左旋氨氯地平的临床疗效与生物学特性

目的 通过观察手性药物左旋氨氯地平在治疗轻、中度高血压的临床疗效,分析手性药物的生物学特性.方法 入选62例轻、中度高血压患者,随机分为左旋氨氯地平治疗组30例,氨氯地平治疗组32例,观察8周后两组血压变化及不良反应情况.结果 左旋氨氯地平治疗轻、中度高血压的总有效率为86.7％,氨氯地平的总有效率为87.5％,无显著性差异,但不良反应方面,左旋氨氯地平低于氨氯地平.结论 手性药左旋氨氯地平是高效、安全的抗高血压药.氨氯地平的有效活性成分是其左旋异构体.     

氨氯地平联合卡托普利治疗原发性高血压疗效观察

目的 观察氨氯地平联合卡托普利治疗原发性高血压的效果.方法 本研究选2007年1月1日-2009年12月31日3年内的高血压患者100例,随机平分为A、B两组,A组给予氨氯地平片口服降血压,B组在A组基础上加用卡托普利治疗高血压,治疗一个月后观察两组患者的血压控制情况,并对结果进行分析.结果 A组50例患者有效例数为38例(76.00%);B组50例患者有效例数为48例(96.00%),两组患者有效率比较,差别有统计学意义(P＜0.05);A组有并发症5例,头晕头痛1例,面色潮红1例,咳嗽2例,心悸1例.B组有并发症6例,头晕头痛1例,面色潮红1例,咳嗽3例,心悸1例.两组患者并发症比较,差别无统计学意义(P＞0.05).结论 氨氯地平联合卡托普利治疗原发性高血压能取得较好的效果,有一定的临床推广应用.     

氨氯地平联合卡托普利治疗原发性高血压疗效观察

目的观察氨氯地平联合卡托普利治疗原发性高血压的效果。方法本研究选2007年1月1日-2009年12月31日3年内的高血压患者100例,随机平分为A、B两组,A组给予氨氯地平片口服降血压,B组在A组基础上加用卡托普利治疗高血压,治疗一个月后观察两组患者的血压控制情况,并对结果进行分析。结果 A组50例患者有效例数为38例（76.00%）;B组50例患者有效例数为48例（96.00%）,两组患者有效率比较,差别有统计学意义（P〈0.05）;A组有并发症5例,头晕头痛1例,面色潮红1例,咳嗽2例,心悸1例。B组有并发症6例,头晕头痛1例,面色潮红1例,咳嗽3例,心悸1例。两组患者并发症比较,差别无统计学意义（P〉0.05）。结论氨氯地平联合卡托普利治疗原发性高血压能取得较好的效果,有一定的临床推广应用。     

左旋氨氯地平和氨氯地平治疗轻中度高血压临床效果观察

目的 观察左旋氨氯地平和氨氯地平治疗轻中度高血压临床效果。方法 选择2017年3月~2018年3月天津市第三中心医院收治的轻中度高血压患者90例,采用随机数字表法将其分为观察组和对照组,各45例,观察组患者采用左旋氨氯地平进行治疗,对照组患者采用氨氯地平治疗,比较两组患者血压变化和不良反应情况。结果 治疗后观察组患者的收缩压和舒张压分别为（118.27±7.23）mmHg、（76.38±4.25）mmHg,低于对照组的（130.43±11.45）mmHg、（84.69±6.42）mmHg,差异有统计学意义（P＜0.05）;观察组患者的不良反应发生率（11.11%）低于对照组（20.00%）,差异有统计学意义（P＜0.05）。结论 采用左旋氨氯地平治疗轻中度高血压患者,临床疗效优于氨氯地平,能够改善和稳定患者的收缩压和舒张压指标,且安全性更高。     

苯磺酸左旋氨氯地平治疗老年高血压疗效观察

目的 观察苯磺酸左旋氨氯地平治疗老年高血压病的临床疗效.方法 给予42例老年高血压患者服用苯磺酸左旋氨氯地平2.5-5mg/d,每日1次,共10周.结果 治疗10周后,血压由(169.0±10.1)/(1 01.0±10.3)mm Hg下降至(138.5±8.9)/(83.5±6.3)nm Hg.显效率为57.14%(24/42)有效率为28.57%(12/42),无效率为9.52%(4/42).结论 苯磺酸左旋氨氯地平治疗老年高血压取得较理想降压效果的同时,对心率、血脂、血糖、肾功能均无明显影响.是治疗老年高血压病较为理想的药物.     

左旋氨氯地平合用辛伐他汀治疗原发性高血压的疗效观察

目的观察左旋氨氯地平合用辛伐他汀治疗原发性高血压的疗效。方法原发性高血压60例,随机分为对照组（左旋氨氯地平）和观察组（左旋氨氟地平＋辛伐他汀）,疗程为2个月。分别在用药后动态监测血压和不良反应。结果治疗2个月后两组患者血压均显著下降,观察组降压更明显,两组降压幅度比较差异有统计学意义（P〈0．05）。降压疗效总有效率对照组为70％,观察组为82％,两组比较差异有统计学意义（P〈0．05）。结论左旋氨氯地平合用辛伐他汀有协同降压作用,降压幅度较单用左旋氨氯地平高。     

联合用药治疗妊高征的临床疗效观察

目的观察硫酸镁、左旋氨氯地平联合用药治疗妊娠高血压综合征的临床疗效。方法选择我科接收治疗的126例妊高征患者为研究对象,试验组(63例,采用硫酸镁静脉滴注),对照组(63例,硫酸镁+左旋氨氯地平);比较两组患者治疗后的顺产率、并发症发生率。结果试验组顺产率高于对照组(P=0.02);并发症发生率低于对照组(P=0.03),具有统计学意义。结论联合用药治疗妊娠高血压综合征临床疗效显著,并发症少,在临床治疗中值得推广应用。     

左旋氨氯地平治疗老年高血压伴抑郁情绪的临床疗效

目的研究老年高血压患者同时出现抑郁情绪时运用左旋氨氯地平治疗的临床效果。方法我院选择92例老年高血压伴有抑郁情绪的患者,同时选择92例患有老年高血压但未出现抑郁情绪的患者,比较两组患者治疗前后的血压以及SDS评分变化,对不良反应进行比较。结果两组患者降压的总有效率、降压幅度以及SDS评分未见明显差异,无统计学意义(t=1.254,P0.05),两组患者的SDS评分均未见明显下降,同时未见有不良反应。结论老年高血压伴抑郁情绪的患者运用左旋氨氯地平治疗的临床效果较为显著,用药后很少出现不良反应。     

高血压患者胰岛素抵抗的探讨

近年来许多研究表明,高血压患者存在高胰岛素血症和胰岛素抵抗。但未见报道高血压患者与C肽的关系。本文对38例非糖尿病高血压患者糖耐量、胰岛素释放试验、C肽释放试验等实验室资料进行研究,以探讨高血压患者胰岛素抵抗的情况。     

观察二甲双胍在治疗甲状腺结节伴胰岛素抵抗中的作用

目的：探究分析对甲状腺良性结节并伴有胰岛素抵抗的患者采用二甲双胍进行治疗的临床效果。方法选取我院2011年10月~2013年10月接收治疗的42例甲状腺结节伴有胰岛素抵抗的患者作为临床研究对象,根据患者治疗方式分为观察组和对照组,各21例,对照组给予左旋甲状腺素,观察组给予左旋甲状腺素联合二甲双胍治疗。结果观察组患者的甲状腺结节体积明显小于对照组(<0.05);治疗后,观察组患者的FT3、FT4以及TSH明显优于对照组(<0.05);观察组患者的HMOA-IR明显低于对照组(<0.05)。结论对甲状腺结节伴胰岛素抵抗患者采取二甲双胍联合左旋甲状腺素治疗,能够有效缩小患者的甲状腺小结节,降低患者的血TSH水平,值得临床推广。     

高血压病患者不同左室构型与胰岛素抵抗的相关性

目的探讨高血压患者胰岛素抵抗对左室构型的影响。方法对高血压组164例进行常规心脏超声、空腹葡萄糖（FBG）、空腹胰岛素（FIN）、血脂检查。采用胰岛素敏感指数（HOMA-IR）作为评价胰岛素抵抗指标,按Gnanu分类法将高血压组划分为正常构型、向心性重构组、向心性肥厚组和离心性肥厚组。采用组间比较、相关性分析等统计学方法进行评价。结果高血压患者按左室重量指数（LVMI）分组,两组间空腹胰岛素及胰岛素抵抗差异无统计学意义（P〉0.05）;但按相对室壁厚度（RWT）分组,空腹胰岛素及胰岛素抵抗差异具有统计学意义（P〈0.05）。并且向心性重构组和向心性肥厚组明显高于正常构型组（P〈0.05）,而离心性肥厚组与正常构型组比较差异无统计学意义（P〉0.05）。逐步回归分析显示LVMI与体重指数、收缩压和舒张压呈正相关（P〈0.05～P〈0.01）,RWT与HOMA-IR呈负相关（P〈0.05）。结论胰岛素抵抗可能是高血压患者合并左室肥厚的重要影响因素之一,改善胰岛素抵抗有利于高血压患者左室肥厚的防治。     

A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension

It has been suggested that the metabolic side effects of antihypertensive drugs are responsible for their failure to reduce cardiovascular morbidity in patients with hypertension. Therefore, in 50 patients with essential hypertension, we performed a randomized, double-blind, crossover study comparing the effects of carbohydrate and lipid metabolism of captopril (mean [+/- SD] dose, 81 +/- 24 mg per day) and hydrochlorothiazide (40 +/- 12 mg per day) over two four-month treatment periods. Captopril increased the insulin-mediated disposal of glucose, as compared with placebo, from 5.7 +/- 2.4 to 6.3 +/- 2.5 mg per kilogram of body weight per minute (P less than 0.05), whereas hydrochlorothiazide caused a decrease from 6.4 +/- 2.0 to 5.7 +/- 1.9 (P less than 0.01). Captopril had no effect on the basal insulin concentration, but it decreased the late (30- to 90-minute) insulin response to glucose and increased the early (2- to 6-minute) insulin peak. Hydrochlorothiazide increased the basal insulin concentration and the late insulin response to glucose. These findings may be explained by an increase in insulin sensitivity with captopril and a decrease with hydrochlorothiazide. Little or no change was seen in serum lipid or lipoprotein levels during treatment with captopril, whereas hydrochlorothiazide caused significant increases in serum total (5 percent) and low-density lipoprotein (6 percent) cholesterol levels and total (15 percent) and very-low-density lipoprotein (25 percent) triglyceride levels, as compared with placebo (P less than 0.01 for all comparisons). We conclude that hydrochlorothiazide for the treatment of essential hypertension has adverse effects on glucose and lipid metabolism. It is possible, but not proved in this study, that these changes may contribute to the risk for diabetes mellitus and coronary heart disease. In contrast, captopril appears to have beneficial or no effects on glucose and lipid metabolism.     

原发性高血压与高胰岛素血症

本文对３２例不伴糖尿病的原发性高血压（ＥＨ）患者及２０名对照组进行口服葡萄糖耐量试验（ＯＧＴＴ），同时测定血糖、胰岛素、Ｃ肽、胆固醇及甘油三酯水平，结果提示ＥＨ患者存在糖而时减低（４６．７％），高脂血症（５０％）、肥胖（４３．８％）、高胰岛素血症（ＨＩＳ）及胰岛素抵抗（ＩＳＲ），ＩＳＲ可有在这些代谢中起主导作用，故认为高血压病不单纯是血压升高，而量一种代谢性疾病，治疗上也不应是单纯地控制高血压，而     

原发性高血压和冠心病患者胰岛素和C-肽的临床观察

目的：观察原发性高血压（EH）和冠心病（CHD）患者的胰岛素抵抗及其差异。方法：检测原发性高血压（EH）52例,冠心病（CHD）47例和健康对照组35例的空腹和服糖2h后胰岛素和C-肽,并进行比较。结果：原发性高血压病人和冠心病人空腹及服糖后2h血糖、胰岛素和C-肽明显高于正常健康人（P〈0.01）。结论：原发性高血压和冠心病患者存在胰岛素抵抗、高胰岛素血症、高C-肽水平。     

Captopril in various forms of severe therapy-resistant hypertension

Summary In this study 51 patients with severe hypertension (20 essential, 15 renovascular and 16 renalparenchymatous) resistant to a standardized triple therapy were treated with the oral converting enzyme inhibitor captopril. Mean treatment period was 8.6 in essential, 8.9 in renovascular and 9.9 months in renalparenchymatous hypertension.In each of the 3 groups a marked and sustained blood pressure reduction was observed promptly after introducing captopril. However, absolute fall in mean blood pressure as well as individual blood pressure response were more pronounced in renovascular than in essential and in renalparenchymatous hypertension demonstrating a higher blood pressure lowering activity of the converting enzyme inhibitor in the former.In addition, our results document that monotherapy with captopril was rather the exception than the rule. More than 90% of all patients required at least the addition of a diuretic and even a substantial percentage of patients needed as a third drug a betablocker (50% in essential, 38% in renalparenchymatous and 26% in renovascular hypertension).As expected renin activity increased under captopril whereas plasma aldosterone and converting enzyme activity decreased.Side-effects (skin rash, pruritus, supraventricular extrasystoles, tachycardia, water and fluid retention, Raynaud-phenomenon, incomplete and complete taste loss and leucopenia) occurred in 17.6% (n=9) of the 51 patients.Our results show that captopril is a potent blood pressure lowering agent in severe and therapy resistant hypertension. The vast majority of patients, however, required concomitant therapy with a diuretic and/or a betablocker. Finally, the frequency of drug induced side-effects necessitates a close and careful monitoring of all patients.     

妊娠期糖尿病患者并发高血压与胰岛素抵抗的关系

目的：探讨妊娠期糖尿病患者并发高血压与其胰岛素敏感性的关系。方法：血糖筛查阳性孕妇95例分为高血压疾病组和血压正常组,口服葡萄糖耐量试验后,比较2组孕妇血糖BG1、BG2、BG3、空腹胰岛素测定值及胰岛素敏感性,并以健康体检合格孕妇85名为对照组。结果：高血压疾病组空腹血糖、服糖1、2．3h后的血糖、空腹胰岛素测定值均高于血压正常组和对照组,差异有显著性（P〈0．05）,胰岛素敏感指数降低高于血压正常组及对照组（P〈0．05）。结论：妊娠期糖尿病患者存在明显的胰岛素抵抗,其晚期发生妊高征的可能性较大。     

Sustained antihypertensive effect of captopril combined with diuretics and beta-adrenergic blocking drugs in patients with resistant hypertension

Ten patients with severe hypertension and unsatisfactory blood pressure control during combined therapy with beta-adrenergic blocking drugs, diuretics, and vasodilators were treated with gradually increasing doses of captopril. Vasodilators were discontinued 24 hours prior to captopril administration. Six patients had essential, two renal, and two renovascular hypertension. Mild renal impairment was observed in four patients. Captopril effectively decreased blood pressure for 3 hours in all patients after the first dose. The antihypertensive effect appeared to be triphasic and was sustained in all but one patient during 12 months of observation. Captopril doses of 25-75 mg t.i.d. were sufficient to achieve acceptable blood pressure control (RR less than or equal to 160/100 mmHg) when given in the above mentioned combination. Side-effects were few and tolerable and discontinuation of captopril was not required.     

Insulin resistance in Nigerians with essential hypertension

Background

Reports on the association between hypertension and insulin resistance have been inconsistent even though most studies show a definite association. It is also not certain if the association between insulin resistance and hypertension applies to all populations.

Objective

To determine the prevalence of insulin resistance in hypertensive Nigerians and to examine the association of insulin resistance with hypertension and some anthropometric indices.

Methods

Thirty five adults with essential hypertension and thirty five normotensives were studied. Anthropometric parameters, blood pressure, fasting glucose and insulin were measured. Homeostasis model assessment (HOMA) was used to determine insulin resistance (IR).

Results

The hypertensive subjects had significantly higher fasting insulin and HOMA-IR compared with normotensives (p =0.02 and 0.04) respectively. There were significant correlations between HOMA-IR, BMI, waist and hip circumference in subjects with hypertension. At multiple linear regression, hypertension and body mass index were found to be the only significant predictors of insulin resistance.

Conclusion

The hypertensives we studied had a higher occurrence of insulin resistance compared to the normotensives. This makes it necessary for persons with hypertensive to have regular screening for diabetes and other categories of glucose intolerance as the increased insulin increases their risk of developing type 2 diabetes mellitus.     

Minoxidil and captopril in severe hypertension

Summary The antihypertensive efficacy of minoxidil and captopril was compared in 23 males with essential or renal parenchymatous hypertension refractory to conventional antihypertensive drug therapy. Following a pretreatment period the patients were randomly assigned to receive either minoxidil, 2.5 mg twice daily (n=12), or captopril, 25 mg twice daily (n=11). In patients with diastolic blood pressure >95 mmHg, doses of minoxidil and captopril were increased in 2-week intervals. Patients who maintained diastolic pressure >95 mmHg and/or those with intolerable side effects were switched over to the alternative substance. After a mean observation period of 12 weeks a significant decrease in systolic and diastolic blood pressure was observed (179/114 vs 148/92 mmHg in the minoxidil group; 176/111 vs 158/97 mmHg in the captopril group). The primary response rate was 75% in patients treated with minoxidil and 55% in those with captopril (not significant). After the change to the alternative substance two of the four non-responders on captopril and one of the two non-responders on minoxidil became responders. Side effects occurred significantly more often during minoxidil than captopril (p<0.05). The high efficacy of minoxidil and captopril in the treatment of severe hypertension refractory to conventional drugs was confirmed. Minoxidil lowered blood pressure slightly more than captopril, but it had a higher incidence of side effects than captopril.     

Insulin resistance in essential hypertension

High blood pressure is prevalent in obesity and in diabetes, both conditions with insulin resistance. To test whether hypertension is associated with insulin resistance independently of obesity and glucose intolerance, we measured insulin sensitivity (using the euglycemic insulin-clamp technique), glucose turnover (using [3H]glucose isotope dilution), and whole-body glucose oxidation (using indirect calorimetry) in 13 young subjects (38 +/- 2 years [+/- SEM]) with untreated essential hypertension (165 +/- 6/112 +/- 3 mm Hg), normal body weight, and normal glucose tolerance. In the postabsorptive state, all measures of glucose metabolism were normal. During steady-state euglycemic hyperinsulinemia (about 60 microU per milliliter), hepatic glucose production and lipolysis were effectively suppressed, and glucose oxidation and potassium disposal were normally stimulated. However, total insulin-induced glucose uptake was markedly impaired (3.80 +/- 0.32 vs. 6.31 +/- 0.42 mg per minute per kilogram of body weight in 11 age- and weight-matched controls, P less than 0.001). Thus, reduced nonoxidative glucose disposal (glycogen synthesis and glycolysis) accounted for virtually all the defect in overall glucose uptake (1.19 +/- 0.24 vs. 3.34 +/- 0.44 mg per minute per kilogram, P less than 0.001). Total glucose uptake was inversely related to systolic or mean blood pressure (r = 0.76 for both, P less than 0.001). These results provide preliminary evidence that essential hypertension is an insulin-resistant state. We conclude that this insulin resistance involves glucose but not lipid or potassium metabolism, is located in peripheral tissues but not the liver, is limited to nonoxidative pathways of intracellular glucose disposal, and is directly correlated with the severity of hypertension.