New insights and approaches to reduce end-organ damage in the treatment of hypertension: subsets of hypertension approach.

Antihypertensive therapy should be directed toward reduction of all end-organ damage including congestive heart failure, left ventricular hypertrophy, coronary heart disease, myocardial infarction, cerebrovascular accident, and chronic renal failure. The Subsets of hypertension approach is based on pathophysiology, hemodynamics, risk factor reduction for end-organ damage, concomitant diseases and problems, demographics, adverse effects on quality of life, compliance, and total health care costs. This approach provides a more individualized and logical treatment of the hypertensive syndrome and addresses the metabolic and structural abnormalities that are present.     

Identification and treatment of hypertriglyceridemia as a risk factor for coronary heart disease

Recent publications, including new population-based studies and a meta-analysis of prospective, population-based studies, provide strong evidence for an elevated triglyceride level as an independent risk factor for coronary heart disease. Pathophysiologic relationships between elevated triglyceride levels and both reduced high-density lipoprotein levels and an increase in the proportion of low density lipoproteins that are small and dense support the epidemiologic data, and suggest that an elevated triglyceride level should constitute a target for lipid-lowering therapy. There are no clear recommendations for management of patients with hypertriglyceridemia available in the current treatment guidelines. Treatment options include life-style measures and, if drug therapy is required, nicotinic acid, fibrates, more potent 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins), or combination therapy with statin plus fibrate or nicotinic acid.     

抑郁症作为冠心病影响因子的机制与治疗研究进展

抑郁症对冠心病的发生发展的影响逐渐被医学界所认知,该文就其影响机制(包括生物学机制、行为机制、治疗依从性及社会支持等)以及相关的治疗研究(包含药物治疗、体育运动和认知行为治疗等)进行简要的综述.     

Analysis between health-related life quality and risk factors in non-diabetic premature coronary heart disease man

<正>Objective To investigate the correlation between health-related quality life(HRQL)and risk factors in non-diabetic premature coronary heart disease(CHD)man.Methods 215 non-diabetic man patients(age fewer than 50)were selected from cardiology department(Sun Yat-sen Memorial Hospital of Sun Yat-sen University)     

冠心病新危险因素研究的进展

冠心病的已知传统危险因素已经不能完全解释其发病原因,而一些新的危险因素如载脂蛋白B、新喋呤等血液相关危险因素,雌激素、睾酮等性激素相关危险因素,抑郁症、D-型人格等身心疾病相关危险因素,对冠心病发病的影响,已经引起人们广泛的关注.本文对这些新危险因素逐一进行综述.     

综合护理干预对冠状动脉介入治疗冠心病患者生活质量的影响

目的 探讨综合护理干预在冠状动脉介入治疗冠心病中的临床应用效果.方法 随机抽取2011年2月至2014年2月我院收治的200例冠状动脉介入治疗术后患者,分为2组.对照组100例,按传统冠状动脉介入治疗冠心病护理常规进行护理;观察组100例,实施综合护理干预措施,比较两组护理效果.采用症状自评量表（SCL-90）和社会功能评定量表（SDSS）对两组结果进行测评、比较.结果 观察组冠状动脉介入治疗患者术后SCL-90在躯体化、强迫、抑郁、焦虑、敌对、恐怖、偏执、精神病项目上的得分与对照组相比差异有统计学意义（P＜0.05）;SDSS在职业和工作、婚姻职能、父母职能、社会性退缩、家庭内活动、家庭外的社会活动、家庭职能、个人生活自理、对外界的兴趣和关心、责任和计划项目上得分与对照组相比差异有统计学意义（P＜0.05）.结论 综合护理干预措施可以减缓冠状动脉介入治疗患者术后负性症状,增强患者的治疗信心和生活能力,提高患者的康复效果.     

Association of carotid hemodynamics with risk of coronary heart disease in a Taiwanese population with essential hypertension

BACKGROUND: The resistive index (RI) of the carotid artery is a hemodynamic parameter that depends on the degree of vascular resistance in hypertensive patients. The pulsatility index (PI) of the carotid artery was shown to be associated with microangiopathy in diabetic patients. In contrast to carotid intima-media thickness (IMT), no study has yet applied the carotid RI and PI to estimate coronary heart disease (CHD) risk. METHODS: Framingham risk scores (FRS) were determined for 62 patients (32 women; mean age 65 years (range 35-83)) with essential hypertension. Duplex sonography of the common carotid artery (CCA) was performed, with determination of RI, PI, and IMT. RESULTS: The mean FRS of all patients was 14.3% (range 1-30%), the mean IMT value of CCA was 0.89 +/- 0.23 mm, the mean RI was 0.71 +/- 0.07, and the mean PI was 1.46 +/- 0.39. FRS was found to have highly significant correlations with RI and PI (r = 0.47, P < 0.001 and r = 0.45, P < 0.001, respectively). The correlation between FRS and IMT was also significant (r = 0.41, P = 0.001). Multiple stepwise regression analysis showed that RI was an independent determinant of the risk of CHD. CONCLUSIONS: Although RI indirectly reflected the atherosclerotic process, the correlation between RI and CHD risk was comparable to the well-known correlation between cardiovascular event and carotid IMT. Hence, carotid RI can be used as a tool for risk stratification in Taiwanese patients with essential hypertension.     

D型人格——冠心病的危险因素

在我国冠心病是发病率高、死亡率高的疾病。关于冠心病危险因素的探讨一直是我们的研究热点。研究发现,D型人格是冠心病发病及预后的独立危险因素。本文回顾了人格与冠心病的相关研究,重点介绍了D型人格,包括其起源、特点及评估方法,阐述了D型人格致冠心病的国内外临床研究进展及相关作用机制,以期为改善D型人格冠心病患者的预后提供依据。     

老年高血压病并发冠心病心率变异性分析

目的 :探讨老年高血压病并发冠心病患者的自主神经活动特点。方法 :　对 5 9例原发性高血压 （EH）、5 4例冠心病 （CHD）和 38例 EH并发 CHD患者与 34例健康老年人的心率变异性 （HRV）进行对比研究。结果 :EH组和CHD组与对照组除 EH组的 R- R间期标准差的平均数 （SDNNIndex）外 ,其余参数差异均有显著性 （P<0 .0 5 ） ;EH并发 CHD组与对照组比较 ,参数差异均有非常显著意义 （P<0 .0 1） ;但不同疾病组间比较 ,差异均无显著性 （P>0 .0 5 ）。结论 :高血压病和冠心病患者的自主神经功能受损 ,当高血压病并发冠心病时这种受损更加明显。其迷走神经张力降低 ,交感神经紧张性相对增高是导致老年患者心率变异性降低的主要原因。     

血浆同型半胱氨酸与冠心病及高血压的相关性研究

目的探讨冠心病及高血压患者中,血浆同型半胱氨酸、一氧化氮水平的变化。方法对99例冠心病患者(冠心病组)与122例单纯高血压患者(高血压组)进行血浆同型半胱氨酸、一氧化氮水平的测定。结果冠心病组血浆同型半胱氨酸浓度为(18.57±7.47)μmol/L,明显高于高血压组(14.53±10.58)μmol/L(P0.01)。冠心病组血清一氧化氮浓度为(51.15±18.78)μmol/L,明显低于高血压组(70.39±41.55)μmol/L(P0.001)。结论高同型半胱氨酸血症与冠心病的发生有密切关系,并且同型半胱氨酸水平与一氧化氮呈反比,可能同型半胱氨酸水平与血管损伤的严重程度有明显的相关性。     

系统性红斑狼疮患者与冠心病糖尿病高血压患者生存质量的比较研究

目的 对比研究系统性红斑狼疮(SLE)患者与慢性疾病(冠心病、糖尿病、高血压)患者的健康相关生存质量(HRQOL).方法 选择门诊的SLE缓解期患者、住院活动期SLE患者及门诊的冠心病、糖尿病、高血压患者进行健康状况调查问卷简表-36(SF-36)量表调查,分析量表各维度得分并进行比较.结果 SLE组平均年龄(39±13)岁,冠心病组(65±16)岁,糖尿病组(60±13)岁,高血压组(59±14)岁.SLE组患者年龄明显小于其他慢性疾病组(P＜0.05).缓解期SLE患者的SF-36量表各维度得分与其他慢性疾病没有差别,而活动期的SLE患者各维度与慢性病及缓解期SLE比较差异均有统计学意义(P＜0.05).结论 活动期SLE患者比其他慢性病患者的生存质量明显下降.     

Apparent treatment-resistant hypertension and risk for stroke,coronary heart disease,and all-cause mortality

Apparent treatment-resistant hypertension (aTRH) is defined as uncontrolled hypertension despite the use of three or more antihypertensive medication classes or controlled hypertension while treated with four or more antihypertensive medication classes. We evaluated the association of aTRH with incident stroke, coronary heart disease (CHD), and all-cause mortality. Participants from the population-based REasons for Geographic And Racial Differences in Stroke (REGARDS) Study treated for hypertension with aTRH (n = 2043) and without aTRH (n = 12,479) were included. aTRH was further categorized as controlled aTRH (≥4 medication classes and controlled hypertension) and uncontrolled aTRH (≥3 medication classes and uncontrolled hypertension). Over a median of 5.9, 4.4, and 6.0 years of follow-up, the multivariable adjusted hazard ratio for stroke, CHD, and all-cause mortality associated with aTRH versus no aTRH was 1.25 (0.94–1.65), 1.69 (1.27–2.24), and 1.29 (1.14–1.46), respectively. Compared with controlled aTRH, uncontrolled aTRH was associated with CHD (hazard ratio, 2.33; 95% confidence interval, 1.21–4.48), but not stroke or mortality. Comparing controlled aTRH with no aTRH, risk of stroke, CHD, and all-cause mortality was not elevated. aTRH was associated with an increased risk for coronary heart disease and all-cause mortality.     

Triglyceride and glucose intolerance as a risk factor for coronary heart disease

The electrophoresis of plasma lipoproteins frequently showed midbands between beta- and pre-beta-lipoproteins in survivors of myocardial infarction. There were increases in intermediate-density-lipoprotein (IDL) cholesterol and triglycerides with an increase in IDL cholesterol/triglycerides in the very-low-density-lipoprotein fraction, even if the increase in cholesterol was not so significant. Impaired glucose tolerance (IGT) was also frequently found in these patients. Among the patients with an apparently normal glucose tolerance, the coronary atherosclerosis scores judged by the American Heart Association reporting system on coronary angiography increased as the total insulin area by 75 g oral glucose tolerance test increased. The correlation between the atherosclerosis score and the insulin area was still significant even after adjustment for body mass index and plasma triglyceride level. Our data suggest that hypertriglyceridemia, IGT, and hyperinsulinemia may become independent risk factors for atherosclerosis in addition to cholesterol. Another study showed that the morbidity of coronary heart disease increased with an elevation of plasma triglyceride levels among patients with familial hypercholesterolemia.     

Dietary patterns and risk of hypertension,type 2 diabetes mellitus,and coronary heart disease

Dietary pattern analysis, which reflects the complexity of dietary intake, has recently received considerable attention by nutritional epidemiologists. Two general approaches have been used to define these summary variables in observational studies. The so-called a posteriori approach builds on statistical exploratory methods, whereas the so-called a priori approach focuses on the construction of pattern variables that reflect hypothesis-oriented patterns based on available scientific evidence for specific diseases. Several studies, both observational and clinical, suggest that these measures of overall diet predict disease risk, and that its application might be especially valuable in the development of food-based dietary guidelines. In this review, we describe different patterning approaches and the available evidence regarding the relationships between dietary patterns and risk of hypertension, type 2 diabetes mellitus, and coronary heart disease.     

Contemporary approaches to the treatment of arterial hypertension and ischemic heart disease

Prognostic advantage of a combination of calcium antagonist and angiotensin converting inhibitor (ACEI) over combination of beta-adrenoblocker with thiazide diuretic was proved in a large randomized study of long term treatment of arterial hypertension. In another randomized study administration of ACEI for 12 months caused substantial retardation of cardiac remodeling in elderly patients with normal left ventricular function in postinfarction period. These results are important for a practical physicians as they concern treatment of wide circle of in- out-patients.     

Genetic determinants of coronary heart disease: new discoveries and insights from genome-wide association studies

With the advent of the Human Genome Project and the genomic era, new tools and methodologies have revitalised genetic research into coronary heart disease (CHD). Unprecedented collaborative efforts are discovering novel risk variants for CHD, with most in hitherto unknown molecular pathways. These findings have stimulated a plethora of follow-up of functional and risk prediction studies to mine this wealth of new data. This review will explore the current state of knowledge of the genetic basis of CHD, with an emphasis on recent genomic studies and how these may eventually lead to the promised goals of new therapeutics and personalised medicine.     

Effects of Tai Chi exercise on cardiovascular disease risk factors and quality of life in adults with essential hypertension: A meta-analysis

BackgroundHypertension is the major attributable risk factor for cardiovascular disease. The effect of Tai Chi on essential hypertension (EH) is contentious.ObjectivesIn this study, we investigated the effects of Tai Chi on the risk factors for cardiovascular disease and quality of life in adults with EH.MethodsUsing data collected from 15 databases up to December 2018, we meta-analyzed randomized controlled trials of the effect of Tai Chi on EH.ResultsTai Chi exercise was associated with lower systolic blood pressure (SBP) (WMD −12.47, 95%CI −16.00 to −8.94, P < 0.001) and diastolic blood pressure (DBP) (WMD −6.46, 95%CI −8.28 to −4.64, P < 0.001); better quality of life (SMD 0.62, 95% CI 0.35 to 0.90, P < 0.001); lower lipid profiles, including total cholesterol (WMD −0.49, 95% CI −0.62 to −0.37, P < 0.001), triglycerides (WMD −0.49, 95% CI −0.92 to −0.07, P = 0.02), and low-density lipoprotein-cholesterol (LDL-C) (WMD −0.86, 95% CI −1.30 to −0.43, P < 0.001); and lower blood glucose (WMD −0.91, 95% CI −1.59 to −0.23, P = 0.009). Tai Chi had no significant effect on high-density lipoprotein–cholesterol (WMD −0.92, 95% CI −2.21 to −0.37, P = 0.16).ConclusionsTai Chi lowers blood pressure, total cholesterol, triglycerides, LDL-C, and blood glucose and significantly increases the quality of life in adults with EH. There is strong evidence for the short-term efficacy of Tai Chi exercises. Larger well-designed RCTs focused on the long-term effect of Tai Chi exercises and patient adherence are needed.