老年人单纯收缩期高血压

本文作者较系统地介绍了老年人单纯收缩期高血压的定义、诊断及处理意见。强调在监测心肌梗塞、中风和充血性心力衰竭方面,收缩压水平的意义与舒张压相似。为此,作者着重讨论了是否对单纯收缩期高血压给与治疗这一有争议的问题,并对老年人单纯收缩期高血压的治疗特点及效果作了评述。     

单纯收缩期高血压

单纯收缩期高血压(ISH)是老年人最常见的高血压类型,也是心血管(CV)并发症的主要危险因素,收缩压(SBP)和脉压(PP)增宽对CV事件有明显的预测价值,抗高血压治疗能改善ISH患者的预后,本文对ISH的流行病学情况,病理生理机制,SBP升高和PP增宽对心血管系统(CVS)的危害,治疗ISH使患者获益的有关临床研究等作了介绍.文章对利尿剂、钙拮抗剂(CCB)、血管紧张素Ⅱ受体拮抗剂(ARBs)、血管紧张素转换酶抑制剂(ACEI)和β受体阻滞剂(βB)等降压药物分别在ISH中的地位及联合用药等情况作了介绍和分析,也对ISH患者脉搏波有关指标变化情况和硝酸盐治疗ISH的意义和方法作了介绍.     

正确理解单纯收缩期高血压

关节僵硬是老化的外在表征，这实在是一种折磨，让你活动速度减慢。或者不能做自己想做的事情。血管僵硬同样问题多多．它是血压随年龄增大而升高的主要元凶。你感觉不到高血压的存在，但它跟关节僵硬一样会降低你的活动能力，有时候是永久性地剥夺了你的活动能力。     

1996年-2002年河北省尘肺病流行病学特征分析

本文对河北省1996年—2002年新发生和死亡的3471例尘肺病人的流行病学特征进行分析，结果显示我省尘肺病平均每年新增273人，较七十年代的每年548人(5484／10)下降了50．2％；说明我省尘肺病防治成效显著，但尘肺发病仍居高不下。唐山市、张家口市、邯郸市仍是我省尘肺病的高发地区，发病人数居前五位的行业是冶金、轻工、煤炭、建材、机械，分别占新病例数的30．1％、19．0％、18．5％、10．4％、6．4％，重视和加强矽肺、陶工尘肺、煤工尘肺的尘肺病防治，有一些工种发病工龄提前应值得关注，肿瘤死亡仍不可忽视。     

老年单纯收缩期高血压

老年单纯收缩期高血压 (EISH)是冠心病脑卒中的独立危险因素之一〔1〕,药物治疗EISH可明显降低其所致的冠心病、脑卒中死亡率和残疾率〔2〕。老年人由于各脏器功能减退 ,内环境稳定性差 ,对药物耐受性、敏感性下降 ,使得EISH患者在抗高血压药物选择上受到诸多限制〔3〕。高血压是老年人常见的心血管病之一 ,收缩期高血压又是高血压中常见的类型 ,它的病因、发病机制、治疗及预后与经典的收缩压与舒张压同时升高有所不同 ,已成为当前老年高血压研究的一个重要课题〔4〕。1　EISH的有效治疗药物老年人可能对不同的药物都有效 ,但目前研…     

单纯收缩期高血压的研究进展

单纯收缩期高血压（isolated systolic hypertension，ISH）是老年人最常见的高血压类型，是心血管并发症的主要危险因素。本文对ISH发生的病理基础，ISH及脉压（PP）增大对心血管系统的影响，ISH的临床特点，治疗ISH对患者的益处及ISH的降压药物治疗等方面的研究进行介绍。     

单纯收缩期高血压

单纯收缩期高血压是高血压病的一种常见类型,指收缩压≥140 mmHg、而舒张压<90 mmHg.收缩压升高和脉压增大是其重要特征.常见于老年高血压病患者(青年人高动力循环者亦可发生).     

心房颤动和单纯收缩期高血压

该文对老年人收缩期高血压研究的数据库进行了回顾分析，以评估心房颤动在老年高血压人群中的发病率、对心血管事件的影响，以及降压治疗是否可以防止其发生（Hypertension，2008，51：1552）。该老年人收缩期高血压研究是一项双盲、安慰剂对照的试验，包含了4736位年龄≥60岁的单纯收缩期高血压患者。排除已发生心房颤动患者。受试者随机分到加强治疗组（氯噻酮和阿替洛尔治疗组，     

乌鲁木齐市不同民族老年ISH患病率及危险因素分析

目的：了解新疆乌鲁木齐市不同民族60岁以上老年人群单纯收缩期高血压（ISH）的患病率,观察ISH患病率与民族、性别、年龄的关系。方法2010年1月~2012年12月采用整群随机抽样方法纳入乌鲁木齐市汉族、维吾尔族和哈萨克族60岁以上老年人3416例,进行心血管疾病患病率横断面调查,统计不同民族、不同性别以及不同年龄人群ISH的患病率。结果共有2957例完成调查,应答率为86.56%（2957/3416）;人群整体ISH患病率为25.50%（754/2957）。按民族比较,汉族、维吾尔族、哈萨克族ISH患病率分别为27.67%（397/1453）、25.00%（260/1040）、20.12%（97/482）,3个民族间存在统计差异（χ2=11.01,P＜0.01）;按性别比较,男性患病率为22.89%（356/1555）,女性为28.39%（398/1402）,女性患病率显著高于男性（χ2=11.72,P＜0.01）;按年龄比较,（61～70）岁、（71～80）岁,80岁以上ISH患病率分别为21.38%（347/1643）、29.56%（295/998）和33.33%（112/336）,3个年龄段之间存在统计学差异（χ2=34.01,P＜0.01）。结论新疆乌鲁木齐ISH患病率存在民族、性别差异,且随年龄增加呈增高趋势。     

Antihypertensive efficacy and tolerability of different drug regimens in isolated systolic hypertension in the elderly

The pharmacological treatment, mainly based on diuretics, ofisolated systolic hypertension (ISH) has recently been shownto reduce the risk of stroke and coronary heart disease in theelderly. The purpose of this study was to compare the antithypertensiveeffect and tolerability of different drug regimens in elderlysubjects with ISH (systolic blood pressure—SBP —160mmHg and diastolic blood pressure — DBP — <90mmHg). A multicentre, randomized, controlled open trial wasplanned in the general practice setting. Four widely used treatmentschedules were tested: hydrochlorothiazide 25 mg plus amiloride2·5 mg (H+Am), nifedipine slow release 20 mg (N), atenolol50 mg (At) and atenolol 25mg plus chlorthalidone 6·25mg (At+C). After a baseline evaluation, 308 patients (76·3% female,mean age 75·3 ± 7·1 years) were randomizedand followed up for 6 months. After 3 months the drug dosagewas doubled if the systolic blood pressure goal (SBP<160mmHg and SBP reduction of at least 20 mmHg) had not been reachedNinety-four subjects (30·5%) presented contraindicationsto ß-blockers. At the 3rd- and 6th-month visits alltreatment groups, except At, showed a significant reductionin SBP compared to the control group; DBP showed no significantreduction in any group at any time. At the end of the follow-upthe percentage of hypertensives who had reached the BP goalwas 14·6% in the control group, 52·9% in H+Am,54·8% in N, 28·6% in At and 52·2% in At+C.Over two-thirds of the patients on H+Am or N, and about 50%of those on At or At+ C at 6 months were taking the medicationat low dose. The rate of therapy discontinuation due to side effects duringfollow-up was significantly different among the drug regimenstested: 1·9% in the H+Am group compared to 12·5%,19·2% and 14·8% respectively in N, At and At+Cgroups (P<0·05 for H+Am vs At). The proportion ofsubjects who spontaneously reported, mild adverse effects after3 and 6 months of therapy was not signficantly different inthe study groups, even if an excess was observed in the N groupat 3 months. In conclusion, these data suggest that. diuretics are a firstchoice in the treatment of ISH, because of their hypotensiveefficacy and acceptability; nifedipine, if well tolerated, isan effective alternative to diuretics; a high proportion ofelderly patient with ISH present contraindications to ß-blockers,and atenolol has a poor antihypertensive effect.     

Isolated systolic hypertension in an elderly Danish population. Prevalence and daytime ambulatory blood pressure

Isolated systolic hypertension (ISH) is a major risk factor for cardiovascular complications. Nevertheless, data on the prevalence in a representative population do not seem to be available. The prevalence of ISH and the white coat effect was thus studied in a cross-sectional survey of 2806 inhabitants aged 70-80 years. In untreated subjects, the prevalence of ISH was 17.4% (95% CI 14.9-20.2) in women and 13.5% (95% CI 11.3-15.9) in men using clinic blood pressure at first visit. The prevalence increased significantly with age. The prevalence was reduced to 10.4% when using the average of all-visits clinic blood pressures. By a simulation model, it was demonstrated that his reduction mainly resulted from a regression towards the mean. Average all-visits clinic blood pressure was 172.6 ±10.4/81.1±6.0 mmHg. Less than one-third of those with all-visit ISH had sustained ISH. Identifying subjects with sustained ISH requires measurements in more than three visits.     

Prevalence of isolated diastolic hypertension and associated risk factors among adults in Kanpur, India

BackgroundIsolated diastolic hypertension (IDH) is a largely unrecognized subtype of hypertension, more commonly seen in the younger age group.Aims(1) To determine the prevalence of IDH in the adult population of Kanpur district. (2) To study the associated risk factors of IDH.MethodsA community-based cross-sectional study was conducted in 801 subjects, aged 20 years and above, using multistage stratified random sampling technique.ResultsThe prevalence of IDH was 4.5%, which was 6.2% in men and 3.1% in women. A significant proportion of IDH was seen in the 40–49 years age group. Multivariate logistic regression analysis of the associated risk factors showed that gender, physical activity and BMI were significantly associated with IDH.ConclusionIsolated diastolic hypertension is an emerging problem in developing countries. IDH is more common among men, sedentary individuals and those with a higher BMI.     

拉西地平治疗老年单纯收缩期高血压的有效性和安全性研究

目的评价拉西地平治疗老年单纯收缩期高血压患者的有效性和安全性。方法选择60例老年单纯收缩期高血压患者,口服用拉西地平2～8mg/d,治疗8周,观察用药前及治疗后8周24h动态血压变化情况。结果治疗后昼夜平均收缩压均明显下降,心率无明显变化,收缩压和舒张压的谷峰比均〉50%,差异均有统计学意义（P均〈0.05）。结论拉西地平能降低老年人单纯收缩期高血压,降压疗效确切、安全。     

Longitudinal analysis of blood pressure trends and prognosis in isolated systolic hypertension in elderly individuals

BACKGROUND: With age, a larger proportion of elderly individuals have isolated systolic hypertension (ISH). However, because of a lack of longitudinal studies, much less is known about the incidence and prognosis of ISH in elderly individuals. The aims of this study were to document blood pressure (BP) trends in development of ISH in elderly individuals, and to investigate the incidence and prognosis for those with ISH. METHODS: Retrograde longitudinal analysis was conducted on 3284 subjects during 1958 to 1984. The presence of ISH in elderly individuals was defined as systolic BP of >or=160 and diastolic BP of or=60 years. Prognosis was subsequently investigated until 2002 and compared with that for age- and sex-matched non-ISH control subjects. RESULTS: Selected as ISH in elderly individuals were 185 subjects. Three subtypes were documented by BP trends: 71 subjects with "de novo" ISH, 68 with "burned out" ISH, and 46 subjects with "unclassifiable" ISH. Incidence of ISH increased with age. Mean onset age of ISH was 71.0 years. Subsequent follow-up revealed that the subjects with ISH lived long lives: 83.2% of ISH subjects and 76.2% of control subjects lived to be >80 years old. However, 58.9% of ISH subjects were found to have cardiovascular disease during the follow-up, showing a higher prevalence than among control subjects (42.2%, P = .0013). In more than 40% of subjects with ISH, cardiovascular disease occurred at >or=80 years of age. CONCLUSIONS: In this study, the incidence of ISH increased with age. Persons with ISH have good prognoses in terms of longevity, but many have late-onset cardiovascular complications, suggesting the importance of BP control even in very elderly individuals.     

糖尿病人群不同类型高血压发病率及影响因素的研究

目的 探讨糖尿病人群不同类型高血压的发病率及影响因素。方法 选择基线血压正常的糖尿病患者2367例,观察平均25.6月后进展为不同类型高血压的发病率及影响因素。 结果 进展为单纯收缩期高血压（ISH）、单纯舒张期高血压（IDH）及收缩期-舒张期双期高血压（SDH）的标化发病率（/1000人年）分别为80.2、89.2、130.8,男性为81.7、97.9、145.6,女性为66.8、55.6、80.3。影响糖尿病人群进展为ISH的危险因素是年龄、SBP及BMI （RR分别为2.409、2.757、1.807,P〈0.05）;进展为IDH的危险因素是男性、DBP、BMI、SUA（RR分别为2.064、1.771、1.569、1.463,P〈0.05）;进展为IDH的保护因素是年龄、糖尿病病程5年以上（RR分别为0.809、0.552,P〈0.05）;进展为SDH的危险因素是男性、SBP、BMI、TG、LDL-C（RR分别为1.882、2.720、1.549、1.284、1.410,P〈0.05）。 结论 糖尿病人群SDH的标化发病率最高,高血压各亚型发病影响因素不同,且有性别差异。     

辽宁省阜新农村地区高血压人群代谢综合征患病率调查

采用分层整群抽样方法对阜新农村6412名高血压成年人进行现场调查及实验室检查。按国际糖尿病联盟（IDF）及美国国家胆固醇教育计划成人治疗组第三次指南（NCEP-ATPⅢ）标准，代谢综合征（MS）患病率分别为36．2％及25．9％，女性高于男性。MS患病率随年龄增加而降低，随血压级别升高而增加。     

一氧化氮对老年单纯收缩期高血压大动脉僵硬度及血压的调节作用

老年单纯收缩期高血压大动脉僵硬度增加,一氧化氮参与大动脉僵硬度调节,外源性一氧化氮供体硝酸酯类药物可选择性地降低收缩压,减小脉压。硝酸酯类药物联合传统降压药有助于老年单纯收缩期高血压患者血压控制。     

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。