血浆儿茶酚胺含量与老年高血压患者室性心律失常的关系

观察老年期与老年前期高血压患者心律失常的发生及与血浆儿茶酚胺（CA）含量的关系。结果表明，老年期高血压患者室性心律失常的发生率较老年前期显著增多；血浆去甲肾上腺素（NE）、肾上腺素（E）含量较老年前期显著增高；血浆NE含量与24h室性早搏（VPC）总数显著正相关（r=0.356，P＜0.01）。经卡托普利治疗后，血浆NE，E含量均显著下降．室性心律失常的发生率显著降低。本文提示，交感─肾上腺素系统活性增强是引起老年高血压患者室性心律失常的重要因素。     

Supine and Standing Plasma Catecholamines in Essential Hypertensive Patients with Different Renin Levels

In this study we measured plasma renin activity (PRA), plasma norepinephrine (NE) and epinephrine (E), heart rate (HR) and blood pressure (BP) in 89 supine (sup) essential hypertensive patients (pts), WHO I–II, after 3–5 days of fixed normal sodium and potassium intake; the same measurements were repeated after 30′ of active standing (stand) in 44/89 pts. In the whole population NE was directly related to PRA, both in sup and in stand position (p < 0.01). NE was above the upper limits of normotensive controls in 2/34 (6%) pts with low PRA, in 6/40 (17%) pts with normal PRA and in 6/15 (40%) pts with high PRA. In respect to normal PRA pts, HR was significantly lower in low PRA pts and higher in high PRA pts, both in sup and in stand position (p < 0.05). Sup and stand NE and E were similar in low and normal PRA pts, while they were significantly higher in high PRA pts (p < 0.05). These results suggest an increased adrenergic tone at least in some high PRA pts, and blunted responsiveness of renal and cardiac beta adrenergic receptors to adrenergic stimuli in low PRA pts     

Plasma Neuropeptide Y and Catecholamines in Women and Men with Essential Hypertension

Neuropeptide-Y (NPY) is a peptide proposed to modulate the effect of the sympathetic nervous system on blood pressure control and contribute to the development of essential hypertension. To assess the possible influence of gender on its role, we evaluated plasma NPY, noradrenaline (NA) and adrenaline (A) concentrations in men and women with essential hypertension. No difference in NPY concentration was found between genders, but NPY concentration was elevated in both hypertensive men and women. NA levels were similar in all investigated hyper- and normotensives, while A was increased only in hypertensive men. These results suggest various patterns of sympatho-adrenal activity in gender subgroups of patients with essential hypertension.     

The Effects of Acth on the Renin-Aldosterone System in Normotensive Man

The present study examined the effects of low dose ACTH administration (0.1 mg/day for 2 days) on plasma renin concentration, (PRC), activity (PRA) and substrate (PRS), cortisol and aldosterone in man. Six healthy male volunteers on a diet calculated to contain 150 mmol Na/day received an infusion of 5% dextrose (6 ml/h) for 24 hours, then ACTH (Synacthen, Ciba-Geigy) was added to the infusion at the rate of 100 μg per day, for 48 h. Blood samples were taken four hourly for determination of plasma cortisol aldosterone, PRC, PRA and PRS. There was a highly significant increase in plasma cortisol and aldosterone concentrations during ACTH infusion compared with dextrose infusion, but no significant increase in active or inactive PRC, PRA or PRS. In a separate study of 15 healthy male volunteers, dexamethasone (1 mg at 2300 h) suppressed plasm a cortisol but had noeffecton PRC. These results do not support the view that stimulation of aldosterone by ACTH ismediated through the renin angiotensin system.     

Potential Functions of Plasma Prorenin; Regional Activation and Tissue Extraction

The fate of circulating inactive prorenin was examined in patients and volunteers. Prorenin was activated either by acid-dialysis with warming at pH 3.3 or with trypsin. The results were similar but omission of warming reduced the value by 13%. In 6 volunteers, 20 min forearm venous occlusion raised regional total (T) and inactive (I) plasma renin concentration (PRC) by 51% and 48% without change of active (A) renin. During intense foream exercise the ratio APRC:IPRC did not change in muscle or skin venous blood. Body anaerobic exercise increased APRC 3.7-fold without change in IPRC. These procedures activate plasminogen but are without effect on prorenin. In 18 patient with stable angina, TPRC was lower in coronary sinus than arterial blood (p<0.001) but APRC was not affected. A-V differences were not detected across the leg. Prorenin is apparently stable in the circulation but extracted by the heart.     

运动高血压与心脏损害的相关性研究

目的研究运动高血压与心肌缺血、左室肥厚的相关性.方法选择运动性高血压病人23例为观察组,同时设对照组23例.观察两组活动平板、超声心动图指标.结果观察组活动平板阳性率及超声心动图舒张期室间隔厚度、左心室后壁厚度和左心室重量指数,均明显高于对照组.结论运动性高血压对心肌缺血及左室肥厚具有诊断及预测价值.     

Muscle Fibre Composition in Relation to Blood Pressure Response to Isometric Exercise in Normotensive and Hypertensive Subjects

A positive relationship was demonstrated between the blood pressure and the fibre composition of the vastus muscle at rest in 17 hypertensive and 17 age- and sex-matched normotensive subjects. The hypertensive group had a higher proportion of fast twitch (FT) fibres (p<0.1). The circulatory response was measured during isometric exercise (IE) and cold pressor test (CPT). During IE the blood pressure increase was positively related to the percentage of FT fibres. No such relationship was demonstrated during CPT. It was thus found, particularly in hypertensive subjects, that an individual's muscle fibre profile is of importance for the blood pressure response during IE.     

Effects of Felodipine, Metoprolol and Their Combination on Blood Pressure at Rest and During Exercise and on Volume Regulatory Hormones in Hypertensive Patients

The effects on blood pressure (BP) and heart rate (HR), at rest and during bicycle exercise, of the vascular selective calcium antagonist felodipine, the cardio-selective beta-blocker metoprolol, and of the two drugs in combination, were assessed in a double-blind, three-way cross-over study comprising 23 patients with essential, mild to moderate hypertension. All three treatment regimens were given to each patient in randomised order for 4 weeks after a 4 week placebo run-in period. Felodipine 10-20 mg daily, metoprolol 100-200 mg daily and the combination of felodipine 10-20 mg plus metoprolol 100 mg daily were all effective antihypertensive treatments both at rest and during exercise. The two drugs seemed to have additive effects and the effect on BP of the combination was greater than that of either drug given as monotherapy. The mean sitting BP was 148/ 103 mmHg at randomisation, after 4 weeks of placebo treatment, and 134/88, 134/94 and 121/84 mmHg, respectively, after 4 weeks' treatment with felodipine, metoprolol and the combination. Maximal exercise capacity was similar irrespective of treatment regimen, and the normal response to exercise of BP and HR was maintained during all active treatments. Changes observed in volume regulatory hormones (PRA, aldosterone and ANP) were consistent with a direct tubular natriuretic-diuretic effect of felodipine and of beta-blocker attenuated release of renin. All treatment regimens were well tolerated and adverse events reported were usually mild and transient.     

Plasma Norepinephrine and Hemorheology in Essential Hypertensive Patients with Different Patterns of Left Ventricular Hypertrophy

对80例不同类型高血压左室肥厚（LVH）患者的血浆去甲肾上腺素（NE）和血液流变学改变进行观察。结果显示，（1）向心性肥厚组（CH）高切变率下全血粘度（WBV230）显著升高；（2）不对称性室间隔肥厚组（ASH）血浆NE和收缩末期室壁应力（ESS）增高较明显；（3）多元回归分析显示，SBP，ESS和血浆NE是影响相对室壁厚度的重要因素。提示CH是一种对压力负荷过重而产生的代偿形式；ASH的形成除了负荷因素外血浆NE可能起更重要的作用。     

血浆致动脉硬化指数预测高血压病患者发生冠心病的风险

目的探讨高血压病合并冠心病与血浆致动脉硬化指数(AIP)的关系。方法入选103例高血压病住院患者,其中高血压病合并冠心病73例,高血压病无合并冠心病30例,由冠脉造影证实或有心肌梗死病史者确诊为冠心病。采血检测患者血脂水平,行24 h动态血压监测,计算AIP=log(TG/HDL-C),并行统计学分析。结果两组患者三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)及动态血压指标差异无统计学意义,而合并冠心病组总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)和AIP高于单纯高血压病组,差异有统计学意义(P<0.0 5)。二分法Logistic回归分析结果表明,高血压病患者是否出现冠心病与TG相关(P<0.05),与TC、LDL-C、AIP高度相关(P<0.01)。结论高血压病合并冠心病患者AIP增加明显,AIP是高血压病患者合并冠心病的一个重要预测指标。     

原发性高血压左心室肥厚与心律失常的关系

目的探讨原发性高血压(EH)病人左心室肥厚(LVH)与心律失常的关系.方法采用24 h动态心电图(DCG)、超声心动图(UCG)对156例EH病人进行检查并分组分析.结果LVH组室性心律失常和复杂室性心律失常的发生率显著高于非LVH组(P＜0.01);房性心律失常的发生率显著高于室性心律失常(P＜0.01).结论左心室肥厚是导致室性心律失常的危险因素之一.     

肿瘤坏死因子-α与原发性高血压关系研究进展

肿瘤坏死因子-α是人体内最重要的炎症细胞因子之一,具有抗肿瘤、抗病毒、抗细菌等作用,同时对各类细胞包括内皮细胞、平滑肌细胞及心肌细胞的增殖也有调控作用。近年研究表明肿瘤坏死因子-α参与多种心脏疾病的病理生理过程。现对肿瘤坏死因子-α与高血压及其心血管重构的研究进展做一综述。     

高血压病患者脉压与靶器官损害的关系

目的　探讨脉压与高血压病靶器官损害的关系。方法　回顾性调查近 5年住我院未治疗高血压病患者 696例(男 3 87例 ,女 3 0 9例 ) ,按平均压 <10 7mmHg和≥ 10 7mmHg分为二组 ,再分别以脉压≤ 60mmHg ,60 10 0mmHg分为 4个亚组。分析各亚组的脉压与体重指数 (BMI)、血糖、血脂、BUN、Cr、UA、CCr、LVMI、EF、FS及心脑并发症发生率的相关性。结果　 ( 1)各亚组的高血压病史、吸烟者、饮酒者、BMI、血糖、甘油三酯 (TG)、胆固醇 (TC)、高密度脂蛋白 (HDL)及低密度脂蛋白 (LDL)无明显差别 (P >0 0 5) ;( 2 )脉压与BUN、Cr、UA、年龄、SBP、LVMI呈正相关 (r分别为 0 75,0 60 ,0 70 ,0 48,0 59,0 56,P均 <0 0 5) ,而与CCr、DBP、FS、EF呈负相关 (r分别为 -0 68,-0 52 ,-0 49,-0 51,P均 <0 0 5)。 ( 3 )左室肥厚、冠心病、心功能不全及脑并发症的发生率与患者年龄、收缩压、舒张压和脉压有关 (P均 <0 0 5) ,统计学分析脉压起着更重要的作用。结论　高血压病患者的靶器官损害与年龄、收缩压、舒张压和脉压等因素有关 ,但脉压起着更重要的作用     

Plasma Na+-K+ATPase Inhibitory Activity in Normal And Hypertensive Subjects: Relationship To Intracellular Electrolytes and Blood Pressure

The ability of plasma extracts to inhibit Na⁺-K⁺ATPase in vitro (P.I.A.) was tested in 20 normotensives, 10 without (F-) and 10 with (F+) familial hypertension, in 20 borderlines (BL) and in 21 essential hypertensives (EH). In these subjects we also measured intralymphocytic sodium (ILSC) and potassium (ILKC) content, P.R.A. urinary aldosterone and Na⁺(Na_u⁺), and blood pressure. P.I.A. of EH, BL and F+ subjects was significantly higher than that of F-. 60% of EH and BL and 40% af F+ had P.I.A. values greater than the high est found in F-. P.I.A. was significantly related to mean blood pressure (r=0.63), to ILSC (r=0.56), to ILKC (r=-0.56), to ILSC/ILKC ratio (r=0.71) and to Na_u⁺(r=0.39) but not to P.R.A. or aldosterone. These data demonstrate that plasma extracts from young subjects prone to hypertension may inhibit sodium pump and that this inhibitor may affect blood pressure by altering the Na⁺/K⁺intracellular ratio.     

Effects of Enalapril Maleate on Plasma Level of Inactive Renin in Renovascular Hypertension

Changes in plasma levels of active and inactive renin after the treatment with enalapril maleate (MK-421), a new angiotensin converting enzyme inhibitor, were studied in five patients with renovascular hypertension(RVH) due to unilateral renal artery stenosis. The dosage was increased when the blood pressure (BP) was not normalized for more than 3 days. Blood sampling was performed before, and 5 hours and 24 hours after the first administration, and on the 3rd day with each dosage. Active and inactive renin concentrations (ARC and IRC) showed a reciprocal change in 4 cases, 5 hours after the first dose. In the chronic treatment, ARC and IRC before the morning dose did not change apparently until the BP was normalized, when both ARC and IRC were evidently increased. It was suspected that a conversion from inactive to active renin may occur in the patients with RVH, when the active renin secretion is stimulated suddenly by the first dose of MK-421. The chronically diminished perfusion pressure in the kidney may stimulate the secretion of inactive renin, but the decrease in endogenous angiotensin II may not.     

Heat Stroke in Endurance Exercise

ABSTRACT Six athletes were examined immediately after collapsing from heat stroke during exercise, and then followed for several weeks. At the time of collapse most of the patients were sweating profusely, their rectal temperatures being more than 42°C. All recovered within a few hours. The renal function was not disturbed more than expected during heavy exercise, serum levels of liver enzymes were, however, increased for several weeks. Electrolyte homeostasis was undisturbed but for a transient hypercalcemia that can not be fully explained. The marked increments in plasma levels of catecholamines, vasopressin and renin were as expected after heavy exercise. We conclude that as heat stroke presents as a continuum of clinical pictures, biochemical evidence of liver cell injury is a sensitive and important parameter for the diagnosis.     

卡托普利对高血压患者血液自由基系统的影响

观察40例高血压患者血液自由基含量、血浆LPO水平和血清SOD活力及给予卡托普利治疗后的变化。高血压患者血液自由基含量及血浆LPO水平明显高于对照组（P＜0．01，P＜0．001），血清SOD活力显著低于对照组（P＜0．001）。经卡托普利治疗后血浆LPO水平明显降低（P＜0．01）．血清SOD活力增加（P＜0．05）。提示卡托普利能使高血压患者体内脂质过氧化速率降低，抗氧化能力增强，自由基代谢紊乱状态得以改善。     

Effects of Psychological and Physical Covariates on Plasma Catecholamines in Borderline Hypertensives and Offspring of Hypertensive Parents

The interpretation of plasma catecholamine measurements may be influenced by psychological and physical factors. Therefore, catecholamine concentrations were adjusted for between-subject differences by the following possible confounding factors, i.e. body-mass index, individual maximal physical work capacity, urinary sodium excretion rates and anxiety score. Subjects were 24 borderline essential hypertensives, aged 18–24 years, 50 age-matched normotensive offspring of hypertensive parents and 49 controls with no family history of hypertension studied at rest and during mental stressors (Stroop colour-word conflict test, mental arithmetic). Borderline hypertensives had consistently higher adjusted venous noradrenaline concentrations than control subjects (p<0.05). Adjusted plasma adrenaline concentrations were higher in borderline hypertensive subjects than in offspring of hypertensive parents during supine rest. Despite its limitations, venous plasma noradrenaline concentrations when adjusted for work capacity, body-mass, sodium excretion and anxiety suggest enhanced sympatho-neural activity in young borderline essential hypertensives.     

Direct Radioimmunoassay of Human Plasma Atrial Natriuretic Peptide in Various Normal and Pathophysiological States: Increase in Renal and Cardiac Failure During Exercise

We have used a sensitive direct radioimmunoassay to study the effects of exercise on plasma atrial natriuretic peptide (ANP) concentrations in man. Plasma ANP concentration increased three-fold in sixteen patients undergoing bicycle ergometer electrocardiographic tests for the investigation of chest pain. Resting ANP concentrations were higher in those patients in whom there was more evidence of heart disease, such as a positive exercise test, treatment with a beta blocker or history of myocardial infarction, although exercise resulted in increased ANP in both groups.

We also confirm the increased plasma ANP concentration observed in patients with congestive cardiac failure and renal failure. In nine patients with renal failure routine haemodialysis was accompanied by a 30 per cent reduction in plasma ANP concentration. Plasma ANP concentrations were similar in treated hypertensive patients, untreated borderline hypertensive patients and normotensive subjects.     

高血压患者糖耐量与超敏C反应蛋白的相关性

目的通过对不同糖耐量水平的原发性高血压患者的血浆超敏C反应蛋白(hsCRP)水平进行比较,探讨hsCRP与原发性高血压患者糖耐量水平的相关性。方法按条件入选原发性高血压患者146例,行葡萄糖耐量试验(OGTT)、血脂及hsCRP检测,根据糖耐量水平分为3组:糖耐量正常(NGT)组、糖耐量异常(IGT)组和2型糖尿病(T2DM)组。结果(1)3组患者之间在年龄、性别、体重、收缩压(SBP)、舒张压(DBP)、体重指数(BMI)、低密度脂蛋白胆固醇(LDL-C)及甘油三酯(TG)等指标上均无显著性的统计学差异,具有较好的可比性;(2)3组患者之间的hsCRP水平逐渐升高,组间比较有明显差异性(P<0·01)。原发性高血压患者糖耐量越差则血浆hsCRP水平越高(r=0·72,P<0.05)。结论对伴有hsCRP升高的原发性高血压患者行OGTT检查可早期发现糖耐量异常,及时给予针对性干预治疗。