曲美他嗪对稳定型劳力性心绞痛患者 心肌缺血的影响

目的探讨曲美他嗪对冠心病(CHD)稳定型劳力性心绞痛患者心肌缺血的影响。方法选择经冠状动脉造影确诊的CHD稳定型劳力性心绞痛患者14例,在原有治疗不变的情况下,加用曲美他嗪治疗12周,治疗前后均行平板运动试验,观察用药前后下述指标的变化①用药前后每周心绞痛发作的次数;②每周硝酸甘油片的用量;③心率及心率和收缩压的乘积;④运动诱发心绞痛发作所需的时间;⑤运动后ST段下降0.1mV所需的时间;⑥运动持续时间。结果患者每周心绞痛发作的次数及硝酸甘油片的用量均明显下降(P＜0.05);心率及心率和收缩压乘积轻度变化(P＞0.05);明显延长运动诱发心绞痛所需的时间及运动后ST段下降≥0.1mV所需的时间(P＜0.05)。结论曲美他嗪能改善运动诱发的心肌缺血,对CHD劳力性心绞痛患者有一定的疗效。     

曲美他嗪对稳定性劳力型心绞痛患者运动耐量的影响

目的探讨曲美他嗪对稳定性劳力型心绞痛患者运动耐量的影响。方法 45例稳定性劳力型心绞痛患者随机分为A、B两组,A组常规治疗,B组在常规治疗基础上,加用曲美他嗪20 mg,3次/d,治疗30周。结果 B组患者每周心绞痛发作的次数较治疗前减少,运动诱发心绞痛发作所需时间较治疗前延长,运动后ST段下降≥1 mm所需时间较治疗前延长,缺血心肌摄取葡萄糖的能力较前改善（P均〈0.05）。结论曲美他嗪能提高稳定性劳力型心绞痛患者运动耐量和缺血心肌的摄糖能力,增加缺血心肌对葡萄糖的利用。     

曲美他嗪对冠心病稳定性劳力型心绞痛患者心肌缺血的影响

目的探讨曲美他嗪对冠心病(CHD)稳定性劳力型心绞痛患者心肌缺血的影响.方法选择在1周内经2次运动试验结果为阳性,且运动持续时间变异低于10%的CHD稳定性劳力型心绞痛患者40例,在原有治疗不变的情况下,加用曲美他唪20mg每日3次,治疗12周.治疗前后均行平板运动试验,观察用药前后下述指标的变化(1)用药前后每周心绞痛发作的次数;(2)每周硝酸甘油片的用量;(3)心率及心率与收缩压的乘积;(4)运动诱发心绞痛发作所需的时间;(5)运动后ST段下降limn所需的时间;(6)运动持续时间;(7)总工作量.结果曲美他嗪应用12周后,患者每周心绞痛发作次数及硝酸甘油片的用量明显下降(P＜0.05),而对心率及心率与收缩压的乘积的影响无统计学显著意义(P＞0.05).与试验前相比,运动耐量和总工作量显著提高(P＜0.01),至心绞痛发作的时间及ST段下降1mm所需的时间均明显延长(P＜0.01).不良反应较少.结论曲美他嗪能增加CHD稳定性劳力型心绞痛患者的运动耐量,改善运动诱发心绞痛的心肌缺血,且安全有效,易于耐受.     

曲美他嗪治疗稳定型心绞痛疗效观察

将稳定型心绞痛（SAP）患者随机分成两组，对照组给予传统常规药物治疗；治疗组在此基础上加用曲美他嗪（TMZ）20mg口服，3次／d；疗程12周。观察两组治疗前后每周心绞痛发作次数、每周硝酸甘油用量、运动实验结果及安全性。结果治疗组每周心绞痛发作次数及硝酸甘油用量明显下降（P均〈0.01），运动持续时间和总工作量显著提高（P均〈0.01），运动中至心绞痛发作时间及ST段下降1mm的时间均明显延长（P均〈0.01）；心率与收缩压的乘积变化较小，无明显不良反应。认为在传统常规药物的基础上加用TMZ能明显改善SAP患者运动诱发的心肌缺血及心绞痛症状，且用药安全，患者易于耐受。     

曲美他嗪治疗稳定性劳力型心绞痛的疗效观察

目的探讨稳定性劳力型心绞痛患者采用曲美他嗪治疗的疗效。方法选取我院2013年5月~2014年5月收治的80例稳定性劳力型心绞痛患者,随机分为两组,各40例。采用硝酸酯类等常规药物治疗为对照组在对照组的基础上加用曲美他嗪治疗为观察组,对比两组疗效。结果两组在治疗前,心绞痛发作次数、舌下硝酸甘油用量差异无统计学意义(P0.05),治疗后,均有减少,但观察组减少幅度明显优于对照组,差异有统计学意义(P0.05)。治疗后,与对照组比较,观察组运动总做功呈显著增加,运动总时间出现延长,ST段压低在运动后最大幅度减少,运动至ST段压低1 mm时间也发生延长,差异均有统计学意义(P0.05)。但两组在运动高峰心率、静息心率、率压积及收缩压比较,差异无统计学意义(P0.05)。观察组治疗期间便秘2例(5%);对照组心悸3例(7.5%),均无需停用药物。结论稳定性劳力型心绞痛,采用曲美他嗪药物治疗,可使心绞痛发作次数减少,运动耐量提高,硝酸甘油量降低,且耐受性良好,无不良反应,有较高安全性,值得广泛推广。     

心肌需氧量增加对日常活动中心肌缺血发生的重要性

很多稳定型冠心病人在日常生活中常有缺血发生,且这种缺血发生大多不伴心绞痛。50例运动试验阳性受试者(ST段压低≥0.1mV)接受了本项试验,且在下列条件中至少具有一项:(1)典型心绞痛发作史;(2)造影证实至少有一支冠脉狭窄≥75％;(3)放射性核素检查结果和运动诱发心肌缺血相一致。全部受试者在日常活动下作动态心电图记录42±6小时,并作踏车试验(同时作连续心电图记录)。A组31例发生241次ST段压低(≥0.1mV),其中伴有心绞痛的ST段压低只占6%。在ST段压低之前心率增加 27±12     

卡托普利治疗稳定劳力型心绞痛的临床效果

目的卡托普利在治疗稳定性劳力型心绞痛在临床治疗中的效果分析。方法选取2005年3月~2012年10月来我院进行治疗的稳定性劳力型心绞痛患者共200例,年龄为53~72岁,并随机分成两组观察组与对照组,每组各100例。对照组与观察组分别采用常规的治疗方法以及在常规治疗方法的基础上施以卡托普利治疗。其中,常规的治疗方法主要是采用β-受体阻滞剂,阿司匹林,硝酸酯类以及钙拮抗剂进行治疗。对两组的治疗情况进行观察与分析。结果在经过一段时间的临床应用治疗之后,观察组与对照组的稳定性劳力性心绞痛的治疗效果有着明显的改善,但是观察组的治疗效果明显优于对照组,观察组与对照组见的心率明显不一样,观察组慢于对照组。并且在运动过程中观察组的心绞痛病症诱发时间明显长于对照组。结论卡托普利在治疗稳定劳力型心绞痛病症的过程中有着显著的疗效,具有重要的临床意义。     

活心丸(浓缩丸)治疗冠心病稳定性心绞痛气虚血瘀证——一项多中心、随机、双盲、安慰剂对照临床研究

目的观察活心丸(浓缩丸)治疗冠心病稳定性心绞痛的有效性及安全性。方法采用多中心、随机、双盲、安慰剂对照的临床研究,对131例冠心病稳定性心绞痛(气虚血瘀证)患者随机分组,分别采用活心丸(浓缩丸)或安慰剂进行治疗8周,其中48例进行心电图平板运动试验,观察治疗前后心绞痛症状、硝酸甘油停减率、心电图平板运动试验(总运动时间、运动诱发ST段下降0.1 m V或出现心绞痛的时间、诱发心电图ST段最大下移程度、运动诱发心电图ST段下移超过0.1 m V的导联数、运动代谢当量)、西雅图心绞痛调查量表总评分、中医证候变化情况、炎性因子以及血脂。结果治疗后,试验组心绞痛症状总积分明显低于对照组(P0.01),试验组硝酸甘油停减率明显高于对照组(P0.01),试验组西雅图心绞痛量表总分明显高于对照组(P0.01),试验组中医证候疗效明显高于对照组(P0.01)。心电图平板运动试验,试验组的ST段下降≥0.1 m V导联数较治疗前的减少数量明显高于对照组(P0.01)。试验组V4、V5、V6导联ST段最大下移幅度较对照组明显降低(P0.05)。炎性因子与血脂指标组间均没有明显统计学差异(P0.05)。试验组不良事件发生率与对照组相当。结论活心丸(浓缩丸)治疗冠心病稳定性心绞痛的效果显著优于对照组,且具有良好的安全性和耐受性。     

辛伐他汀对稳定劳力型心绞痛合并高胆固醇血症患者心肌缺血的影响

目的　探讨辛伐他汀调脂治疗对稳定劳力型心绞痛合并高胆固醇血症患者运动诱发心肌缺血的影响。方法　选择运动试验阳性且血浆总胆固醇浓度增高的稳定劳力型心绞痛患者 90例 ,随机分为治疗组和对照组 ,治疗组给予辛伐他汀 12周 ,对照组仅予饮食控制 ,治疗前后行心电图运动试验 ,比较两组运动试验结果的差异。结果　①经 12周治疗后 ,治疗组血TC、TG、LDL C均显著降低 ,HDL C显著升高 (P <0 0 5) ,而对照组血脂各项指标的变化均无统计学意义。②辛伐他汀组治疗后运动耐量显著提高 ,运动试验阳性率明显降低 ,至ST段下移 1mm时间明显延长 ,ST段下移值显著减少 (P <0 0 5) ,而对照组治疗前后各项指标的变化均无统计学意义。结论　辛伐他汀治疗在降低血脂的同时 ,还可明显减轻稳定劳力型心绞痛合并高胆固醇血症患者运动诱发的心肌缺血     

曲美他嗪辅助治疗稳定型心绞痛的疗效观察

目的 观察曲美他嗪辅助治疗稳定型心绞痛的临床效果。方法136例稳定型心绞痛患者被随机分成两组,对照组给予常规治疗;治疗组在给予常规治疗的基础上加服曲美他嗪片（20mg,每日3次）。连续治疗2个月。治疗结束后,记录两组患者心绞痛发作次数、硝酸甘油消耗量,进行运动试验,并观察不良反应。结果与对照组比较,治疗组总有效率升高（P〈0．05）,运动总时间、运动总作功、运动至ST段压低1mV的时间减少,运动至sT段压低的最大幅度明显增加（P〈0．05）,未见明显不良反应。结论曲美他嗪辅助治疗稳定型心绞痛安全、有效。     

Overview of blood pressure measurement by Brazilian health professionals

Although automated monitors for blood pressure (BP) measurement are used increasingly worldwide, understanding of how such devices are used in Brazil is low. This study analyzed the status of BP measurement by Brazilian health professionals. A questionnaire regarding experience with BP measurement was sent electronically to Brazilian nurses, nursing assistants, and doctors. It had 2004 responses. Previous experience with use of automated monitors was most frequent in men (71.2%), nursing technicians (65.5%), specialists (61.1%), secondary care (71.9%), emergency care (70.6%), or the private sector (66.3%). The least complied aspects of the standardized measurement protocol were availability of various cuff sizes (53.9% and 72.9% for auscultatory and oscillometric methods, respectively) and proper calibration checks (21.5% and 46.8% for auscultatory and oscillometric methods, respectively). Brazilian health professionals report not adequately performing all the necessary aspects to measure BP in accordance with the standardized protocol in both methods, but mainly regarding the oscillometric.     

200例正常中老年人24小时动态血压特征

目的 :动态血压测定值常因地区、种族、时节不同而异。方法 :我们于 1996年～ 1998年对成都地区 2 0 0例中老年人进行了 2 4小时动态血压监测。结果 :平均年龄 5 8.15± 8.19岁 ,昼夜均值 93～ 146 / 5 2～ 93mm Hg,日间均值10 0～ 135 / 5 9～ 92 m m Hg,夜间均值 10 0～ 132 / 5 5～ 83mm Hg,昼夜平均压均值 93± 10 .19mm Hg,血压负荷值 12～ 30 /10～ 15 %。结论 :本组结果可作为成都地区动态血压的参考正常值     

Nocturnal blood pressure surge in seconds is associated with arterial stiffness independently of conventional nocturnal blood pressure variability in suspected obstructive sleep apnea patients

Nocturnal blood pressure (BP) surge in seconds (sec-surge), which is characterized as acute transient BP elevation over several tens of seconds is induced by obstructive sleep apnea (OSA) and OSA-related sympathetic hyperactivity. The authors assessed the relationship between sec-surge and arterial stiffness in 34 nocturnal hypertensive patients with suspected OSA (mean age 63.9 ± 12.6 years, 32.4% female). During the night, they had beat-by-beat (BbB) BP and cuff-oscillometric BP measurements, and brachial-ankle pulse wave velocity (baPWV) was assessed as an arterial stiffness index. Multiple linear regression analysis revealed that the upward duration (UD) of sec-surge was significantly associated with baPWV independently of nocturnal oscillometric systolic BP variability (β = .365, p = .046). This study suggests that the UD of sec-surge, which can only be measured using a BbB BP monitoring device, may be worth monitoring in addition to nocturnal BP level.     

Ambulatory blood pressure phenotypes and isolated elevation of office central or brachial blood pressure

Disagreements in office brachial and central blood pressure (BP) have resulted in the identification of novel hypertension phenotypes, namely isolated central hypertension (ICH) and isolated brachial hypertension (IBH). This study investigated the relationship of ICH and IBH with ambulatory BP phenotypes among 753 individuals (mean age = 47.6 ± 15.2 years, 48% males) who underwent office and 24‐hours brachial and central BP measures using a Mobil‐O‐Graph PWA monitor. Thresholds for elevated office central and brachial BP were 130/90 and 140/90 mm Hg. Results of multivariable analysis adjusted for potential confounders showed that ICH (n = 25) had 3.71‐fold (95% CI 1.48‐9.32; P = .005) greater risk of masked hypertension than normal brachial/central BP (n = 362), while IBH (n = 20) had 4.65‐fold (95% CI 1.76‐12.25; P = .002) greater risk of white coat hypertension compared with combined brachial/central hypertension (n = 346). These findings suggest that the diagnosis of ICH and IBH might be useful in identifying individuals at higher risk of presenting discordant office and ambulatory BP phenotypes.     

高血压患者24小时动态血压分析

对１００例高血压患者进行２４ｈ动态血压监测，结果２４ｈ动态血压波动规律呈双峰双谷状，第一高峰在上午７～１１时左右，第二高峰在下午１６～２１时左右，且收缩压第二高峰值明显高于第一高峰值，２４ｈ动态血压均值昼夜为１３９／８３ｍｍＨｇ，日间为１４０／８６ｍｍＨｇ，夜间为１３６／８０ｍｍＨｇ。血压负荷收缩压为４８％，舒张压为３２％。     

Oscillometric blood pressure: a review for clinicians

Oscillometric devices for the non–invasive estimation of blood pressure (BP) have become the “clinical standard” because of training requirements for determination of BP by auscultation, cost, and the phasing–out/banning of mercury in many states and countries. Analysis of recent publications reveals a lack of understanding of the “meaning” of oscillometric blood pressure (OBP) measurements by authors, journal editors, and clinicians. We were invited to submit a review of OBP methodology written for clinicians. We hope that the material contained herein will clarify how clinicians should interpret OBP values for their patients.     

Practical Aspects of Home and Ambulatory Blood Pressure Monitoring

Out-of-office blood pressure (BP) monitoring is becoming increasingly important in the diagnosis and management of hypertension. Home BP and ambulatory BP monitoring (ABPM) are the two forms of monitoring BP in the out-of-office environment. Home BP monitoring is easy to perform, inexpensive, and engages patients in the care of their hypertension. Although ABPM is expensive and not widely available, it remains the gold standard for diagnosing hypertension. Observational studies show that both home BP and ABPM are stronger predictors of hypertension-related outcomes than office BP monitoring. There are no clinical trials showing their superiority over office BP monitoring in guiding the treatment of hypertension, but the consistency of observational data make a compelling case for their preferential use in clinical practice.     

Dialysis unit blood pressure two hours after hemodialysis is useful for predicting home blood pressure and ambulatory blood pressure in maintenance hemodialysis patients

This study aimed to determine which BP measurement obtained in the HD unit correlated best with home BP and ambulatory BP monitoring (ABPM). We retrospectively analyzed data from 40 patients that received maintenance HD who had available home BP and ABPM data. Dialysis unit BPs were the averages of pre-, 2hr- (2 h after starting HD), and post-HD BP during a 9-month study. Home BP was defined as the average of morning and evening home BPs. Dialysis unit BP and home BP were compared over the 9-month study period. ABPM was performed once for 24 h in the absence of dialysis during the final 2 weeks of the study period and was compared to the 2-week dialysis unit BP and home BP. There was a significant difference between dialysis unit systolic blood pressure (SBP) and home SBP over the 9-month period. No significant difference was observed between the 2hr-HD SBP and home SBP. When analyzing 2 weeks of dialysis unit BP and home BP, including ABPM, SBPs were significantly different (dialysis unit BP > home BP > ABPM; P = 0.009). Consistent with the 9-month study period, no significant difference was observed between 2hr-HD SBP and home SBP (P = 0.809). The difference between 2hr-HD SBP and ambulatory SBP was not significant (P = 0.113). In conclusion, the 2hr-HD SBP might be useful for predicting home BP and ABPM in HD patients.     

Central blood pressure variability is increased in hypertensive patients with target organ damage

We aimed to evaluate the association of aortic and brachial short‐term blood pressure variability (BPV) with the presence of target organ damage (TOD) in hypertensive patients. One‐hundred seventy‐eight patients, aged 57 ± 12 years, 33% women were studied. TOD was defined by the presence of left ventricular hypertrophy on echocardiogram, microalbuminuria, reduced glomerular filtration rate, or increased aortic pulse wave velocity. Aortic and brachial BPV was assessed by 24‐hour ambulatory BP monitoring (Mobil‐O‐Graph). TOD was present in 92 patients (51.7%). Compared to those without evidence of TOD, they had increased night‐to‐day ratios of systolic and diastolic BP (both aortic and brachial) and heart rate. They also had significant increased systolic BPV, as measured by both aortic and brachial daytime and 24‐hours standard deviations and coefficients of variation, as well as for average real variability. Circadian patterns and short‐term variability measures were very similar for aortic and brachial BP. We conclude that BPV is increased in hypertensive‐related TOD. Aortic BPV does not add relevant information in comparison to brachial BPV.     

Effect of Hypotensive Drugs on the Circadian Blood Pressure Pattern in Essential Hypertension: a Comparative Study

To compare the effect of four drug groups on the ambulatorycircadian blood pressure (BP) pattern, amiloride hydrochlorothiazide,atenolol, nifedipine, and perindopril (5/50 mg/d, 100 mg/d, 40mg/d, and 4 mg/d respectively, for 14 days) were alternated in eachof 20 essential hypertension patients. Diuretics induced the largest (P<0.05) drop in mean 24-hour systolic BP (–12 mmHg, P < 0.001).Atenolol reduced only its standard deviation, and nifedipine reduced onlythe mean daytime systolic BP (P < 0.05). The mean 24-hour diastolic BPwas equally reduced by all drugs except nifedipine, which only reduced (P< 0.05) the mean daytime value. The mean 24-hour heart rate wasdecreased by atenolol (P < 0.001), increased by diuretics (P <0.05), and unchanged with perindopril, while nifedipine increased (P < 0.05) only its night-time value. In conclusion, diuretics were the strongest agents in reducing systolic BP, atenolol the only agent thatreduced variability, perindopril the only agent that did not affect theheart rate, and nifedipine reduced only daytime BP values.