The genetics of essential hypertension

Essential hypertension is an escalating problem for industrialized populations. It is currently seen as a 'complex' genetic trait caused by multiple susceptibility genes the effects of which are modulated by gene-environment and gene-gene interactions. Nevertheless, the success to date in identifying these susceptibility genes has been very limited. A number of candidates has been proposed, but demonstrating consistently the linkage or association with hypertension has been problematic. The data for angiotensinogen is undoubtedly the most extensive and meta-analysis has confirmed a significant association overall, although the risk contributed by this gene appears to be modest (odds ratio of 1.2). Identifying further genes - probably conferring even smaller attributable risks - represents a major challenge for future developments in this area. This contrasts markedly with the success that has been achieved in the past 5 years in solving the molecular genetics of a number of rare familial hypertension syndromes. The true incidences of some of these disorders may be higher than first appreciated, but it is still unclear if the genes for these syndromes also play a part in essential hypertension. A more complete understanding of the genetic basis of essential hypertension should be possible in the coming years using new strategies that take advantage of the information provided by the human genome project. This knowledge will irrevocably change the way we approach this disease in terms of its diagnosis, risk assessment for end-points such as stroke and heart disease, and the customised treatment that might be offered in the future.     

激活素A与原发性高血压的相关性研究

目的：通过对高血压患者血清激活素A（ACTA）表达水平的检测,来探讨其与高血压痛的发生发展的相关性。方法：选择单纯高血压病患者31例、高血压病合并冠心病患者33例为实验组,健康者20例为对照组。用酶联免疫吸附测试法对各组血清ACTA的浓度进行测定。同时检测血生化指标。数据采用SPSS13．0软件进行统计学比对分析。结果：单纯高血压病组血清ACTA含量高于正常对照组（P〈0．05）,高血压病合并冠心病组高于单纯高血压病组差异有统计学意义（P〈0．01）。并且血清ACTA水平与血压水平呈正相关。结论：ACTA表达水平与血压水平呈正相关,提示其可能参与了高血压痛的发生发展。作用方式可能与血管壁的炎症反应有关。     

伊贝沙坦治疗原发性高血压临床疗效

目的 :观察伊贝沙坦对原发性高血压患者降压的疗效及安全性。方法 :采用自身对照开放试验 ,选取 40例原发性高血压患者 ,服用伊贝沙坦 15 0mg·d-1,如 4wk无效加至 30 0mg·d-1,至 8wk。每 2wk随访BP ,HR ,并记录不良反应。结果 :经 8wk治疗 ,伊贝沙坦降压总有效率达 95 % ,平均SBP由 (146 3± 14 7)mmHg降至 (130 9± 11 0 )mmHg ,DBP由 (94 6± 15 2 )mmHg降至 (79 3± 6 8)mmHg ,P <0 0 5。整个治疗期间无明显不良反应发生。结论 :伊贝沙坦是一个安全、有效的降压药物     

有氧运动对原发性高血压服药患者的影响

目的:探讨有氧运动个体化方案在原发性高血压患者风险管理中的作用及意义。方法:对30例单纯原发性高血压患者在保持原药物治疗不变的情况下,以平板运动仪测试的结果为依据确定运动方案,实施个体化运动,对运动干预前后的血压及运动起始达目标心率所用时间和运动平板试验达目标心率前3 min和平板运动停止后4 min内(每隔30 s)的心率变化进行对照分析。结果:运动干预3个月后,收缩压(SBP)下降(11.9±0.4)mm Hg(1 mm Hg=0.133 kPa),舒张压(DBP)下降(8±3)mm Hg,运动前后对比差异有统计学意义(P<0.05),运动干预后未出现并发症。结论:有氧运动个体化是提高原发性高血压服药患者血压控制率、运动耐力及降低运动风险的有效途径。     

拉西地平对高血压病患者肾脏的作用

目的:评价拉西地平对原发性高血压患者肾脏的作用.方法:18例原发性高血压病住院患者(男16例,女2例),血压(23±2/14±1)kPa[(169±13/108±9)mmHg],分别在停降压药1～2wk.低钠饮食(20mmol/d)×5d,高钠饮食(26mmol/d)×5d及服用拉西地平(4～6mg/d)×4wk,测定肾小球滤过率(GFR内生肌酐清除率),同位素肾血流量(RPF),尿微量白蛋白排泄率(UMAE)及视黄醛结合蛋白排泄率(URE).结果:低钠比高钠状态UMAE显著下降(P<0.01),服拉西地平后GFR、RPF均有增加,但不显著.在GFR由(127±43)上升到(143±36)ml/min时UMAE明显减少(26.2mg/24h到15.0mg/24h,P<0.05),结论:拉西地平不降低原发性高血压病病人的肾功能,并能减少UMAE;减少UMAE可能与肾血流动力学改变无关.     

国产尼索地平片对轻中度原发性高血压近期和长期的疗效

目的:观察国产尼索地平片对轻、中度原发性高血压的疗效和不良反应.方法:采用自身对照开放试验.在268例舒张压(DBP)12.6～15.2 kPa之间的高血压患者中.经过7～10 d的安慰剂观察期后.给予国产尼索地平片10～20mg,bid.治疗6wk.结果:收缩压(SBP)和DBP分别从(21.6±2.3)和(13.7±0.9)kPa降至(18.6±1.6)和(11.7±1.2)kPa(P<0.005).显效率达75.37%(202/268).有效率达21.27%(57/268),总有效率达 96.63%.不良反应多为轻中度头痛、面红、踝部浮肿等.其中60例患者在接受单用尼索地平片6mo的长期治疗中.血压得到稳定的控制,SBP和DBP分别平均波动在18.1～18.8kPa和11.4～11.7kPa.结论:国产尼索地平片是一种有效且不良反应较轻的抗高血压药物.     

阿罗洛尔治疗老年原发性高血压的临床研究

目的观察小剂量阿罗洛尔治疗老年原发性高血压的疗效.方法6 5岁以上原发性高血压患者41例,采用自身前后对照方法予以阿罗洛尔5mg,bid,治疗8周, 其中12例进行动态血压监测比较.结果通过阿罗洛尔治疗8周,收缩压从( 21.71±2.20)kPa下降为(18.54±1.80)kPa(P<0.01),舒张压从(12.86±1.67)kPa 下降为(11.27±1.42)kPa(P<0.01);12例动态血压监测结果显示,小剂量阿罗洛尔在白昼和夜晚均能平稳降压,且两者差异无显著性.降压疗效显效率58.5%(24/41),有效率31 .7%(13/41),总有效率90.2%.不良反应轻微,心动过缓无1例低于50次*min-1.结论小剂量阿罗洛尔能降低原发性高血压患者的收缩压和舒张压,疗效显著且降压作用平稳,具有良好的耐受性.     

缬沙坦对原发性高血压伴糖尿病性视网膜病变的治疗作用

目的 探讨缬沙坦对原发性高血压糖尿病性视网膜病变的治疗作用.方法 选择原发性高血压伴2型糖尿病合并Ⅱ～Ⅲ期糖尿病性视网膜病变35例,随机分为缬沙坦治疗组17例和对照组18例,分别口服缬沙坦和其他降压药物治疗,于服药前和服药后2个月及12个月时测定收缩压、舒张压、空腹血糖、餐后2h血糖和散瞳眼底检查及眼底荧光造影结果.结果 缬沙坦组治疗2个月、12个月时收缩压、舒张压、空腹血糖、餐后2h血糖均较治疗前明显下降,差异有显著性(P＜0.01);与对照组同期相比降压及降糖效果明显(P＜0.05);且眼底病变进展缓慢(P＜0.05).结论 缬沙坦在降低血压的同时确有改善糖代谢、延缓糖尿病性视网膜病变发展的作用,可用于高血压合并2型糖尿病治疗.     

The effects of oxprenolol on ambulatory intra-arterial blood pressure in essential hypertension

Summary Continuous intra-arterial blood pressure recording using the Oxford technique has been used to study the antihypertensive effects of oxprenolol taken three times daily in fully ambulatory patients with essential hypertension, outside hospital. During the first 24 h of treatment there was a reduction in daytime heart rate and a small reduction in daytime blood pressure. After 10 weeks treatment there was a more substantial fall in daytime blood pressure from the hour of waking, but no effect on sleeping nighttime blood pressure or heart rate. Twenty-four hour variation, as assessed by the amplitude of a fitted regression curve, showed a reduction in heart rate but not blood pressure variation. In 4 patients restudied after 11 weeks treatment with oxprenolol (tid) and cyclopenthiazide at 9 a.m. there was some evidence of an antihypertensive effect occuring during both the daytime and nighttime.     

比索洛尔治疗轻—中度原发性高血压的临床疗效

目的;观察新型强效选择性β_1受体阻断剂比索洛尔(Biso)对原发性高血压的临床疗效.方法:选取34例轻～中度原发性高血压患者给予治疗观察,总疗程为6wk.结果:①Biso有明显的降压疗效;②轻度减慢心率的作用;③对血糖、血脂、肝肾功能无不利影响;④无明显而严重的不良反应.结论:Biso在原发性高血压的治疗中是一种安全、有效的药物.     

盐酸乐卡地平治疗原发性高血压的耐受性及疗效

目的：观察盐酸乐卡地平对轻中度原发性高血压患者的耐受性和降压疗效。方法：采用自身双因素交叉试验法，入选50例患者，停用原来正服用的二氢吡啶类钙通道阻滞剂，1～4周改服盐酸乐卡地平，每次10mg(必要时增加到20mg)，qd，5～8周恢复服用入选前的二氢吡啶类钙通道阻滞剂，患者在0，2，4，6和8周来医院就诊，整个临床试验过程中患者可继续应用原合并使用的利尿剂。结果：服用盐酸乐卡地平期间，收缩压在2周和4周时降低分别达1．26，1．45kPa，具有显著统计学意义(P均=0．000)；舒张压在2和4周时降低分别达1．13，1．63kPa，具有显著统计学意义(P均=0．000)。评价足踝小腿部水肿的水溢出量在2周和4周时降低分别达28．565，30．185mL，说明没有足踝小腿部水肿发生，具有显著统计学意义(2周P=0．001，4周P=0．000)。心率降低在2周时有统计学显著意义(P=0．011)。结论：盐酸乐卡地平可以明显降低收缩压和舒张压，降压作用可达24h，尤其是通常二氢吡啶类钙通道阻滞剂常见的不良反应如下肢水肿、颜面潮红、头痛和眩晕等发生率很低。     

治疗原发性高血压症3种药物治疗方案的成本—效果分析

目的：探讨不同药物治疗原发性高血压症的经济效益。方法：选择106例原发性高血压症（临床诊断1-2级），无严重心、脑、肾并发症患者，用3种不同的药物治疗，分为A组；卡托普利 西之达 银杏叶（38你）、B组：倍他乐克 西之达 银杏叶（33例）、C组：波依定 西之达 银杏叶（35例）3组，均为口服给药，疗程10wk。运用药物经济学的成本-效果分析方法进行评价，结果：3种治疗方案的总成本依次为3596.50、3671.90,3885.40元，其总有效率分别为86.84%,90.91%,97.14%。结论：B方案为最佳治疗方案。     

The role of the kidney in essential hypertension

1. Many forms of human and experimental hypertension begin with compromised renal function. Essential hypertension may be another such case. 2. The kidneys of subjects with essential hypertension excrete normal amounts of salt and water at higher-than-normal renal perfusing pressures. Other overt signs of renal dysfunction are few; renal disease is excluded by definition. However, renal blood flow and glomerular filtration rate are usually less than normal in essential hypertension. 3. Renal afferent resistance can be calculated from arterial pressure, renal blood flow, and an estimate of glomerular capillary pressure. These calculations indicate that afferent resistance is increased to two or more times normal in essential hypertension. 4. It is not clear whether afferent constriction causes hypertension or results from it. The ability of high pressure to produce vascular damage points to the latter. But, most essential hypertensives show low-to-normal plasma renin levels and a marked afferent dilation after saline loading. These observations do not suggest nephrosclerosis: they are consistent with a causal role for afferent constriction. 5. We can speculate that, in essential hypertension, there is a defect in one of the mechanisms that sets afferent resistance. Afferent constriction could result from extrinsic influences (neural or humoral) or something totally within the kidney, such as abnormal handling of information from the macula densa. 6. The effect of afferent constriction on salt-and-water excretion would theoretically be offset by elevated arterial pressure so that the actual salt-and-water excretion would be normal, but only so long as the arterial pressure remained elevated.     

Treatment of benign essential hypertension

Summary Furosemide (Impugan^®) 12.5, 25 or 40 mg twice daily, has been compared as an antihypertensive with hydrochlorothiazide 12.5 mg twice daily and a placebo. A double blind, cross-over design was used with a run-in period of 4 weeks, preceding five 4-week periods of treatment with these compounds alone. There were 34 patients in the trial, 17 men and 17 women. Paired comparison showed that furosemide 25 or 40 mg twice daily and hydrochlorothiazide 12.5 mg twice daily had a similar hypotensive effect, irrespective of the initial blood pressure. Furosemide 40 mg twice daily and hydrochlorothiazide 12.5 mg twice daily caused a slight fall of blood pressure as compared with placebo (0.10>p>0.05, p<0.05). There was a distinct correlation between blood pressure and age. Serum K⁺ fell significantly during treatment, particularly with hydrochlorothiazide 12.5 mg twice daily, as well as with furosemide 25 or 40 mg twice daily. As compared with placebo, urinary output increased significantly after furosemide 12.5, 25 or 40 mg twice daily, but it rose only to a non-significant extent after hydrochlorothiazide. The fall of blood pressure and decrease in serum K⁺ were linearly related. There were only a few, mild side effects which did not necessitate discontinuation of the trial.     

ACEI联合ARB治疗中重度原发性高血压的临床研究

目的分析血管紧张素转化酶抑制剂(ACEI)联合血管紧张素受体拮抗剂(ARB)治疗中重度原发性高血压的临床效果。方法将我院78例原发性高血压患者按照双盲法随机分为3组,分别采用ACEI、ARB和联合使用2种药物3种治疗方案。比较3组患者一般资料的差异,服用药物治疗前后心功能相关指标变化、血压变化和不良发应的发生情况。结果 3组患者服用药物治疗前一般情况的差异没有统计学意义。服用药物前后3组患者心功能各项指标都有显著提升,ACEI组和ARB组改善程度接近,联合组的改善程度比ACEI组和ARB组效果好,差异有统计学意义。3组血压都明显下降,前2组血压下降程度相似,血压接近正常高值,联合组血压下降到正常值范围。3组患者发生不良反应的情况基本相似,联合组并未产生更加严重或频繁的不良反应。结论本研究通过数据证明,服用ACEI联合ARB类药物治疗原发性高血压有着显著的临床疗效。     

原发性高血压患者单纯收缩期高血压及单纯舒张期高血压血压负荷值相关性

目的 探讨原发性高血压患者单纯收缩期高血压及单纯舒张期高血压血压负荷值相关性.方法 随机选取2012年8月至2015年8月收治的高血压患者60例,依据疾病类型患者分为2组,即单纯收缩期高血压组(A组,n=30)和单纯舒张期高血压组(B组,n=30).应用ECG LAB HOLTER SYSTEM 7.0动态心电监测系统和MGY-ABPI型动态血压监测仪对2组患者的24 hDCG和ABPM进行同步监测,对2组患者的平均STD、ST段压低持续时间、白昼和夜间的STD、ST段压低持续时间、24 h、白昼、夜间ST段压低发作频率进行分析.结果 A组24h血压负荷值轻度、中度患者的STD均显著低于B组(P＜0.05),ST段压低持续时间均显著短于B组(P＜0.05),STD均显著低于B组(P＜0.05),ST段压低持续时间均显著短于B组(P＜0.05),24 h血压负荷值轻度、中度患者24 h、白昼、夜间的ST段压低发作频率均显著低于B组(P＜0.05).结论 原发性高血压患者单纯收缩期高血压及单纯舒张期高血压血压负荷值的增高会提升ST段压低程度及SMI发作频率,延长其持续时间,且舒张压比收缩压显著.     

Comparison of enalapril and propranolol in essential hypertension

Summary In 40 patients with essential hypertension, enalapril was compared with propranolol as an antihypertensive agent in a double-blind study. The patients were randomly given either enalapril 5–10–20 mg bid or propranolol 40–80–120 mg bid in a treatment consisting of step-by-step increases in dosage. When the diastolic blood pressure remained >90 mm Hg on the highest dosage, hydrochlorothiazide was added. Both enalapril and propranolol reduced blood pressure, although the patients tended to achieve lower blood pressures while on enalapril. More patients on propranolol required additional diuretic therapy than patients on enalapril.Propranolol reduced heart rate; with enalapril there were no changes in heart rate. Both drugs increased serum potassium and urea. Plasma renin substrate was reduced by enalapril, but raised by propranolol. Enalapril increased plasma renin activity and angiotensin I, while propranolol reduced both. Converting enzyme activity was lowered with enalapril but was unchanged with propranolol. Both drugs reduced angiotensin II. Plasma aldosterone concentration was more suppressed with propranolol than with enalapril.     

老年原发性高血压患者血压与血糖水平的临床观察

目的 观察老年原发性高血压患者的血压及血糖水平，探讨其特征及二者之间的关系。方法 老年原发性高血压患者40人及老年非高血压患者45人，测定入院时的血压及空腹血糖水平。结果 高血压组较非高血压组的血糖水平高；在老年原发性高血压患者中血糖水平正常者所占的构成比明显低于血糖水平升高及糖尿病患者；不同血糖水平的高血压患者的血压差异无显著性。结论 高血压与糖尿病有一定相关性，测定原发性高血压患者的血糖水平对糖尿病的防治有重要意义。     

卡维地洛与美托洛尔对照治疗原发性高血压60例

目的:评价卡维地洛对原发性高血压的临床疗效及安全性.方法:60例原发性高血压患者经过2周安慰剂洗脱期后随机分为:对照组30例给予美托洛尔25mg,bid,服药2周末血压下降未达有效标准增至50mg,bid,疗程共8周.治疗组给予卡维地洛10mg,bid,服药2周末血压下降未达有效标准者增至20mg,bid,疗程共8周.结果:治疗组降压总有效率80.0%,显效率56.7%,对照组总有效率73.3%,显效率53.3%;两组疗效比较差异无显著性(P>0.05),不良反应发生率差异无显著性(P>0.05).不良反应程度轻微,可耐受.结论:卡维地洛是治疗原发性高血压的安全有效的药物.     

国产西尼地平治疗原发性高血压的多中心随机双盲双模拟临床研究

目的 对西尼地平治疗原发性高血压患者的疗效与安全性进行临床评价。方法 用多中心双盲双摸拟随机平行对照的试验方法,研究国产西尼地平与对照药苯磺酸氨氯地平对233例轻中度原发性高血压患者的降压疗效及药物不良反应。结果 治疗8周后,西尼地平组平均坐位收缩压(SBP)及舒张压(DBP)下降幅度分别为16.2,1 2.7 mmHg,苯磺酸氨氯地平组分别下降23.1,15.1 mmHg;两药总有效率分别为76.6％和87.7％,与治疗前比较有显著性差异(P<0.01);两药对心率无明显影响;两组药物不良反应的发生率分别为16.7％和12.9％。长期服用西尼地平疗效能持续,并有良好的耐受性。结论 西尼地平治疗轻中度原发性高血压具有明确的降压疗效与良好的安全性。