Clinical Characteristics of Young-Onset and Medical Treatment-Requiring Hypertension Identified By Targeted Screening in University Health Check-Up

Based on targeted screening for hypertension at a university health check-up, we previously reported a high incidence of white-coat hypertension and estimated prevalence of hypertension requiring medical treatments (HT) as around 0.1% in young population aged less than 30. In spite of such low prevalence, continuous screening for seven consecutive years (2003–2009) increased the number of HT students to 20 (19 males and 1 female). We presently assessed the clinical characteristics of these HTs. Renovascular hypertension was found in the only female HT and aortic valve regurgitation in two HTs. Resting 17 HTs were diagnosed as having essential hypertension (EH). A father and/or a mother had EH in 16 out of 17 EHs, and blood pressure (BP) at home was slightly elevated (135–145 mm Hg in systolic) except three obese EHs (body mass index more than 30) who demonstrated more than 160 mm Hg in systolic. Plasma aldosterone-renin ratio (ARR) of EHs did not differ from that of normal controls, and Pearson correlation coefficient (R) between ARR and systolic BP (SBP) was ?0.2. Its partial correlation coefficient, however, was statistically significant (R = ?0.55, P = .026) after correcting for body mass index, which was significantly correlated with both SBP (P = .006, after correcting for ARR) and ARR (P = .004, after correcting for SBP). In conclusion, most of young-onset HTs are male EHs, and aortic valve regurgitation should be carefully checked. Excess plasma renin activity would be one of additional characteristics of young-onset EH to male gender, genetic background, and increased body mass.     

血管内皮功能与运动后血压反应相关性的研究

目的:研究原发性高血压(EH)患者的内皮依赖性血管舒张功能与运动后血压反应的关系。方法:对53例EH(EH组)患者及42例正常人(对照组),采用高分辨率血管超声进行内皮依赖性血管舒张功能的检测,采用平板运动试验系统进行亚极量运动负荷试验,于运动前、达亚极量负荷后即刻及休息 6 min后测定血压。结果:除2例患者运动前血压≥160/100 mmHg(1 mmHg=0.133 kPa)被除外,其余患者均完成试验。与运动前比较,运动后即刻收缩压在对照组及EH组均显著升高(对照组:P<0.05,EH组: P<0.01),且 EH组的升高幅度较对照组显著(P<0.01),舒张压仅EH组显著升高(P<0.01);运动后6min两组的血压较运动前差异无统计学意义。EH组的内皮依赖性血管舒张功能(FMD%)较对照组显著减低(P<0.05)。运动后舒张压差值与FMD%呈显著负相关( r=-0.809, P<0.01),但收缩压与 FMD%无相关关系( r=-0.296, P>0.05)。结论:运动可使EH患者血压升高,但很快恢复;运动后收缩压升高与内皮依赖性舒张功能无关,而舒张压升高与之密切有关。     

Effect of exercise on blood pressure in older persons: a randomized controlled trial

BACKGROUND: Because of age-related differences in the cause of hypertension, it is uncertain whether current exercise guidelines for reducing blood pressure (BP) are applicable to older persons. Few exercise studies in older persons have evaluated BP changes in relation to changes in body composition or fitness. METHODS: This was a 6-month randomized controlled trial of combined aerobic and resistance training; controls followed usual care physical activity and diet advice. Participants (aged 55-75 years) had untreated systolic BP (SBP) of 130 to 159 mm Hg or diastolic BP (DBP) of 85 to 99 mm Hg. RESULTS: Fifty-one exercisers and 53 controls completed the trial. Exercisers significantly improved aerobic and strength fitness, increased lean mass, and reduced general and abdominal obesity. Mean decreases in SBP and DBP, respectively, were 5.3 and 3.7 mm Hg among exercisers and 4.5 and 1.5 mm Hg among controls (P < .001 for all). There were no significant group differences in mean SBP change from baseline (-0.8 mm Hg; P=.67). The mean DBP reduction was greater among exercisers (-2.2 mm Hg; P=.02). Aortic stiffness, indexed by aortofemoral pulse-wave velocity, was unchanged in both groups. Body composition improvements explained 8% of the SBP reduction (P = .006) and 17% of the DBP reduction (P<.001). CONCLUSIONS: A 6-month program of aerobic and resistance training lowered DBP but not SBP in older adults with mild hypertension more than in controls. The concomitant lack of improvement in aortic stiffness in exercisers suggests that older persons may be resistant to exercise-induced reductions in SBP. Body composition improvements were associated with BP reductions and may be a pathway by which exercise training improves cardiovascular health in older men and women.     

Characteristics of young-onset hypertension identified by targeted screening performed at a university health check-up.

Since the prevalence and clinical characteristics of young-onset hypertension are still to be elucidated, we performed targeted-screening at an annual university health check-up for two consecutive years. Out of 16,464 subjects in 2003 and 17,032 in 2004 that were aged less than 30 years, 22 and 26 students (all males) exhibited high blood pressure (BP), respectively, on three occasions during casual BP measurements at the Tohoku University Health Center (systolic and diastolic BP of 140 and/or 90 mmHg or greater, respectively). These students were asked to measure their BP at home, and 9 subjects in total were diagnosed as having essential hypertension (EH). The remaining students were diagnosed as having white coat hypertension (WCH). In 8 out of 9 EH students, their father and/or mother had also been treated with antihypertensive medication. Adjustment by attendance ratio for each BP measurement suggested that the incidence of EH was around 0.1% and that of hypertension (EH and WCH) was around 0.5% in university students aged less than 25 years, since most of the subjects and hypertensive students were between 18 and 24 years old. Body mass index of the EH, which was more than 25 kg/m2 (overweight), was significantly higher than that with WCH. In conclusion, the combination of repeated casual BP measurements and home BP effectively identified young-onset EH. The clinical parameters indicated that male gender, genetic background, and excessive weight were risk factors for young-onset hypertension.     

高血压病患者的真胰岛素、胰岛素原水平及其与血压的关系

目的 探讨高血压病患的真胰岛素（TI）,胰岛素原（PI）水平及其与血压的关系,方法 测定非糖尿病的66例高血压病患及73例血压正常的收缩压（SBP）,舒张压（DBP）,血脂及口服葡萄糖耐量试验（OGTT）各点的血糖,血清TI和PI水平,TI及PI测定采用特异的单克隆抗体放大酶联免疫分析法（BA－ELISA）。结果 高血压病组在调整年龄,体重指数（BMI）和腰臂比（WHR）,其糖负荷后2h的PI及PI／TI水平显高于对照组（P＜0．05）,两而组间TI差异无统计学意义,单相关分析显SBP与空腹PI,2h PI及2h PI/TI 显相关,而BP仅与2h PI/TI显相关（P＜0．05）,仅在非肥胖组发现SBP与2hTI呈正相关（P＜0．05）,多因素回归分析显示2h PI独立于年龄,BMI,血糖和血脂等影响血压的混杂因素与SBP及高血压显相关。结论 本人群中高血压病患存在糖负荷后高PI血症,血清PI而非TI水平与高血压显正相关。     

高血压病合并2型糖尿病患者动态血压与CAVI及ABI相关性研究

目的探讨高血压病（EH）及合并2型糖尿病（T2DM）患者24 h动态血压水平及与心踝血管指数（CAVI）、踝臂指数（ABI）的相关性。方法随机入选90例高血压病患者,分为单纯高血压病组（EH组,n=47）,高血压病伴糖尿病组（EH＋T2DM组,n=43）。所有入选者进行24 h动态血压监测,CAVI、ABI指标及颈动脉超声检查。对两组上述指标进行比较,并对动态血压与CAVI、ABI进行直线相关分析。结果与EH组患者比较,EH＋T2DM组患者各时段的平均收缩压（SBP）、脉压（PP）、收缩压负荷（SBP-L）及CAVI呈增高趋势,而ABI和夜间血压下降率降低,两组比较均有统计学差异（P均〈0.05）。EH组患者杓型血压占42.5%,EH＋T2DM杓型血压占23.3%,两组比较有统计学差异（P〈0.05）。CAVI与24 h平均收缩压（24 hSBP）、夜间平均收缩压（nSBP）、24 h平均脉压差（24 hPP）、日间平均脉压差（dPP）、夜间平均脉压差（nPP）、夜间收缩压负荷（nSBP-L）、夜间舒张压负荷（nDBP-L）呈正相关,ABI与24 hSBP、白天平均收缩压（dSBP）、dPP、白天收缩压负荷（dSBP-L）、nSBP-L等指标呈负相关。结论合并T2DM可增加EH患者收缩压、脉压及收缩压负荷水平,并加速动脉硬化的进展。     

Diminished nocturnal decline in blood pressure in elderly hypertensive patients with left ventricular hypertrophy.

To assess the circadian blood pressure (BP) changes in elderly hypertensive patients with left ventricular hypertrophy (LVH), the ambulatory BP was measured noninvasively every 30 minutes for 24 hours in those patients with LVH (n = 15) and without LVH (n = 23), and in normotensive elderly subjects (n = 11). Although the daytime systolic BP (SBP) was comparable in the two hypertensive groups, the nighttime SBP in patients with LVH tended to be higher than in patients without LVH (149.0 +/- 15.1 versus 138.4 +/- 20.1 mm Hg, p less than 0.10). The LV mass index correlated significantly with the nighttime SBP (r = 0.43, p less than 0.01), but not with the daytime SBP (r = 0.24, ns), with clinic SBP (r = 0.14, p = ns) or the SBP after handgrip exercise (r = 0.31, p = ns). The difference in the systolic BP between daytime and nighttime (D-N SBP) in patients with LVH (2.8 +/- 9.4 mm Hg) was significantly less than that in patients without LVH (12.8 +/- 16.0 mm Hg) (p less than 0.02). In addition, the D-N SBP correlated inversely with the left ventricular mass index (r = -0.33, p less than 0.05). It was concluded that hypertension in the elderly with LVH was associated with a diminished nocturnal decline in blood pressure.     

针刺治疗原发性高血压及获得性因素对降压疗效的影响

目的 观察针刺降压的疗效及获得性因素对降压疗效的影响.方法 选择40例原发性高血压患者,收集患者性别、有无家族史、病程长短、体质量指数(BMI)指数、治疗前后血压等.结果 针刺对收缩压、舒张压均有疗效,且对收缩压的疗效优于舒张压;性别对于针刺降压疗效的影响无统计学意义;无家族史者降压疗效优于有家族史者;病程对针刺降压疗效的影响无统计学意义;BMI指数越小,针刺降压疗效越明显.结论 针刺可有效控制血压,且获得性因素对疗效有一定的影响.     

Factors influencing left ventricular structure and stress-corrected systolic function in men and women with asymptomatic aortic valve stenosis (a SEAS Substudy)

To identify determinants of left ventricular (LV) structure and stress-corrected systolic function in men and women with asymptomatic aortic stenosis (AS), Doppler echocardiography was performed at baseline in 1,046 men and 674 women 28 to 86 years of age (mean 67 +/- 10) recruited in the Simvastatin Ezetimibe in Aortic Stenosis (SEAS) study evaluating placebo-controlled combined simvastatin and ezetimibe treatment in AS. LV hypertrophy was less prevalent in women despite older age, higher systolic blood pressure, and smaller aortic valve area/body surface area (all p values <0.05). In logistic regression analyses, LV hypertrophy was independently associated with male gender, severity of AS, hypertension, higher systolic blood pressure, and lower stress-corrected midwall shortening (scMWS) or stress-corrected fractional shortening (scFS; all p values <0.01). In men aortic regurgitation also was a predictor of LV hypertrophy (p <0.05). Women had greater scFS and scMWS when corrected for LV size or geometry (all p values <0.001). In multivariate analyses, female gender predicted 11% greater scFS and 4% greater scMWS independent of age, body mass index, heart rate, aortic valve area, LV mass, relative wall thickness, aortic regurgitation, hypertension, and end-systolic stress (R(2) = 0.23 and 0.59, respectively, p <0.001). In conclusion, the major determinants of LV hypertrophy in patients with asymptomatic AS are male gender, severity of AS, and concomitant hypertension. Women have higher stress-corrected indexes of systolic function independent of LV geometry or size, wall stress, older age, or more concomitant hypertension.     

动脉粥样硬化性肾动脉狭窄患者24小时动态血压特征及靶器官损害相关研究

目的探讨动脉粥样硬化性肾动脉狭窄(ARAS)患者24 h动态血压、昼夜节律变化特征及靶器官损害。方法选择2014年1月~2018年12月在上海交通大学医学院附属瑞金医院高血压科连续住院的ARAS患者121例(ARAS组),另选择同期年龄、性别、体质量指数和高血压病程等匹配的原发性高血压(EH)患者418例(EH组),观察并比较2组诊室及24 h动态血压及靶器官损害的差异。结果与EH组比较,ARAS组诊室收缩压[(155±23)mm Hg(1mm Hg=0.133k Pa)vs(145±22)mm Hg,P<0.01]、诊室脉压[(75±20)mm Hg vs(65±18)mm Hg,P<0.01]、24h收缩压[(143±19)mm Hg vs(130±16)mm Hg,P<0.01]、昼间收缩压[(145±18)mm Hg vs(133±16)mm Hg,P<0.01]、夜间收缩压[(138±21)mm Hg vs(123±18)mm Hg,P<0.01]、夜间舒张压[(75±12)mm Hg vs(73±10)mm Hg,P<0.05]明显升高,差异有统计学意义。与EH组比较,ARAS组杓型血压比例明显降低,反杓型血压比例明显升高(P<0.05)。校正相关因素后,与EH组比较,ARAS组颈动脉内膜中层厚度、左心室质量指数及血浆N末端B型钠尿肽前体水平明显升高,差异有统计学意义(P<0.01)。结论ARAS患者收缩压及夜间血压较高,更多表现为反杓型血压。有独立于血压及肾功能水平更严重的靶器官损害。     

Association between body composition and blood pressure in a contemporary cohort of 9-year-old children

Elevated blood pressure (BP) in children is an early risk factor for cardiovascular disease and is positively associated with body mass index (BMI). However, BMI does not distinguish between fat and lean masses, and the relationship of BP in children to different elements of body composition is not well established. BP, BMI and body composition were measured in 6863 children enrolled in the Avon Longitudinal Study of Parents and Children. Fat mass, lean mass and trunk fat were assessed using dual-energy X-ray absorptiometry. After full adjustment for confounders, total body fat and BMI were positively associated with systolic blood pressure (SBP) (beta=3.29, 95% confidence interval CI 3.02, 3.57 mm Hg/standard deviation (s.d.) and beta=3.97, 95% CI 3.73, 4.21 mm Hg/s.d., respectively) and diastolic blood pressure (DBP) (beta=1.26, 95% CI 1.05, 1.46 mm Hg/s.d. and beta=1.37, 95% CI 1.19, 1.54 mm Hg/s.d., respectively). SBP was also positively associated with lean mass (beta=3.38, 95% CI 2.95, 3.81 mm Hg/s.d.), and weakly associated with trunk fat (beta=1.42, 95% CI -0.06, 2.90 mm Hg/s.d., independent of total fat mass), which was robust in girls only. The association between lean mass and SBP remained even after accounting for fat mass. SBP in 9-year-old children is independently associated with fat mass and lean mass and, to a lesser extent, trunk fat in girls. In this analysis, because both fat and lean masses are associated with BP, BMI predicts BP at least as well as these components of body composition.     

Clinical and genetic correlates of aldosterone-to-renin ratio and relations to blood pressure in a community sample

Aldosterone:renin ratio (ARR) is used to screen for hyperaldosteronism. Data regarding correlates of ambulatory ARR in the community and its relation to hypertension incidence are limited. We defined clinical correlates of ARR, determined its heritability, tested for association and linkage, and related ARR to blood pressure (BP) progression in nonhypertensive individuals among 3326 individuals from the Framingham Heart Study (53% women; mean age: 59 years). Ambulatory morning ARR (serum aldosterone and plasma renin concentrations) were related to clinical covariates, genetic variation across the REN locus, a 10-cM linkage map, and among nonhypertensive participants (n=1773) to progression of >or=1 Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure BP category (optimal: <120/80 mm Hg, normal: 120 to 129/80 to 84 mm Hg, high normal: 130 to 139/85 to 89 mm Hg, hypertension: >or=140/90 mm Hg), or incident hypertension (systolic BP: >or=140 mm Hg, diastolic BP: >or=90 mm Hg, or use of antihypertensive treatment). ARR was positively associated with age, female sex, untreated hypertension, total/high-density lipoprotein cholesterol ratio, hormone replacement therapy, and beta-blocker use, but negatively associated with angiotensin-converting enzyme inhibitor and diuretic use. ARR was heritable (h(2)=0.40), had modest linkage to chromosome 11p (logarithm of the odds: 1.89), but was not associated with 17 common variants in REN (n=1729). On follow-up (mean: 3 years), 607 nonhypertensive individuals (34.2%) developed BP progression, and 283 (16.0%) developed hypertension. Higher baseline logARR was associated with increased risk of BP progression (odds ratio per SD increment: 1.23; 95% CI: 1.11 to 1.37) and hypertension incidence (odds ratio per SD increment: 1.16; 95% CI: 1.00 to 1.33). ARR is a heritable trait influenced by clinical and genetic factors. There is a continuous gradient of increasing risk of BP progression across ARR levels in nonhypertensive individuals.     

肾血管性与原发性高血压患者24h动态血压的比较

目的 比较肾血管性高血压(RVH)与原发性高血压(EH)患者24 h动态血压的差别.方法 应用动态血压监测仪观察51例RVH患者的24 h动态血压,并与年龄、性别与之相匹配的51例EH患者的24 h动态血压进行比较.结果 RVH组24 h、白天及夜间动态收缩压、舒张压及脉压均值都比EH组有不同程度的升高(P<0.05),尤以夜间收缩压升高明显;血压负荷增加明显,24 h收缩压、舒张压负荷分别达到58.96%和35.98%,而EH组血压负荷均在20.00%左右,两组比较差异有统计学意义(P<0.05).EH组夜间血压下降率为10.36%,血压曲线呈勺型(60.8%的患者夜间血压下降率>10%);而RVH组夜间血压下降率为5.39%,血压曲线呈非勺型(仅有27.50%的患者夜间血压下降率>10%).结论 RVH患者动态血压均值、脉压和血压负荷明显增加,昼夜节律减弱.

Abstract：

Objective To compare 24 h ambulatory blood pressure changes between patients with renovascular hypertension and essential hypertension.Methods The 24 h ambulatory blood pressure of patients with age and gender matched renovascular hypertension (RVH, n=51) was compared with that of patients with essential hypertension (EH, n=51).Results The 24 h, daytime and nighttime systolic blood pressures(SBP),diastolic blood pressures(DBP) and pulse pressures (PP) in RVH were significantly higher than in EH (all P<0.05), especially the nocturnal SBP (P<0.05). The SBP and DBP loads in RVH were 58.96% and 35.98% respectively, while blood pressure loads were around 20.00% in EH (P<0.05). In patients with RVH, The nocturnal blood pressure fall was 5.39%, and only 27.50% patients were dippers, while the nocturnal blood pressure fall was 10.36% and 60.8% patients were dippers in EH.Conclusion RVH patients have higher dynamic BP, PP, BP loads and blunted diurnal rhythm compared to those with EH.     

老年男性原发性高血压患者收缩压水平降低对心脑血管事件的影响

目的探讨老年男性原发性高血压患者降压治疗后,收缩压(SBP)水平与心脑血管事件发生的关系。方法采用回顾性研究方法 ,将836例老年男性原发性高血压患者,按降压治疗后SBP水平分为7组:1组29例,SBP110 mm Hg(1 mm Hg=0.133 kPa);2组71例,SBP 110～11 9 mm Hg;3组224例,SBP 120～1 29 mm Hg,4组290例,SBP 1 30～1 39 mm Hg,5组150例,SBP 140～149 mm Hg,6组45例,SBP 150～1 59 mm Hg,7组27例,SBP≥1 60 mm Hg;应用COX比例风险模型分析不同SBP水平对心脑血管事件的影响。结果与4组比较,6组和7组心脑血管事件发生相对风险分别增加了123%和251%(P0.01);在校正传统危险因素后,与4组比较,1组、6组和7组心脑血管终点事件发生相对风险分别增加了118%、75%和148%(P0.05),心脑血管事件发生与SBP水平呈"J型曲线"现象。结论老年原发性高血压患者SBP水平过高或过低,均显著增加心脑血管事件,SBP在130～139 mm Hg是老年男性高血压患者合适的目标血压范围。     

Long-term effects of weight-reducing interventions in hypertensive patients: systematic review and meta-analysis

Weight loss is recommended in all major guidelines for antihypertensive therapy. We searched for randomized controlled trials investigating the effects of weight-reducing diets, pharmacologic substances, and invasive interventions for weight reduction on patient-relevant end points and blood pressure (BP) in patients with essential hypertension. No information on the effects on patient-relevant end points was available. Patients assigned to weight loss diets, orlistat, or sibutramine reduced their body weight more effectively than did patients in the usual care/placebo groups. Reduction of BP was higher in patients treated with weight loss diets (systolic BP [SBP]: weighted mean difference [WMD], -6.3 mm Hg; diastolic BP [DBP]: WMD, -3.4 mm Hg) or orlistat (SBP: WMD, -2.5 mm Hg; DBP: WMD, -2.0 mm Hg). Systolic BP increased with sibutramine treatment (WMD, 3.2 mm Hg). In patients with essential hypertension, therapy with a weight loss diet or orlistat resulted in reductions in body weight and BP. Although sibutramine treatment reduced body weight, it did not lower BP.     

Aortic root dilatation at sinuses of valsalva and aortic regurgitation in hypertensive and normotensive subjects: The Hypertension Genetic Epidemiology Network Study

The association of sinuses of Valsalva dilatation and aortic regurgitation with hypertension is disputed, and few data are available in population-based samples. We explored the relations of sinuses of Valsalva dilatation and aortic regurgitation to hypertension and additional clinical and echocardiographic data in 2096 hypertensive and 361 normotensive participants in the Hypertension Genetic Epidemiology Network study. Age and body surface area were used to predict aortic root diameter using published equations developed from a separated reference population. Aortic dilatation was defined as measured sinuses of Valsalva diameter exceeding the 97.5th percentile of the confidence interval of predicted diameter for age and body size. Aortic dilatation was present in 4.6% of the population. After adjustment for age and body surface area, mean aortic root diameter was larger in hypertensives with suboptimal blood pressure control than normotensives or hypertensives with optimal blood pressure control. In multivariate models, sinuses of Valsalva diameter was weakly positively related to diastolic blood pressure and to left ventricular mass independent of aortic regurgitation. Subjects with aortic dilatation were slightly older, were more frequently men, had higher left ventricular mass, and had lower left ventricular systolic chamber function independent of covariates. Sinuses of Valsalva dilatation was independently related to male gender, aortic valve fibrocalcification, and echocardiographic wall motion abnormalities but not to diastolic blood pressure (or history of hypertension in a separate model). The likelihood of aortic regurgitation increased with larger aortic root diameter, older age, female gender, presence of aortic valve fibrocalcification, and lower body mass index but not hypertension or diabetes. In a subsequent model, diastolic blood pressure was negatively related to aortic regurgitation independent of covariates. In a large population-based sample, sinuses of Valsalva diameter was only mildly larger in subjects with suboptimally controlled hypertension than in normotensives or well-controlled hypertensives, which did not result in differences in prevalence of aortic regurgitation among groups. Sinuses of Valsalva dilatation was associated with higher left ventricular mass and lower systolic function, which may contribute to higher cardiovascular risk in subjects with aortic root dilatation.     

Pulse hypertension: a new component of the metabolic syndrome in elderly women?

The classification of arterial hypertension (HT) to define metabolic syndrome (MS) is unclear in that different cutoffs of blood pressure (BP) have been proposed. We evaluated the categorization of HT most qualified to define MS in relationship with coronary heart disease (CHD) mortality at a population level. A total of 3257 subjects aged > or =65 years were followed up for 12 years. MS was defined according to the criteria of the National Education Cholesterol Program using three different categories of HT: MS-1 (systolic blood pressure (SBP) > or =130 and diastolic blood pressure (DBP) > or =85 mm Hg), MS-2 (SBP > or =130 or DBP > or =85 mm Hg) and MS-3 (pulse pressure (PP) > or =75 mm Hg in men and > or =80 mm Hg in women). Gender-specific adjusted hazard ratio (HR) with 95% confidence intervals (CI) for CHD mortality was derived from Cox analysis in the three MS groups, both including and excluding antihypertensive treatment. In women with MS untreated for HT, the risk of CHD mortality was always significantly higher than in those without MS, independent of categorization; the HR of MS was 1.73 (CI 1.12-2.67) using MS-1, 1.75 (CI 1.10-2.83) using MS-2 and 2.39 (CI 3.71-1.31) using MS-3. In women with MS treated for HT, the HR of CHD mortality was significantly increased only in the MS-3 group (1.92, CI 1.1-2.88). MS did not predict CHD in men. In conclusion, MS can predict CHD mortality in elderly women with untreated HT but not in those with treated HT; in the latter, PP is the most predictive BP value.     

2型糖尿病合并原发性高血压患者的动态血压及脉压和左心室结构功能的关系

目的 :探讨 2型糖尿病 (DM)、原发性高血压 (EH)及DM +EH时 2 4小时动态血压和脉压的变化特点及与左心室结构和功能的关系。　　方法 :将 2 45例患者分为DM组 (n =72 )、EH组 (n =96)及DM +EH组 (n =77) ,进行动态血压及超声心动图检查。　　结果 :DM +EH组全天收缩压、全天脉压、左心室重量显著大于DM组及EH组 (P <0 0 5 )。左心室射血分数、短轴缩短率、舒张早期血流峰值速度 /舒张晚期血流峰值速度 (E/A)值、等容舒张时间 3组间无显著差异。相关分析表明 ,DM组左心室重量和全天脉压相关 (P <0 0 1) ;EH组左心室重量和全天收缩压相关 (P <0 0 5 ) ;DM +EH组左心室重量和全天收缩压及全天脉压相关 (P <0 0 5 )。 3组左心室舒张功能异常患者的全天收缩压、全天脉压均显著高于左心室舒张功能正常患者 (P均 <0 0 5～ 0 0 1) ,左心室的收缩功能正常患者和异常患者比较 ,2 4小时动态血压和脉压值均无显著差异 (P均 >0 0 5 )。　　结论 :DM组、EH组和DM +EH组 3组患者全天收缩压、全天脉压及左心室重量有显著差异 ,左心室重量和血压及脉压的相关性在 3组患者中不完全一致 ,可能与 3组患者体液及压力因素在左心室肥厚中的作用各不相同有关。     

Correlates of aortic distensibility in chronic aortic regurgitation and relation to progression to surgery.

Aortic distensibility decreases with increasing age. Patients with chronic aortic regurgitation eject a large stroke volume into the proximal aorta. A decrease in distensibility of the aorta may impose a higher afterload on the left ventricule and may contribute to deterioration of left ventricular function over time. Accordingly, aortic distensibility was measured in 33 patients aged 13 to 73 years who had chronic isolated aortic regurgitation with minimal or no symptoms. Ascending aortic diameter was measured 4 cm above the aortic valve by two-dimensional echocardiography and pulse pressure was measured simultaneously by sphygmomanometry. Aortic distensibility was calculated as (Change in aortic diameter between systole and diastole/End-diastolic diameter)/Pulse pressure. Left ventricular systolic wall stress and mass were derived from standard M-mode echocardiographic measurements. Left ventricular volumes and ejection fraction were measured by radionuclide ventriculography. Aortic distensibility decreased logarithmically with increasing age (r = -0.62, p less than 0.001) and also correlated inversely with systolic wall stress, left ventricular mass and end-diastolic volume. Patients who eventually underwent aortic valve replacement for symptoms of left ventricular dysfunction had significantly lower aortic distensibility than did those who did not yet require valve replacement: 0.09 +/- 0.08 vs. 0.22 +/- 0.19 x 1/100 (1/mm Hg) (p less than 0.05). Thus, the reduced aortic distensibility that occurs with increasing age may contribute to the gradual left ventricular dilation and dysfunction seen in patients with chronic aortic regurgitation.     

Aliskiren alone or in combination with hydrochlorothiazide in patients with the lower ranges of stage 2 hypertension: The ACQUIRE randomized double-blind study

Patients with stage 2 hypertension (systolic blood pressure [SBP] ≥160mm Hg and/or diastolic blood pressure [DBP] ≥100mm Hg) are at high cardiovascular risk and require intensive blood pressure (BP)-lowering therapy. This randomized double-blind study is the first prospective trial specifically designed to evaluate the direct renin inhibitor aliskiren in patients with a mean sitting SBP ≥160 mm Hg and <180mm Hg (the lower ranges of stage 2 systolic hypertension). After a 2- to 4-week washout period, 688 patients were randomized to once-daily aliskiren/hydrochlorothiazide (HCT) 150/12.5mg or aliskiren 150mg for 1 week and then double the doses for 11 weeks. Baseline BP was 167.1/95.0mm Hg. At week 12, both aliskiren/HCT and aliskiren provided substantial BP reductions from baseline (30.0/12.6 mm Hg and 20.3/8.2 mm Hg, respectively). Aliskiren/HCT lowered BP significantly more than aliskiren (least-squares mean between-treatment differences [95% confidence interval] were -9.7 [-12.0 to -7.4] for SBP and -4.5 [-5.8 to -3.2] for DBP; both P<.0001). Similar BP reductions were seen in the subgroups of patients with isolated systolic hypertension and obesity. Aliskiren, with or without HCT, provides clinically significant BP reductions and may therefore be an effective treatment option in patients with stage 2 hypertension.