血清脂肪因子visfatin、A-FABP与老年高血压血压变异性的相关性

目的 探讨血清visfatin、A-FABP与老年高血压血压变异性（BPV）相关性。 方法 选取2017年1月至2019年2月保定市第二医院收治的老年高血压患者（≥ 60岁）235例，采用ELISA法检测血清visfatin、A-FABP水平，分析不同水平组visfatin、A-FABP与老年高血压24 h平均动脉压（24 hMABP）、24 h舒张压变异率（24 hDBPV）、24 h收缩压变异率（24 hSBPV）的相关性。 结果 采用最大选择检验法确定血清visfatin、A-FABP的截断点分别为43.5 ng/ml、20.9 ng/ml，visfatin低水平组的24 hMABP、24 hDBPV、24 hSBPV较高水平组明显降低（均P < 0.01）。A-FABP低水平组24 hDBPV、24 hSBPV、visfatin显著低于高水平组（均P<0.01）。24 hSBPV与年龄、LDL-C、血清visfatin、血清A-FABP呈正相关（均P < 0.01）。24 hDBPV与年龄、血清visfatin、血清A-FABP呈正相关（均P < 0.01）。 结论 年龄、A-FABP、visfatin是BPV增高的独立相关因素。     

老年原发性高血压患者24小时动态血压与左室肥厚的关系

目的观察老年原发性高血压患者24h动态血压与左室肥厚的关系。方法选择老年原发性高血压患者58例，分别作24小时动态血压及心脏超声心动图检查，观察24h动态血压（包括24h平均收缩压、24h平均舒张压、24h平均脉压）与室间隔厚度、左室后壁厚度的关系。结果24h平均收缩压、24h平均脉压与室间隔厚度、左室后壁厚度有相关性（分别为前者：r=0.415、P〈0.01，r=0.363、P〈0.01；后者：r=0.336，P〈0.05，r=0.346，P〈0.05）。结论老年原发性高血压患者随着24h平均收缩压增高、24h平均脉压增大而左室肥厚。     

气道正压通气对阻塞性睡眠呼吸暂停低通气综合征合并高血压患者脉压的影响

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）合并高血压患者脉压的变化及经鼻持续气道正压通气（nCPAP）的影响。方法选择85例经多导睡眠图仪（PSG）诊断的OSAHS患者，同时随机选取15例中重度OSAHS患者进行nCPAP治疗，在PSG监测前后及期间每2小时测量其血压，计算出脉压、脉压变化幅度、平均收缩压及平均舒张压，并计算体重指数。结果41％OSAHS患者同时合并有高血压；OSAHS合并高血压组患者的呼吸紊乱指数、脉压及体重指数明显高于单纯OSAHS患者，其最低血氧饱和度以及平均血氧饱和度均低于单纯OSAHS患者；重度OSAHS患者的脉压、体重指数、平均收缩压及平均舒张压均明显大于轻、中度OSAHS患者，而轻、中OSAHS患者之间差异无显著性意义。nCPAP可提高OSAHS患者最低血氧饱和度，同时降低其呼吸紊乱指数、平均收缩压、平均舒张压及脉压。相关分析结果表明，呼吸紊乱指数与脉压（r=0．395，P〈0．01）、平均收缩压（r=0．403，P〈0．01）、平均舒张压（r=0．313，P〈0．01）呈正相关，与最低氧饱和度（r=-0．424，P〈0．01）呈负相关，与体重指数、平均氧饱和度无相关。结论脉压是OSAHS的严重程度及是否并发高血压心血管事件的预测因子；nCPAP能下调OSAHS患者脉压及血压，是缓解OSAHS病情进展的有效治疗措施。     

肱踝脉搏波速度测定在心血管病风险评估中的应用

目的 探讨肱踝脉搏波速度（baPWV）与心血管病危险因素的相关性，以及在心血管病风险评估中的价值。 方法 入选309例具有心血管病危险因素的患者，测量baPWV、身高、体质量、腰围、血压，检测血脂、血糖、尿酸、肌酐、血同型半胱氨酸等，收集临床资料，并进行Framingham风险评分（FRS）。比较高baPWV组（≥1750 cm/s）与低baPWV组（<1750 cm/s）心血管病危险因素的差异。分析baPWV与心血管危险因素积累和FRS之间的关系。 结果 两组在年龄、甘油三酯、血糖、尿酸、收缩压、舒张压、脉压、高血压史、糖尿病史、心血管病家族史有统计学差异（均P<0.05），多因素Logistic回归分析显示主要影响因素为年龄（P<0.01）、收缩压（P=0.01）、高血压病（P<0.01）和心血管病家族史（P<0.05）。而且，随着心血管危险因素个数的积累，baPWV水平呈逐渐上升趋势（P<0.01）。随着FRS风险等级的增加，baPWV水平呈上升趋势（P<0.01）。 结论 baPWV升高可能预示着心血管病危险因素累积个数增加和（或）心血管病风险升高。年龄、收缩压、高血压病史和心血管病家族史是影响baPWV的主要危险因素。     

随诊间血压变异性对脑卒中复发的影响

目的探讨随诊间血压变异性对脑卒中复发的影响。方法回顾性分析12所医院进行的西洛他唑和阿司匹林预防脑卒中复发试验中698例患者的每次随诊血压,通过Cox比例风险回归模型,计算随诊间血压变异性对脑卒中复发影响的风险比。结果随诊间收缩压标准差与平均收缩压相关(r=0.282,P=0.000),变异系数与平均收缩压相关(r=0.128,P=0.001);调整平均收缩压后,收缩压标准差HR:3.641,95%CI:2.368⁵.599,收缩压变异系数HR:3.327,95%CI:2.1305.599,收缩压变异系数HR:3.327,95%CI:2.130⁵.195,收缩压独立均值变异(VIM)HR:3.657,95%CI:2.3205.195,收缩压独立均值变异(VIM)HR:3.657,95%CI:2.320⁵.763,差异有统计学意义(P=0.000)。平均舒张压HR:4.149,95%CI:2.3815.763,差异有统计学意义(P=0.000)。平均舒张压HR:4.149,95%CI:2.381⁷.229(P=0.000),舒张压标准差、舒张压变异系数、舒张压VIM差异无统计学意义(P>0.05)。调整平均脉压后,脉压标准差HR:4.973,95%CI:3.2957.229(P=0.000),舒张压标准差、舒张压变异系数、舒张压VIM差异无统计学意义(P>0.05)。调整平均脉压后,脉压标准差HR:4.973,95%CI:3.295⁷.506,脉压变异系数HR:6.410,95%:CI::3.8987.506,脉压变异系数HR:6.410,95%:CI::3.898¹0.538,差异有统计学意义(P=0.000)。结论随诊间收缩压和脉压变异性均是影响脑卒中复发的因素;但随诊间舒张压变异性不是影响脑卒中复发的因素。     

老老年H型高血压患者动态血压参数特点分析

目的：研究老老年H型高血压患者动态血压特征。方法：根据纳入患者血浆Hcy水平,分H型高血压组为1组,共147例;非H型高血压组为2组,共50例;均行动态血压监测,比较两组患者动态血压参数的差异。结果：两组患者比较,谷丙转氨酶：1组（24.70±8.10）＞2组（20.14±12.55）;夜间脉压：1组（67.02±15.90）＞2组（60.26±13.45）;夜间平均动脉压：1组（85.91±11.27）＞2组（79.64±11.55）;夜间收缩压负荷：1组（33.46±33.28）＞2组（22.32±30.76）;夜间收缩压下降率：1组（-1.89±10.88）＜2组（4.25±8.98）;夜间舒张压下降率：1组（0.25±11.39）＜2组（6.21±10.77）;均P＜0.05,差异有统计学意义。Spearman相关性分析显示,谷丙转氨酶（r=-0.209 ,p=0.041）夜间脉压(r=0.223,P=0.03)、夜间平均动脉(r=0.252,p=.014)、夜间 收缩压负荷（r=0.311,p=0.002）、夜间收缩压下降率（r=-0.28,p=0.008）、夜间舒张压下降率（r=-0.244,p=0.022）与H型高血压存在相关性。经二元logistic回归分析显示,夜间APP、夜间收缩压下降率为老老年H型高血压的独立影响因素。结论：老老年H型高血压患者与非H型高血压患者动态血压参数之间存在差异,其中夜间平均动脉压、夜间收缩压下降率与H型高血压关系最密切,两者或许可以作为老老年H型高血压的指征之一,同时提示在临床实践中应重视老老年夜间血压的监测,从而有效的进行诊疗,改善心脑血管病预后及生活质量。     

老年高血压患者动态脉压和脉压指数与颈动脉内膜中层厚度的关系

目的：探讨动态脉压及其指数与高血压患者颈动脉内膜-中层厚度（IMT）的关系。方法：测量159例研究对象的24h动态血压,并计算动态脉压（平均收缩压-平均舒张压）及动态脉压指数（动态脉压/平均收缩压）。使用彩色多普勒超声检测颈动脉IMT。分析动态脉压指数与颈动脉IMT的相关性。结果：Pearson相关分析发现,颈动脉IMT与年龄（r=0．353）、平均收缩压（r=0．594）、平均舒张压（r=0．355）、动态脉压（r=0．855）、动态脉压指数（r=0．883）有良好的相关性（P均〈0．001）。进一步行多元逐步回归分析显示,颈动脉IMT与动态脉压及动态脉压指数具有显著线性关系（R2=0．789）,动态脉压指数的标准回归系数（p=0．621）大于动态脉压的（p=0．284）。结论：动态脉压指数和动态脉压是评价颈动脉血管硬化的良好指标,动态脉压指数的价值更大。     

老老年高血压患者伴慢性心衰患者心功能分级与动态血压参数相关性研究

【摘要】目的：研究老老年原发性高血压伴慢性心力衰竭患者,心功能分级与动态血压参数之间的相关性。方法：选取2013年5月至2014年4月广安门医院心内科住院的老老年高血压患者147例,根据纽约心功能分级标准将患者分成心功能Ⅰ级48例,Ⅱ级31例,Ⅲ级38例,Ⅳ级30例,比较各组间动态血压参数的数值,并进行相关性分析。结果：不同心功能分级各组间行Spearman相关性分析显示：心功能分级与全天收缩压（r=-0.253,p=0.004）、全天舒张压（r=-0.247,p=0.005）、白天收缩压（r=-0.309,p=0.000）、白天舒张压（r=-0.293,p=0.001）、白天脉压（r=-0.179,p=0.044）、全天平均动脉压（r=-0.282,p=0.001）、白天平均动脉压（r=-0.309,p=0.000）、夜间收缩压下降率（r=-0.375,p=0.000）、24小时收缩压负荷（r=-0.262,p=0.003）、24小时舒张压负荷（r=-0.275,p=0.002）、白天收缩压负荷（r=-0.246,p=0.005）、白天舒张压负荷（r=-0.275,p=0.002）、夜间舒张压负荷（r=-0.229,p=0.01）均呈负相关,p值均＜0.05,有统计学意义。经多元线性回归分析显示,白天平均收缩压、夜间平均收缩压为老老年高血压伴随慢性心力衰竭患者的最终影响因素。结论：在老老年原发性高血压伴慢性心衰患者中,心功能与动态血压关系密切,尤其是白天、夜间平均收缩压,故应密切观察患者的动态血压参数,并进行合理的临床干预,从而有利于患者心功能的改善,预防心功能的进一步恶化,改善老老年高血压患者的生活质量及预后。     

维、汉两族间中心动脉压和周围动脉压及其与尿微量蛋白的关系

目的 探讨中心动脉压与外周动脉血压的关系，并比较这种关系在汉、维族间的差异及其与尿微量白蛋白的相关性。方法 选取2013年12月至2014年7月在新疆维吾尔族自治区人民医院心内科行冠脉造影的患者304例, 术中测量患者的中心动脉压和外周肱动脉压, 分为4组：无冠心病（正常组）、单纯冠心病组、单纯高血压组、冠心病合并高血压组，比较几组间的收缩压、舒张压，并分析两者和尿微量白蛋白关系。结果 总体比较中外周动脉收缩压高于中心动脉收缩压, 差异有统计学意义(t=3.235, P=0.001)，外周动脉舒张压与中心动脉舒张压未见统计学差异（t=2.091,P=0.037），这种差别在维汉两族及不同疾病组间未见统计学差异（P＞0.01）；4组内两族间未见统计学差异（P＞0.01）；4组中以冠心病合并高血压组尿微量白蛋白值最高，差异有统计学意义（F=4.304，P=0.005），单一疾病和正常组内未见统计学差异，且在维汉两族间未见统计学差异（P＞0.01）。结论 外周动脉收缩压高于中心动脉收缩压，尿微量白蛋白在合并两种疾病组中有意义,但均与种族无关，可能与疾病种类有关。     

老年高血压患者脉压与颈动脉粥样斑块的关系

目的 研究老年高血压患者血压水平与颈动脉粥样斑块形成的关系。方法选取84例老年原发性高血压患者，根据彩色多普勒超声检查颈动脉粥样斑块情况分为两组，斑块组54例，无斑块组30例，检测血脂和尿酸变化，监测24h动态血压，比较两组间性别构成、年龄、血脂和尿酸水平、24h平均收缩压、舒张压及脉压差水平有无统计学差异。结果两组之间年龄分布存在明显的统计学差异（P〈0．001）；斑块组PP明显高于无斑块组（P=0．003）；年龄与脉压之间呈正相关（r=0．301，P=0．005）。结论脉压增大可能是导致颈动脉粥样斑块形成的危险因子，降低脉压对老年高血压患者靶器官的保护可能起重要的作用。     

非酒精性脂肪肝并发原发性高血压患者与血压变异性的关系

目的 探讨非酒精性脂肪肝(Non-alcoholic Fatty Liver Disease,NAFLD)并发原发性高血压对血压变异性的影响.方法 纳入在2019年9月～2020年7月就诊于宣城市人民医院心血管内科的原发性高血压患者206例,进行动态血压、动态心电图及腹部超声检查.以动态血压测量参数中24 h收缩压变异...     

Increased C-reactive protein concentrations in never-treated hypertension: the role of systolic and pulse pressures

OBJECTIVE: To test whether the plasma concentration of C-reactive protein (CRP), a sensitive marker of systemic inflammation, is increased in patients with newly diagnosed, never-treated hypertension and whether blood pressure and its pulsatile component, pulse pressure, are correlated with plasma CRP concentration independently of a consistent number of cardiovascular risk factors. DESIGN: Cross-sectional study in a hospital outpatient hypertension clinic. METHODS: A total of 135 newly diagnosed, never-treated patients with hypertension and 40 healthy matched non-hypertensive controls underwent office and 24-h blood pressure measurement and blood sampling for determination of plasma CRP and serum lipid concentrations. RESULTS: Plasma CRP concentration was greater in hypertensive individuals (1.85 mg/l, interquartile range 0.74-3.64) than in control individuals (1.01 mg/l, interquartile range 0.67-1.88; P = 0.02). In the entire population, CRP had a significant direct association with office systolic blood pressure and pulse pressure, but not with diastolic blood pressure. Among hypertensive patients, plasma CRP was related to 24-h systolic blood pressure (r = 0.28, P < 0.01) and pulse pressure (r = 0.32, P < 0.01), but not to diastolic blood pressure (r = 0.12, P > 0.2). CRP was also directly associated with body mass index (r = 0.25, P < 0.01), serum low-density lipoprotein cholesterol (r = 0.21, P = 0.03) and serum triglycerides (r = 0.21, P = 0.03). In the multivariate analysis, systolic blood pressure and pulse pressure, but not diastolic blood pressure, were significant predictors of plasma CRP concentration when a consistent number of cardiovascular risk factors was controlled for simultaneously. CONCLUSIONS: Systolic blood pressure and pulse pressure, but not diastolic blood pressure, are predictors of plasma C-reactive protein concentrations in patients with newly diagnosed, never-treated hypertension, irrespective of the potential proinflammatory action of traditional cardiovascular risk factors.     

Relationship between small-artery structure and systolic, diastolic and pulse pressure in essential hypertension

OBJECTIVE: Studies of cerebral arterioles have suggested that pulse pressure may be a more important determinant of small-artery structure than systolic, diastolic or mean blood pressure in stroke-prone spontaneously hypertensive rats and in rats with an arterio-venous shunt. A study of small arteries has suggested that this is not the case in human essential hypertension. We therefore investigated the role of hemodynamic determinants on small-artery structure in hypertensive patients. DESIGN AND METHODS: To determine whether pulse pressure contributes to structural alterations in human essential hypertension, small arteries (lumen < 300 microns) were obtained from gluteal subcutaneous biopsies of 40 normotensive subjects aged 40.7 +/- 1.2 years and 45 untreated essential hypertensive humans aged 46.5 +/- 1.3 years. The relationship between the media: lumen ratio of the small arteries and levels of systolic, diastolic and mean blood pressure and pulse pressure was investigated. RESULTS: The media: lumen ratio (5.33 +/- 0.001%) of small gluteal subcutaneous arteries of normotensive subjects was significantly smaller and the lumen diameter (306 +/- 13 microns) significantly larger than in untreated hypertensive patients (7.42 +/- 0.001% and 244 +/- 9.7 microns respectively, P < 0.001). The media: lumen ratio of both groups examined together correlated with systolic blood pressure (r = 0.45, P < 0.001), diastolic blood pressure (r = 0.56, P < 0.001) and mean arterial pressure (r = 0.55, P < 0.001). The media: lumen ratio of vessels from hypertensive patients correlated with diastolic blood pressure (r = 0.22, P < 0.01) but not with systolic or mean blood pressure. There was no correlation between the media: lumen ratio of small gluteal subcutaneous arteries and pulse pressure in this population of normotensive and hypertensive subjects, examined together or separately. CONCLUSION: These results suggest that in 30- to 65-year-old humans with systolodiastolic essential hypertension, pulse pressure does not appear to be an important determinant of small-artery structure.     

Systolic and diastolic hypertension impair endothelial vasodilatory function in different types of vessels in the elderly: the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study

BACKGROUND: Endothelium-dependent vasodilation (EDV) is known to be impaired in middle-aged hypertensive individuals, but less is known regarding hypertension in the elderly. OBJECTIVE: In the Prospective Study of the Vasculature in Uppsala Seniors (PIVUS) study, different techniques to evaluate EDV in resistance and conduit arteries were applied in elderly subjects and were related to the type of hypertension. DESIGN AND METHODS: In this population-based study, 1016 subjects aged 70 years were evaluated by the invasive forearm technique with acetylcholine (EDV), brachial artery ultrasound to assess flow-mediated dilatation (FMD) and pulse wave analysis with a beta-2 receptor agonist challenge, terbutaline. Those without antihypertensive treatment were divided into three groups: normotensive individuals (n = 256), and those with isolated systolic hypertension (n = 309) or combined systolic/diastolic hypertension (n = 79). RESULTS: Compared with normotensive individuals, EDV was reduced in those with combined systolic/diastolic hypertension only (P = 0.0019), whereas FMD was mainly reduced in those with isolated systolic hypertension (P = 0.013). Furthermore, in regression analysis, EDV was related to diastolic blood pressure only (r = -0.10, P = 0.017), whereas FMD was mainly related to systolic blood pressure (r = -0.13, P = 0.0023). The pulse wave-based method to analyse vasoreactivity was not consistently affected by hypertension. CONCLUSIONS: In elderly subjects, systolic hypertension mainly impairs conduit artery endothelial vasodilatory function, whereas diastolic hypertension mainly induces dysfunction in resistance arteries.     

老年高血压病患者血浆甲状腺激素浓度的变化

目的　探讨老年高血压病患者血浆甲状腺激素的浓度变化及其与血压的关系。方法　 1 1 8例老年高血压病患者在空腹状态下抽取血样本 ,采用放射免疫测定法检测其血浆水平。结果　 t检验显示 :男性和女性患者 TSH有显著性差异 (P=0 .0 0 9)。单因素方差分析提示 :在按年龄分为 3组中 T3存在显著性差异 (P=0 .0 2 1 )。 Pearson相关分析显示 :T3与年龄显著负相关 (r=- 0 .2 30 ,P=0 .0 1 2 )。均衡性别、SBP、DBP、PP、BMI后 ,年龄与各参数偏相关分析结果显示 T3仍与年龄呈显著负相关 (r=- 0 .2 58,P=0 .0 0 6)。结论　在老年高血压病患者中 ,甲状腺激素 (T3)与年龄密切相关。     

Validation of pulse dynamic blood pressure measurement by auscultation

BACKGROUND: The accurate measurement of arterial blood pressure is essential for the diagnosis and treatment of hypertension. The development of new automated methods of measurement that provide reliable determinations of blood pressure should be valuable in the assessment of hypertension not only in the clinic or hospital but also, in the home for self-monitoring. DESIGN: We evaluated a noninvasive method for the measurement of systolic and diastolic blood pressures in 132 subjects. METHODS: Measurements obtained using the pulse dynamic method of blood pressure determination were validated with simultaneous manual measurements. Two qualified nurses used Korotkoff sounds to determine systolic (phase I) and diastolic (phase IV) blood pressures according to the Association for the Advancement of Medical Instrumentation 1987 guidelines. RESULTS: Inter-nurse variability was 2.7 +/- 4.1 mmHg (mean +/- SD) for systolic blood pressure and 4.0 +/- 3.7 mmHg for diastolic blood pressure and correlations were r = 0.98 and 0.94, respectively. We observed excellent agreement between auscultatory and pulse dynamic methods for systolic (127 +/- 21 versus 132 +/- 20 mmHg; r = 0.97) and diastolic (72 +/- 10 versus 71 +/- 10 mmHg; r = 0.89) blood pressures. Bland-Altman analysis demonstrated that there was a mean difference (reference-device) between the two methods of - mmHg (pulse dynamic value higher) and SD of 5 mmHg for systolic blood pressure and a mean difference of 1 mmHg (pulse dynamic value lower) and SD of 5 mmHg for diastolic blood pressure. CONCLUSION: The results of this study demonstrate that this noninvasive method of measurement of blood pressure is accurate and reliable and should therefore be appropriate for the evaluation of hypertension both in the home and in clinical settings.     

Casual, ambulatory and stress blood pressure: relationships with left ventricular mass and filling

In arterial hypertension, casual blood pressure seems to be weakly related to the level of cardiac involvement. The aim of the present study was to assess if blood pressure during ambulatory monitoring, and during different stress tests, is a stronger predictor of anatomical and functional changes observed in hypertensive heart disease. To this aim, 29 untreated patients with borderline-to-moderate essential hypertension underwent an echo-Doppler evaluation to determine left ventricular thickness and mass. From transmitral flow, the ratio between late and early filling velocities (A/E ratio) was used to assess left ventricular diastolic behaviour. On the same day that ultrasonic study was carried out, we also measured a set of casual blood pressures; conducted a mental arithmetic test (standardized series of mental subtractions); a handgrip test (30% of maximum voluntary contraction for 3 minutes); and performed noninvasive ambulatory monitoring of blood pressure (Spacelabs 5200). Significant relationships were observed between left ventricular mass and both night-time systolic blood pressure (r = 0.46, P less than 0.02) and peak systolic blood pressure during mental stress (r = 0.39, P less than 0.05). The A/E ratio was significantly associated with casual systolic and diastolic blood pressure (r = 0.45, P less than 0.02; r = 0.38, P less than 0.05, respectively); day-time diastolic blood pressure (r = 0.47, P less than 0.02); night-time systolic and diastolic blood pressure (r = 0.44, P less than 0.05; r = 0.42, P less than 0.05 respectively); and peak systolic blood pressure during the mental arithmetic test (r = 0.44, P less than 0.05). Our results seem to confirm the presence of a relationship between causal blood pressure and left ventricular filling. Moreover, the transmitral flow seems to be dependent on both mean levels of blood pressure on ambulatory monitoring and systolic blood pressure during mental stress. As concerns left ventricular mass, the correlations observed support the weakness of the links between blood pressure and left ventricular anatomy.