厄贝沙坦对老年高血压患者昼夜血压及心率变异性的影响

目的:观察厄贝沙坦对老年高血压病患者血压及心率变异性的影响。方法:140例原发性高血压患者服厄贝沙坦1次/d,共8周。治疗前和治疗8周后行24h动态心电图检查和24h动态血压监测。结果:厄贝沙坦能明显降低高压病患者的24h平均血压(P<0.01)、白昼平均血压(P<0.01)和夜间平均血压(P<0.01)。对夜间血压高于正常值的高血压病患者,厄贝沙坦能明显降低夜间血压(P<0.01),而对夜间血压已属正常者,厄贝沙坦无进一步降压作用(P>0.05),并使心率变异性时域指标SDNN、SDANN、SDNNI升高(P<0.05),频域指标HF升高(P<0.05),VLF和LF下降(P<0.05)。结论:厄贝沙坦在对老年原发性高血压患者控制血压的同时,也对改善心率变异性产生有益作用。     

2型糖尿病合并高血压患者昼夜血压特点分析

目的了解2型糖尿病合并高血压患动态血压的特点。方法将120例患按有无糖尿病和有无高血压分4组，对每组30例受试进行24h动态血压监测。结果糖尿病伴高血压组24h平均收缩压及收缩压负荷大于无糖尿病的原发性高血压组，而24h平均舒张压及舒张压负荷略小于无糖尿病的原发性高血压组；糖尿病组无论是否伴有高血压，其昼夜血压差值均小于无糖尿病的两组。结论糖尿病组失去正常昼高夜低的血压波动规律，这种异常在患未出现高血压时已经存在。提示：糖尿病患发生高血压的机理可能有别于非糖尿病，对糖尿病定期监测血压，并根据异常情况，在高血压出现之前即采取防治措施。     

Impact of ambulatory blood pressure monitoring on daily activity

We evaluated the impact of wearing an ambulatory blood pressure (ABP) monitor on the usual daily activity of 16 healthy men and women. Daily ABP and heart rate (HR) were recorded on 2 days using the DynaPulse 5000 A system. Daily HR and activity were recorded on two further days using a dedicated HR monitoring system. All four sets of measurements were made for 8 h during which time the volunteers kept a simultaneous diary record of their physical activity. There was no detectable difference in physical activity records on any day. Mean daily HR was lower during ABP monitoring than during the dedicated HR monitoring carried out on different occasions (73+/-7 versus 81+/-7 beats min(-1), P<0.001). The lower mean HR observed during ABP monitoring compared with dedicated HR monitoring may reflect subtle differences in the physical behaviour of subjects being monitored, which could not be detected from the diary records.     

动态血压及其模拟家庭自测血压评价动态动脉硬化指数的方法学简化

目的探讨动态血压及其模拟家庭自测血压评价动态动脉硬化指数（ambulatory arterial stiffness index,AASI）的方法学简化。方法连续入选81例行24小时动态血压监测的患者。AASI的计算：首先根据血压监测所得舒张压与收缩压之间的关系计算出回归斜率,AASI定义为1减去该斜率。AASI2的计算：把动态血压监测数值按收缩压排序,从中选取收缩压的25%及75%分位数,计算出该两个收缩压对应的血压间关系的回归斜率。AASI2定义为1减去该斜率。家庭自测血压的模拟简化（AASI4）：应用24小时动态血压监测期间7：00、12：00、18：00、22：00 4个时间点的血压模拟家庭自测的4次血压。AASI4定义为1减去该4点舒张压与收缩压关系的斜率。Sym-AASI的计算：1-（1-AASI）/r,其中r为动态血压直线回归模型的相关系数。结果 AASI为0.51±0.16,AASI2为0.50（0.24,0.68）,两组比较差异无统计学意义（Z=-1.196,P〉0.05）,两者无相关性（r=0.186,P〉0.05）;AASI4为0.52（0.29,0.71）,与标准AASI差异无统计学意义（Z=-0.480,P〉0.05）,两者无相关性（r=0.123,P〉0.05）;标准的sym-AASI为0.26±0.16,4点sym-AASI4为0.29（0.08,0.47）,两组比较差异无统计学意义（Z=-0.005,P〉0.05）,且两者呈正相关关系（r=0.307,P〈0.01）。Bland-Altman及Mountain plot分析显示标准AASI与AASI2、AASI4不能替换使用,sym-AASI与sym-AASI4不能够替换使用。结论简化AASI2不能替代标准AASI,不能利用1日内家庭自测血压值来简化AASI的计算。     

Improving patient outcomes with ambulatory blood pressure monitoring in elderly with hypertension

PURPOSE: The purpose of this article is to review the current knowledge regarding ambulatory blood pressure monitoring (ABPM) use in clinical practice and to provide example cases for its use in a hypertension (HTN) specialty clinic. DATA SOURCES: Published research trials, medical literature, and cases from the Center for Senior Hypertension. CONCLUSIONS: The knowledge of ABPM benefits to using ABPM are substantial and improves the care and management of many conditions, including white coat HTN, white coat normotension, resistant, borderline, episodic, paroxysmal HTN, and finally orthostatic hypotension. Third-party payers only cover ABPM for "white coat" HTN. IMPLICATIONS FOR PRACTICE: This article reviews previous studies and explains the benefit to changing our current practice to match the knowledge we have gained through research through case studies.     

腹型肥胖对高血压患者血压变异性的影响

目的评估腹型肥胖对原发性高血压患者血压变异性的影响。方法选择2014年1月至2014年4月核工业416医院收治的单纯性高血压患者159例,根据患者腹围分组,腹围正常者(男性90 cm,女性85 cm)72例为对照组,其中男38例,女34例;合并腹围增高者(男性≥90 cm,女性≥85 cm)87例为观察组,其中男45例,女42例。所有患者行24 h动态血压监测(ABPM),观察患者血压变异性(BPV)的特点。结果观察组24 h收缩压变异系数、日间平均收缩压变异系数均高于对照组,差异有统计学意义(P0.05);两组男性患者夜间平均舒张压变异系数均高于女性患者,差异有统计学意义(P0.05);且观察组男性患者24 h收缩压变异系数高于女性患者,差异有统计学意义(P0.05)。结论腹型肥胖时,高血压患者BPV增高,且男性患者较女性患者明显。     

帕金森病患者动态血压对认知功能的影响

目的 帕金森病（PD）患者多伴有动态血压（ABP）异常和认知功能障碍,PD认知功能减退的机制不明确,本研究旨在探讨PD患者ABP的变化对其认知功能改变的影响。方法 选取60例简易精神状态检查量表（Minimum Mental State Examination, MMSE）评分排除严重认知功能障碍的PD患者和40例年龄、性别相匹配的健康人作为对照,分别予以24小时 ABP监测和蒙特利尔认知功能评估（MoCA）评分,比较两组ABP的变化,并评价ABP的变化值对认知功能的影响程度。结果 PD组非杓型血压的发生率明显高于对照组（P=0.028）;PD组夜间平均血压(nMBP)与对照组比较显著增高(P=0.049);PD组夜间平均动脉血压下降水平(MABP%)明显低于对照组(P=0.022);PD组MoCA评分明显低于对照组（P=0.024）;PD组MABP%、帕金森病评定量表第三部分（UPDRS）评分、年龄和教育年限对MoCA评分有着显著的影响（P=0.04、0.012、0.015、0.020）,对照组教育年限和年龄对MoCA评分有显著影响（P=0.010和0.035）。结论 PD患者而非正常人的MABP%是其认知功能下降的独立危险因素。     

原发性高血压患者早期降压治疗后血压变异性、血压昼夜节律及靶器官损伤的变化

目的评估初诊未经治疗的原发性高血压患者经过早期正规降压治疗后能否改善血压变异性、血压昼夜节律以及靶器官损伤。方法选取2017年8月至2018年8月于安徽省立医院心血管内科门诊或体检中心初步确诊未经降压治疗的原发性高血压患者100例。根据每个患者的特点选用合适的药物进行降压治疗,按3个月内血压能否降至<130/80 mmHg将研究对象分为达标组(87例)和未达标组(13例)。分析入组前以及1年后两组患者的一般生化检查、血压变异性、血压昼夜节律、肱踝脉搏波传导速度(BaPWV)、左心室质量指数(LVMI)及尿微量白蛋白。结果治疗后,两组的SBP、DBP均可控制达标(P<0.05),但组间比较,差异无统计学意义(P>0.05);治疗后,两组的24 h SSD、dSSD、nSSD均改善,且达标组优于未达标组,差异具有统计学意义(P<0.05);治疗后,两组的24 h DSD、dDSD、n DSD比较,差异无统计学意义(P>0.05);治疗后,达标组杓型血压占比明显高于治疗前及未达标组,差异具有统计学意义(P<0.05);治疗后,两组的BaPWV、LVMI、尿微量白蛋白均改善,且达标组优于未达标组,差异具有统计学意义(P<0.05)。达标组靶器官损伤改善率高于未达标组,差异具有统计学意义(P<0.05)。结论经过1年的降压治疗后,高血压患者的血压变异性、血压昼夜节律以及靶器官损伤可被改善,早期降压,早期获益。     

慢性肾脏病合并顽固性高血压患者动态血压监测结果分析

目的了解动态血压监测（ABPM）在慢性肾脏病（CKD）患者合并顽固性高血压诊疗中的应用价值。方法回顾性收集本院2006年1月至2008年6月81例CKD合并顽固性高血压患者调整降压治疗至少两周后的临床资料,药物治疗情况,诊室血压（CBP）及ABPM资料并分析。根据每日限定剂量数（DDD）计算方法量化患者每日降压药物量。ABPM采用携带式血压监测仪（Mobil-0GRAPH S／N B03441）完成,应用Hypertension Management Softwarefor Windows进行数据分析。结果根据24小时平均血压与CBP测定结果比较,12．4％（10／81）的患者表现为隐性高血压;8．6％（7／81）的患者有白大衣性高血压。在均有夜间降压药物治疗的基础上,91．4％（74／81）的患者存在血压节律异常;夜间收缩压和舒张压负荷均高于白天。该组患者利尿剂使用率仅19．8％,显著低于其他种类降压药。结论ABPM能为CKD合并顽固性高血压患者血压控制水平的判断及节律观察提供重要信息。     

Predicting arterial stiffness with ambulatory blood pressure: an 11-year follow-up

No prospective data have been published on whether ambulatory blood pressure (BP) works better than casual measurements in predicting arterial stiffness. This study with 11-year follow-up was launched to evaluate the usefulness of ambulatory intra-arterial BP in predicting pulse wave velocity (PWV). Ninety-seven previously healthy men were recruited from a routine physical check-up at baseline. BP was measured with standard cuff and intra-arterial ambulatory methods. Sixty-seven subjects with no antihypertensive medication were enrolled for a visit after a follow-up of 11 years. Arterial stiffness was estimated with PWV derived with impedance cardiography. Ambulatory 24-h systolic blood pressure (SBP) (r = 0.30, P = 0.01), 24-h mean arterial pressure (r = 0.27, P = 0.03), 24-h pulse pressure (r = 0.27, P = 0.03) and daytime SBP (r = 0.26, P = 0.03) were the best BP variables in predicting future PWV. Casual BP values did not bear significant correlations with future PWV. In hierarchical regression analysis, the best predictive value for future PWV was achieved with the model including ambulatory 24-h SBP, smoking (number of cigarettes) and age (adjusted R(2) = 0.26). In conclusion, to our knowledge, this is the only prospective follow-up study to show that ambulatory BP is superior to casual BP measurement in predicting future PWV.     

Diurnal blood pressure profiles and variability in normotensive ambulant subjects

Summary. The 24-hour variability in blood pressure and heart rate of 14 normotensive subjects was examined under ambulatory conditions with a continuous, invasive method. The results were analysed with 30-second means calculated from beat-to-beat values. The registered time series had three different types of variation: (1) a continuous, fast variation around the mean level; (2) a stepwise, permanent change to a new level; and (3) a slow, continuous rise or fall. Variability in blood pressure and heart rate was determined by the 80 percent range of variation calculated from the cumulative distribution as the difference between the 90th and 10th percentiles. The variability in blood pressure and heart rate was significantly greater during waking hours than during night-time. Variability followed a similar type of diurnal profile as the mean level. However, variability of diastolic pressure changed to a lesser extent than that of systolic pressure. Total 24-hour variability was on average 45 mmHg in systolic blood pressure, 24 mmHg in diastolic pressure and 40 b.p.m. in heart rate. Using night-time to describe the basal state, physical and mental activities in the evening and during daytime were found to raise variability in systolic pressure with 66%, diastolic with 8–16% and heart rate with 130–180%, respectively. The results show that in normotensive subjects the sleep-wake state and activity are the major factors that affect both the diurnal profile and the variability in blood pressure and heart rate.     

维持性血液透析与腹膜透析患者血压变异性比较

目的对比维持性血液透析(MHD)和连续性非卧床腹膜透析(CAPD)患者血压变异性,观察不同透析方式血压变化的特点。方法选择MHD和CAPD治疗的非糖尿病尿毒症患者各30例,对MHD患者进行非透析期间的44 h动态血压(ABP)检测,对CAPD患者进行24 h ABP检测。分析MHD患者透析日与非透析日ABP特点,并与CAPD患者ABP参数进行对比,分析尿毒症患者不同治疗模式对于血压变异性的影响。结果 MHD患者非透析日血压明显高于CAPD患者,收缩血压(SBP)平均148.9±20.6 mmHg对129.9±16.4 mmHg,差异有显著性(P<0.001);舒张血压(DBP)平均89.9±12.5 mmHg对82.9±11.5 mmHg,差异具有显著性(P=0.028);MHD患者透析日杓型血压5例(16.7%),明显高于CAPD患者(0例),差异有显著性(P=0.029);MHD与CAPD患者血压标准差的均值(SD)和SBP变异系数(CV)的差异无显著性,但MHD患者非透析日DBP的SD明显高于透析日,10.4±2.9对12.5±5.0,差异有显著性(P=0.031)。结论 MHD患者非透析日血压较CAPD患者高,部分MHD患者透析后可恢复"杓型"节律,MHD患者非透析日血压变异性大。     

动态血压参数与冠状动脉病变的相关性

目的探讨不同动态血压参数与冠状动脉病变严重程度的相关性。方法可疑冠心病患者212例,行冠状动脉造影同时进行24h动态血压监测,根据造影结果分为非冠状动脉病变组（43例）和冠状动脉病变组（169例）,冠状动脉病变组患者根据病变范围再分为单支血管病变组（56例）、双支血管病变组（38例）与3支血管病变组（75例）,分析比较各组动态血压参数。结果冠状动脉病变组24h平均收缩压、24h平均脉压、白天平均收缩压、白天平均脉压、夜间平均收缩压、夜间平均脉压、最高收缩压、最低收缩压均明显高于非冠状动脉病变组（P〈0.05）,且随着狭窄支数增加而逐渐增高,以3支血管病变组明显（P〈0.05）;冠状动脉病变组白天平均舒张压、夜间平均舒张压、24h平均舒张压、最高舒张压均明显低于非冠状动脉病变组（P〈0.05）,且随狭窄支数增加有逐渐下降趋势,但差异无统计学意义（P〉0.05）;与杓型血压模式比较,非杓型、反杓型、超杓型血压模式患者双支和3支血管病变发生率率明显增高（P〈0.05）;多因素回归分析结果显示,夜间平均收缩压对冠心病有独立的预测价值（P〈0.05）。结论夜间平均脉压、最高收缩压与冠状动脉病变严重程度密切相关,夜间平均收缩压是预测冠状动脉病变的最佳参数;血压模式的改变是造成冠状动脉病变的重要因素。     

高血压患者动态血压变化与糖代谢异常55例分析

目的 探讨糖代谢异常对高血压患者动态血压变化的影响。方法 对55例既往无糖尿病的高血压患者行24小时动态血压监测和糖耐量试验（OGTT），根据OGTT分为糖耐量正常（NGT）、糖耐量减低（IGT）和新发现2型糖尿病（2-DM）3组。结果 从NGT至IGT至2-DM，非杓型血压发生率逐渐增高（分别为52．17％、64．70％和80．00％，P〈0．01），且2-DM患者夜间高血压的发生率较NGT及IGT显著增加（分别为13．04％、17．64％和33．33％，P〈0．01）；IGT组的24小时舒张压负荷、24小时舒张压和夜间舒张压均显著低于NGT组和2-DM组（P〈0．05），且脉压增大；并且发现，从NGT至IGT至2-DM过程中，胰岛素抵抗指数逐渐增加（分别为1．41、1．66和1．92，P〈0．05），胰岛素敏感指数在IGT阶段较NGT增高（39．90比33．83，P〈0．05），而到2-DM阶段较NGT下降（27．15比33．83，P〈0．05）；Logistic回归分析显示，影响脉压的主要因素为餐后血糖。结论 糖代谢异常的高血压惠者其24h血压的昼夜节律紊乱，其中以IGT患者的舒张压降低和脉压增大为著，而脉压增大与餐后血糖及血浆胰岛素水平相关。     

正常人血压变异性分析方法及生理意义

目的　建立正常人长时血压变异参数的正常参照值上限 (95 %可信限 ) ,并探讨其生理意义。方法　选择 6 2名正常人行 2 4h动态血压监测 ,性别和年龄匹配 ,以各时间段血压的标准差作为血压变异指标。结果　① 2 4h收缩压与舒张压变异各 <12 90、5 0 1;白昼收缩压与舒张压变异各 <11 31、4 2 3;夜间收缩压与舒张压变异各 <9 90、2 6 7。②L BPV强度依次为 2 4h收缩压变异 >白昼收缩压变异 >夜间收缩压变异 ;2 4h舒张压变异 >白昼舒张压变异 >夜间舒张压变异。③ 2 4h收缩压与舒张压变异在正常男女间比较差异均无显著意义 (P >0 0 5 ) ;不同年龄段的 2 4h收缩压变异性比较差异无显著意义 (P >0 0 5 )。结论　交感与迷走神经功能的动态平衡是血压变异得以维持在生理范畴的重要机制。增强的血压变异与体力及脑力劳动有关 ,而睡眠是降低血压变异的有效方法。     

个体化治疗模式对高血压维持性血液透析患者居家血压变异度的影响

目的 了解高血压血液透析（hemodialysis,HD）患者居家血压变异度状况,并观察根据HD患者高血压发病机制进行个体化治疗后,HD患者居家血压变异度的变化情况.方法 选取北京朝阳医院肾内科透析室部分稳定维持性HD患者进行家庭血压（Home-BP）监测,了解HD患者居家血压变异度情况,以居家血压的变异系数表示血压变异度.并以家庭收缩压≥150mmHg （1mmHg=0.133kPa）为未控制的高血压的诊断标准,对未控制的高血压患者进行生物电阻抗监测、透析前后血清钠测定、药物使用情况调查,了解水、钠负荷及药物应用合理性情况,进而针对性地分别进行降低干体质量、应用低钠透析液和合理使用降压药物的干预措施.随访2个月,观察患者血压及血压变异度情况. 结果 共有105例稳定维持HD患者进行家庭血压监测,患者居家血压变异度为（4.8±2.2/5.0±2.4）％.未控制的高血压患者有60例（57.1％）,经个体化降压治疗后,居家血压从（166.3±12.6/87.5±11.7） mmHg降至（154.1±14.2/82.6±11.4）mmHg（P＜0.001,t=7.223; t=4.796,P＜0.001）,收缩压变异度由（4.9±2.2）％降至（4.6±2.5）％ （P=0.340,t=0.961）.其中30例容量超负荷患者,予降低干体质量后,家庭收缩压和舒张压明显降低,变异系数分别下降0.4％和0.1％（P=0.027,t=2.329;P=0.041,t=2.138）.12例患者应用低钠透析液（136mmol/L）后,居家血压下降,血压变异度无明显改变.其余18例容量负荷正常、未使用低钠透析的患者通过增加肾素-血管紧张素抑制剂和αβ受体阻滞剂等,居家血压下降,血压变异度减小,但未达统计学差异.结论 针对高血压HD患者高血压的病因进行治疗,能够有效地改善患者的家庭血压及血压变异度.     

动态血压监测对血液透析患者预后判断的作用

目的探讨动态血压监测对维持性血透患者预后判断的价值。方法2010年3月～7月北京大学第三医院维持性血液透析患者45例,行24h动态血压监测后随访至患者死亡或2013年12月31日,对可能影响预后的因素进行单因素和多因素Cox回归分析。结果平均随访3．5年后死亡9例,其中7例死因为心脑血管疾病,平均动脉压、夜间舒张压最低值、夜间舒张压变异度及非杓型血压与年龄是患者死亡的独立危险因素（HR分别为1．248,1．577,2．101,0．000,1．461,P〈0．05）。结论动态血压监测所得平均动脉压、夜问舒张压最低值,夜间舒张压变异度、血压节律可能对患者死亡有一定的预测价值。     

Loss of the nocturnal dip and increased variability of blood pressure in normotensive patients with noninsulin-dependent diabetes mellitus

Summary. Eleven normotensive diabetics with noninsulin-dependent diabetes mellitus (NIDDM) (mean age 52.5 SD 8.2 years) and 11 controls (mean age 47.4 SD 8.9 years) had their ambulatory blood pressure and heart rate recorded non-invasively by the Oxford Medilog System in standard hospital conditions. The results were averaged as hourly means of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), and heart rate (HR) for the 24-h period and similarly for the ‘awake’ period (14.16 h) and the ‘asleep’ period (8–10 h). Hourly means for diabetics and controls showed no differences in blood pressure and heart rate over the 24 h. During sleep, control subjects showed a significant drop in SBP (P < 0.001), DBP (P < 0.001), MAP (P < 0.001) and HR (P < 0.001). However, this nocturnal dip in blood pressure could not be demonstrated in the diabetic group. Blood pressure variability was significantly increased in diabetics compared to controls during waking hours (P < 0.01). These results indicate that in noninsulin-dependent diabetics during sleep there is loss of the nocturnal dip of BP seen in normal subjects, and they have increased BP variability. These may be contributing factors to the development of hypertension and the accelerated target organ damage (TOD) seen in diabetes.,     

Lessons learned as a research assistant studying ambulatory blood pressure in elderly Japanese stroke patients

The research assistant plays a critical part in research projects, yet there is little structured information about the role. The present paper describes the research assistant"s role and provides an example of the research assistant"s activities in nursing research. In this pilot study, 24 h ambulatory blood pressure monitoring was conducted on 15 elderly Japanese stroke patients in a hospital rehabilitation unit. The research assistant's involvement is described along the course of the study: pre-data collection; data collection and data processing. A research assistant needs to have good communication skills, a detail-oriented focus and an inquisitive nature.     

厄贝沙坦及倍他乐克对高血压患者动态血压的影响

目的观察厄贝沙坦及倍他乐克对高血压患者动态血压的影响。方法选择80例原发性高血压患者,分成厄贝沙坦组及倍他乐克组,每组40例。治疗前及治疗后3个月行24h动态血压检测,观察血压控制情况。结果治疗前两组患者血压无显著差异,经治疗后两组患者血压都有显著性下降,两组在治疗后24h夜均舒张压没有显著差异性,其余24h收缩压、24h舒张压、日间收缩压和舒张压、夜间收缩压均有显著差异性,厄贝沙坦组血压下降更明显。结论厄贝沙坦和倍他乐克对原发性高血压降压疗效均明显,厄贝沙坦组血压下降效果更佳。