for treating hypertension

This retrospective database analysis compared the effectiveness of dihydropyridine calcium channel blockers (DHPs), angiotensin-converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs) added to diuretics or beta-blockers. Adults with hypertension treated with diuretic or beta-blocker monotherapy between 1998 and 2001 were identified from a large US electronic medical records database of primary care practices. Patients were required to have a baseline blood pressure (BP) > or =140/90 mmHg (> or =130/80 mmHg for diabetes mellitus) and recorded BP measurements within 6 months before and 1-12 months following index date. Patients were matched 1:1:1 by propensity score to correct for differences in baseline characteristics. 1875 patients met study criteria and 660 (220 in each cohort) were matched based on propensity scores. Matched cohorts had no significant differences in baseline characteristics. Mean changes in systolic/diastolic BP were -17.5/-8.8, -15.7/-6.3, and -13.0/-8.0 mmHg with DHPs, ACE inhibitors, and ARBs, respectively. Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High BP 6/7 goal attainment for each regimen was 47.3%, 40.0%, and 32.2%, respectively. DHPs, ACE inhibitors, and ARBs improved BP when added to patients' beta-blocker or diuretic therapy. The greatest benefits were observed with DHPs, followed by ACE inhibitors, then ARBs.     

ACE inhibitor-based treatment and antihypertensive effects in patients with type 2 diabetes

AIM: The presence of hypertension significantly increases cardiovascular risk in diabetic patients. Different classes of antihypertensive drugs, by targeting different pathophysiological mechanisms and therapeutic targets, might provide different antihypertensive effects. The authors speculated that drugs specifically targeting the renin-angiotensin-aldosterone system provide better antihypertensive control than other therapeutic agents. METHODS: Fifty consecutive type 2 diabetic patients with hypertension (M:F 29:21) were followed for 3-9 yrs. Antihypertensive treatment was stable for the last 12 months and included angiotensin convertying enzyme (ACE) inhibitors (ACEI) alone in 8 patients (group IA), ACEI combined with other drugs in 11 patients (group IB) and non-ACEI treatment in 31 patients (group II), 23 of whom were treated with Ca-channel blockers and 8 were treated with beta-blockers alone or with diuretics. During the last month of the study a 3-7 days antihypertensive drugs wash-out was performed. Measurements were performed in sitting position in the same ambulatory conditions, in supine position after 20 min of absolute rest, and in motionless standing station after quickly rising up from sitting rest. RESULTS: Groups IA, IB, and II had similar blood pressure values during antihypertensive therapy within the last year. However, blood pressure values after antihypertensive drug wash-out were significantly higher in groups IA and IB vs. group II (SBP and DBP resting sitting position, P=0.039 and P=0.014 respectively; SBP and DBP in standing position, P=0.001 and P=0.016, respectively). CONCLUSION: These data show that the underlying condition in terms of pathophysiologic mechanisms is more severe in groups IA and IB, including a greater increase of peripheral resistance. Thus we may conclude that the antihypertensive effect of ACEI is greater than other classes of antihypertensive drugs.     

The practice guideline 'Hypertension' (third revision) from the Dutch College of General Practitioners; a response from the perspective of general practice

In the revised practice guideline on hypertension from the Dutch College of General Practitioners, some changes have been made in the areas of diagnosis and therapy in comparison to the previous edition. Finding people with hypertension is a major goal for the prevention of cardiovascular disease. A systolic blood pressure > 140 mmHg (> 160 mmHg in patients > 60 years) necessitates non-pharmaceutical advice and antihypertensive therapy with diuretics, beta-blockers, angiotensin-converting-enzyme (ACE) inhibitors or calcium antagonists, either as monotherapy or in combination. In view of the ever-increasing importance of ACE inhibitors in antihypertensive therapy, we expect that the next revision of the practice guideline will soon be necessary.     

Manidipine-delapril combination in the management of hypertension

High blood pressure (BP) is the major cardiovascular risk factor and the main cause of death around the world. Control of blood pressure reduces the high mortality associated with hypertension and the most recent guidelines recommend reducing arterial BP values below 140/90 mmHg for all hypertensive patients (130/80 in diabetics) as a necessary step to reduce global cardiovascular risk, which is the fundamental objective of the treatment. To achieve these target BP goals frequently requires combination therapy with two or more antihypertensive agents. Although the combination of a diuretic and an angiotensin converting enzyme inhibitor (ACEI) is the most commonly used in the clinical practice, the combination of an ACEI and a calcium channel blocker may have an additive antihypertensive effect, a favorable effect on the metabolic profile, and an increased target organ damage protection. The new oral fixed combination manidipine 10 mg/delapril 30 mg has a greater antihypertensive effect than both components of the combination separately, and in non-responders to monotherapy with manidipine or delapril the average reduction of systolic and diastolic BP is 16/10 mmHg. The combination is well tolerated and the observed adverse effects are of the same nature as those observed in patients treated with the components as monotherapy. However, combination therapy reduces the incidence of ankle edema in patients treated with manidipine.     

ACE inhibitors are better than diuretics for treatment of hypertension in the elderly

Despite similar reductions in blood pressure, angiotensin-converting enzyme (ACE) inhibitors demonstrate lower combined rates of cardiovascular events or all-cause mortality in elderly hypertensive patients compared with diuretics. This benefit is most evident in men. These results may differ from those of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack (ALLHAT) trial because that study included younger patients, had a greater representation of patients with African ancestry, used different brands of medication, and had a slightly different primary outcome. Despite these differences, both treatments offer an inexpensive means for reducing blood pressure and preventing hypertension-related complications.     

Management of Hypertension in Patients with Diabetes Mellitus

Hypertension and diabetes mellitus are significant and independent risk factors for cardiovascular disease.Antihypertensive therapy reduces cerebrovascular and cardiovascular morbidity and mortality in patients with hypertension. Tight blood pressure (BP) control [target diastolic BP (DBP) ≤80mm Hg] reduced the incidence of major cardiovascular events by 51% compared with less tight control (DBP ≤90mm Hg) in patients with diabetes mellitus in the Hypertension Optimal Treatment (HOT) study. Similarly, in the UK Prospective Diabetes Study (UKPDS), tight BP control [mean systolic BP (SBP)/DBP = 144/82mm Hg] with captopril or atenolol reduced diabetes mellitus-related morbidity and mortality by 24% compared with less tight control (mean SBP/DBP = 154/87mm Hg). Importantly, the frequency of microvascular disease (including retinopathy) was reduced by 37% among those randomised to tight BP control in the UKPDS.In the diabetic subgroup in the Heart Outcomes Prevention Evaluation (HOPE) study, there was a 25% reduction in the composite end-point of death due to cardiovascular causes, or myocardial infarction or stroke during 5 years of treatment with ramipril 10 mg/day relative to placebo.Lisinopril is an ACE inhibitor indicated for use in hypertension, heart failure and post-myocardial infarction. As an antihypertensive agent the drug is effective and generally well tolerated in patients with type 1 or 2 diabetes mellitus and in those with early or overt nephropathy.In the Swedish Treatment of Old People (STOP) Hypertension 2 trial, there was no difference in the relative risk of cardiovascular death between those assigned to ACE inhibitors (lisinopril or enalapril), calcium channel blockers (felodipine or isradipine) or ‘conventional’ antihypertensive therapy (thiazide diuretics or β blockers); treatment effects did not differ significantly between diabetic and nondiabetic patients (10.9% of the 6614 patients had diabetes mellitus). Importantly, lower frequencies of nonfatal or fatal myocardial infarction [relative risk (RR) 0.77; 95% confidence interval (CI) 0.61 to 0.96] and congestive heart failure (RR 0.78; CI 0.83 to 0.97) were detected during 4 years’ treatment with lisinopril or enalapril than felodipine or isradipine in this study.Lisinopril reduced albumin excretion rates in patients with type 1 or 2 diabetes mellitus. In the 2-year EURODIAB Controlled Trial of Lisinopril in IDDM (EUCLID) study, albumin excretion rates decreased by 49.7% relative to placebo in normotensive patients with type 1 diabetes mellitus and microalbuminuria during treatment with lisinopril 10 to 20 mg/day. Progression of retinopathy was attenuated in normotensive patients with type 1 diabetes mellitus during treatment with lisinopril in this study.In conclusion, lisinopril, like other ACE inhibitors should be considered a first-line agent for reducing BP and attenuating nephropathy in patients with type 1 or 2 diabetes mellitus.     

Cognitive impairment and nocturnal blood pressure fall in treated elderly hypertensives

Objectives We investigated the association between the fall of nocturnal blood pressure (BP) and cognitive impairment in elderly subjects. Methods The study was a cross-sectional survey of 204 elderly subjects who had no cerebrovasucular episodes. Ambulatory BP monitoring and assessments of cognitive functions using the Mini-Mental State Examination (MMSE) were performed at the subjects’ homes. We classified, the subjects treated with antihypertensive drugs into three groups: non-dippers (nocturnal fall<10% of the mean day diastolic BP; n=51), normal dippers (10% to less than 20%; n=58), and extreme dippers (20% or more; n=17). The subjects not treated with antihypertensive drugs were also classified as non-dippers (n=40), normal dippers (n=24), and extreme dippers (n=14). Results The mean age of participants was 75.2±7.2 years, and 126 (61.7%) were being treated with antihypertensive drugs. In the group of antihypertensive drug users, the number with MMSE≤23 was 30 and the adjusted odds ratio for cognitive impairment in those with an extreme dip in diastolic BP (DBP) was 4.18 (95% CI, 1.07–16.40) in reference to the normal dippers. In contrast, no association was observed between cognitive function and nocturnal BP fall in the group no using antihypertensive drugs. Conclusions Cognitive impairment was associated with an extreme dip in DBP in the antihypertensive drug users only. It remains to be seen whether careful monitoring of nighttime BP as well as daytime BP may reduce the risk of cognitive impairment in antihypertensive drug users.     

The less familiar side of heart failure: symptomatic diastolic dysfunction

Arrange for echocardiography or radionuclide angiography within 72 hours of a heart failure exacerbation. An ejection fraction >50% in the presence of signs and symptoms of heart failure makes the diagnosis of diastolic heart failure probable. To treat associated hypertension, use angiotensin receptor blockers (ARBs), angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, calcium channel blockers, or diuretics to achieve a blood pressure goal of <130/80 mm Hg. When using beta-blockers to control heart rate, titrate doses more aggressively than would be done for systolic failure, to reach a goal of 60 to 70 bpm. Use ACE inhibitors/ARBs to decrease hospitalizations, decrease symptoms, and prevent left ventricular remodeling.     

Fluid matters in choosing antihypertensive therapy: a hypothesis that the data speak volumes

Assuming that blood pressure is lowered equivalently, diuretics are more effective than angiotensin-converting enzyme inhibitors (ACEIs), calcium channel blockers (CCBs), and alpha-adrenergic receptor blockers (alpha-blockers) at preventing heart failure, and they are more effective than ACEIs and alpha-blockers at preventing strokes. Compared with beta-adrenergic receptor blockers (beta-blockers) and ACEIs, CCBs are less effective at reducing myocardial infarcts and heart failure. There is currently no conceptual framework by which to organize data indicating that some antihypertensive medications are better than others at preventing cardiovascular diseases. The thesis of this article is that the fluid reduction or fluid retention attributable to antihypertensive medications, either alone or in combination, provides a basis for ranking these medications. Diuretics have a theoretical advantage compared with other antihypertensive medications because they reduce total body fluid more than other agents. Therefore, they are the preferred drugs for treating hypertension. The other antihypertensive agents that promote fluid reduction, ACEIs and angiotensin receptor blockers (ARBs), are next in preference, ranking a close second to diuretics. Because beta-blockers have a neutral effect on total body fluid, they rank on a third tier of preference, after ACEIs and ARBs. CCBs and alpha-blockers are the least preferred medications for treating hypertension because they promote fluid retention.