原发性高血压24小时动态血压分析

目的：分析原发性高血压24小时动态血压变化。方法：应用美国产动态血压监测仪观察40例原发性高血压24小时动态血压并与96例血压正常进行比较。结果：单纯高血压患白天,夜间,平均收缩压,平均舒张压及24小时血压负荷值均比血压正常组高（P＜0．01）,高血压靶器官损害各组收缩压和舒张压又比单纯高压患高（P＜0．01）,结论：24小时动态血压与高血压靶器官损害有关,血压越高,靶器官损害越多,多脏器损害血压最高,脑,肾损害血压次之。     

24小时动态血压评价苯那普利治疗高血压的临床疗效

用苯那普利治疗原发性高血压病人２４例，并以２４小时动态血压评价其临床效果，结果２４小时血压水平显著下降，昼夜降压幅度相似；不良反应轻，能坚持治疗。说明苯那普利治疗高血压具有长效，平稳，安全的特点。     

依那普利与卡托普利对原发性高血压降压疗效的动态血压观察

对50例轻、中度高血压（EH）患者用依那普利（5mg，4／d）和卡托普利（2.5mg，2／d）口服做单盲平等两组对照研究。治疗4周结果两组总有效率相似（分别60.6％，65.2％，P＞0.05），无论SBP和DBP均值的下降均明显（P＜0.05～0.001）。但对每组各抽5例的24h动态血压监测治疗前后比较，依那普利组24h血压控制均较满意，而卡托普利组白天血压控制满意，但夜晚又翌晨血压与治疗前接近（P＜0.05）。如昼夜血压均高者，选用依那普利等长效制剂为佳，如夜间血压正常者，可用卡托普利治疗，唯晨剂应在睡醒后即服为宜。     

高血压患者24小时动态血压的变化及其临床意义(附241例分析)

目的：评价监测高血压患24小时动态血压的意义。方法：应用无创动态血压监测系统记录正常组（35例），高血压1级组（103例）、2级组（78例）、3级组（60例）对象的动态血压，并作对照分析。结果：241例高血压患的动态血压监测显示，高血压患1、2、3级组的夜间收缩压（SBP）／舒张压（DBP）的下降率分别为16％／13％、9．7％／7．4％、1％／2％；夜间高血压下降程度为1级＞2级＞3级（P＜0．001）。结论：动态血压监测可以正确评价高血压病人病情的严重程度，指导治疗；夜间血压下降率可作为评价靶器官受损状况的一项指标。     

Losartan治疗原发性高血压的动态血压观察

目的：观察Ｌｏｓａｒｔａｎ（商品名科素亚,杭州默沙东制药有限公司生产）对原发性高血压患者动态血压监测的影响。方法：选择原发性高血压患者３４例,用科素亚５０ｍｇ／ｄ,共４周。治疗前后进行动态血压测定。结果：科素亚治疗后各时点的血压及２４ｈ、日夜平均收缩压、舒张压、平均压、血压负荷均下降,部分昼夜节律消失者恢复正常。结论：科素亚能在２４ｈ内平稳降压。     

24h动态血压监测评价福辛普利治疗原发性高血压的疗效

近年来研究发现，清晨是心脑血管事件的高发阶段，这就要求降压药能24h平稳降压。本研究通过动态血压监测，观察长效血管转换酶抑制剂福辛普利对高血压病病人的降压疗效及对24h血压节律的影响。     

24 h动态血压监测评价福辛普利治疗原发性高血压的疗效

近年来研究发现,清晨是心脑血管事件的高发阶段,这就要求降压药能24 h平稳降压.本研究通过动态血压监测,观察长效血管转换酶抑制剂福辛普利对高血压病病人的降压疗效及对     

拉西地平治疗原发性高血压43例动态血压观察

我院应用拉西地平治疗原发性高血压病 43例 ,并用动态血压观察治疗前后的血压情况。现报告如下。一般资料 :43例患者中 ,男 2 8例 ,女 15例 ,年龄 34～ 6 3岁 ,平均 48.3± 2 .6 7岁 ,其中 1级 8例 ,2级 35例 ;糖尿病患者 4例 ,高血脂 19例。入选患者除外以下情况 :1心源性休克 ;2心动过缓 ,房室传导阻滞、窦房传导阻滞和其他严重的心律失常 ;3严重的肝、肾功能障碍 ;4孕妇、哺乳期和有可能正在怀孕的妇女 ;5充血性心力衰竭和肺动脉高压所致的右心衰 ,6有心梗病史和脑卒中病史。方法 :1治疗方法 :43例患者停用其他降压药物 5天 ,然后用拉西…     

阿罗洛尔、咪唑普利与依那普利治疗高血压病24小时动态血压观察

我们通过２４小时动态血压监测，对３种降压药阿罗洛尔、咪唑普利、依那普利的降压效果、谷／峰比值、安全性等方面进行研究，现将结果报告如下。一、对象与方法门诊轻、中度高血压病患者，共选择符合入选标准患者６０例，按随机区组法分为３组，每组２０例，组间性别、年龄、入选基础血压基本一致。临床观察过程：治疗前均停药服安慰剂２周，停药第２周２次门诊非同日血压均值作为基础诊室血压。服药方法：阿罗洛尔１０～１５ｍｇ，２／ｄ。咪唑普利、依那普利均５～１０ｍｇ／ｄ，治疗期共６周。以治疗第６周２次门诊非同日血压均值作为治…     

Losartan versus atenolol on 24-hour ambulatory blood pressure. A LIFE substudy

Objective. The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study showed that losartan-based treatment reduced risk of the composite endpoint of cardiovascular death, stroke and myocardial infarction compared with atenolol-based treatment in patients with hypertension and left ventricular hypertrophy with similar office blood pressure (BP) reduction. Our aim was to investigate the effect of losartan- and atenolol-based treatment on 24-h ambulatory BP and heart rate (HR) in LIFE. Methods: In 110 patients, 24-h ambulatory BP and heart rate were recorded at baseline and 1 year after randomization. Results: Ambulatory BP was comparably reduced throughout the 24-h period after 1 year of losartan- vs atenolol-based antihypertensive treatment. Office and ambulatory BP were comparably reduced in the follow-up period. Early morning surge in BP was similar between groups. Non-dipping status was more frequent in the losartan group (p = 0.01). From baseline to Year 1 the 24-h HR profile for the losartan group was unchanged, but, as expected, there was a significant decrease in daytime HR in the atenolol group, which was not as large during early night-time. Conclusion: There were no differences in 24-h BP burden and HR that could explain the difference in outcome in favor of losartan vs atenolol in the LIFE study.     

高血压伴糖尿病患者的动态血压变异性改变

对单纯原发性高血压患者96例、高血压合并糖尿病患者32例及对照组5 6例,分别动态测量血压24h,计算血压变异性,并分别进行对照研究。结果：①高血压组与对照组比较：24hSBP、24hSBP、dSBP、dDBP、nSBP、nDBP及SPBp、DPBd、DBPp均有显著性差异（P＜0．01）,24hSBP、24hSBP、dSBPv有明显差异（P＜0．05）;②高血压合并糖尿病组与对照组比较：24hSBP、24hSBP、dSBP、nSBP、nDBP、SBPp、DBPp存在显著差异（P＜0．01）,dSBPv、dDBP、DBPd存在明显差异（P＜0．05）;③高血压组与高血压合并糖尿病组比较：24hSBPv、24hDBPv、dDBP、DBPd减低,显示动态血压的变异性减低,但统计学无明显差异。认为高血压合并糖尿病患者血压变异性降低,可能与糖尿病自主神经病变相关,使正常的血压节律消失。     

Limited reproducibility of 24-h ambulatory blood pressure monitoring

Abstract

Results of 24-h ambulatory blood pressure monitoring (ABPM) including average blood pressure, variability, and nocturnal dipping are considered the gold standard for diagnosis and the best predictor of the future end organ damage in chronic hypertension. Here we report on the reproducibility of ABPM results for these three measures over a period of months. A total of 35 hypertensive patients (43% female, mean age 64 years), underwent two separate ABPM recordings within 14 weeks, with unchanged medical treatment and lifestyle in the interim. The day and night average blood pressure, dipping status of systolic pressure, and the standard deviation of systolic and diastolic blood pressure as a measure of variability were compared between the two recordings. Individual values for average systolic and diastolic pressures showed only a modest correlation between the two measurements (r?=?0.56, r?=?0.81, p?<?0.01). Standard deviations of 24-h pressure were also positively but weakly correlated (r?=?0.4, p?<?0.001). The occurrence of dipping was reproducible in 71% of the patients. Average blood pressure, pressure variability, and dipping as assessed by ABPM are only moderately reproducible. Clinical decision-making based on single ABPM datasets should be made with caution, and repetition of ABPM seems justified in some cases.     

24小时动态血压参数正常参照值的研究

目的　探讨国人２４ 小时动态血压（２４ ｈ ＡＢＰ）参数的正常参照值。方法　采用无创性携带式动态血压监测仪检测３００ 例，年龄２０～７９ 岁临床健康者的动态血压。结果　国人２４ 小时动态血压均值：（１１１－８／６８－２ ±８－５／６－１）ｍｍＨｇ（１ ｍｍＨｇ ＝ ０－１３３ ｋＰａ），白昼（１１３－９／７０－１ ±１０－４／６－９）ｍｍＨｇ；夜间（１０７－０／６５－３±９－０／６－０）ｍｍＨｇ。结论　推荐２４ 小时动态血压均值＜ １３０／８０ ｍｍＨｇ；白昼均值＜ １３５／８５ ｍｍＨｇ，夜间均值＜ １２５／７７ ｍｍＨｇ；夜间／白昼比值≤０－９０，即夜间血压下降率≥１０％ 可暂时作为动态血压参数的正常参照值。     

Clinical characteristics of resistant hypertension evaluated by ambulatory blood pressure monitoring

Strict control of blood pressure is important to prevent cardiovascular disease, although it is sometimes difficult to decrease blood pressure to target levels. The aim of this study was to investigate the clinical characteristics of resistant hypertension evaluated by ambulatory blood pressure monitoring. One hundred in-hospital patients, whose 24-hour average blood pressure was higher than 130/80?mmHg even after treatment with more than three antihypertensive drugs, were included in the present analysis. Circadian variation of blood pressure was evaluated by nocturnal fall in systolic blood pressure. Average blood pressures of all patients were high in both daytime and nighttime, 150.0/82.9 and 143.8/78.2?mmHg, respectively. Twenty patients had been treated with hemodialysis or peritoneal dialysis. In 63 patients out of the other 80 patients (79%), estimated glomerular filtration rate (eGFR) was also decreased (<60?mL/min/1.73 m²). The patients classified into dipper, non-dipper, riser and extreme-dipper were 20%, 43%, 34% and 3%, respectively. In addition, in 17 patients whose eGFR was preserved, 12 patients showed a non-dipper or riser pattern, suggesting that it was difficult to account for this altered circadian blood pressure variation only by renal dysfunction. These results show that a large number of the patients with resistant hypertension suffered from renal dysfunction, although it was difficult to explain altered circadian blood pressure variation based on renal dysfunction alone.     

Cost-effectiveness of ambulatory blood pressure monitoring in the follow-up of hypertension

Aims. To study the cost of the follow-up of hypertension in primary care (PC) using clinical blood pressure (CBP) and ambulatory blood pressure monitoring (ABPM), and to analyse the cost-effectiveness (CE) of both methods. Major findings and principal conclusion. Good control of hypertension was achieved in 8.3% with CBP (95% CI 4.8-11.8) and in 55.6% with ABPM (95% CI 49.3-61.9). The cost of one patient with good control of hypertension is almost four times higher with CBP than with ABPM (€940 vs €238). Reaching the gold standard (ABPM) involved an after-cost of €115 per patient. The results for a 5% discount rate showed a saving of €68,883 if ABPM was performed in all the patients included in the study (n = 241, €285 per patient). An analysis of sensitivity, changing the discount rate and life expectancy indicated that ABPM provides a better CE ratio and a lower global cost. ABPM is more cost-effective than CBP. However, if we include the new treatment cost of poorly monitored patients, it is less cost-effective. Excellent control of hypertension is still an important challenge for all healthcare professionals, especially for those working in PC, where most monitoring of hypertensive patients takes place.     

动态血压观察卡维地洛降压疗效

目的 :观察卡维地洛的降压疗效。方法 :服用安慰剂 10～ 14 d后服用卡维地洛 10～ 40mg/ d,上午 8时顿服 ,总疗程为 4周 ,共治疗轻中度原发性高血压 ( EH)患者 2 5例。采用血压监测仪测定 2 4h动态血压。结果 :治疗 4周后 2 4h平均血压、白昼及夜间平均血压、血压负荷值均较用药前显著下降 ( P <0 .0 1) ,收缩压和舒张压的谷 /峰比值分别降低 5 4.1%和 65 .6%。结论 :卡维地洛每日 1次投药能有效地控制轻中度 EH患者 2 4h血压水平。     

高血压伴鼾症患者夜间低氧血症与动态血压关系的研究

目的:探讨高血压伴鼾症患者夜间低氧血症与动态血压变化的关系。方法:对95例高血压伴鼾症患者进行夜间持续经皮血氧饱和度监测,次日行24小时动态血压监测。根据夜间最低血氧饱和度(LSaO2)结果,将患者分为高血压合并低氧血症(EHL)组(51例)及单纯高血压(EH)组(44例),进行两组的一般状况及24小时动态血压各指标对比分析,并进一步行LSaO2、体重指数(BMI)、年龄(Age)与24小时动态血压各指标相关性分析。结果:95例患者中杓型组33例,占34.7%;非杓型组62例,占65.3%。EHL组24hSBP、24hHR、dSBP、dHR、nSBP、nHR、偶测SBP(cSBP)、偶测DBP(cDBP)与EH组相比有显著差异(P<0.05);低氧血症组中84.3%患者动态血压昼夜节律消失。EHL组与EH组血压昼夜节律异常者存在显著性差异(P<0.001)。结论:高血压伴OSAS者血压增高的程度以及血压昼夜节律异常与夜间低氧血症密切相关。     

肾实质性高血压与原发性高血压昼夜节律对比分析

目的：比较肾实质性高血压与轻,中度原发性高血压的昼夜血压节律之差异,方法：实验组（A组）对象为经临床和实验室检查确诊的肾实质性高血压病人,共23例,对照组（B组）为同期随机抽取的我科23例轻,中度原发性高血压病人,两组均作动态血压检测（ABPM）,ABPM前1周均停服降压药物。结果：A,B两组24小时收缩压,舒张压,白天收缩压,舒张压无显性差异（P＞0．05）,夜间收缩压,舒张压则有高度显性差异（P＜0．01）,夜间血压下降率A组收缩压,舒张压均＜10％,B组则＞10％,两组间亦有高度显性差异（P＜0．01）。结论：肾实质性高血压夜间收缩压,舒张压下降较少,昼夜节律改变减弱,治疗时应重视恢复昼夜节律。