非洛地平治疗老年人单纯收缩期高血压的疗效观察及对肾脏功能的影响

钙拮抗剂作为重要的抗高血压药物，一直为临床广泛使用。非洛地平是一种新型的二氢吡啶类钙离子拮抗剂，由于降压平稳和长效，特别适合老年高血压的治疗。我们通过４～６ｗ用药前后２４ｈ动态血压监测（ＡＢＰＭ）和自身用药前后β２微球蛋白（β２－ＭＧ）变化，观察了非...     

非洛地平，氨氯地平对高血压病患者24小时血压的影响

目的：比较非洛地平,氨氯地平对高血压病患者24小时血压的降压疗效。方法：采用随机、单盲和平行对照的方法,运用24小时动态血压监测。结果：二药均能显著降低血压、彼此间降低偶测血压的幅度无显著差异。二药均能降低24小时平均,白天平均及夜间平均血压、均能有效控制清晨血压高峰期的血压。结论：非洛地平,氨氯地平均可每日服用1次,均能有效控制24小时血压及清晨醒后的高峰期血压。     

高血压左心室重构及对心脏功能的影响

102例原发性高血压患者,以彩色多普勒超声心动图检查结果为基础进行分组研究,并与34例正常组对照,发现高血压组左心室重构,且左心功能与对照组明显不同(P<0.01).高血压心室重构早期左心房增大,继之室壁向心性对称性肥厚,最后左室内径容积扩大,这种心室重构的变化与高血压的程度和持续时间呈正相关.左室形态的变化使心室不能正常的舒缓,顺应性降低,舒张功能首先受损.随着室壁应力的过度增加,舒张功能进一步恶化,收缩功能降低.     

非洛地平对高血压患者内皮功能的影响

目的　探讨高血压患者内皮血管活性物质的变化及非洛地平对其影响。方法　对 30例高血压患者和 2 4例正常对照组的血浆采用化学比色法测定 NO、NOS及采用射放免疫分析法测定 ET、Ang- 、TXA2 及 PGI2 ,并进行对照研究 ;对高血压组给予非洛地平治疗 ,并进行治疗前后的对照研究。结果　高血压组 ET、Ang- 及 TXA2 明显高于正常对照组 ,而 NO、NOS及 PGI2 明显低于正常对照组 ;非洛地平治疗组治疗后 ET、Ang- 及 TXA2 明显低于治疗前 ,NO、NOS及 PGI2 较治疗前无明显变化 ;非洛地平治疗高血压有效率 83.3%。结论　非洛地平抗高血压作用除主要通过拮抗钙通道以外 ,尚可通过降低 ET、Ang- 及 TXA2 起作用 ,而 NO通路不是其主要的作用机制。     

苯磺酸氨氯地平片、硝苯地平控释片和非洛地平缓释片长期降压疗效的比较

目的比较苯磺酸氨氯地平片(络活喜)、硝苯地平控释片(拜新同)和非洛地平缓释片(波依定)三者在老年高血压病患者中的长期降压疗效。方法采用随机和对照的方法,通过24小时动态血压检测,分别比较服用络活喜、拜新同、波依定12个月后的疗效。结果三种药物均能有效控制24小时平均血压、白天平均血压和夜间平均血压,并维持良好的血压昼夜节律。结论络活喜、拜新同和波依定每日服用1次(1片),均能有效控制全天24小时血压。     

非洛地平缓释片治疗原发性高血压疗效观察

非洛地平缓释片是一种新型的二氢吡啶类钙拮抗剂，具有高度的血管选择性，半衰期24h，口服后2～5h起效，作用可维持24h。其具有独特的药代动力学特性，扩血管效应缓和持久，降压平稳，T／P高，口服吸收好，生物利用度高，近年来国内外有不少使用该药治疗高血压的临床研究，显示非洛地平缓释片的降压效果好。有显著降低血压及总外周阻力的作用。我们采用非洛地平缓释片治疗轻、中度原发性高血（EH）患者30例，并与单服尼群地平30例进行对照，现报告如下。     

非洛地平缓释片每日一次治疗高血压病的疗效观察

本研究采用自身对照开放试验方法，观察了非洛地平缓释片对轻、中度高血压病患者治疗的疗效和耐受性。本研究共收入２０４例病人，其舒张压在９５ｍｍＨｇ至１１５ｍｍＨｇ（１ｍｍＨｇ＝０．１３３ｋＰａ）之间，经两周观察期，给予非洛地平缓释片（２．５、５、１０、２０ｍｇ）治疗。经８周治疗，病人的收缩压／舒张压下降了２４．１±１３．５／１７．１±６．１ｍｍＨｇ，与治疗前血压相比差异有非常显著性（Ｐ＜０．００１），显效率为８８．２％（１８０／２０４），总有效率为９６．５％（１９７／２０４），不良反应多为轻中度头痛、踝部水肿等。其中有４８例接受了半年的长期治疗，结果显示血压仍然得到稳定的控制且无耐药性产生，平均收缩压／舒张压波动范围１２８．０～１５０．０／８２．６～９０．０ｍｍＨｇ。有２１例病人接受２４小时动态血压监测，结果显示：２４小时平均收缩压／舒张压较治疗前分别下降了１９．５／１２．６ｍｍＨｇ（Ｐ＜０．００１），收缩压／舒张压的谷峰值比率值分别为６７．６％和７９．１％。由此可见，非洛地平缓释片是有效且易于耐受的抗高血压药物。     

不同剂量非洛地平对原发性高血压病患者内皮功能的影响

将69例高血压患者随机分为A、B、C三组各23例,分别予口服非洛地平5 、10、15 mg,1次/d,疗程5周.观察治疗前后血压、肱动脉内皮依赖性血管舒张功能变化,并检测血浆一氧化氮(NO)、内皮素-1(ET-1)水平.结果 用药后三组血压均明显下降,血浆NO水平均明显升高,血流介导的内皮依赖性舒张功能明显改善,ET-1水平明显降低,与A、B组比较,C组上述指标变化明显.认为非洛地平可明显改善高血压患者内皮功能,且改善程度随剂量增加而增高.     

非洛地平治疗高血压180例疗效分析

目的观察非洛地平(联环尔定)对Ⅰ级、Ⅱ级、Ⅲ级高血压病病人的降压疗效及不良反应。方法将高血压病病人180例分为Ⅰ级、Ⅱ级、Ⅲ级高血压组,每组60例,每组随机分为A、B两个亚组,每个亚组各30例,两个亚组间病人的年龄、性别相当。Ⅰ级高血压A(ⅠA)组非洛地平2.5mg,每日2次口服;B(ⅠB)组非洛地平5.0mg,每日2次口服。Ⅱ级高血压A(ⅡA)组非洛地平5.0mg,每日2次口服;B(ⅡB)组非洛地平7.5mg,每日2次口服。Ⅲ级高血压A(ⅢA)组非洛地平7.5mg,每日2次口服;B(ⅢB)组非洛地平10.0mg日2次口服。疗程2个月。结果ⅠA组总有效率93.3%,ⅠB组总有效率100.0%,ⅡA组总有效率90.0%,ⅡB组总有效率96.7%,ⅢA组显总有效率83.3%,ⅢB组总有效率90.0%。非洛地平的不良反应轻微,主要有下肢及踝部水肿、头痛、心悸、齿龈轻度增生等。结论非洛地平是治疗高血压尤其是Ⅰ级、Ⅱ级高血压病的理想降压药。在允许剂量内,剂量增加,降压疗效随之增加。不良反应少而轻微,病人多可耐受。     

非杓型高血压对左心室肥厚的影响及其临床意义

目的：以杓型高血压患者为对照，探讨非杓型高血压在左心室肥厚发生和发展中的作用。方法：应用２４小时动态血压和超声心动图检测２３０例高血压患者，选择年龄、病程、昼间血压基本相同的杓型、非杓型高血压患者１５０例，其中男性各４５例，女性各３０例。结果：非杓型高血压患者舒张末期左心房内径显著大于杓型高血压患者，男性分别为３５．８±２．９ｍｍ与３１．２±２．７ｍｍ（Ｐ＜０．０１）；女性分别为３２．４±２．５ｍｍ与２９．４±１．８ｍｍ（Ｐ＜０．０５）。女性杓型、非杓型高血压患者间舒张末期左心室内径的差异（４９．５±３．２ｍｍ与５４．８±３．７ｍｍ，Ｐ＜０．０１）比男性（５３．８±４．６ｍｍ与５７．４±４．５ｍｍ，Ｐ＜０．０５）更为显著。非杓型高血压患者左心室重量指数显著大于杓型高血压患者，男性分别为１５８．０±７．９ｇ／ｍ２与１３０．０±６．７ｇ／ｍ２（Ｐ＜０．０１）；女性分别为１３８．０±５．６ｇ／ｍ２与１１５．０±４．７ｇ／ｍ２（Ｐ＜０．０１）。结论：非杓型高血压患者左心室肥厚的检出率比杓型高血压患者为高。     

24-h Ambulatory blood pressure in patients with ECG-determined left ventricular hypertrophy: left ventricular geometry and urinary albumin excretion-a LIFE substudy

This study was undertaken to evaluate the relationships among left ventricular (LV) geometric patterns and urinary albumin excretion in patients with hypertension and electrocardiographic (ECG) LV hypertrophy. In 143 patients with stage II-III hypertension, 24-h ambulatory blood pressure (BP) monitoring, single urine albumin determination, and echocardiography were performed after 14 days of placebo treatment. Mean age was 68+/-7 years, 35% were women, body mass index was 28+/-5 kg/m(2), LV mass index (LVMI) was 125+/-26 g/m(2), and 24% had microalbuminuria. The mean office BP was 176+/-15/99+/-8 mmHg and the mean daytime ambulatory BP was 161+/-18/92+/-12 mmHg. Ambulatory BP, but not office BP, was higher among albuminuric compared to normoalbuminuric patients. In patients with established hypertension, daytime pulse pressure and office BP were different in the four patterns of LV geometry, with the highest pressure in those with abnormal geometry. Furthermore, microalbuminuria was more frequent in hypertensive patients with LV hypertrophy than in those with either normal geometry or concentric remodelling. White coat hypertensives (10%) showed lower LVMI and no microalbuminuria compared to patients with established hypertension. There were no differences in the prevalence of nondippers (26%) among the four LV geometric patterns or in microalbuminuria. In conclusion, increased daytime pulse pressure and office BP were associated with increased prevalence of abnormal LV geometry. Microalbuminuria was more frequent in groups with concentric and eccentric LV hypertrophy. Ambulatory BP, but not office BP, was higher in albuminuric than normoalbuminuric patients. With regard to the relationship among BP, LV geometric patterns, and urine albumin excretion in this population, 24-h ambulatory BP did not provide additional information beyond the office BP.     

Clinical effects of nifedipine on blood pressure and left ventricular performance in patients with isolated hypertension

17 patients with isolated systolic hypertension (ISH) and 8 with diastolic hypertension (DH) were treated with 10 mg of nifedipine sublingually. In ISH group the blood pressure decreased on the average from 180.2/87.4 to 166.2/84.2, 161.9/82.6, 163.4/83.7 mmHg after 5.20 and 60 minutes, while in DH group the blood pressure decreased on the average from 139.2/102.0 to 138.0/100.0, 137.6/97.6, 134.4/97.2 mmHg. With pulsed Doppler echocardiography, we found that early diastolic time-velocity integral increased (P less than 0.001) and E time prolonged (P less than 0.01) after 20 and 60 minutes in ISH group; and 1/3 filling fraction increased (P less than 0.05) after 20 minutes in DH group. With M-mode echocardiography we found that cardiac index and ejection fraction were improved in both groups. No obvious side effects were noted. From above-mentioned findings we are of the opinion that sublingual nifedipine is effective in reducing blood pressure and improving left ventricular performance especially in ISH patients.     

Calcium antagonists,a useful additional therapy in treatment resistant hypertension: Comparison of felodipine ER and nifedipine Retard by 24-h ambulatory blood pressure monitoring

Objective: To compare the efficacy and tolerability of felodipine extended release (ER) 2.5 mg (F2.5) and 5 mg (F5) once daily with nifedipine Retard 10 mg (N20) and 20 mg (N40) twice daily as additional therapy in patients who remained hypertensive despite treatment with an ACE-inhibitor, β-blocker or diuretic.Design and methods: In a multicentre, double-blind parallel study, 61 men and 54 women, aged 35–75, with a supine diastolic blood pressure between 95 and 115 mmHg were randomised to treatment with F2.5, F5, N20 or N40 for 8 weeks, with optional doubling of the dose after 4 weeks. Blood pressure was measured at the office after 0, 4 and 8 weeks and by 24-h ambulatory monitoring (ABPM) after 0 and 4 weeks. Spontaneously reported adverse events and a subjective symptom assessment questionnaire were used for side-effect profiling.Results: Mean office systolic; diastolic blood pressure was clinically relevantly reduced in all treatment groups after 4 weeks by 8/7, 12/9, 11/9 and 18/11 mmHg for F2.5, F5, N20 and N40, respectively, and after 8 weeks (F2.5–5: 17/11 mmHg; F5–10: 18/14 mmHg; N20–40: 19/14 mmHg; N40–80: 25/14 mmHg) with no statistically significant differences between these groups. The lowest dose of felodipine (F2.5) was the least effective. After 4 weeks the ABPM showed consistent 24-h reductions in blood pressure (4/2; 8/5; 7/5; 10/6 mmHg, respectively) over 24 h for the felodipine ER 5 mg group only and for both nifedipine groups. No statistically significant difference between these groups was found. An office responder does not appear to be identical to an ambulatory one and vice versa. The adverse events, mostly oedema, flushing and headache, were dose-related.Conclusions: Both felodipine ER and nifedipine Retard are effective ‘add-on’ drugs in patients with monotherapy-resistant hypertension. The blood-pressure-lowering effect is dose-dependent and tolerability is inversely related to efficacy. The results emphasize the benefits of combining two agents with low doses.     

Pulsatile and steady 24-h blood pressure components as determinants of left ventricular mass in young and middle-aged essential hypertensives

In order to explore the relations between left ventricular mass (LVM) and the pulsatile (pulse pressure) and steady (mean pressure) components of the blood pressure (BP) curve, 304 young and middle-aged essential hypertensive patients were studied by means of 24-h ambulatory BP monitoring and echocardiography. In the overall study population, both the BP components showed significant correlations with LVM. These correlations were unevenly distributed in the subgroups of subjects younger and in those older than 50 years. While in this latter subgroup, in multivariate analysis, both 24-h mean BP (24-MBP) (beta = 0.27; P = 0.008) and 24-h pulse pressure (24-h PP) (beta = 0.23; P = 0.02) were associated with LVM, in the subset of younger hypertensives only 24-h MBP (beta = 0.21; P = 0.009) was related to LVM, independent of other covariates. The relations observed between 24-h PP and LVM in the entire study population and in the patients older than 50 years lost statistical significance when the effect of 24-h systolic blood pressure (24-h SBP) was taken into account, in a multiple regression model in which 24-h MBP was replaced by 24-h SBP. Our findings seem to suggest that the association of PP with LVM in middle-aged hypertensives may partially explain the increased cardiovascular risk, documented in subjects with high PP. However, this relation is not independent, but is mediated by SBP.     

The importance of 24-h blood pressure control

The primary goal of antihypertensive therapy is to restore blood pressure to normal levels and to prevent the complications associated with hypertension. In order to maximize these goals by improving patient compliance, clinical researchers have focused on developing antihypertensive agents that can be given once daily. These agents provide many advantages over multiple-dose daily therapies, but it should not be assumed that they are all equivalent in providing adequate blood pressure control over the full 24-h dosing interval. Ambulatory blood pressure monitoring has uncovered important differences in commonly used once-daily therapies and has provided additional insights into the cardiovascular risks associated with high blood pressure loads and blood pressure variability. In addition to ambulatory blood pressure monitoring data, the calculated trough:peak ratio provides useful information on an agent's ability to provide smooth and consistent blood pressure control. Using such assessments, it has been found that agents with a trough:peak ratio > or = 0.50 are better able to control blood pressure over the full 24h while maintaining natural circadian patterns. Ambulatory blood pressure monitoring studies assessing a recently introduced class of antihypertensive drugs, the angiotensin receptor blockers, have demonstrated 24-h efficacy with once-daily dosing, particularly with the newer agents.     

The effects of blood pressure reduction on abnormal left ventricular diastolic function in hypertensive patients

To investigate whether reduction in blood pressure has a beneficial effect on left ventricular diastolic function, we investigated 20 hypertensive patients with evidence of diastolic dysfunction at baseline and at 3 and 6 months after initiation of captopril therapy. Two-dimensional echocardiography was used to determine left ventricular mass index and Doppler ultrasound to assess diastolic function. Fifteen of the 20 patients had a significant reduction in blood pressure at 3 and 6 months and left ventricular mass index remained unchanged during the study period. Despite reduction in blood pressure, no difference in isovolumic relaxation time, early and atrial filling velocities or their ratio was observed. Our results suggest that a direct relationship between blood pressure and left ventricular diastolic function does not exist and that other factors such as alterations in muscle or collagen composition of the left ventricle may be more important in determining abnormal diastolic function in hypertension.     

Brachial artery vasomotor function is inversely associated with 24-h ambulatory blood pressure

BACKGROUND: Impaired endothelial function has been reported in hypertensive individuals. The extent to which such changes reflect the co-existence of other cardiovascular disease risk factors rather than an independent association with blood pressure remains uncertain. OBJECTIVE: To assess the relationship between brachial artery vasomotor function and ambulatory blood pressure in hypertensive individuals and normotensive controls. METHODS: We assessed 24-h ambulatory blood pressure and brachial artery endothelial and smooth muscle function in 155 patients with hypertension and 40 normotensive controls. The vasomotor functions were determined by ultrasonographic assessment of vasodilator responses to flow and sublingual glyceryl trinitrate, respectively. Patients with hypertension were categorized as either treated (n = 85) or untreated (n = 70), and further subdivided on the basis of either no or at least one other cardiovascular risk factor. These included hyperlipidaemia, smoking, diabetes or a previous coronary or cerebrovascular event. RESULTS: Age- and sex-adjusted flow-mediated and glyceryl trinitrate-mediated responses were not significantly different in hypertensive individuals with respect to treatment status or the presence of risk factors when compared with controls. However, when data from all 195 study participants were pooled, 24-h ambulatory systolic blood pressure was inversely related to flow-mediated response (P = 0.002), and both systolic and diastolic blood pressure were inversely related to glyceryl trinitrate response (P < 0.001 and P = 0.009, respectively). Observed relationships were largely unaltered after further adjustment for body mass index, antihypertensive treatment or the presence of other risk factors. CONCLUSIONS: The finding of a direct and inverse relationship between the level of ambulatory blood pressure and flow-mediated and glyceryl trinitrate responses is consistent with a direct influence of blood pressure on conduit vessel vascular function.     

Effects of age and 24-hour ambulatory blood pressure on rapid left ventricular filling

To determine the associations of age, blood pressure (BP) and cardiac structure with left ventricular (LV) diastolic performance, 47 subjects (21 normotensives and 26 age-matched, previously untreated hypertensives) were studied by 24-hour ambulatory BP monitoring, radionuclide ventriculography and sector-guided M-mode echocardiography. Normotension was defined as an awake ambulatory BP less than 130/80 mm Hg and hypertension as an awake ambulatory BP greater than 135/85 mm Hg. Univariate analyses revealed strong negative correlations of LV filling rate with age (r = -0.67, p less than 0.001), 24-hour systolic or diastolic BP (r = -0.59 for systolic BP and -0.57 for diastolic BP, p less than 0.001 for both) and a modest positive correlation with LV ejection fraction (r = 0.42, p less than 0.05). After multivariate analysis, significant dependencies of both the left atrial index and LV mass index on ambulatory BP were found, which negated the significance of the relation of these 2 cardiac structural variables with LV filling rate. The final regression equation predicted LV filling rate from age, BP and LV ejection fraction. Age was the most important single correlate of LV filling, as evidenced by the 14 of 16 subjects (88%) over the age of 53 years (8 hypertensives, 6 normotensives) who had reduced LV filling rates compared with only 9 of the remaining 31 subjects (29%, all hypertensives) under the age of 53 years with reduced LV filling rates. These data demonstrate that LV filling rate is more dependent upon age and BP than left atrial or LV size.(ABSTRACT TRUNCATED AT 250 WORDS)