药物治疗后血压平滑指数变化的临床探讨

目的　应用动态血压监测血压 ,探讨药物治疗后血压平滑指数变化的临床意义。方法　对 5 5例高血压患者 (分别给予缬沙坦或氨氯地平治疗 )和 3 1例非高血压者进行 2 4小时动态血压监测 ,分别计算血压平滑指数及血压变异性等指标 ,并进行t检验和相关分析。结果　高血压组经治疗后平均血压可达到正常范围 ,但其收缩压的平滑指数仍明显低于非高血压组 ,而血压变异性高于非高血压组 ,两组比较差异有显著性 (P <0 .0 5 )。收缩压的平滑指数与其变异性呈显著负相关 (r=-0 .3 95 ,P <0 .0 1)。血压变异性大的高血压人群在药物治疗后平滑指数仍较非高血压人群小 ,且与血压变异性呈负相关。结论　平滑指数可以反映血压变异性的差异 ,可将非高血压人群的平滑指数作为参考以衡量高血压病药物的疗效。     

阿托伐他汀联合降压治疗对老年高血压患者平滑指数的影响

目的 观察应用阿托伐他汀调脂联合贝那普利和氨氯地平对老年高血压患者平滑指数的影响.方法 选取2013年10月至2014年2月上海市嘉定区南翔医院≥2级老年高血压患者120例,随机分为单纯降压组及调脂联合降压组,各60例.单纯降压组患者接受贝那普利和氨氯地平治疗,调脂联合降压组在此基础上加用阿托伐他汀（10mgqn po）调脂治疗.治疗3个月和6个月后随访,两组分别进行血脂及24 h动态血压监测,记录24 h平均收缩压（24 h SBP）和平均舒张压（24 h DBP）,计算24h收缩、舒张压平滑指数（SISBP和SIDBP）及脉压（PP）、脉压指数（PPI）,分别比较两组患者治疗前后血脂、动态血压值及稳定性的变化.结果 治疗3个月及个6月后,两组患者血压均控制良好.与单纯降压组相比,调脂联合降压组患者的总胆固醇及甘油三酯水平明显降低,PP及PPI明显降低（P＜0.05）,而SISBP和SIDBP明显升高（P＜0.05,P＜0.01）.结论 阿托伐他汀调脂联合降压治疗能更加有效降低≥2级高血压患者动态血压的PP及PPI,并且明显提高血压平滑指数,能有效减轻老年高血压患者靶器官损害.     

调脂联合降压对高血压病患者动态血压及其平滑指数的影响

目的：观察阿托伐他汀联合贝那普利降压治疗对老年人动态血压及其平滑指数（SI）的影响。方法：180例诊断为原发性高血压的老年患者被随机分为贝那普利降压组和调脂降压联合治疗组,调脂降压联合治疗组在贝那普利降压基础上加用阿托伐他汀10mg,1次／d,所有病人均于治疗前及治疗6个月后行血脂及动态血压检查,记录24h平均收缩压（24hSBP）及24h平均舒张压（24hDBP）,计算24h收缩、舒张压平滑指数（SISBP和SIDBP）及脉压（PP）、脉压指数（PPI）,比较两组病人治疗前后血脂、动态血压值及其稳定性的变化。结果：6个月后,两组患者血压控制良好,与治疗前比较,联合治疗组总胆固醇[（5．79±0．5）mmol／L比（3．78±0．11）mmol／L]、甘油三酯[（1．81±0．27）mmol／L比（1．22±0．1）mmol／L]水平明显降低（P〈0．01）;与单纯降压组比较,PP[（51±10）mmHg比（45±8）mmHg]及PPI[（0．38±0．05）mmHg比（0．35±0．08）mmHg]明显降低（P〈0．05）,而SISBP[（1．26±0．2）mmol／L比（1．37±0．16）mmol／L]和SIDBP[（1．18±0．23）mmol／L比（1．28±0．14）mmol／L]明显升高（P〈0．05～0．01）。结论：降压协同阿托伐他汀降脂治疗能更降低动态血压的脉压及脉压指数,并且明显提高血压平滑指数。     

药物基因组学与高血压的个性化治疗

不同个体对降压药物的治疗效果反应不同,多项研究发现基因多态性与不同个体对降压药物的反应之间存在一定联系。药物基因组学从基因水平研究多态性与药物效应多样性之间的关系,从而推动个性化用药,提高用药的安全性和有效性。文章介绍临床常用降压药与基因多态性的关系,预测药物基因组学在高血压个性化治疗中的前景。     

原发性高血压并发胰岛素抵抗的临床治疗进展

近年来胰岛素抵抗(IR)与原发性高血压(EH)的相互关系日益受到人们的关注。1966年Wel-burn发现EH患者同时存在胰岛素敏感性降低和高胰岛素血症现象。几十年来,大量的动物实验和流行病学研究证实了并发IR的多发性,后者占EH人群中的50%左右。患EH同时伴有代谢异常,如血脂异常、肥胖时,IR的发生率更高,而且其严重程度与EH呈正相关〔1,2〕。1IR与EH的关系EH是IR综合征的一个重要组成部分,IR与EH的形成紧密相联。目前研究认为,高胰岛素血症导致EH的机制可能与以下途径有关〔2~4〕:①增加近、远曲肾小管对钠、水重吸收,使血容量增加,…     

The individual RDH index: a novel vector index for statistical assessment of antihypertensive treatment reduction, duration, and homogeneity

We propose a new vector index for the statistical assessment of antihypertensive treatment duration and homogeneity from ambulatory blood pressure monitoring. We termed this approach for evaluating and comparing blood pressure coverage offered by antihypertensive drugs over 24 h as the reduction-duration-homogeneity index. The reduction-duration-homogeneity index is a three-component vector index that incorporates information about the reduction, duration, and homogeneity of antihypertensive treatment, as well as their statistical significance. The advantages of the reduction-duration-homogeneity index are demonstrated by several comparative examples.     

培哚普利治疗老年组原发性高血压的临床观察

40例轻中度老年组原发性高血压患者予培哚普利(Perindopril)治疗共8周,观察随诊血压(Casual blood pressure CBP)及24小时动态血压监测(Ambulatory blood pressure mornitorABPM),结果显示,治疗4周、8周降压有效率分别为50%及62.5%,24小时动态血压曲线8周时呈明显下降,除咳嗽外未发现其它严重副反应,认为培哚普利是安全有效的降压药物.     

Clinical application of wave intensity for the treatment of essential hypertension

Wave intensity analysis is a method of studying intravascular flow wave propagation, calculated as the product of the rate of change in pressure (dP/t) and the rate of change in velocity (dU/dt). The typical pattern of wave intensity seen during the cardiac cycle has two dominant peaks. The larger first peak (FP) occurs during early systole when a forward traveling compression wave is generated by the left ventricle. The second smaller peak (SP) follows a period of relatively little net wave production during mid-systole. Wave reflection is seen as a small backward-traveling compression wave occurring just after the first peak of wave intensity (NP). In this study, we investigated the usefulness of parameters from the wave intensity for estimating the efficacy of the -1 blocker, doxazosin, to reduce blood pressure, by the reduction of peripheral vascular resistance. We examined 20 patients with essential hypertension. Patients were included if their diastolic blood pressure was 95mmHg on at least three separate visits to the clinic. The study consisted of a 2-week baseline phase followed by a 2–4-week dose-adjusted phase with doxazosin. Treatment began with 1mg/day doxazosin, and the dose was doubled fortnightly until the diastolic blood pressure was 90mmHg. Blood–pressure measurements and side effects were recorded at intervals of 2 weeks. Before and after 4 weeks of stable treatment with doxazosin, a comprehensive clinical evaluation was given. Doxazosin reduced systolic and diastolic blood pressure. Both FP and SP increased and NP decreased. MBP (change in mean blood pressure) correlated well with NP before and after the antihypertensive therapy. The efficacy of doxazosin was confirmed by the decreased reflection wave of aortic flow from wave intensity analysis. Thus, patients with a significant reflection wave may be good candidates for antihypertensive treatment by a vasodilator, such as doxazosin.     

The development of coronary insufficiency during prolonged treatment of essential hypertension

The occurrence of signs of coronary insufficiency during prolonged combined treatment of essential hypertension was analysed in a selected group of 42 patients with left ventricular myocardial hypertrophy. During a four-year antihypertensive therapy 17% of patients developed angina pectoris on effort myocardial infarction occurred in 7%, and ischaemic ECG changes during bicycle ergometry or transoesophageal atrial pacing were detected in 36%. In the subgroup with an insufficient hypotensive effect and sustained severe myocardial hypertrophy the signs of coronary insufficiency occurred in 53%. Nevertheless, the attainment of a stable pressure normalization and regression of myocardial hypertrophy does not exclude the development of coronary insufficiency, even in patients treated with beta-adrenoblocking drugs.     

The population RDH index: a novel vector index and graphical method for statistical assessment of antihypertensive treatment reduction, duration, and homogeneity

Current indices used in the evaluation of antihypertensive treatment duration and homogeneity such as the trough-peak, smoothness index, and normalized smoothness index were designed to be applied to ambulatory blood pressure monitoring recordings from individual participants. Evaluation of antihypertensive treatment in populations is often carried out by calculating these individual indices for each of the participants and providing summarizing statistics about the population, such as the mean and median. We describe a new population vector index and graphical method for the statistical assessment of antihypertensive treatment reduction, duration, and homogeneity (RDH) from ambulatory blood pressure monitoring. The population (RDH) was specifically designed as a tool to evaluate and compare blood pressure coverage offered by antihypertensive drugs over 24 h in populations. The population RDH is a three-component vector index that incorporates information about the reduction, duration, and homogeneity of antihypertensive treatment, as well as their statistical significance over the 24 h period. In addition to defining the RDH index, in this paper we also demonstrate its usefulness and advantages as an index and graphical method for antihypertensive treatment duration and homogeneity assessment by using it to analyze two data sets.     

国产盐酸特拉唑嗪片治疗原发性高血压的临床研究

目的：评价国产盐酸特拉唑嗪片治疗原发性高血压（EH）的有效性及安全性。方法：采用单盲、随机对比的多中心临床试验方法，研究受试药国产特拉唑嗪片和进口同类对照药Hytrin对124例轻、中度EH患者的降压效果及不良反应。结果：治疗4周后，国产特拉唑嗪片可使平均坐位收缩压及舒张压下降16．4％和14．0％（均P＜0．01），Hytrin下降16．1％和15．2％（P＜0．01）；它们的降压疗效分别为88．5％和90．5％，无统计学差异（P＞0．05）。两药均能改善EH患者的脂质代谢。日服一次，国产特拉唑嗪可较平稳地控制24h血压。常见的不良反应为头晕等，在服药过程中逐渐减轻，无固不良反应而终止试验者。结论：国产特拉唑嗪的临床疗效和药物不良反应与Hytrin类似，降压作用肯定，维持时间长，可降低高血脂及不良反应轻，是一种治疗轻、中度EH患者较为理想的降压药。     

Twenty-four-hour hemodynamic profile during treatment of essential hypertension by once-a-day nadolol

The effect of nadolol (N) on 24-hour blood pressure (BP) and heart rate (HR) values and on their variability was examined in ambulant patients with essential hypertension, using the Oxford method to obtain continuous intraarterial recording and a computer to have a beat-to-beat analysis of the data. The recording was carried out without treatment and after 10 days' administration of N once daily by mouth (dose range: 80-320 mg). After N, 24-hour BP and HR were reduced by 17 +/- 3% and 27 +/- 4% respectively as compared to before N, the effect being similar for both systolic and diastolic BP. The hypertension and bradycardia were significantly more marked during the day than during the night, neither showing any attenuation in the hours furthest from the administration of the drug. During N, there was a reduction in the 24-hour variation coefficient for HR but the reduction was limited to the longer term component of this phenomenon, the moment-to-moment variations remaining unaffected. The long- and short-term variation coefficients for BP were not modified under N. These findings suggest that N once a day can reduce BP for 24 hours in ambulant hypertensive patients. The lack of alteration in variability of BP and moment-to-moment HR suggests that the hypotension is achieved without interfering with the mechanisms involved in cardiovascular homeostasis.     

The smoothness index, but not the trough-to-peak ratio predicts changes in carotid artery wall thickness during antihypertensive treatment

BACKGROUND: It has recently been demonstrated that the smoothness index (SI) (the ratio between the average of the blood pressure changes computed for each hour of the recording and its standard deviation), a new and reproducible measure of the homogeneity of blood pressure reduction by antihypertensive treatment, has evident advantages over trough-to-peak ratio (T/P) in the prediction of the regression of left ventricular hypertrophy. Therefore we considered it to be worthwhile to compare the ability of SI and T/P to predict changes of the carotid artery intima-media thickness (IMT) during pharmacological treatment in patients with essential hypertension. METHODS: In 100 patients with essential hypertension, 24 h ambulatory blood pressure and carotid artery IMT were measured after 3 weeks of therapeutic wash-out and after 12 months of antihypertensive treatment (calcium antagonists, diuretics, angiotensin converting enzyme (ACE) inhibitors or beta-blockers). The homogeneity of the effect of treatment over blood pressure was evaluated by computing T/P and SI. RESULTS: Twenty-four hour blood pressure was significantly reduced by therapy, while, on average, a small but significant increase in indices of carotid artery wall thickness was observed. However, IMT was clearly reduced in patients with high SI. Statistically significant correlations were observed between changes in indices of carotid artery IMT during therapy and SI. No significant correlation was observed between indices of carotid artery morphology and T/P, basal 24 h blood pressure or changes in blood pressure during therapy. CONCLUSIONS: SI, but not T/P is the predictor of changes in carotid artery wall thickness. The information provided by SI is independent from basal blood pressure values. For carotid artery morphology, the smoothness of blood pressure reduction is even more important than its absolute change.     

卡维地洛治疗老年轻中度原发性高血压疗效观察

目的本研究以高选择性β受体阻滞剂比索洛尔为对照药，研究了卡维地洛治疗轻中度原发性高血压的临床疗效及安全性。方法选择轻中度原发性高血压患者60例，分别随机给予卡维地洛和比索洛尔口服治疗。结果2组在治疗2周时诊室血压均有所下降，在治疗6～8周末下降最明显，并维持至24周。卡维地洛组和比索洛尔组降压总有效率分别为93．3％和90％，总显效率分别为70％和56．7％。卡维地洛主要的不良反应有头晕（13％）、乏力（2％）、嗜睡（2％）。在服药过程中逐渐减轻，无因药物不良反应而终止者。结论本研究中的原发性高血压患者每日口服1次卡维地洛12．5～50mg，降压疗效明显，耐受性及安全性好。