老年高血压患者小剂量、个体化、联合用药的临床分析

目的考察小剂量、个体化、联合用药的降压方案对老年高血压患者的临床疗效和安全性。方法回顾性分析2012年5月至2013年10月来我院就诊、并随访至少半年的68例老年高血压患者的临床资料。其中男33例,女35例;年龄60~81岁,平均(69.5±8.6)岁。患者均接受原发基础疾病的治疗和并发症的治疗以及降血压药物治疗。据此将患者分为传统药物组(13例)、单药组(27例)和联合用药组(28例)。考察患者接受不同降压用药方案的临床疗效和安全性。结果三组均存在依从性不好、患者中断用药的情况,但三组的具体原因各异,其中联合用药组出现依从性不好的例次最低;控制血压方面,治疗后三组的降压效果(收缩压)差异有统计学意义(P<0.05);临床疗效方面,联合用药组的总有效率更高,差异具有统计学意义(P<0.05)。随访半年,三组均未出现严重不良事件。结论传统药物的临床降压效果不尽如人意,且因药物临床疗效不佳或不良反应多等原因故而患者的依从性较差;单药降压治疗不及联合用药的总有效率高;针对老年高血压有并发症的患者,临床需采用小剂量、个体化的联合用药方案进行降压治疗来获得满意的临床疗效和可靠的安全性。     

老年高血压患者降压药物的应用及用药指导

目的探讨老年高血压患者降压药物的使用情况及用药指导。方法回顾性分析2010年入我院疗养的327例老年高血压患者的药物治疗情况,并进行统计分析。结果老年高血压患者常用的降压药物主要有利尿剂、钙拮抗剂、血管紧张素转换酶抑制剂、血管紧张素Ⅱ受体拮抗剂、β受体阻滞剂、α受体阻滞剂6类药物。327例老年患者服用降压药物种类1～5种,平均(2.27±0.34)种。结论老年高血压患者用药种类多、情况复杂,应加强用药指导,提高高血压病用药质量,加强高血压病的控制,减少并发症的产生。     

大连湾地区农村原发性高血压患者降压药使用及血压控制情况

目的:了解大连湾农村地区原发性高血压患者用药及血压控制情况,为该血压预防和控制奠定数据依据。方法:①选择2003-01-01/12-31大连市甘井子区大连湾地区医院内科门诊就诊的高血压患者261例,均对检查及调查项目知情同意。②根据高血压危险度将患者分为3组:低危组(n=33):Ⅰ～Ⅱ级,无危险因子,无靶器官损害;中危组(n=77):Ⅰ～Ⅱ级+1～2个危险因子;高危及高危以上组(n=151):Ⅲ级并存有1或3个以上危险因子或靶器官损害和/或糖尿病(并发症);Ⅰ～Ⅱ级伴有心血管并发症。③测量患者血压,测量时详细询问病史,包括年龄、性别、高血压病史、口服药物种类、联合用药情况、血压控制情况、合并症以及吸烟、饮酒史等。行常规心电图、血脂、血糖、肾功能检测。血压控制水平判定标准为显效[舒张压下降≥10mmHg(1mmHg=0.133kPa),且降至正常范围(≤90mmHg)或舒张压下降≥20mmHg以上],有效[治疗后舒张压下降虽未达到10mmHg,但达到正常或收缩压下降≥20mmHg],无效(未达到上述标准)。有效率=(显效例数+有效例数)/用药总例数;控制率=显效例数/用药总例数。结果:原发性高血压患者261例均进入结果分析。①药物应用情况:261例患者中,185例患者进行药物降压治疗,治疗率70.9%;其中联合用药(两种或两种以上)25例(13.5%)和160例(86.5%)。高危及高危以上组、中危组、低危组中分别有130例(70.3%),44例(23.8%),11例(5.9%)患者服用降压药物治疗。降压药物中,以复方制剂处方率最高,占76.2%,其中复方降压片117例,降压O号24例;钙拮抗剂24例(13.0%);再次为血管紧张素转换酶抑制剂0例(5.4%);最后为β受体阻滞剂5例(2.7%);另外一些中成药5例(2.7%);185例用药患者中,163例患者使用单一降压药物,两种药物联合应用19例,只有3例应用3种降压药物。②血压控制情况:应用降压药物治疗的185例患者中显效14例(7.6%),有效165例(89.2%),无效6例(3.2%),有效率96.8%,控制率7.6%。结论:大连湾农村地区高血压服药品种比较单一,血压控制率不高。     

时间治疗学对非杓型高血压患者降压疗效的临床研究

目的探讨不同服药方法对非杓型高血压患者降压疗效的影响。方法 48例非杓型高血压患者随机分为早上顿服组(24例)和分次服用组(24例),使用药物为非洛地平缓释片和培哚普利片,用药8周,观察用药前后24h动态血压参数,并比较两组患者血压昼夜节律的变化。结果服药8周后,与早上顿服相比较,分次服用降压药物能使患者取得了更好的降压效果(t分别=4.45、2.38,P<0.05)。此外,早晚分次给药患者的血压昼夜节律由非杓型恢复为杓型的显著多于早晨顿服组,差异具有统计学意义(χ2=10.10,P<0.05)。结论联合长效降压药物治疗2级和3级非杓型高血压患者,早晚分次给药与早晨顿服相比,降压效果更好、降压更加平稳,有利于血压的昼夜节律由非杓型恢复为正常的杓型。     

叶酸联合降压药物对H型高血压的临床疗效观察

目的:对H型高血压患者施用叶酸联合降压药物的效果进行研究分析。方法:回顾性分析70例H型高血压患者的病史资料,于2020年4月至2021年4月在本院就诊,按治疗方法不同分为两组各35例,研究组采用叶酸联合马来酸依那普利治疗,对照组采用马来酸依那普利单药治疗。比较两组治疗前及治疗6个月后的血压、血浆同型半胱氨酸(Hcy)水平及血脂、肾功能指标。结果:两组患者治疗前所有指标均无统计学差异(P>0.05)。两组患者治疗后血压均明显下降(P<0.05),但两组之间比较并无统计学意义(P>0.05)。两组患者治疗后血浆Hcy水平均明显下降(P<0.05),研究组患者血浆Hcy水平与对照组相比,明显更低(P<0.05)。治疗后,研究组患者血脂各项指标均明显改善(P<0.05),且TC和LDL-C改善明显优于对照组(P<0.05),而对照组患者治疗后血脂及肾功能指标无明显变化(P>0.05)。进行差异性治疗前后,两组患者的Scr水平比较无明显差异(P>0.05),但治疗后,研究组患者UA水平明显低于治疗前(P<0.05),且明显低于对照组(P<0.05)。结论:与降压药物单药治疗H型高血压相比,叶酸联合降压药物治疗H型高血压产生的临床效果更佳。     

老年性高血压予以中医熄风降压汤治疗的临床评估

目的分析老年性高血压患者采用中医熄风降压汤治疗的临床疗效。方法使用前瞻性研究法收集医院心血管内科2017年6月～2018年5月收治的154例老年性高血压患者为研究对象,分层随机分为各77例的对照组与观察组,对照组行常规西医降压对症治疗,观察组在对照组用药基础上联合中医熄风降压汤治疗,统计学分析比较两组临床疗效及用药安全性。结果治疗1个月后,观察组血压控制总有效率96.10%,显著高于对照组总有效率84.42%(P<0.05);治疗后观察组舒张压、收缩压改善水平更优于对照组(P<0.05);对照组不良反应总发生率11.69%,观察组总发生率12.99%,两组治疗期间不良反应无比较差异(P>0.05)。结论常规西医用药基础上联合应用中医熄风降压汤治疗老年性高血压,血压控制效果更佳,认为可以将此用药方案推广应用。     

高血压患者临床三种药物降压疗效对比

目的:比较缬沙坦、硝苯地平控释片和贝那普利对高血压病的降压疗效。方法:54例高血压患者随机分为A、B、C三组各18例。A组给予缬沙坦治疗,B组给予硝苯地平控释片治疗,C组给贝那普利,观察三组临床疗效、血压变化情况和血压谷/峰值(T/P)。结果:三组用药后血压均下降(P<0.01),A组优于B、C组(P<0.05);A组总有效率高于B、C组(P<0.05和P<0.01);A组SBP和DBP的T/P值分别为78%和74%,B组为70%和65%,C组为81%和71%。结论:缬沙坦、硝苯地平控释片和贝那普利均可每日服用1次,前两类药控制24 h血压及清晨醒后的高峰期血压较后者为佳。     

八段锦联合盐酸地尔硫卓缓释胶囊治疗Ⅰ~Ⅱ级原发性高血压患者的疗效

目的探讨八段锦联合盐酸地尔硫卓缓释胶囊治疗Ⅰ~Ⅱ级原发性高血压(EH)的疗效.方法选取某院Ⅰ~Ⅱ级EH患者152例,随机数表法分为联合组和对照组,各76例.对照组给予替米沙坦治疗,联合组在对照组用药基础上给予八段锦联合盐酸地尔硫卓缓释胶囊治疗.观察对比两组治疗效果及治疗前后血压[舒张压(DBP)、收缩压(SBP)]水平.结果联合组总有效率96.05%,对照组总有效率85.53%,联合组高于对照组,差异有统计学意义,P<0.05;治疗后,两组SBP、DBP水平均明显改善,且联合改善效果优于对照组,差异有统计学意义(P<0.05).结论八段锦联合盐酸地尔硫卓缓释胶囊治疗Ⅰ~Ⅱ级EH患者,疗效显著,可有效控制血压.     

昆明温泉地区自然疗养因子对高血压病患者血压的影响

目的探讨昆明温泉地区自然疗养因子对高血压病患者血压的影响。方法选择轻、中度高血压患者136例,随机分为观察组和对照组各68例。观察组患者在原剂量降压药物基础上,接受昆明温泉自然疗养因子(环境、景观、森林、空气及高热低矿化温泉水浴等)治疗,对照组继续服用原剂量降压药物治疗,两组均治疗1个月,比较两组治疗后血压变化。结果治疗后,观察组收缩压(SBP)与舒张压(DBP)分别为(138.0±9.8)mmHg(1 mmHg=0.133 kPa)、(81.0±6.8)mmHg,对照组收缩压与舒张压分别为(158.3±8.7)mmHg、(99.5±6.0)mmHg,两组比较差异有高度统计学意义(P0.01)。结论昆明温泉地区自然疗养因子对高血压患者具有明显降压作用。     

认知干预对中青年高血压患者用药依从性及疗效的影响

目的探讨认知干预对中青年高血压患者疗效的影响。方法选取2012年8月~2014年8月本科收治的180例中青年高血压患者,随机分成对照组和干预组各90例,两组患者均依病情行降压药物治疗,干预组患者在药物治疗的同时给予认知干预,于治疗3个月后以问卷调查的形式观察用药依从性的变化,同时检测患者血压的变化。结果干预组治疗3个月后用药依从性显著提高,明显高于治疗前和对照组,差异有统计学意义(P0.01)。治疗3个月后血压值显著低于治疗前和对照组,差异均有统计学意义(P0.05),而且干预组较对照组血压下降更加明显。结论认知干预能显著提高中青年高血压病患者用药依从性,降低血压,值得借鉴。     

Prospects of use of the combined preparation logimax in patients with essential hypertension

AIM: To study the effectiveness and tolerance of a combined drug logimax in patients with essential hypertension (EH). MATERIAL AND METHODS: The antihypertensive activity and safety of logimax was evaluated in 15 EH patients at week 10 of therapy. RESULTS: Logimax has a good antihypertensive effect for 24 hours in 86.7% patients. This was evidenced by the lowered mean systolic and diastolic pressures shown during 24-hour monitoring. Logimax was well tolerated. There were no side effects in 73.3% of the patients. CONCLUSION: The combined drug logimax is indicated for patients with EH as an antihypertensive agent to treat and prevent cardiovascular events.     

Possibilities of achieving target blood pressure in patients with essential hypertension in relation to renal functional status and age

AIM: To study renal functional changes in patients with essential hypertension (EH) and normal blood creatinine levels during antihypertensive therapy with currently available drugs to achieve blood pressure lower than 140/90 mm Hg. MATERIALS AND METHODS: Renal functional changes were studied in 114 patients with EH and normal blood creatinine levels during antihypertensive therapy aimed at achieving blood pressure lower than 140/90 mm Hg. Glomerular filtration rate (GFR) was calculated by the Cockcroft-Gault formula and blood creatinine levels were measured before and 6, 12, 24, 52 weeks of treatment. RESULTS: Renal dysfunction was detected in 43.9% of the patients as GFR < 80 ml/min in 35.1% and hyperfiltration (GFR > 140 ml/min) in 8.8%. The patients with baseline decreased GFR were older, had a longer history of EH, and lower body-mass index than those with hyperfiltration (p < 0.05). There was a considerable renal functional improvement in patients with baseline decreased GFR and achieved BP < 140/90 mm Hg. Target BP could be achieved only in 20% of the patients with hyperfiltration. Antihypertensive therapy caused reduced hyperfiltration in these patients. In patients aged over 60 years who had a baseline GFR < 80 ml/min, achievement of target BP also promoted renal functional improvement. CONCLUSION: Most patients with EH and normal blood creatinine levels have renal dysfunction. Normalization of BP substantially improves renal functional parameters irrespective of age.     

老年高血压病患者停服降压药物的原因分析

目的为了调查老年高血压病患者停服降压药物的原因,以提高老年高血压患者的治疗效果.方法采用面谈和查阅患者病历的方法,调查115例高血压病患者停服降压药物的原因及其动态血压检测结果,然后进行数据统计和分析.结果 115例停服降压药物的原因分别为多次测量血压偏低、对高血压病了解不够、对降压药物了解不够、服药方案过于复杂、老年患者记忆力较差、一时配不到同种药物,其中因血压偏低而停药患者(血压控制率为77.35%)与因其他原因而停药患者(血压控制率为33.87%)比较,差异有统计学意义(P＜0.001).结论对患者加强健康教育,定期检测血压,以提高血压控制率.     

Use of plasmapheresis in the treatment of patients with severe arterial hypertension refractory to drug therapy

Thirty patients with severe and malignant arterial hypertension (AH) received 1-4 sessions (in most cases 2) of plasmapheresis to overcome refractiveness to drug therapy. Stable BP reduction, improvement of the vascular picture of the fundus of the eye and raised sensitivity to antihypertensive therapy were noted in 26 patients. Though antihypertensive drug dosages were reduced, the antihypertensive effect of plasmapheresis could be observed within 3-8 mos (an average of 5.3 +/- 0.5 mos). The efficacy of plasmapheresis was approximately equal both in symptomatic AH and in essential hypertension. Plasmapheresis was shown to be a method of overcoming refractiveness to antihypertensive therapy which could not be used alone for therapy of refractory AH. Possible mechanisms of BP reduction after plasmapheresis were discussed.     

Characteristics of hypotensive effect in patients with arterial hypertension and desaturation signs of obstructive sleep apnea syndrome during sleep

AIM: To estimate the efficacy of 8-week antihypertensive monotherapy in patients with arterial hypertension (AH) regarding the presence of obstructive sleep apnea syndrome (OSAS). MATERIAL AND METHODS: We analysed the results of 24-h blood pressure (BP) monitoring of 26 inpatients (mean age 54 +/- 2 years) with mild (n = 18) and moderate (n = 8) AH before and after 8 weeks of treatment with 5-10 mg amlodipine or 50-100 mg of losartan once daily to assess blood pressure profile parameters. The patients underwent nocturnal monitoring of arterial oxygen saturation (pulsoximeter NONIN-8500 M, USA). The presence of OSAS was confirmed when a characteristic clinical picture was combined with the presence of significant (> 4%) sleep desaturation episodes > 15 episodes per hour or the presence of group desaturation episodes below 90%. Seven hypertensive patients with OSAS were assigned to group 1, nineteen patients without OSAS--to group 2. The differences in estimated parameters between the groups were tested by Mann-Whitney U test, the dynamics of BP profile parameters--by Wilcoxon matched pairs test. RESULTS: In group 1 there were no significant differences by most of BP profile parameters before and after antihypertensive treatment, except mean nocturnal systolic BP. In group 2 a significant hypotensive effect was seen by all parameters of BP profile except BP variability. Hypotensive efficacy in group 2 was 1.5-2 times higher vs group 1, but the difficulties were not significant. CONCLUSION: Antihypertensive therapy in hypertensive patients with OSAS is less effective than in those without OSAS but it is not uneffective.     

Hypertension

An estimated 58 million Americans are at increased risk of morbidity and premature death due to high blood pressure (BP) and require some type of therapy or systematic monitoring. This article focuses on recent advances in our understanding of the pathogenesis of hypertension, new approaches to the diagnosis and treatment of secondary hypertension, and current views of the most appropriate nonpharmacologic and pharmacologic therapy for essential hypertension. In view of the extremely high prevalence of the disorder, emphasis is placed on efficient and cost-effective strategies for diagnosing and managing the hypertensive patient. Recent evidence indicates that nonpharmacologic therapy, including dietary potassium and calcium supplements, reduction of salt intake, weight loss for the obese patient, regular exercise, a diet high in fiber and low in cholesterol and saturated fats, smoking cessation, and moderation of alcohol consumption produces significant sustained reductions in BP while reducing overall cardiovascular risk. Accordingly, nonpharmacologic antihypertensive therapy should be included in the treatment of all hypertensive patients. In persons with mild hypertension, nonpharmacologic approaches may adequately reduce BP, thereby avoiding the expense and potential side effects of drug therapy. In patients with more severe hypertension, nonpharmacologic therapy, used in conjunction with pharmacologic therapy, can reduce the dosage of antihypertensive medications necessary for BP control. Patients treated with nonpharmacologic therapy only should be followed closely, and if BP control is not satisfactory, drug therapy should be added. The large number of drugs available for use in hypertension treatment, coupled with our rapidly expanding knowledge of the pathophysiology of hypertension and of the adverse effects of these drugs in individual patient groups, make it possible to individualize antihypertensive treatment. When used as monotherapy, most agents effectively lower BP in the majority of patients with mild or moderate essential hypertension. Thus, a single agent from one of four classes: diuretics, angiotensin-converting enzyme inhibitors, calcium channel blockers, and beta-adrenergic blockers, usually provides effective BP control with minimal side effects in most patients. Therapy should be initiated with the agent most likely to be effective in BP lowering and best tolerated. If the initial agent is ineffective at maximal recommended therapeutic doses or has undue side effects, an alternative agent from another class should be tried. When monotherapy is unsuccessful, a second agent, usually of a different mechanism of action, should be     

A circadian profile of arterial pressure in hypertensive patients with diabetes mellitus: relation with affected renal circulation

AIM: To study a circadian profile of blood pressure (BP) in normotensive patients with diabetes mellitus type 2 (DM-2) and hypertensive patients with DM-2; to examine BP circadian rhythm disorders for correlation with dopplerographic indices of intrarenal blood circulation. MATERIAL AND METHODS: A total of 35 normotensive diabetics and 309 hypertensive diabetics were examined. Control groups consisted of 90 patients with essential hypertension (EH) and normal carbohydrate tolerance (CT) and 34 healthy subjects, respectively. Patients with hypertension and DM-2 and EH patients had no differences by duration of hypertension and office BP. The following methods of examination were used: outpatient 24-h BP monitoring, tests for glycemia, insulinemia and microalbuminuria (MAU), duplex scanning with colour impulse doppler mapping of blood flow in the arcuate intrarenal arteries to measure intrarenal resistance. RESULTS: A circadian BP profile in normotensive diabetics is characterized by insufficient fall of nocturnal BP and indirect signs of neurohumoral hyperactivation--high mean diurnal variability and morning rise of systolic BP. Hypertensive diabetics had more pronounced neurohumoral hyperactivation, lower drop of nocturnal BP. EH patients with normal CT had higher and longer diastolic diurnal hypertension. In combination of hypertension with DM-2 pulse blood pressure (PBP) rises earlier, in duration of hypertension up to 10 years nocturnal PBP rise was more pronounced. Circadian PBP rose significantly later. CONCLUSION: Stepwise regression analysis has revealed that a nocturnal PBP rise in line with postprandial insulinemia contributes significantly to growth of intrarenal vascular resistance in combination of hypertension with DM-2.     

Clinical experience with transdermal clonidine in African-American and Hispanic-American patients with hypertension: evaluation from a 12-week prospective, open-label clinical trial in community-based clinics.

The objective of this study was to assess the efficacy and tolerability of transdermal clonidine in inner-city African-American and Hispanic-American patients with essential hypertension. A multiclinic open-label, prospective trial for 12 weeks was used. Dose titration was based on office blood pressure (BP) measurements of > 140/90 mm Hg. Clinical sites were community-based primary care centers. Untreated and treated hypertensive patients whose diastolic BP exceeded 90 mm Hg were administered transdermal clonidine at 0.1 mg or 0.2 mg delivery daily. The drug was titrated after 1 month if diastolic BP was greater than 90 mm Hg. At 12 weeks of treatment, change in blood pressure from baseline as well as adverse effects and patient satisfaction were assessed. A total of 357 patients entered the treatment phase of the study, and 315 patients (244 African-Americans, 67 Hispanic-Americans) had evaluable data. Transdermal clonidine significantly (P <.001) lowered BP in all patients by 15.7/12.8 +/- 18.1/9.6 mm Hg, and heart rate was reduced by 3 +/- 9 beats/min (P <.001). There were no differences in BP reduction according to race and ethnicity, gender, or age. The most common adverse effects were pruritus or discomfort at the patch site, dizziness, dry mouth, and fatigue. Eleven percent of the patients discontinued treatment because of one of these adverse effects. A large proportion of patients (67%) reported that transdermal clonidine was more convenient to use than oral therapy. Transdermal clonidine, alone or in combination with other antihypertensive therapies, significantly lowered BP and heart rate in inner-city hypertensive patients. The drug was generally well tolerated, with 89% of the patients remaining in the trial. Patient acceptability was high with the once-weekly treatment, which is an important feature for this particular hypertensive population.     

Co-renitek treatment of patients with moderate and severe forms of hypertensive disease

AIM: To evaluate efficacy and tolerance of a compound drug co-renitec combining an ACE inhibitor enalapril maleate and diuretic hydrochlorothiazide co-renitec taken for 16 weeks in essential hypertension (EH). MATERIAL AND METHODS: 28 patients with EH (16 males and 12 females aged 47-74 years) of mean duration 13.1 +/- 1.6 years. Blood pressure (BP) was monitored for 24 hours with the device SL 90207 (SpaceLabs Medical, USA). Microalbuminuria (MAU) was estimated with the use of immunoturbodimetric test. RESULTS: By 24-hour monitoring, co-renitec reduced day BP by 14.9/8.9 +/- 3/2 mm Hg, nocturnal BP lowered by 18.6/11.4 +/- 3/2 mmHg, pulse pressure also fell. Coefficient T/P was 53.5% for systolic BP (SBP) and 59.6% for diastolic BP (DBP). The target SBP was reached in 77% patients, target DBP--in 69%. Co-renitec significantly decreased MAU, albumines excretion normalized in 46% patients. CONCLUSION: Co-renitec lowers both day and nocturnal blood pressure, improves 24-h rhythm of BP, has a positive effect on the kidneys. This allows its recommendation as a first-line drug in patients with moderate and severe EH.     

An overview of the pharmacology and clinical efficacy of indapamide sustained release

The relationship between blood pressure (BP) and cardiovascular risk is clearly established; hypertension increases the rate of cardiovascular. High systolic blood pressure (SBP) may be the main parameter involved in cardiovascular morbidity and mortality. The benefit of lowering BP, particularly with diuretics has been proven in many outcome studies. Indapamide, a thiazide-type diuretic, was available for many years at a dosage of 2.5 mg in an immediate release formulation. A new sustained release (SR) formulation has been developed in order to allow the same antihypertensive efficacy with a better acceptability profile. This paper reviews the pharmacology of indapamide 1.5 mg SR from the bench to the bedside. Indapamide has a dual mechanism of action: diuretic effect at the level of the distal tubule in the kidney and a direct vascular effect, both of which contribute to the antihypertensive efficacy of the drug. The SR formulation contains a hydrophilic matrix, which delivers a smoother pharmacokinetic profile. This avoids unnecessary plasma peak concentrations, which may be associated with side effects. Indapamide SR has now been extensively used in hypertensive patients, including those at increased risk, for example elderly or diabetic patients. It has been shown to decrease BP, particularly SBP, with 24-h efficacy, allowing a once-daily dosage. Studies have demonstrated BP lowering to be at least as effective as all major therapeutic classes including the more recent antihypertensive drugs. Beyond BP decrease, indapamide SR has also been shown to protect against hypertensive target-organ damage in the heart and the kidney and to have a favorable metabolic profile. A broad evidence-base has accumulated to support the benefit of indapamide 1.5 mg SR in hypertensive patients, alone or as part of combination therapy, as recommended by the majority of guidelines.