中国人群低血压患病率及影响因素研究

方法：利用1991年全国血压抽样调查的资料，进行低血压的横断面分析。低血压的定义为：收缩压（SBP）≤98mmHg并且舒张张压（DBP）≤60mmHg。结果：男性和女性的低血压患病率分别为2．70％和7．36％，女性明显高于男性（P＜0．01）。从低年龄组一高年龄组（15－、25－、35－、45－、55－、65－岁），低血压的患病率分别为7．62％、6．97％、4．40％、3．22％、2．65％、1．94％，随年龄的增加，低血压的患病率呈下降趋势。不同民族低血压患病率变异大。低血压患病率在地区分布上呈现南高北低的现象。Logistic回归分析显示，年龄，体重体数、饮酒、心率与低血压状态呈负相关，女性比男性更易低血压。低血压人群的脑卒中和心肌梗死患病率明显低于正常血压和高血压人群。提示：我国人群低血压的患病率变异较大，影响因素较多；低血压可能是一种正常的生理现象，但它对于健康的确切影响需要进行前瞻性才能证实。     

北京市在职医务人员血脂流行病学及影响因素调查

目的:了解在职医务人员血脂分布特点及变化规律,为在职医务人员血脂异常防治提供科学依据。方法:对北京市某三级医院1 885例医务工作者的体检结果进行统计,分析血脂异常及影响因素。结果:该人群血脂异常患病率为35.1%,男性患病率(53.4%)显著高于女性(28.1%)(P<0.01);<30岁、30~39岁、40~49岁和≥50岁组人群的患病率分别为23.8%、31.8%、46.8%和58.5%,随年龄增长患病率升高,年龄组之间比较差异有统计学意义(P<0.01),<50岁人群患病率男性明显高于女性,≥50岁患病率女性(56.8%)与男性(59.8%)差异无统计学意义(P=0.67);多因素Logistic回归分析显示:男性、年龄增长、体质量指数增加、血压升高和血糖升高与血脂异常有关。结论:该人群血脂异常随年龄增长逐渐增高,男性患病率显著高于女性;50岁以后女性患病率明显升高;男性、年龄增长、体质量指数增加、BP升高、Glu升高是血脂异常的独立危险因素。     

北京地区2740人的血压水平10年（1992-2002）变化情况

目的探讨北京地区人群个体血压水平10年的变化情况。方法采用前瞻性队列研究的方法，于1992年对北京大学社区和首钢地区35～64岁人群，进行了基线心血管病危险因素调查，并持续10年对心血管病的发病情况进行了随访。在2002年对相同人群再次进行了危险因素调查，对两次调查结果中血压水平的变化情况进行了流行病学分析。结果(1)10年间平均收缩压水平随年龄的增长而持续增加；平均舒张压水平在55岁以前呈上升变化，在55～64岁组呈轻度下降；(2)1992年与2002年相同年龄组间比较(例如1992年45～54岁与2002年45～54岁)．平均收缩压水平、平均舒张压水平及高血压患病率均明显增加；(3)10年间总的高血压患病率由27．6％增加到48．8％，55～64岁组高血压患病率最高，35～44岁组高血压患病率增加的幅度最大；单纯收缩期高血压(ISH)在全部高血压患者中所占比例随年龄的增长明显增加，65～岁组的ISt{所占比例最高，达61．8％；(4)1992年血压在120／80mmHg以下、120～129／80～84mmHg、130～139／85～89mmHg3个亚组的人群到2002年成为高血压患者的比例分别为22．2％、44．7％和64．3％。结论收缩压和舒张压随年龄的增长呈现不同的变化；目前45～64岁年龄组人群的平均收缩压水平、平均舒张压水平及高血压患病率，均较10年前45～64岁年龄组人群高；随年龄的增长单纯收缩期高血压在全部高血压患者中所占比例增加；血压在120～139／80～89mmHg的亚组人群10年后的高血压发病率，与血压在120／80mmHg以下的亚组人群相比明显增加。     

河北省农村居民单纯收缩期高血压流行病学特征分析

目的了解河北省部分农村居民单纯收缩期高血压(ISH)的流行病学特征及影响因素。方法按照1999年WHO/ISH的ISH诊断标准(收缩压≥140mmHg和舒张压<90mmHg),分析2002年河北省农村居民营养与健康状况调查资料中的单纯收缩期高血压患病率及影响因素。结果1.河北省15岁以上农村居民单纯收缩期高血压(ISH)粗患病率为12.5%(标化率10.28%),其中男性为12.3%,女性为12.6%,35岁以前男性ISH患病率高于女性,45岁～54岁则女性高于男性;ISH总患病率随年龄增长而增长;45岁以后呈快速增长。2.ISH患病率随着体质指数(BMI)、腰围(WC)的增加而增高。3.影响ISH患病率的主要因素是年龄、BMI、性别。结论ISH患病率占高血压总患病率的33.3%,随年龄增长而迅速增高;预防控制ISH从早期开始并以控制肥胖为主,是降低人群高血压致残致死的重要措施。     

河北省藁城市农村社区居民高血压流行状况调查

目的了解河北省农村社区居民高血压流行现况,为制定科学合理的高血压防治措施提供依据.方法按照统一方法对河北省藁城市梅花镇5 892名25岁以上居民进行了现场询问、血压测量等横断面调查,统计分析了不同年龄、性别等人群血压水平、高血压患病率、患病知晓率、治疗率、控制率、高血压防治知识知晓率等指标.结果被调查居民平均收缩压为(127.8±21.4)mm Hg,男性(130.2±20.7)mm Hg,女性(125.8±21.8)mm Hg,平均舒张压为(81.6±11.4)mm Hg,男性(84.0±11.5)mm Hg,女性(79.7±11.0)mm Hg;高血压粗患病率为39.4%(男性44.0%,女性35.8%),标化率为34.9%(男性38.8%,女性30.7%);人群平均收缩压水平及高血压患病率均随着年龄增加上升,高血压患病率45岁以下人群男性高于女性,45～64岁人群男性与女性持平,65岁以上人群女性高于男性;工人、大专及以上文化程度或经济收入高的人群高血压患病率高于其他人群;居民高血压知晓率、治疗率、控制率分别为34.7%、 17.6%和6.1%;高血压防治知识知晓率19.6%.结论河北省藁城市农村居民高血压患病率高,患病知晓率、治疗率、控制率低,高血压防治知识知晓率低,高血压防治水平低,需要加强对人群的健康教育、高血压筛查和高血压病人的随访管理工作.     

我国老年人群单纯性收缩期高血压患病率及影响因素

目的　了解我国老年人群单纯性收缩期高血压的患病率及影响因素。方法　使用1991年全国高血压抽样调查资料 ,以≥ 6 0岁为老年人 ,单纯性收缩期高血压诊断标准按照 1999年WHO/ISH的规定 :收缩压≥ 14 0mmHg(1mmHg =0 133kPa)和舒张压 <90mmHg ,其亚型为收缩压 14 0～ 14 9mmHg和舒张压 <90mmHg ,分析患病率及其相关的影响因素。结果　 (1)我国 6 0岁及以上人群单纯性收缩期高血压患病率为 2 1 5 0 % ,亚型患病率为 9 0 4 % ;如按收缩压≥ 16 0mmHg和舒张压 <90mmHg计算患病率则为 6 83%。 (2 )年龄增长是影响患病率最为明显的因素 ,35岁始患病率随年龄增长而显著升高 ;每增长 10岁患病率约增高一倍。性别差异则表明 35岁前男性患病率高于女性 ,但此后女性随年龄增长单纯性收缩期高血压上升幅度则高于男性。 (3)体重指数的大小与患病率成正比。结论　我国老年单纯性收缩期高血压患病率为 2 1 5 0 % ,占老年高血压总人数的5 3 2 1%。在老年高血压患者中防治单纯性收缩期高血压是降低人群高血压致死致残的重要组成部分。     

河北省藁城市农村社区居民高血压流行状况调查

目的　了解河北省农村社区居民高血压流行现况,为制定科学合理的高血压防治措施提供依据。方法 按照统一方法对河北省藁城市梅花镇5 892名25岁以上居民进行了现场询问、血压测量等横断面调查,统计分析了不同年龄、性别等人群血压水平、高血压患病率、患病知晓率、治疗率、控制率、高血压防治知识知晓率等指标。结果 被调查居民平均收缩压为(127.8±21. 4) mmHg,男性(130 .2±20 .7)mm Hg,女性(125.8±21 .8)mm Hg,平均舒张压为(81 6±11.. 4)mm Hg,男性(84 .0±11. 5)mm Hg,女性(79. 7±11 .0)mm Hg;高血压粗患病率为 39. 4%(男性 44 .0%,女性35. 8%),标化率为34. 9%(男性38. 8%,女性30. 7%);人群平均收缩压水平及高血压患病率均随着年龄增加上升,高血压患病率45岁以下人群男性高于女性,45~64 岁人群男性与女性持平,65 岁以上人群女性高于男性;工人、大专及以上文化程度或经济收入高的人群高血压患病率高于其他人群;居民高血压知晓率、治疗率、控制率分别为34 .7%、17. 6%和6 .1%;高血压防治知识知晓率 19 .6%。结论 河北省藁城市农村居民高血压患病率高,患病知晓率、治疗率、控制率低,高血压防治知识知晓率低,高血压防治水平低,需要加强对人群的健康教育、高血压筛查和高血压病人的随访管理工作。     

云南省不同民族高血压患病率及血压平均水平分布特征分析

目的:了解云南省部分民族的高血压患病、血压平均水平情况。方法:应用2007年中国成人慢性病危险因素监测第二次调查云南省资料,分析不同民族高血压患病率及其收缩压、舒张压平均水平。结果:按2000年人口年龄构成标化后,男性高血压患病率最高的民族为白族(30.4%),最低的民族为壮族(19.3%),女性高血压患病率最高的为回族(24.7%),最低的为傈僳族(12.9%);收缩压男性以白族最高(133.21±21.05)mmHg、以哈尼族最低(125.25±15.78)mmHg,女性以回族最高(132.26±27.02)mmHg、哈尼族最低(118.65±16.65)mmHg;舒张压男性以白族最高(81.92±11.69)mmHg、哈尼族最低(77.38±11.37)mmHg,女性以回族最高(81.45±13.12)mmHg、哈尼族最低(72.95±11.03)mmHg。结论:高血压的患病及血压均值在所调查的民族间各不相同;与全国不同时期同类调查结果比较,高血压患病率及人群血压均值呈现大幅度上升。     

连云港农村社区中老年高血压人群脉压水平及其影响因素

目的观察连云港农村社区中老年高血压人群脉压水平的分布,并探讨其相关的影响因素。方法 2008-10-2009-07,在连云港市赣榆和东海两县农村社区筛选45～75岁原发性高血压患者,进行流行病学问卷调查、血压测量、体格检查等。结果共调查20127人,其中未服用降压药物且无关键变量缺失者共9998人纳入本研究。总人群平均脉压为(73.2±18.5)mmHg[男性(70.1±19.2)mmHg,女性(75.1±17.8)mmHg,P<0.01];脉压过宽者(脉压≥60mmHg)占78.2%,其中男性占70.8%,女性占83.0%(P<0.01)。脉压水平和脉压过宽的比例均随着年龄增高而增高,并与高血压严重程度呈正比。多元线性回归显示,脉压的影响因素包括年龄、性别、心率、空腹血糖、体质量指数、血压值等级和吸烟。结论连云港农村社区中老年高血压人群脉压水平女性高于男性,且随着年龄和高血压等级的上升而增加,脉压增高可能是年龄、性别、高血压、血糖、吸烟等多种因素综合作用的结果。     

南京某医院中青年体检人群高血压前期和高血压病流行现状及其危险因素分析

目的通过分析中青年群体高血压前期和高血压病的患病现状及可能危险因素,为相应疾病防控提供研究依据。方法选取南京鼓楼医院体检中心2009—2016年的中青年(18~44岁为青年,45~59岁为中年)体检人群作为研究对象,通过分析该人群的体检资料,探讨高血压前期[收缩压120~139 mmHg(1 mmHg=0.133 kPa)和/或舒张压80~89 mmHg]和高血压病的流行现状及其危险因素。结果调查总人群为142857例,高血压前期患者有64220例,高血压患者有3912例,高血压总患病率为9.74%,男性为12.51%,女性为5.82%。高血压前期总患病率为44.95%,男性为53.31%,女性为33.15%。中年组中,高血压前期患病率为51.68%,高血压病患病率为15.13%,而这两个指标在青年组分别为37.95%和4.13%。2013—2016年高血压前期和高血压病患病率分别为45.37%和10.65%,均高于2009—2012年的44.52%和8.78%。此外,中青年体检人群中高血压前期组合并血糖、血脂、糖脂代谢异常的检出率均高于正常血压组,低于高血压组(P<0.001)。多因素分析显示,年龄、超重/肥胖、高血糖、高甘油三酯血症及高胆固醇血症与男性高血压前期密切相关,而年龄、超重/肥胖、高血糖、高甘油三酯血症、高胆固醇血症及高低密度胆固醇血症与男性高血压病和女性高血压前期及高血压病密切相关。结论中年、超重/肥胖、高血糖、高甘油三酯血症及高胆固醇血症均为中青年男性和女性体检人群高血压前期和高血压患病的可能危险因素,需要强化对上述因素的干预。     

What is the most relevant definition of orthostatic hypotension: systolic blood pressure drop, diastolic blood pressure drop, or both?

The agreed definition of orthostatic hypotension (OH) is a drop of 20 mmHg systolic and/or 10 mmHg diastolic blood pressure (BP) within the first 3 min of erect posture. For elderly people, a question can be raised about diastolic BP relevance in OH's definition. OBJECTIVE: To determinate HO's prevalence and risks factors considering systolic blood pressure (SBP)'s drop, or diastolic blood pressure (DBP)'s drop, or either. METHODS: We assessed OH for 554 consecutive, ambulatory, elderly subjects, attending a geriatric outpatient clinic. OH was defined as a SBP drop>20mmHg (SBP-OH), or a DBP drop>10 mmHg (DBP-OH), or a drop in either (SBP. DBP-OH). OH's prevalence and risks factors were determined. RESULTS: In this population, 76 +/- 6 years of age, (70% hypertension), SBP-OH's prevalence was 17%, DBP-OH's prevalence was 12% and SBP. DBP-OH's prevalence was 25%. OH's risks factors varied considering OH's definition. After adjusting for significant determinants, SBP-OH's risk factors were: Antihypertensive therapy (OR=2.95; IC 95%: 1.21-4.04), age>75years (OR=2.11; IC 95%: 1.22-3.66), anti-hypertensive poly therapy (OR=2.01; IC 95%: 1.39-2.92) and SBP level (OR=1.16; IC 95%: 1.01-1.33). Considering DBP-OH, the only significant risk factor was DBP's level (OR=2.64; IC 95%: 1.89-3.68). SBP. DBP-OH was only determined by anti-hypertensive poly therapy (OR=1.61; IC 95%: 1.13-2.29) and DPB level (OR=1.32; IC 95%: 1.08-1.60). CONCLUSION: For elderly people, OH's prevalence and risks factors vary considering OH's definition. SBP's drop seems to be more relevant than DBP's drop. A long term follow up is necessary to determine if SBP-OH is correlated with HO' s side effects and to establish the dangerous level of SBP' s drop.     

他汀类药物对高血压患者降压效应的Meta分析

目的 评价他汀类药物对高血压患者的降压效应.方法 在PubMed、Embase和Cochrane library中检索2012年12月31日之前的所有关于他汀类药物与高血压相关的随机对照试验,按照纳入与排除标准纳入合格文献,采用改良Jadad量表对纳入文献进行质量评价.两位作者独立从文本和表格中提取干预组和对照组治疗前后的收缩压和舒张压值及样本量.运用Review manager 5.0软件分析加权均数差及95%可信区间.结果 符合纳入标准的文献有33篇,共计2915例患者.与对照组相比,他汀类药物治疗组收缩压下降1.52 mmHg[95%可信区间（CI）：-2.35～-0.68,P=0.0004],舒张压下降1.02 mmHg（95%CI：-1.70～-0.34,P=0.003）.若基线血压≥140/90 mmHg,他汀类药物组收缩压下降 2.28 mmHg（95%CI：-3.57～-1.00,P=0.0005）,舒张压下降1.87 mmHg（95%CI：-3.12～-0.62,P=0.003）;基线收缩压＜140/90 mmHg,他汀类药物对血压的影响不明显（P均＞0.05）.在不同他汀类药物的亚组分析中,阿托伐他汀可使收缩压下降4.04 mmHg （95%CI：-6.43～-1.65,P=0.00009）,舒张压下降2.67 mmHg（95%CI：-4.32～-1.02,P=0.002）,其他他汀类药物对血压的影响不明显（P均＞0.05）.他汀类药物治疗（3～6）个月时降压效果最明显.结论 他汀类药物可降低高血压患者的收缩压和舒张压,且与基线血压相关,当基线血压高于140/90 mmHg时降压效应显著,以阿托伐他汀的降压效应最为明显,且治疗3～6个月时效果明显.     

High blood pressure is inversely related with the presence and extent of coronary collaterals

Patients with hypertension have an increased case fatality during acute myocardial infarction (MI). Coronary collateral (CC) circulation has been proposed to reduce the risk of death during acute ischaemia. We determined whether and to which degree high blood pressure (BP) affects the presence and extent of CC circulation. A cross-sectional study in 237 patients (84% males), admitted for elective coronary angioplasty between January 1998 and July 2002, was conducted. Collaterals were graded with Rentrop's classification (grade 0-3). CC presence was defined as Rentrop-grade > or =1. BP was measured twice with an inflatable cuff manometer in seated position. Pulse pressure was calculated by systolic blood pressure (SBP)-diastolic blood pressure (DBP). Mean arterial pressure was calculated by DBP+1/3 x (SBP-DBP). Systolic hypertension was defined by a reading > or =140 mmHg. We used logistic regression with adjustment for putative confounders. SBP (odds ratio (OR) 0.86 per 10 mmHg; 95% confidence interval (CI) 0.73-1.00), DBP (OR 0.67 per 10 mmHg; 95% CI 0.49-0.93), mean arterial pressure (OR 0.73 per 10 mmHg; 95% CI 0.56-0.94), systolic hypertension (OR 0.49; 95% CI 0.26-0.94), and antihypertensive treatment (OR 0.53; 95% CI 0.27-1.02), each were inversely associated with the presence of CCs. Also, among patients with CCs, there was a graded, significant inverse relation between levels of SBP, levels of pulse pressure, and collateral extent. There is an inverse relationship between BP and the presence and extent of CC circulation in patients with ischaemic heart disease.     

Nationwide prevalence study of hypertension and related non-communicable diseases in The Gambia

The prevalence of hypertension, diabetes and obesity in The Gambia was assessed in a 1% population sample of 6048 adults over 15 years of age. 572 (9.5%) subjects were hypertensive according to WHO criteria (a diastolic blood pressure (DBP) of 95 mmHg or above and/or a systolic blood pressure (SBP) of 160 mmHg or above); 325 (5.4%) had a DBP of 95 mmHg or above, and 39 (2.3%) a DBP of 105 mmHg or above; 428 (7.1%) had a SBP of 160 mmHg or above. By less conservative criteria (a DBP of 90 mmHg or above and/or SBP of 140 mmHg or above), 24.2% of subjects were hypertensive. The prevalence of hypertension was similar in the major ethnic groups and in urban and rural communities. Age and obesity were risk factors for hypertension; female sex was an additional risk factor for diastolic hypertension. Several communities had a prevalence of diastolic hypertension double the national rate, and significant community clustering of diastolic hypertension ( P < 0.01) was confirmed by Monte Carlo methods. Genetic and/or localized environmental factors (such as diet or Schistosoma haematobium infection), may be involved. 140 (2.3%) subjects were obese. Obesity was associated with female sex, increasing age, urban environment, non-manual work and diastolic hypertension. Only 14 (0.3%) subjects were found to be diabetic. Hypertension appears to be very prevalent in The Gambia, with a substantial population at risk of developing target organ damage. Further studies to delineate this risk and appropriate interventions to reduce it are needed.     

Comparison of noninvasive oscillometric and intra-arterial blood pressure measurements in hyperacute stroke

OBJECTIVES: This study aims to compare automatic oscillometric blood pressure recordings with simultaneous direct intra-arterial blood pressure measurements in hyperacute stroke patients to test the accuracy of oscillometric readings. METHODS: A total of 51 first-ever stroke patients underwent simultaneous noninvasive automatic oscillometric and intra-arterial blood pressure monitoring within 3 h of ictus. Casual blood pressure was measured in both arms using a standard mercury sphygmomanometer on hospital admission. Patients who received antihypertensive medication during the blood pressure monitoring were excluded. RESULTS: The estimation of systolic blood pressure (SBP) using oscillometric recordings underestimated direct radial artery SBP by 9.7 mmHg (95% confidence interval: 6.5-13.0, P<0.001). In contrast, an upward bias of 5.6 mmHg (95% confidence interval: 3.5-7.7, P<0.001) was documented when noninvasive diastolic blood pressure (DBP) recordings were compared with intra-arterial DBP recordings. For SBP and DBP, the Pearson correlation coefficients between noninvasive and intra-arterial recordings were 0.854 and 0.832, respectively. When the study population was stratified according to SBP bands (group A: SBP160 mmHg and SBP180 mmHg), higher mean DeltaSBP (intra-arterial SBP-oscillometric SBP) levels were documented in group C (+19.8 mmHg, 95% confidence intervals: 12.2-27.4) when compared with groups B (+8.5 mmHg, 95% confidence intervals: 2.7-14.5; P=0.025) and A (+5.9 mmHg, 95% confidence intervals: 1.8-9.9; P=0.002). CONCLUSION: Noninvasive automatic oscillometric BP measurements underestimate direct SBP recordings and overestimate direct DBP readings in acute stroke. The magnitude of the discrepancy between intra-arterial and oscillometric SBP recordings is even more prominent in patients with critically elevated SBP levels.     

Predictive factors for masked hypertension within a population of controlled hypertensives

CONTEXT: Prevalence of masked hypertension (MH) is far from negligible reaching 40% in some studies. The SHEAF study (Self measurement of blood pressure at Home in the Elderly: Assessment and Follow-Up) and others clearly showed that masked hypertension (MH) as detected by home blood pressure measurement (HBPM) is associated with poor cardiovascular prognosis. OBJECTIVE: Systematic HBPM to detect MH is not yet routine. The aim of this work is to better define the clinical profile of masked hypertensives within a population with controlled office blood pressure (BP) and the factors associated with a higher prevalence of MH. MATERIALS AND METHODS: BP was measured at the clinic by the doctor and at home by the patient himself. Risk factors for MH were analysed in a cohort of 1150 treated hypertensive patients over the age of 60 (mean age 70 +/- 6.5, 48.9% men) with controlled office BP. (SBP < 140 mmHg and DBP < 90 mmHg). RESULTS: 463 patients (40%) were masked hypertensives (SBP > or = 135 mmHg or DBP > or = 85 mmHg at home). Three parameters were associated with MH (odds ratio OR): office SBP (OR = 1.110), male gender (OR = 2.214) and age (OR = 1.031). Decision trees showed a 130 mmHg SBP was an efficient threshold to propose HBPM with a higher probability to detect MH. Subsequent variables were male gender and age over 70 in males. CONCLUSION: To detect masked hypertension, it would be logical to first of all select patients whose office SBP is between 130 and 140 mmHg.     

Low ambulatory blood pressure is associated with lower cognitive function in healthy elderly men

INTRODUCTION: Low blood pressure (BP) has been found to be associated with cerebrovascular damage in the elderly. Studies of the relation of ambulatory BP to cognitive function in elderly persons aged 80 years or above is lacking, however. METHODS: Ninety-seven 81-year-old men from the population study 'Men born in 1914' underwent ambulatory BP monitoring and were given a cognitive test battery, 79 subjects completing all six tests. Low ambulatory systolic blood pressure (SBP) was defined as <130 mmHg and low ambulatory diastolic blood pressure (DBP) as <80 mmHg (corresponding in terms of office BP to approximately <140 and <90 mmHg, respectively). Odds ratios (OR) for lower cognitive function were calculated using a forward stepwise logistic regression model, controlling for confounding factors. RESULTS: Subjects with ambulatory SBP <130 mmHg had higher OR values for daytime (OR 2.6; P=0.037), nighttime (OR 3.6; P=0.032) and 24h (OR 2.6; P=0.038) BP measurements. A lower cognitive function was associated with lower nighttime SBP and DBP levels and lower 24-h mean SBP compared to subjects with higher cognitive function. OR values connected to low nocturnal SBP, had a tendency to be particularly high among subjects on anti-hypertensive drugs (OR 9.1; P=0.067, n.s.). CONCLUSION: Ambulatory SBP levels <130 mmHg and lower nighttime SBP and DBP were associated with lower cognitive function in healthy elderly men. Further investigation is needed to ascertain the effects of the presently recommended treatment goal of <140 mmHg for office SBP also on elderly over 80 years of age.     

Predictors and Impact of Low Diastolic Blood Pressure and Widened Pulse Pressure Following Transcatheter Aortic Valve Replacement

BackgroundThe association between post-operative diastolic blood pressure (DBP) and pulse pressure (PP) with outcomes following transcatheter aortic valve replacement (TAVR) remains unclear. We sought to assess the prevalence, predictors, and impact of post-operative DBP and PP on presence of post-procedural aortic insufficiency (AI) and mortality in adults undergoing TAVR.MethodsThe study population included 194 patients who underwent TAVR from 2016 to 2017 at an academic tertiary medical center, of which 176 had invasive arterial pressures available postoperatively. Low DBP and widened PP were defined as ≤40 mmHg and ≥80 mmHg respectively on invasive arterial line on post-operative day 1. Clinical outcomes of interest included post-procedural AI and 1-year all-cause mortality.ResultsPost-operative low DBP and widened PP were noted in 32.4% and 58.5% of the study population. No significant association between post-operative AI and low DBP (p = 0.82) or widened PP (p = 0.32) was noted. There was a trend toward higher rates of mortality in patients with low DBP (19.3% vs 9.2%, p = 0.06) but no difference in mortality in patients with widened PP (10.7% vs 15.1%, p = 0.39) or those with ≥1+ post-procedural AI (16.7% vs 10.7%, p = 0.32). In multivariable analysis, low DBP was associated with a trend toward higher rates of 1-year mortality [odds ratio (OR) 2.43, 95% confidence interval (CI) 0.97–6.11, p = 0.06]. When excluding patients with a post-operative invasive systolic blood pressure < 80 mmHg, low DBP was associated with significantly higher risk-adjusted mortality at 1 year [OR 2.75, 95% CI (1.07–7.07), p = 0.04].ConclusionsIn this contemporary study of adults undergoing TAVR, low DBP and widened PP were widely prevalent post TAVR. Low DBP was associated with a trend toward higher rates of 1-year mortality but not with post-procedural AI.     

老年高血压病患者脉压与心电图异常关系的临床探讨

目的　探讨老年高血压病患者脉压与心电图异常的关系。方法　抽样调查 6 0岁以上人群进行血压及心电图检查 ,对其中 75 0例高血压病患者进行分析 ,按平均动脉压 <113mmHg、≥ 113mmHg分为两组 ,再以脉压 <6 5mmHg、6 5～ 85mmHg、>85mmHg分为三个亚组。 结果　 (1)随着脉压增加 ,心肌肥厚 ,心电图异常均逐渐增加 ,P <0 .0 1。 (2 )总胆固醇、甘油三酯、低密度脂蛋白胆固醇并不随脉压增加而改变 ,P >0 .0 5。 (3)脉压相同而平均动脉压分别为 <113mmHg、≥ 113mmHg两组进行比较 ,心肌肥厚 ,心电图异常均无差异 ,而平均动脉压≥113mmHg组的收缩压 (SBP)、舒张压 (DBP)、平均动脉压均高于平均动脉压 <113mmHg组 ,两组差异有显著性 ,P<0 .0 1。结论　高血压病患者脉压比SBP、DBP与心电图的相关性更为密切。     

饮酒对于不同血压的人群产生心房间传导阻滞风险的影响

目的 探讨饮酒对于不同血压的人群产生心房间传导阻滞（intra-atrial block, IAB）风险的影响,为不同血压的人群饮酒导致IAB提供有力防治依据。 方法 为了评估酒精摄入与不同血压人群产生IAB风险,将11 271名35岁以上的中国东北农村心脑血管健康常驻居民为研究对象,根据是否发生IAB（P波宽度≥0.12 s）为依据分为非IAB组（n=10 559）和IAB组（n=712）。分层研究中分为4组:不饮酒正常血压组（n=4 321）、不饮酒高血压组（n=4 178）、饮酒正常血压组（n=1 201）、饮酒高血压组（n=1 571）。对人群进行基线特征分析、分层分析以及多因素Logistic回归分析。 结果 在校正了混杂因素后,与非高血压人群比较,高血压合并饮酒患者的IAB患病率显著增高,OR值（95%可信区间）是1.47（1.04～2.07）,且有统计学意义（P<0.01 ）,在正常血压人群中,饮酒与否不是影响IAB患病率的重要影响因素,而在高血压人群中饮酒与否是IAB产生的重要影响因素,无论在饮酒人群,还是非饮酒人群,高血压均是影响IAB产生的重要危险因素。在IAB患者中,2、3级血压产生IAB的风险远高于正常血压人群和1级高血压人群。饮酒2级高血压（160/100≤BP<180/110 mmHg）组,OR（95%CI）是1.64（1.08～2.50）;饮酒3级高血压（BP≥180/110 mmHg）组,OR(95%CI)为1.73（1.03～2.89）,均有统计学意义。而在饮酒1级高血压（140/90≤BP<160/100 mmHg）组,OR(95%CI)是 1.32（0.90～1.92）,心房间传导阻滞产生与血压无明显相关,在非饮酒人群中血压饮酒无明显相关。 结论 饮酒对于不同血压人群产生心房间传导阻滞风险的影响有明显差异。