高血压病病人动态脉压与早期肾脏损害的临床观察

目的　通过对高血压病人临床资料分析 ,探讨高血压病人动态脉压与早期肾脏损害的关系。方法　高血压病人 86例按动态脉压分为脉压 (4 0～ 60 )mmHg组 3 7例和脉压 >60mmHg组 49例。对入选者做以下检查 :2 4h动态血压监测 ,同时检测 2 4h尿 β2 -MG、尿mAlb、尿α1-MG、血 β2 -MG、血肌酐。结果 :脉压 >60mmHg组的反映肾小球滤过功能的指标血肌酐、血 β2 -MG、尿mAlb明显低于脉压 (4 0～ 60 )mmHg组 ,而脉压 >60mmHg组的肾小管重吸收功能指标尿 β2 -MG、尿α1-MG明显低于脉压 (4 0～ 60 )mmHg组。结论　高血压病人脉压增大 ,肾损害指标就增高。     

老年高血压患者动态脉压及脉压指数与尿白蛋白关系

目的 探讨老年高血压患者动态收缩压（SBP）、舒张压（DBP）、脉压（PP）和脉压指数（PPI）与尿白蛋白（ALB）的关系，评价PP和PPI在反映高血压患者早期肾损伤方面的价值。方法 用动态血压监测仪测量220例老年高血压患者的PP和PPI，按PPI≤40mmHg（51例）、41～60mmHg（71例）、61～80mmHg（66例）和〉80mmHg（32例）分为4组；按PPI≤0．40（54例）、0．41～0．50（75例）、0．51～0．60（62例）和〉0．60（29例）分为4组。采用免疫比浊法测定研究对象的尿ALB和血脂，比较各组尿ALB的水平。结果 各组间性别比、年龄、血脂异常均无显著性差异，随着PP、PPI的增加，尿ALB水平明显增高（P〈0．05）。经Spearman相关分析，PP和PPI与尿ALB水平的相关系数（r）值（0．416，0．483）大于SBP和DBP与尿ALB的r值（0．325，0．302）。结论 PP和PPI与尿ALB水平密切相关，其在反映高血压患者早期肾损伤的价值优于SBP和DBP。     

轻中度高血压患者早期肾损害与脉压的关系

目的:探讨轻中度高血压患者早期肾损害与脉压、脉压指数的关系。方法:100例轻中度高血压患者检测血、尿β_2-MG及尿白蛋白,同时计算脉压、脉压指数,根据有、无肾损害分组比较脉压、脉压指数差异;根据脉压、脉压指数分组比较血、尿β_2-MG及尿白蛋白含量。结果:高血压患者脉压>60mmHg组血β_2-MG 4.24±1.18 mg/L,尿β_2-MG 1.17±0.88 mg/L,尿白蛋白24.8±7.3 mg/L;脉压<60mmHg组血β_2-MG 2.56±1.34 mg/L,尿β_2-MG 0.42±0.10 mg/L,尿白蛋白18.3±4.7 mg/L,两组比较 P<0.05;脉压指数>0.6组血β_2-MG 4.56±1.23 mg/L,尿β_2-MG 1.09±0.56 mg/L,尿白蛋白25.3±4.5 mg/L;脉压指数<0.6组血β_2-MG2.49±1.09 mg/L,尿β_2-MG0.33±0.09 mg/L,尿白蛋白17.4±3.3 mg/L,两组比较P<0.05。结论:高血压患者随着PP和PPI的增大而出现肾损害的加重。     

老年高血压患者动态脉压指数与颈动脉内膜-中层厚度的相关性探讨

目的探讨动态脉压、脉压指数与颈动脉内膜-中层厚度的相关性。方法动态血压测量253例研究对象的动态脉压和脉压指数，按动态脉压≤40mmHg（59例）、4l-60mmHg（82例）、61-80mmHg（76例）及〉80mmHg（36例）分为4组；按动态脉雎指数≤0.40（62例）、0.41-0．50（86例）、0.5l-0.60（72例）及〉0.60（33例）分为4组。颈动脉内膜-中层厚度使用超声检测。比较不同动态脉压组及不同动态脉压指数组的颈动脉内膜-中层厚度。结果随着收缩压、舒张压、动态脉压和脉压指数的增加，颈动脉内膜-中层厚度随之增加，动态脉压、脉压指数与颈动脉内膜-中层厚度的相关系数r值大于收缩压和舒张压。结论动态脉压和脉压指数评价血管硬化的价值优于收缩压、舒张压，而动态脉压指数评价血管硬化比脉压更有优越性。     

高血压患者血压水平和脉压及脉压指数与蛋白尿的关系

目的　高血压患者收缩压 (SBP)、舒张压 (DBP)、脉压 (PP)及脉压指数 (PPI)与蛋白尿的关系 ,并进一步评价各自在反映蛋白尿严重程度上的优劣和 (或 )一致性。方法　将所有研究对象按SBP≥ 180mmHg(6 8例 )、16 0～ 179mmHg(81例 )、14 0～ 15 9mmHg(5 7例 )分为 3组 ;按DBP≥110mmHg(5 9例 )、10 0～ 10 9mmHg(79例 )、90～ 99mmHg(6 7例 )分为 3组 ;按PP≤ 4 0mmHg(39例 )、4 1～ 6 0mmHg(6 1例 )、6 1～ 80mmHg(5 6例 )和大于 80mmHg(4 3例 )分为 4组 ;按PPI≤ 0 4 0 0(5 0例 )、0 4 0 1～ 0 5 0 0 (70例 )、0 5 0 1～ 0 6 0 0 (6 2例 )和大于 0 6 0 0 (17例 )分为 4组。采用全自动散射比浊仪及全自动生化分析仪测定所有研究对象的尿蛋白和血脂水平 ,比较各组蛋白尿的发生率。结果　各组间性别、年龄、总胆固醇、甘油三酯、高密度脂蛋白胆固醇和低密度脂蛋白胆固醇水平均无显著性差异。随收缩压、舒张压、脉压及脉压指数的增加 ,蛋白尿的发生率明显增高 (P <0 0 5 )。结论　收缩压、舒张压、脉压水平和脉压指数与蛋白尿的发生密切相关 ,且 4者在反映蛋白尿的发生上具有较好的一致性。     

老年原发性高血压患者动态脉压与靶器官损害的相关性研究

目的通过对老年原发性高血压患者临床资料分析,探讨老年原发性高血压患者动态脉压与靶器官损害的关系.方法入选老年原发性高血压患者96例,按动态脉压分为脉压40～60mmHg(1 mmHg=0.133kPa)组45例和脉压＞60mmHg组51例.对入选患者做以下检查心电图、超声心动图、24小时动态血压、头颅计算机断层摄影术、颈动脉超声,并查血肌酐、尿白蛋白.结果脉压＞60mmHg组左心室重量指数、颈动脉内膜厚度、尿白蛋白定量、左心室舒张末期内径、颈动脉斑块指数均高于脉压40～60mmHg组(P＜0.05～0.01),靶器官损害发生率高于脉压40～60mmHg组(P均＜0.05);直线相关分析示颈动脉内膜厚度与收缩压、脉压、脉压变异相关.左心室重量指数与收缩压、收缩压变异、舒张压、脉压、脉压变异相关;多因素逐步回归分析得到逐步回归方程,提示颈动脉内膜厚度与脉压呈正相关,左心室重量指数与脉压及脉压变异成正相关.结论老年原发性高血压患者靶器官损害与增大的脉压有关,脉压是颈动脉内膜增厚和左心室肥厚的危险因素之一.     

老年高血压患者动态脉压和脉压指数与估测肾小球滤过率的相关性

目的 评价老年高血压患者动态脉压(PP)及脉压指数(PPI)与估测肾小球滤过率(eGFR)的相关性,探讨PP及PPI在老年高血压患者肾功能受损中的作用.方法 218例行24 h动态血压检查的老年高血压患者,根据PP(≤55 mmHg 或>55 mmHg)和PPI(≤0.45或>0.45)进行分组,比较各组间eGFR的差异,以及与PP、PPI的相关性.结果 与PP≤55 mmHg组或PPI≤0.45组比较,在PP>55 mmHg或PPI>0.45组中eGFR值明显降低(P<0.01).Pearson相关分析显示,eGFR与PP及PPI呈显著负相关;控制年龄、平均收缩压、平均舒张压、血肌酐水平等因素后,偏相关分析显示,eGFR仍与PP(r=-0.230,P<0.01)及PPI(r= -0.250,P<0.01)相关.多元逐步回归分析显示eGFR与肌酐水平、PPI及PP独立相关,标准化偏回归系数分别为-0.827、-0.177和-0.170,P<0.001.结论 老年高血压患者随着PP及PPI水平的升高,eGFR值明显降低,PP和PPI是老年高血压患者肾功能受损的独立危险因素.     

脉压与老年高血压患者肾损害的关系探讨

将老年高血压肾损害患者按脉压（PP）水平分为〈50mmHg，50～59mmHg，60～69mmHg和≥70mmHg四组，分别检测其血尿素氮（BUN）、肌酐（CRE）、肌酐清除率（Ccr）、β2-微球蛋白（β2-MG）和尿微量蛋白（umAlb）、β2-MG。随着PP水平的增高，血BUN、CRE、β2-MG及尿UmAlb、β2-MG水平相应增高，血Ccr水平相应降低，提示老年高血压患者肾损害程度与PP水平有关。     

高血压病患者动态脉压与尿微量白蛋白的相关性分析

目的探讨高血压病患者动态脉压(APP)与24小时尿微量白蛋白的相关性。方法应用24h动态血压监测仪监测78例年龄46~82岁,常规尿蛋白(UP)、血清肌酐(SCr)、尿素氮(BUN)水平在正常范围的高血压病患者的APP水平,根据APP将患者分为两组,<60mmHg为A组,≥60mmHg为B组。测定两组患者UP、SCr、BUN、尿微量白蛋白(UMA)、尿β2-微球蛋白(Uβ2-MG)水平。结果两组UP、SCr、BUN、Uβ2-MG差异均无显著性意义;B组UMA为2.5±1.2mg/L,A组为8.7±2.3mg/L,两组差异有显著性(P<0.01);UMA与APP呈显著性正相关(r=0.43,P<0.01)。结论APP高的高血压病患者较APP低者的早期肾小球滤过功能损害更明显;APP越高,肾小球滤过功能损害越明显。     

行冠脉造影老年患者212例脉压、脉压指数与冠状动脉病变的关系

高血压在冠心病的发生发展中起较大作用,且血压水平与冠心病发病率有密切关系.另外,有研究<'[1-3]>表明动脉脉压(主动脉脉压、肱动脉脉压)能够反映动脉弹性情况,与收缩压(SBP)和舒张压(DBP)相比能够更好地预测心血管事件的发生.但脉压(PP)本身具有一定的可变性,脉压指数(PPI)能够同时反映血管的固有和动态的顺应性,并且变化幅度小于PP<'[4]>.本研究通过24 h监测行冠脉造影的老年住院患者血压取其平均值,探讨肱动脉PP、PPI与冠状动脉关系.     

脉压、脉压指数与老年退行性主动脉瓣钙化的关系

目的：探讨脉压、脉压指数在老年退行性主动脉瓣钙化中的作用和影响。方法：选择2008年1月至2009年8月在我院住院,年龄≥60岁的老年患者160例为研究对象,根据超声心动图有、无退行性主动脉瓣钙化分为钙化组（78例）和无钙化对照组（82例）;所有入选对象均排除对脉压和瓣膜钙化有影响的疾病。观察两组收缩压、舒张压、脉压及脉压指数情况。结果：与无钙化对照组比较,钙化组患者的收缩压[（138.5±7.852）mmHg∶（155.2±8.678）mmHg,P〈0.05]、脉压[（48.96±5.468）mmHg∶（76.03±6.561）mmHg,P〈0.01]和脉压指数[（0.34±0.043）∶（0.49±0.051）,P〈0.01]明显升高,而舒张压在两组之间无显著差异。结论：脉压和脉压指数增大与老年退行性心脏瓣膜病有关。     

Systolic versus diastolic blood pressure versus pulse pressure

Elevation of systolic blood pressure (BP) has been recognized as an independent risk factor that far exceeds the risk associated with an elevated diastolic BP in older patients with hypertension. Isolated systolic hypertension (ISH) is a disorder typically defined when the systolic BP is greater than 140 mm Hg but with diastolic BP below 90 mm Hg. Pulse pressure (the difference between systolic and diastolic pressure) has recently become an active area of discussion in the literature as an independent factor of cardiovascular risk. An increased pulse pressure nearly always indicates reduced vascular compliance of large arteries and, by definition, is always increased in patients with isolated systolic hypertension. Although the evidence that a widened pulse pressure is an independent marker of cardiovascular risk is quite well established, therapeutic morbidity and mortality studies in ISH have focused on reductions in systolic pressure. At the present time, outcomes data have not been well established for reductions in pulse pressure in older patients with hypertension.     

Metabolic syndrome and pulse pressure

AIM: Pulse pressure (PP) has been reported to be increased in patients with abdominal adiposity and insulin resistance. Aim of the present study is to verify the association of high PP with metabolic syndrome (MS) and with its individual components. METHODS: The relationship between PP and MS was studied in a sample of 1724 subjects aged (mean +/- s.d.) 52.8 +/- 1.3 years, enrolled in a screening programme for diabetes FIrenze-Bango A Ripoli (FIBAR) study, and in a consecutive series of 1775 patients with type 2 diabetes aged 64.3 +/- 9.1 years; only subjects not treated with antihypertensive medication were included in the analysis. RESULTS: In the FIBAR sample, PP was significantly higher in subjects with MS. A significant correlation of PP was found in women with waist circumference, fasting glucose and triglyceride (r = 0.14, 0.15, and 0.09 respectively), and in men with fasting glucose only (r = 0.09); the correlation was no longer significant after adjustment for age and mean blood pressure. Similar results were obtained in the series of patients with type 2 diabetes. DISCUSSION: High PP is associated with MS and its components, but this association seems to disappear after adjustment for age and mean blood pressure. On the basis of the present data, high PP cannot be considered as one of the alterations associated with MS.     

Comparison of central pulse pressure estimated from pulse wave propagation velocity and carotid pulse pressure measured by applantation tonometry

BACKGROUND: Pulse pressure (PP) corresponds to the difference between arterial systolic blood pressure and diastolic blood pressure. Central PP seems to be a stronger coronary risk marker than brachial PP. Central PP can be estimated by aortic PP measured non invasively by aplanation tonometry of the carotid artery. The aim of this study was to compare 2 methods of estimation of aortic PP: estimation from Pulse Wave Velocities (PWV) and by aplanation tonometry of the carotid artery. Estimation from PWV is based on the non uniform transmission of the PP i.e. the amplification of PP from the aorta to brachial artery, through arteries of increasing impedance. METHODS: One hundred and fifty one subjects were included, 111 hemodialysis patients and 40 subjects free of cardiovascular treatment or cardiovascular organ damage, recruited in a preventive medicine setting. Central PP was measured by aplanation tonometry of the carotid artery. The following formula was used for the relationship between PP and PWV in the two arterial segments considered for pulse wave travel (waterhammer formula): [formula: see text] Where measurement of brachial PP (PPBr) and PWV at aortic (PWVAo) and brachial (PWVBr) gives an estimation of aortic PP (PPAo estimated). Carotid-femoral PWV was used for PWVAo and carotid-radial PWV was used for PWVBr. The two methods were compared by t-test and according to Bland and Altman's method. RESULTS: In the hemodialysis group (73 males, 44 +/- 12 years old), brachial PP was 56 +/- 15 mm Hg and central PP as measured at the carotid level was 47 +/- 15 mmHg. In the healthy group (29 males, 46 +/- 11 years old), these values were 46 +/- 10 mmHg and 35 +/- 10 mmHg respectively. Compared to carotid artery aplanation tonometry, PPAo estimated was larger than central PP by 2.9 +/- 6.3 mmHg in hemodialysis patients and by 5.4 +/- 6.6 mmHg in the healthy group. The difference was significantly larger in healthy subjects than in hemodialysis patients (p = 0.031). CONCLUSION: The PWV estimated PP is larger than the central PP measured at the carotid level by aplanation tonometry. The difference is larger in cardiovascular event free subjects than in patients on hemodialysis.     

脑卒中患者急性期动态脉压和脉压指数与近期预后的关系

目的　探讨脑卒中患者急性期动态脉压 (PP)和脉压指数 (PPI)的变化及与近期预后的关系。方法　利用动态血压监测 (ABPM )手段 ,测定 76例脑卒中患者急性期 2 4hABPM变化 ,与 45例健康人ABPM值做对比 ,并在患者入院第 1 5天做神经功能缺损程度评分。结果　脑卒中患者急性期 2 4h平均PP(2 4hPP)、2 4h平均PPI(2 4hPPI)均高于对照组 (P <0 0 5)。其中 ,重度神经功能缺损者 2 4hPP、2 4hPPI均高于轻度和中度患者 (P <0 0 5)。中度患者 2 4hPPI高于轻度患者 (P <0 0 5) ,2 4hPP差异无显著 (P >0 0 5)。 2 4hPP与神经功能缺损评分间呈弱的正相关(P <0 0 5) ,2 4hPPI与评分间呈强的正相关 (P <0 0 1 )。结论　脑卒中患者急性期PP和PPI发生异常 ,并对预后的判断有一定的指导意义。     

白大衣高血压患者动态脉压及脉压指数的特征分析

目的 分析白大衣高血压(WCH)患者动态脉压(APP)及动态脉压指数(APPI)的特征,探讨WCH对血管硬化的影响.方法 WCH患者60例、高血压I级患者60例(高血压组)和血压正常者50名(对照组)入选本研究,测量其诊室血压和动态血压,对各组APP及APPI进行组间比较.结果 WCH组和高血压组患者的诊室脉压及脉压指数高于对照组(P＜0.01),且WCH组高于高血压组(P＜0.01);高血压组患者24 h APP大于WCH组和对照组(P＜0.01),WCH组患者的白天动态脉压(dAPP)大于对照组(P＜0.01),高血压组患者24 h APPI、白天APPI(dAPPI)和夜间APPI(nAPPI)均大于WCH组和对照组(P＜0.01),WCH组24 h APPI、dAPPI和nAPPI亦均大于对照组(P＜0.05).结论 WCH不同于正常人群,会对血管造成一定程度的损伤,引起血管硬化,但其危害程度小于高血压,造成的损伤作用白天更明显.     

脉压及脉压指数与冠状动脉病变严重程度的相关性研究

目的:探讨脉压、脉压指数与冠心病严重程度的相关性,并比较脉压与脉压指数用以评价冠脉病变严重程度的相对优越性。方法:经冠脉造影（CAG）确诊的冠心病患者154例,其中ACS患者104例,包括急性心肌梗死（AMI）44例,不稳定型心绞痛（UAP）60例;稳定型心绞痛（SAP）50例;另设冠脉造影排除冠心病患者43例作为正常对照组。冠心病病变的严重程度分别用冠状动脉病变的血管支数、冠状动脉病变评分和冠状动脉狭窄程度表示。结果:脉压及脉压指数与冠心病患者冠脉病变的严重程度密切相关,而与血脂、血糖、体重指数等无明显关系。结论:脉压及脉压指数是较为方便的反映大动脉弹性的参数,与冠状动脉病变的严重程度密切相关,可作为全身心血管病的一个危险信号,指导早期干预,且脉压指数在一定程度上较之脉压有更大的优势。     

A clinical interpretation of pulse pressure

In summary I will say that the minute volume of the heart, being the product of heart rate and stroke volume, may be varied by altering either one or both of these factors; augmented blood flow results from an increase in one or both, and diminished flow follows a decrease in one or both. Proportionate changes in both but in opposite directions tend to maintain a constant minute volume. I have shown that in certain conditions alterations in pulse pressure occur which are in the same direction as one would expect stroke volume to vary in these conditions. While pulse pressure is not a measure of systolic output, its direction and magnitude of variation seem to parallel the changes in output.This is illustrated by the known circulatory changes in elevated metabolism, whether in exercise or diseased states. Augmentation of minute volume here is usually effected by increasing heart rate and stroke volume. The blood pressure findings which characterize this state are normal diastolic and wide pulse pressure, resulting in elevated systolic pressure.When an adequate minute volume is maintained in the presence of a very slow pulse resulting from heart-block, the systolic output per beat is increased. The blood pressure alterations in this instance are marked elevation of systolic with normal or lowered diastolic pressure.These clinical observations suggest that the physiological significance of elevated pulse pressure, with normal diastolic pressure, is increased stroke volume.