药学服务在高血压患者合理用药干预中的应用

目的 探究药学服务在高血压患者合理用药干预中的应用效果.方法 收集2015年1月-2015年12月收治的200例高血压患者进行研究,将上述患者随机分为两组,对照组接受常规护理,观察组接受药学服务干预,比较两组患者血压水平、服药依从性.结果 ①治疗后,观察组收缩压(127.0±9.5)mmHg、舒张压水平(75.8 ±7.0)mmHg显著优于对照组,组间比较差异具有统计学意义(P＜0.05).②观察组充分依从88例,占88.0％,显著高于对照组64.0％,组间比较差异具有统计学意义(P＜0.05).结论 药学服务有助于改善高血压患者的血压水平和依从性,值得临床推广.     

脑梗死患者急性期血压变化与预后关系的研究进展

高血压是脑血管病重要的、独立的危险因素,收缩压与舒张压的升高都与脑卒中的发病呈正相关,并呈线性关系。研究表明[1],收缩压〉160mmHg和（或）舒张压〉95mmHg,卒中的相对风险约为血压正常者的4倍。作为脑卒中最常见类型的脑梗死（约为70%）,急性期血压的变化规律与影响因素,对患者的转归与预后具有至关重要的作用,现就近几年有关该方面的研究进展综述如下。     

老年高血压患者护理干预对降压效果的影响体会

目的：分析老年高血压患者护理干预对降压效果的影响。方法分析收治的74例老年高血压患者的临床资料,按照入院顺序将所有患者分为两组,即：观察组（37例）与对照组（37例）。对照组37例老年高血压患者给予常规护理,观察组37例老年高血压患者给予护理干预;对比两组老年高血压患者的舒张压、收缩压与血压控制率。结果护理之后,两组老年高血压患者的舒张压、收缩压显著低于护理之前,护理前后差异有统计学意义（ P＜0．05）;护理之后,观察组37例老年高血压患者的舒张压、收缩压显著低于对照组37例老年高血压患者,差异有统计学意义（ P＜0．05）。结论护理干预应用于老年高血压患者临床护理中的效果十分显著。     

社区护理对临界高血压患者血压的影响研究

目的探讨社区护理干预对临界高血压患者血压的影响。方法将106例患者随机分为对照组和实验组,每组53例,对照组不用药物治疗采用随访观察,对实验组患者采用健康教育、心理干预、指导血压监测,定期随访护理干预等措施,随访时做好记录,6个月后比较两组患者的收缩压和舒张压变化情况。结果实验组患者的收缩压和舒张压在护理干预前与对照组比较差异无统计学意义（P〉0.05）,实验组患者的收缩压和舒张压在护理干预后血压下降情况好于对照组,两组比较差异有统计学意义（P〈0.05）。结论对临界高血压患者进行社区护理干预,可以提高患者的自我保健意识,有效的控制血压,能够有效预防高血压的发展,改善患者的生活质量。     

贝尼地平治疗原发性高血压的疗效观察

目的用动态血压监测(ABPM)的方法评价贝尼地平治疗原发性高血压的疗效。方法选择原发性高血压患者56例,随机分为贝尼地平组26例,厄贝沙坦组30例。分别观察服药前和服药后(8周末)的血压变化及贝尼地平服药前、后的24h,白昼、夜间的动态血压变化。结果贝尼地平组服药8周后SBP和DBP下降(16.9±11.8)和(12.8±9.2)mmHg(P<0.01)。厄贝沙坦组SBP和DBP下降(14.8±10.9)和(11.2±8.7)mmHg(P<0.01)。动态血压资料分析示服用贝尼地平后24h、白天、夜间平均收缩压/舒张压显著下降,收缩压和舒张压的谷峰比值分别为0.62和0.61。无严重不良反应。结论贝尼地平是一种安全有效的抗高血压药。     

长期应用非洛地平对原发性高血压患者血管内皮功能的影响

目的观察长期应用非洛地平对原发性高血压患者血管内皮功能的影响。方法60例轻-中度原发性高血压患者给予非洛地平口服治疗24周。采用高分辨率血管外超声法检测治疗前后肱动脉内皮依赖性血管舒张功能。结果非洛地平治疗24周后,原发性高血压患者的收缩压[(122.8±11.7)mmHg]及舒张压[(76.4±8.2)mmHg]均较治疗前[收缩压:(160.4±14.8)mmHg,舒张压:(96.2±10.1)mmHg]显著降低(均P<0.01);治疗后肱动脉内径的基础值[(4.98±0.41)mm]及血流介导的内皮依赖性舒张功能[(6.21±1.28)%]均较治疗前[(分别为(4.02±0.50)mm和(4.91±1.03)%]明显改善(均P<0.01)。结论非洛地平能够在有效降压的同时显著改善原发性高血压患者肱动脉内皮依赖性舒张功能。     

高血压病人用药护理干预及效果观察

目的探讨对高血压病人用药护理干预的效果,以提高高血压病人的治疗效果和病人生活质量。方法通过100例高血压病人用药前、中、后三个环节的护理干预及健康指导,应用生活质量自评表在三环节进行评定,对比护理干预前后患者各项指标的变化情况。结果对高血压病人进行用药护理干预及健康指导后,患者的收缩压、舒张压均显著得到控制（P〈0．05）。遵医行为均显著提高（P〈0．05）。结论对高血压病人进行用药护理干预及健康指导,使病人的血压水平的控制以及生活质量提高,自我保健意识增强,对巩固治疗成果起到了重要的作用。     

强化物理干预对高血压合并阻塞性睡眠呼吸暂停的疗效

 

目的 探讨强化物理干预方式对高血压合并阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)的疗效。方法 50例Ⅰ、Ⅱ级高血压合并OSA患者随机分为常规组和干预组,两组均给予标准药物治疗和高血压常规护理,干预组强化针对OSA的物理干预,包括对OSA的健康宣教,指导和调整科学睡眠姿势,“三阴交”穴位按摩催眠法等,干预1周后,重复检测两组24 h动态血压和多导睡眠监测,评价临床疗效、血压和OSA指标变化情况。结果 经过1周针对OSA的物理干预,干预组血压下降幅度和OSA指标改善程度显著优于常规组[24 h平均收缩压(131.6±12.7)mmHg vs.(138.5±13.4)mmHg;24 h平均舒张压(82.6±9.1)mmHg vs.(90.3±8.9)mmHg;AHI(10.5±5.9)次/h vs. (17.5±6.7)次/h;SPO₂(92.5%±7.8%)vs.(87.6%±8.4%)],差异均有统计学意义(P＜0.05)。结论 给予高血压合并OSA患者强化物理干预,能协同有效降低血压,改善OSA指标。

     

中低强度体育锻炼对社区高血压患者康复疗效分析

目的 :探讨以中低强度为主的锻炼方法对社区高血压患者的康复疗效。方法 :对 70名坚持进行中低强度体育锻炼及 67名不进行锻炼的社区高血压患者进行为期 1年的随访 ,比较其血压变化情况 ,并对锻炼组中 48名记录完整的高血压患者的血压及医疗费用支出的变化情况进行分析。结果 :经过 1年的体育锻炼 ,锻炼组高血压患者的收缩压 (SBP)与舒张压 (DBP)分别较对照组高血压患者降低 5 5 7± 2 2 9mmHg和 3 5 3± 1 3 9mmHg。锻炼组高血压患者在锻炼 1个月后收缩压和舒张压较锻炼前有显著性的降低 ,在锻炼后 3个月、6个月、9个月和 1 2个月血压下降稳定 ;肺活量较锻炼前有所改善 ;锻炼最后 1个月用于高血压治疗的月均医疗费用支出较开始锻炼 3个月约降低 40元。结论 :高血压患者在社区中开展中低强度的体育锻炼可以取得较好的控制血压和强身健体的效果 ,并有利于医疗费用的控制     

治疗高血压记住五个"三"

现将治疗高血压的有关知识归纳为5个"三",以便于高血压患者记忆和实践。血压程度分三级世界卫生组织对高血压规定为三级:1级高血压(轻度):收缩压140～159mmHg,舒张压90～99mmHg;2级高血压(中度):收缩压160～179mmHg,舒张压100～109mmHg;3级高血压(重     

Endovascular radiofrequency renal denervation in treating refractory arterial hypertension: a preliminary experience

Purpose

This study was done to investigate the efficacy and safety of percutaneous renal denervation with the Symplicity catheter for reducing blood pressure in patients with essential hypertension resistant to medical therapy (systolic blood pressure >160 mmHg despite the use of three or more antihypertensive drugs, including a diuretic).

Materials and methods

In September 2010, five patients affected by essential hypertension resistant to medical therapy were treated. All patients were studied by computed tomography angiography (CTA) of the renal arteries before the procedure and underwent follow-up at 30 and 60 days with colour Doppler ultrasound (CDUS) with evaluation of resistive index, glomerular filtration rate (GFR), 24-h blood pressure and serum catecholamine concentration. Student??s t test was used to assess the effectiveness of the procedure in lowering blood pressure.

Results

In treated patients, mean blood pressure at baseline was 171/100 mmHg [standard deviation (SD)±8/10]; mean GFR was 91.6 ml/min/1.73 m² (SD±15). Blood pressure after the procedure was reduced by ?18/?5 and ?13/?10 mmHg at 30 and 60 days, respectively, with a mean medication reduction of 3.6. No complications occurred during the intra- or periprocedural period or during short-term follow-up.

Conclusions

The Symplicity system proved to be efficacious and without serious adverse events in reducing blood pressure and antihypertensive medication use in patients affected by essential hypertension resistant to medical therapy. Although encouraging, our data are preliminary and need to be validated by larger prospective randomised studies.     

北京市某社区高血压患者及其高危人群的社区干预效果分析

 目的 评价社区开展高血压患者和高血压高危人群高血压规范化管理的效果.方法 随机抽取北京市丰台区南苑社区参加规范化管理的高血压患者和高血压高危人群作为研究对象.采用高血压分级管理,通过健康教育和健康促进,优化生活方式,控制危险因素,指导规律性用药等措施进行社区人群综合性干预,追踪随访观测4年,对干预效果进行评价.结果 与基线相比社区内高血压患者血压控制情况明显得到改善,4年平均收缩压分别为(140.48±1.11),(132.32±0.87),(130.75±1.65),(126.98±1.32) mmHg(P﹤0.01);平均舒张压分别为(94.68±5.81),(80.80±0.72),(84.01±4.97),(79.91±0.82) mmHg(P﹤0.05).按医嘱服药情况明显得到改善(P﹤0.05),高血压高危分层结构比例明显改善(P﹤0.05),高血压患者高盐和高脂饮食的比例明显降低,患者中经常食用豆制品和注意保持心理平衡的所占比例明显增加(P﹤0.05).高危人群上述指标均没有明显改变(P﹥0.05).结论 社区开展高血压规范化管理可以改善高血压患者的高危分层结构比例,促进患者有规律服药,有效控制血压水平.     

某部官兵无症状性心律失常的筛查与干预对策

 目的 探究某部官兵无症状性心律失常的筛查与干预对策。方法 收集某部2019-12至2021-12无症状性心律失常官兵80例作为观察组,另选取50例体检、听诊心律规则的官兵作为对照组。对80例无症状心律失常患者的类型构成进行分析,对比两组心率变异性(HRV)指标,即相邻正常R-R间期差值＞50 ms的%(PNN50)、24 h正常R-R间期的标准差(SDNN)、每5 min的平均NN间期的标准差(SDANN)、相邻正常R-R间期差值的均方根(RMSSD)、NN间期的个数除以NN期间直方图的高度(HRV三角指数))及动态血压[总体平均收缩压(mSBP)、总体平均舒张压(mDBP)、白天平均收缩压(dSBP)、白天平均舒张压(dDBP)、夜间平均收缩压(nSBP)、夜间平均舒张压(nDBP)]的差异,观察两组超声检查结果。结果 (1)80例中良性室性期前收缩占比最高,为61.25%(49/80);(2)观察组PNN50(3.29%±1.50%)、SDNN[(160.02±43.38)ms]、SDANN[(146.58±41.10)ms]、RMSSD[(33.65±13.34)ms]、HRV三角指数(45.77±13.36)水平均明显低于对照组[(11.05%±5.39%),(247.21±51.35)ms,(238.50±59.78)ms,(61.10±20.17)ms,57.94±15.32],差异有统计学意义(P<0.05);(3)观察组mSBP[(117.35±8.94)mmHg]、mDBP[(67.47±5.38)mmHg]、dSBP[(125.98±10.35)mmHg]、dDBP[(74.33±8.25)mmHg]、nDBP[(62.45±4.84)mmHg]水平均显著高于对照组[(112.32±7.89),(64.31±4.29),(121.05±7.99),(70.78±5.90),(59.32±3.65)mmHg],差异有统计学意义(P<0.05);(4)心脏超声心动图检测结果均未发现心房及心室增大、肺动脉高压。结论 部队官兵的无症状性心律失常表现为心率变异性的降低与动态血压的升高,应及时采取针对性的防治措施。     

Amlodipine reduces blood pressure during dynamic resistance exercise in hypertensive patients

This study investigated the effect of the dihydropyridine calcium channel antagonist, amlodipine, on blood pressure (BP) during resistance exercise performed at different intensities in hypertensives. Eleven hypertensives underwent 4 weeks of placebo and amlodipine (random double‐blinded crossover design). In each phase, they performed knee extension exercise until exhaustion following three protocols: one set at 100% of 1 RM (repetition maximum), three sets at 80% of 1 RM, and three sets at 40% of 1 RM. Intraarterial BP was measured before and during exercise. Amlodipine reduced maximal systolic/diastolic BP values achieved at all intensities (100% = 225 ± 6/141 ± 3 vs. 207 ± 6/130 ± 6 mmHg; 80% = 289 ± 8/178 ± 5 vs. 273 ± 10/169 ± 6 mmHg; 40% = 289 ± 10/176 ± 8 vs. 271 ± 11/154 ± 6 mmHg). Amlodipine blunted the increase in diastolic BP that occurred during the second and third sets of exercise at 40% of 1RM (+75 ± 6 vs. +61 ± 5 mmHg and +78 ± 7 vs. +64 ± 5 mmHg, respectively). Amlodipine was effective in reducing the absolute values of systolic and diastolic BP during resistance exercise and in preventing the progressive increase in diastolic BP that occurs over sets of low‐intensity exercise. These results suggest that systemic vascular resistance is involved in BP increase during resistance exercise, and imply that hypertensives receiving amlodipine are at lower risk of increased BP during resistance exercise than non‐medicated patients.     

降压药物对高血压颈动脉粥样硬化干预的超声评价

目的通过超声检查评价波依定对高血压颈动脉粥样硬化的干预,探讨颈动脉超声检查在降压药物疗效评估中的作用。方法检查80例高血压患者服药前后收缩压、舒张压、平均IMT、最大IMT、动脉粥样硬化等级评分指标水平变化。结果经治疗后收缩压、舒张压、平均IMT、最大IMT、等级评分指标水平较治疗前均明显下调,与治疗前比较有显著性差异（P〈0.05或P〈0.01）。结论颈动脉超声可以检测动脉粥样硬化病理变化的改善,可用于临床药物评价。     

Does Renal Artery Supply Indicate Treatment Success of Renal Denervation?

Purpose

Renal denervation (RDN) emerged as an innovative interventional antihypertensive therapy. With the exception of pretreatment blood pressure (BP) level, no other clear predictor for treatment efficacy is yet known. We analyzed whether the presence of multiple renal arteries has an impact on BP reduction after RDN.

Methods

Fifty-three patients with treatment-resistant hypertension (office BP ≥ 140/90 mmHg and 24-h ambulatory BP monitoring (≥130/80 mmHg) underwent bilateral catheter-based RDN. Patients were stratified into one-vessel (OV) (both sides) and at least multivessel (MV) supply at one side. Both groups were treated on one vessel at each side; in case of multiple arteries, only the dominant artery was treated on each side.

Results

Baseline clinical characteristics (including BP, age, and estimated glomerular filtration rate) did not differ between patients with OV (n = 32) and MV (n = 21). Office BP was significantly reduced in both groups at 3 months (systolic: OV ?15 ± 23 vs. MV ?16 ± 20 mmHg; diastolic: OV ?10 ± 12 vs. MV ?8 ± 11 mmHg, both p = NS) as well as 6 months (systolic: OV ?18 ± 18 vs. MV ?17 ± 22 mmHg; diastolic: OV ?10 ± 10 vs. ?10 ± 12 mmHg, both p = NS) after RDN. There was no difference in responder rate (rate of patients with office systolic BP reduction of at least 10 mmHg after 6 months) between the groups.

Conclusion

In patients with multiple renal arteries, RDN of one renal artery—namely, the dominant one—is sufficient to induce BP reduction in treatment-resistant hypertension.     

Use of iodine-123 metaiodobenzylguanidine scintigraphy to assess cardiac sympathetic denervation and the impact of hypertension in patients with non-insulin-dependent diabetes mellitus

The objectives of this clinical study using iodine-123 metaiodobenzylguanidine (MIBG) scintigraphy were (a) to evaluate cardiac sympathetic denervation in non-insulin-dependent diabetes mellitus (NIDDM) patients with and without hypertension and (b) to investigate the relation between cardiac sympathetic denervation and prognosis in NIDDM patients. We compared clinical characteristics and MIBG data [heart to mediastinum (H/M) ratio and % washout rate (WR)] in a control group and NIDDM patients with and without hypertension. MIBG scintigraphy was performed in 11 controls and 82 NIDDM patients without overt cardiovascular disease except for hypertension (systolic blood pressure ≥140 and/or diastolic blood pressure ≥90 mmHg). After MIBG examination, blood pressure was measured regularly in all NIDDM patients. There were significant differences between 65 normotensive and 17 hypertensive NIDDM patients with respect to age (55±11 vs 63±12 years, respectively, P<0.05), prevalence of diabetic retinopathy (12% vs 35%, respectively, P<0.05) and systolic blood pressure (120±12 vs 145±16 mmHg, respectively, P<0.001). The H/M ratio in hypertensive NIDDM patients was significantly lower than in the control group (1.81±0.29 vs 2.27±0.20, respectively, P<0.01). During the follow-up period (18± 12 months), 17 NIDDM patients newly developed hypertension after MIBG examination. There were no significant differences in their clinical characteristics compared with persistently normotensive or hypertensive NIDDM patients. %WR in patients with new onset hypertension was significantly higher than in the control group (30.88%±16.87% vs 12.89%±11.94%, respectively, P<0.05). Moreover, in these patients %WR correlated with duration from the date of MIBG scintigraphy to the onset of hypertension (r=-0.512, P<0.05). Five NIDDM patients died during the follow-up period (four newly hypertensive patients and one normotensive patient). There were significant statistical differences between the control group and non-survivors in terms of age (54±11 vs 73±11 years, respectively, P<0.01), H/M ratio (2.27± 0.20 vs 1.64±0.36, respectively, P<0.01) and %WR (12.89%±11.94% vs 42.52%±22.39%, respectively, P<0.01). In conclusion, cardiac sympathetic denervation using MIBG scintigraphy observed in hypertensive NIDDM patients, and was more profound in non-survivors. MIBG scintigraphy proved useful for the evaluation of NIDDM patients with new onset hypertension, and it was found that NIDDM patients with abnormalities on MIBG scintigraphy needed to be observe carefully. Received 1 April and in revised form 27 May 1999     

First-in-Man Experience with a Novel Catheter-Based Renal Denervation System of Ultrasonic Ablation in Patients with Resistant Hypertension

Purpose

To report results of renal denervation (RDN) with the first catheter-based, non–balloon occlusion ultrasonic system in patients with resistant hypertension.