高血压无左室肥厚患者舒张功能改变的观察

目的：探讨高血压无左室肥厚患者舒张功能的改变。方法：高血压无左室肥厚患者、高血压伴左室肥厚患者与正常血压者各４０例,均进行超声心动图检查和动态血压检测。结果：高血压伴左室肥厚组、高血压无左室肥厚组与正常对照组比较,二尖瓣血流Ｅ峰、Ａ峰、Ｅ／Ａ比率、等容舒张时间及舒张早期减速度均有明显差异（Ｐ＜００５,Ｐ＜００１）,而高血压左室肥厚组与高血压无左室肥厚组两组间,则无明显差异（Ｐ＞００５）。３个组的左室射血分数（ＥＦ）无明显差异（Ｐ＞００５）。动态血压监测显示,高血压左室肥厚组与高血压无左室肥厚组２４ｈ平均收缩压和舒张压、白昼平均收缩压和舒张压、血压负荷有显著差异（Ｐ＜００５,Ｐ＜０．０１）,而夜间平均收缩压、舒张压无显著差异（Ｐ＞００５）。结论：高血压患者在出现左室肥厚前可出现舒张功能异常,可能与夜间血压持续升高有关。     

Meditation training and essential hypertension: A methodological study

Meditation training appears to be a promising psychological approach to the control of hypertension. However, most studies to date have had serious deficiencies. This study attempted to correct many of these deficiencies. Forty-one unmedicated hypertensives referred by general practitioners were randomly allocated to three groups. The treatment group (SRELAX) underwent training procedures based on Transcendental Meditation; a placebo control group (NSRELAX) underwent identical training but without a mantra. Both procedures were compared with a no-treatment control group. The results showed modest reductions in blood pressure in both SRELAX and NSRELAX groups, compared with the no-treatment controls, with diastolic percentage reductions reaching significance (p<0.05). There was considerable subject variation in response, with overall a mean decline in diastolic blood pressure of 8–10% on 3-month follow-up. Possible indicators to predict the response of subjects are considered and reasons for the similarity in the effectiveness of the SRELAX and NSRELAX conditions are discussed.This research was funded by a grant from the Auckland Medical Research Foundation.     

The effect of adjunct questions on older adults' recall of information from a patient education booklet

The effect of adjunct questions on the amount of information retained from the reading of a patient education booklet was investigated experimentally. Ninety older adults (mean age 77 years) were assigned randomly to a treatment, treatment control or non-treatment control group, 30 in each. The treatment condition was established by having subjects spend 30 min with a booklet about post-operative eye care. The booklet included four sets of review questions. The treatment control group spent the same period with a booklet which was identical apart from the questions. Knowledge of eye care was measured using a checklist scored on the basis of responses secured in a standardised interview. Although the two treatment groups decisively outperformed the control group on the measure, no effect attributable to the adjunct questions was detected. Factors which might account for this outcome are discussed. Directions for further research and implications for practice are indicated.     

社区高血压管理效果及影响因素分析

目的 研究社区高血压患者管理效果及其影响因素。方法 选择南充市顺庆区8个社区卫生服务中心进行调查和研究,随机抽取在管的社区高血压患者共5614人,观察社区高血压的控制效果及其影响因素。结果 本研究社区高血压患者共5614人,血压控制标准3035人,控制不标准2579人,血压控制率为54.06%。实行规范管理的高血压患者血压控制率高于一般管理的患者（P＜0.05）;血压控制标准的平均年龄高于血压控制不标准的平均年龄（P＜0.05）,但血压控制率与性别无关（P＞0.05）;对于规范管理的高血压患者,病情越重,血压越容易控制（P＜0.05）;有良好生活方式较有不良生活方式的患者血压易于控制（P＜0.05）;患者服药种类会影响血压的控制,但差异无统计学意义（P＞0.05）;高血压患者就医治疗频率越高,血压的控制率就越高。结论 对于所有的社区高血压患者一定要实施规范化管理,提高患者高血压知识的普及,重视各种并发症的防治,及时就医治疗,对于社区高血压的控制有积极的作用。     

The effects of calcium supplementation on ambulatory blood pressure in African-American adolescents.

This longitudinal trial investigated the effects of calcium supplementation on the mean 24-hour blood pressure in African-American adolescents. Subjects were self-identified African-American adolescents from a high school in a suburb of Los Angeles, California. The subjects were randomly placed in a placebo or treatment group (placebo versus 1.5 g of calcium/day x 4 weeks). Follow-up mean 24-hour ambulatory blood pressure (ABP) for both the treatment and control groups was lower than the baseline mean 24-hour ABP. In the treatment group, there was a decrease of 2.2 mm Hg in the mean systolic blood pressure and 0.7 mm Hg in the diastolic blood pressure. Relative to the placebo group, the net change in ABP was -1.7 mm Hg for systolic blood pressure and -0.5 mm Hg for the diastolic blood pressure. There was no statistically significant effect of calcium supplementation on the 24-hour mean ABP. The net effect of supplementation on ABP during waking and sleeping hours also was not significant.     

Understanding of blood pressure by people with type 2 diabetes: a primary care focus group study

BACKGROUND: For many people with type 2 diabetes most care is provided in primary care. While people with both diabetes and hypertension are at increased risk of complications, little is known about their understanding of blood pressure. AIM: To explore the understanding and beliefs about the importance of blood pressure held by people with type 2 diabetes. DESIGN OF STUDY: Framework analysis of qualitative research using focus groups. SETTING: Thirty-two participants were recruited from four general practices and a religious meeting group in Nottingham. Discussions took place in five community centres providing familiar surroundings for participants. METHOD: In order to get views expressed fully, white, Asian, and African-Caribbean participants met in five separate groups. Facilitators were fluent in the appropriate language and one member of the research team was present at all focus groups. RESULTS: Some participants, including those with raised blood pressure, were not aware of the increased importance of achieving good blood pressure control. No participants mentioned the increased risk of eye or kidney disease as a result of the combination of diabetes and raised blood pressure. Participants' perceptions regarding the control of blood sugar and blood pressure were different: blood sugar control was seen as their responsibility but blood pressure control was seen as the responsibility of the doctor. There was scepticism regarding the diagnosis of raised blood pressure, of targets and the management of blood pressure. There was also scepticism about the advice and education about diabetes given in primary care. CONCLUSIONS: People with type 2 diabetes require more knowledge of the increased risks they have from raised blood pressure, although this alone is unlikely to improve blood-pressure control. Strategies to increase the degree of control over and responsibility taken for the control of blood pressure need development and may require the specific development of participatory and negotiating skills among people with type 2 diabetes. Increasing the participation of these people in their own care will require doctors and nurses to work in a different way.     

Study on the effectiveness of remote mental healing

A study which involved eight healers and ninety-six patients was conducted to determine the effectiveness of remote mental healing. The test subjects were hypertension patients between the ages of sixteen and sixty. Neither the doctor nor the patients knew who received the mental healing treatments. Normal medical treatment was continued in all cases. Improvement was judged by changes in the diastolic blood pressure, systolic blood pressure, heart beat rate, and weight.The statistical analysis showed a significant improvement in the systolic blood pressure of the healer-treated group compared with the change in the control group. There were no significant differences in the changes of diastolic blood pressure, pulse, and weight of the two groups. Four of the healers had a 92.3 per cent improvement ratio in their total group of patients compared with a 73.7 per cent improvement for the control group.The general healing treatment used by the healers involved (a) a relaxation step, (b) attunement with a Higher Power or Infinite Being, (c) a visualization and/or affirmation of the patient being in a state of perfect health, and (d) expression of thanks to God or to the Source of all power and energy.     

壮侗语族族群高血压现况及其生化指标值分析

目的 探讨中国壮侗语族族群高血压患病率及生化指标的特点。 方法 对壮侗语族5个族群7411例（男性3248例，女性4163例）进行血压测量及生化指标检测。 结果 壮侗语族各族群之间高血压患病率差异具有统计学意义。壮侗语族族群同年龄组男性高血压患病率高于女性，男性、女性收缩压、舒张压均随年龄增长而升高，高血压患病率也随年龄增长而升高。壮侗语族族群男性甘油三酯、胆固醇、低密度脂蛋白均值均低于女性。高血压患者血尿酸、血尿素、血脂均值明显高于血压正常者，高血压患者与血压正常者胆红素、血清蛋白均值接近，高血压患者血脂均值多超出正常范围。 结论 壮侗语族族群高血压患病率较高，高血压患者要注意自身血尿酸、血尿素、血脂的增高。     

社区一体化分级管理模式对社区老年高血压患者的管理效果

目的 观察一体化分级管理模式对社区老年高血压患者的管理效果,验证其可行性。方法 回顾性分析2015年11月~2017年8月96例社区老年高血压患者的临床资料,将患者细化为三个管理组:低危组、中危组、高危/很高危组。对所有患者进行为期5个月的社区一体化分级管理,比较管理前后患者血压控制情况、遵医嘱服药情况、运动情况与自我管理情况。结果 干预前患者96例,干预后90例,脱落6例,干预前血压控制率为35.40%,干预后为96.71%,差异有统计学意义（P＜0.05）;低危、中危、高危/很高危三组患者经干预后收缩压、舒张压与干预前相比较,均有所改善,差异有统计学意义（P＜0.05）;三组患者干预前后自我管理能力均有所提升,差异有统计学意义（P＜0.05）。结论 对社区老年高血压患者实施社区一体化分级管理模式,能够显著改善患者血压控制效果,强化患者自我管理能力,有助于改善患者生活质量。     

Effects of education and relaxation training with essential hypertension patients

Thirty subjects with essential hypertension were assigned randomly to either a no treatment control, education, or education with relaxation training group. Independent blood pressure recordings were collected by medical staff at pretest, posttest, and 8-week follow-up. Results suggest a significant interaction between treatment and time for the dependent physiological measure, systolic blood pressure. During the pretest to follow-up period, the control group averaged a 5.9 mm. Hg. increase, the education with relaxation group an 8.8 mm. Hg. decrease, and the education group a 14.9 mm. Hg. decrease in systolic blood pressure. There was no significant difference in group means for diastolic blood pressure within groups over time. As measured at follow-up, education appeared more effective in reducing systolic blood pressure than education with relaxation training. More than one-third of subjects associated unpleasant side effects with their antihypertensive medication. Almost all treatment subjects rated the education and relaxation as helpful for understanding and managing their hypertension.     

The RAMBLER study: the role of ambulatory blood pressure measurement in routine clinical practice: a cross-sectional study

Ambulatory blood pressure measurement (ABPM) is a useful and important way of guiding clinical decisions in the diagnosis and treatment of hypertension. There has been little research on how ABPM is actually used in the community where hypertension is mainly diagnosed and managed. We aimed to review the use of ABPM in daily community practice in terms of patient demographics, changes in pharmaceutical treatment and the proportion of patients achieving recommended levels. Six practices using the dabI device for ABPM participated in this cross-sectional study. Patients who had the ABPM performed over the preceding 12 months were included. We recorded demographic details, pre- and post-ABPM clinic blood pressure measurements, the ABPM result and treatment before and after the test. 381 patients were included in the study, of whom 38.6% were male. The mean age was 58 years (SD= 14) and 46.7% were GMS eligible. 33.8%/ had a normal BP result on ABPM. There was a statistically significant reduction in both the mean systolic pressure(10.4 mmHg, CI 7.2-12.9, P<0.001) and diastolic pressure (5.1 mmHg, CI 3.2-6.6, P< 0.05) between the pre and the post-ABPM clinic measurements. It was found that 38.1% had a change in their medication after the test, with 31.7% having a new medication started. This pragmatic study provides information about the use of ABPM in routine general practice in Ireland. ABPM readings appear to have an impact on General Practitioners' decision- making and on the medical management of hypertensive patients in the community.     

Management of hypertension in twelve Oxfordshire general practices

The general practice records of 2371 hypertensive patients on drug therapy in 12 practices were reviewed retrospectively. It was found that the mean systolic blood pressure of the patients had fallen by 29 mmHg and the mean diastolic pressure by 16 mmHg after one year of treatment and that there was a further reduction of 5 mmHg in the systolic pressure and 5 mmHg in the diastolic pressure at the most recent recording of blood pressure. Half of the patients had only a single blood pressure reading recorded before treatment was started and for 56% of the patients there was no record of smoking habit and for 69% no record of weight. Twenty-seven per cent of the patients suffered from mild hypertension, that is blood pressure less than 180/110 mmHg, and 56% were over 65 years of age. These results indicate the need for policies for selection of patients for treatment and for standards of recording. It is suggested that practices should review their results and undertake to treat elderly hypertensive patients and those with mild hypertension only when they can demonstrate that their policies are effective for young hypertensive patients and for those with moderate or severe hypertension.     

吸烟对动态血压及动脉硬化指数影响的相关性分析

目的 分析吸烟对动态血压及动脉硬化指数影响的相关性。方法 选取四会万隆医院心内科2018年1月~12月收治的120例高血压患者设为观察组,另选同期120例健康体检者为对照组,分别比较观察组与对照组、观察组内吸烟患者与不吸烟患者动态血压（24h平均收缩压、24h平均舒张压）、动脉硬化指数,并使用Pearson相关性分析法对其相关性进行检验。结果 观察组24h平均收缩压（134.65±2.10）mmHg、24h平均舒张压（86.20±2.45）mmHg、动脉硬化指数（0.67±0.05）,分别高于对照组的（117.45±2.35）mmHg、（75.25±2.70）mmHg、（0.52±0.03）,差异有统计学意义（P＜0.05）;观察组吸烟患者24h平均收缩压（137.21±2.40）mmHg、24h平均舒张压（90.20±2.35）mmHg、动脉硬化指数（0.75±0.05）,高于不吸烟患者的（132.48±2.32）mmHg、（82.49±2.41）mmHg、（0.61±0.08）,差异有统计学意义（P＜0.05）;Pearson相关性分析结果提示,吸烟与动态血压及动脉硬化指数呈正相关性（r=0.68、0.85,P＜0.05）。结论 吸烟与动态血压及动脉性硬化指数之间存在着密切的关联性,戒烟有助于遏制高血压及动脉粥样硬化的进一步恶化。     

血液灌流联合血液透析治疗肾功能衰竭难治性高血压的效果

目的 探讨血液灌流联合血液透析对肾功能衰竭难治性高血压的治疗效果。方法 选取2017年10月~2019年2月我院收治的肾功能衰竭难治性高血压患者168例,随机分为对照组和研究组,每组84例。对照组应用血液透析治疗,研究组应用血液灌流联合血液透析治疗,比较两组治疗前后血压改善情况、肾素（PRA）、血管紧张素Ⅱ（ATⅡ）水平变化。结果 治疗后,两组收缩压、舒张压、平均动脉压均低于治疗前,差异有统计学意义（P＜0.05）;研究组收缩压、舒张压、平均动脉压均低于对照组[（145.37±14.54）mmHg vs（185.25±18.46）mmHg]、[（76.26±5.72）mmHg vs（107.51±9.27）mmHg]、[（100.47±9.39）mmHg vs（143.52±11.74）mmHg],差异有统计学意义（P＜0.05）。治疗后,两组PRA、ATⅡ水平均低于治疗前,差异有统计学意义（P＜0.05）;研究组PRA、ATⅡ水平低于对照组[（1.05±0.36）ng/L vs（1.88±0.57）ng/L]、[（91.31±13.47）ng/L vs（170.54±20.66）ng/L],差异有统计学意义（P＜0.05）。结论 血液灌流联合血液透析治疗肾功能衰竭难治性高血压效果理想,可有效控制高血压症状,改善患者PRA、ATⅡ水平。     

Cardiovascular Responses to Emotional Stress (Quiz Interview) in Post-Myocardial Infarction Patients and Matched Control Subjects

Abstract

In this investigation, 30 male post-myocardial infarction patients and 30 male control subjects matched according to age and occupation were given a 12-minute tape-recorded stress quiz described by Schiffer et al.' Cardiovascular responses (electrocardiogram, heart rate, systolic, blood pressure, and diastolic blood pressure) to emotional stimuli were monitored in a laboratory setting at rest before the quiz and at two-minute intervals during the quiz. Heart rate and blood pressure values were significantly higher during the quiz than at rest for both patient and control groups. There was a significantly higher response for diastolic pressure and a significantly lower response for heart rate in the patient group compared with the control group. In the analysis for occupational status in the entire population, systolic pressure was significantly higher for the executives than for non-executives. Subgroup analyses of patients with angina, hypertension and/or ECG changes (N=12) revealed a significantly higher diastolic pressure response than found in either the patients without these symptoms (N=18) or in the controls (N=30). In comparison to exercise test results, the emotional stress test (quiz) elicited somewhat more PVC's but less ST segment depression. These results support previous reports suggesting that emotional stress testing may be a valid tool in the diagnosis of coronary heart disease and in determining the physiological mechanisms which underlie the association between emotional stress and coronary heart disease.     

The management of hypertension — a survey of opinions among general practitioners

In order to clarify current opinion on aspects of the management of hypertension, a postal questionnaire was sent to all 420 general practitioners in the Lothian Health Board Area. Three hundred and nine doctors (74 per cent) replied.

A high proportion were willing to undertake the investigation and follow-up of most hypertensive patients in general practice but there were conflicting opinions on the use of Phase 4 and Phase 5 in the measurement of blood pressure, the number and type of investigations which were appropriate, the level of diastolic blood pressure at which treatment should begin, and the level to which the diastolic blood pressure should be reduced with treatment.

     

Impact on hypertension control of a patient-held guideline: a randomised controlled trial

BACKGROUND: Hypertension is generally poorly controlled in primary care. One possible intervention for improving control is the harnessing of patient expertise through education and encouragement to challenge their care. AIM: To determine whether encouraging patients to manage their hypertension in an 'expert' manner, by providing them with information in a clear clinical guideline, coupled with an explicit exhortation to become involved in and to challenge their own care if appropriate, would improve their care. DESIGN OF STUDY: Single blind randomised controlled trial of detailed guideline versus standard information. SETTING: Single urban general practice over 1 year. METHOD: Patient-held guideline with written explicit exhortation to challenge care when appropriate. Two hundred and ninety-four of 536 eligible patients on the practice hypertension register were recruited, all of whom were randomised into one of two groups. Two hundred and thirty-six patients completed the study. RESULTS: Primary outcome: average systolic blood pressure. Secondary outcomes: proportion of patients with blood pressure < 150 mmHg systolic and < 90 mmHg diastolic, average cholesterol, proportion of patients prescribed statins and aspirin according to guideline, hospital anxiety and depression score. No clinically, or statistically significant differences were found between intervention and control with respect to all parameters or in anxiety and depression levels. Statin and aspirin use improved throughout the course of the study in both groups. Statin use showed a trend (P = 0.02) in favour of control. CONCLUSION: In this study there was no clinically significant perceived benefit to patients as a result of providing them with a hypertension guideline. Patient guidelines are currently planned for many chronic illnesses. It is important to determine the utility of such interventions before scarce resources are applied to them.     

Relaxation behavior therapy as sole treatment for mild hypertension.

This study tested the efficacy of relaxation therapy as sole treatment for mild hypertension in 110 men and women recruited from a five-stage worksite blood pressure screening program. Participants were randomized to 12-weeks of relaxation therapy or support therapy. Outcome blood pressure assessments made by assessors who were unaware of group allocation revealed similar decreases in both treatment groups at post-treatment and 6-month follow-up. While body weight did not change, alcohol consumption decreased similarly in both groups, and alcohol consumption was positively correlated with both absolute diastolic blood pressure and change in diastolic blood pressure at outcome. In conclusion, a superior blood pressure effect was not associated with relaxation therapy; however, alcohol consumption decreased in both treatment groups, suggesting that both interventions facilitated changes in health risk behaviors and indirectly on blood pressure level.     

Telmisartan prevents high-fat diet-induced hypertension and decreases perirenal fat in rats

We sought to investigate the effects of telmisartan on high-fat diet-induced hypertension and to explore the possible underlying mechanisms.Rats receiving high-fat diet were randomly divided into two groups,the telmisartan group(n = 9) and the high-fat diet group(n = 10).The control group consisted of age-matched rats on a regular diet(n = 10).At the end of the treatment,the body weight,blood pressure,insulin sensitivity and serum adiponectin levels of all rats were examined,and their visceral fat was extracted and weighed.Our results showed that telmisartan improved insulin resistance and dyslipidemia and increased serum adiponectin levels.Telmisartan also lowered both systolic blood pressure and diastolic blood pressure,and decreased the accumulation of perirenal fat associated with high-fat diet.Furthermore,telmisartan increased adiponectin mRNA expression in the perirenal fat.Correlation analysis showed that both systolic blood pressure and diastolic blood pressure were positively correlated with perirenal fat.These effects of telmisartan may be mediated through decreases in perirenal fat and contributed to the improvement of perirenal fat function.Our findings suggested a strong link between perirenal fat and high-fat diet-induced hypertension,and identified telmisartan as a potential drug for the treatment of obesity-related hypertension.