Changes in Plasma Angiotensin Ⅱ and Circadian Rhythm of Blood Pressure in Hypertensive Patients with Sleep Apnea Syndrome Before and After Treatment

Objective To explore the changes in plasma angiotensin II (Ang II) and circadian rhythm of blood pressure among hypertensive patients with sleep apnea syndrome (SAS) before and after continuous positive airway pressure (CPAP) or surgical treatment.Methods A total of 180 essential hypertension patients were enrolled in our study.The determination of plasma Ang II concentration,ambulatory blood pressure (ABP),and polysomnography (PSG) monitoring were performed before and 3 months after CPAP or surgical treatment.Results Patients were classified into three groups by their apnea-hypopnea index (AHI):essential hypertension group (EH group,n=72;AHI<5),essential hypertension with mild SAS group (EH+mild SAS group,n=60,5≤AHI<20),and essential hypertension with moderate and severe SAS group (EH+moderate-severe SAS group,n=48,AHI≥20).The concentrations of plasma AngⅡ in the above three groups were 13.42±3.27,16.17±3.82,and 18.73±4.05 ng/mL respectively before treatment,and AngⅡ concentration in EH patients combined with SAS was significantly higher than that in EH group (all P<0.05).After treatment the values in the latter two groups significantly decreased to 14.67±2.56 and 15.03±3.41 ng/mL respectively (P<0.05).The incidence of non-dipper blood pressure curve in EH patients was 31.9%,and those in hypertensive patients with mild SAS and moderate-severe SAS were 51.7% and 58.3%,respectively before treatment.The incidence of non-dipper blood pressure curve in the EH patients with mild SAS was significantly higher than that of patients with EH alone (P<0.05).After CPAP treatment or surgery,the incidence of non-dipper blood pressure curve in the two SAS groups was significantly decreased to 38.3% and 39.6%,respectively (P<0.05).Conclusions Ang II might play a role in blood pressure variability in patients with obstructive SAS.CPAP or surgical treatment can improve blood pressure disorder and decrease plasma Ang II level in patients with obstructive SAS.     

非洛地平对原发性高血压患者血脂、血糖及血尿酸的影响

AimTo investigate the effect of felodipine on blood lipid,sugar and uricacid in patients with essential hypertension.Methods42 patients with essential hypertension were given felodipine,10 mg per day or 10 mg BID,po,and the total time of treatment was 6 weeks.Before and after treatment,the blood was collected from patients to determine the alternation of blood sugar,lipid and uricacid.ResultsThere was a significant difference(P＜0.05) between systolic blood pressure(SBP,(25.00±6.00) kPa),diastolic blood pressure(DBP,(13.90±2.40) kPa),total cholesterol(TC,(6.7±2.3) mmol/L) and high density lipoprotein cholesterol(HDL-ch,(1.12±0.25) mmol/L) in patients before treatment,and SBP(18.9±2.1) kPa,DBP(12.1±1.9) kPa,TC(4.9±1.5) mmol/L after treatment(P＞0.05).ConclusionFelodipine is suitable for treating patients with essential hypertension and hypertension complicated with diabetes and blood lipid disorder,and the efficacy of felodipine on blood pressure smooth and dependable.     

Impact of Intraoperative Blood Pressure Control and Temporary Parent Artery Blocking on Prognosis in Cerebral Aneurysms Surgery

Objective In cerebral aneurysm clipping and embolization, blood pressure control and temporary parent artery blocking are common methods to prevent aneurysm rupture. Their influence on the prognosis is uncertain. In this study, we try to find out the association between methods above and prognostic indicators. Methods We held a retrospective analysis on patients’ medical records of cerebral aneurysms surgical clipping and endovascular coiling , and recorded gender, age, diagnosis, Hunt-Hess grade, Glasgow coma scale score, treatment methods, a history of hypertension, preoperative systolic blood pressure, with or without controlled hypotension, systolic blood pressure difference before and after controlled hypotension, with or without temporary artery blocking, with or without hypertension after treated aneurysm, prognostic indicators including mortality after 1 month, intensive care unit (ICU) stay time of survivors, discharged Glasgow outcome scale (GOS) score. Prognostic indicators were regarded as dependent variable, all the factors were regarded as independent variable, and the strength analysis of influence factors on prognostic indicators was made by binary logistic regression. Results Total cases were 165, including 68 males and 97 females, with an average age of 56 (12-85) years. The mortality after 1 month was 10.9% (18 cases). The ICU stay time of survivors was 7.35 (0-67) days. GOS score at discharge was 1-3 in 40 (24.2%) patients and 4-5 in 125 (75.8%) patients. Systolic blood pressure difference before and after controlled hypotension was an independent factor influencing mortality (t=2.273,P=0.024), and the greater the difference was, the higher the mortality would be. Timely hypertension after aneurysm treated was an independent factor affecting ICU stay time of survivors and patients with hypertension had shorter ICU stay time (χ2=10.017,P=0.001). Blood pressure control (χ2=0.088,P=0.767) and temporary blocking (χ2=1.307,P=0.253) did not show significant influence on GOS score at discharge. Conclusions Timely controlled hypertension after aneurysm clipping and embolization can significantly shorten the stay time in ICU. The degree of controlled hypotension associates with postoperative mortality, the greater systolic blood pressure difference before and after antihypertensive treatment is, the higher the mortality will be.     

Insulin Resistance and Hypertension

The insulin sensitivity in hypertensive patients with normal glucose tolerance (NGT),impaired glucose tolerance (IGT) and type 2 diabetes mellitus (DM) and the insulin resistance (IR) under the disorder or grucose metabolism and hypertension were studied.by glucose tolerance test and insulin release test,insulin sensitivity index (ISI) and the ratio of area under glucose tolerance curve (AUCG) to area under insulin release curve (AUC1) were calculated and analyzed.The results showed that ISI was decreased to varying degrees in the patients with hypertension,the mildest in the group of NGT with hypertension,followed by the group of IGT without hypertension,the group of IGT with hypertension and DM(P=0).There was very significant difference in the ratio of AUCG/AUC1 between the hypertensive patients with NGT and controls (P=0).It was concluded that a significant IR existed during the development of IGT both in hypertension and nonhypertension.The increase of total insulin secretion (AUC1) was associated with nonhypertension simultaneously.IR of the hypertensive patients even existed in NGT and was worsened with the deterioration of glucose metabolism disorder,but the AUC1 in the HT group changed slightly.A relative deficiency of insulin secretion of dysfunction of β-cell of islet existed in IGT and DM of the hypertensive patients.     

PLATELET FREE CALCIUM AND SERUM FREE CALCIUM IN ESSENTIAL HYPERTENSION

Intracellular free calcium of platelets and serum free calcium were studied in human essential hypertension. Intracellular free calcium of platelets was significantly higher in hypertensive patients than that in normotensive subjects, and this was correlated with blood pressure. There was no difference of serum free calcium between hypertensives and normotensive controls. Antihypertensive treatment with nifedipine resulted in a reduction of platelet free calcium, and this was correlated with the fall of blood pressure. In patients treated with clonidine, although there was no difference of platelet free calcium between hypertensives and normotensive controls, serum free clacium was significantly reduced. These results indicated that intracellular free calcium may be regulated by same hormonal or pharmacological factors which determined the height of blood pressure, calcium channel blockers may be more effective in prevention of cardiovascular and cerebrovascular complications caused by platelet hyperfunction in essential hypertension.     

Changes of atrial natriuretic peptide and antidiuretic hormone in children with postural tachycardia syndrome and orthostatic hypertension: a case control study

Background The abnormal blood volume regulation is one of the most important pathogenesis in postural tachycardia syndrome in children.This study was designed to investigate the plasma atrial natriuretic peptide and antidiuretic hormone levels in postural tachycardia syndrome children,and their associations with the changes in heart rate and blood pressure in head-up test.Methods Twenty-one postural tachycardia syndrome patients （（12±2） years） and 26 healthy children （（12±1） years） were included.According to blood pressure changes in head-up test,the postural tachycardia syndrome patients were divided into two subgroups：postural tachycardia syndrome with orthostatic hypertension and postural tachycardia syndrome without orthostatic hypertension.The plasma atrial natriuretic peptide and antidiuretic hormone levels were measured using enzyme-linked immunosorbent assay.Results The plasma atrial natriuretic peptide level in postural tachycardia syndrome patients was higher than the control （P=0.004）,whereas the difference in plasma antidiuretic hormone level between postural tachycardia syndrome and controls was not significant （P=0.222）.The plasma antidiuretic hormone level of patients suffering from postural tachycardia syndrome with orthostatic hypertension was much higher than that of children having postural tachycardia syndrome without orthostatic hypertension （P ＜0.05）.In postural tachycardia syndrome patients,the updght max heart rate was positively correlated with the plasma atrial natriuretic peptide level （r=0.490,P＜0.05） and the upright systolic blood pressure was positively correlated with the plasma antidiuretic hormone levels （r=0.472,P ＜0.05）.Conclusions There was a disturbance of plasma atrial natriuretic peptide and antidiuretic hormone in postural tachycardia syndrome children.     

The Different Expression of PPARγ in the Artery Tissues of Hypertensive Patients with Different Ages

Objective： To study the expression of the peroxisome proliferator-activated receptor γ（PPARγ） in the artery tissues of essential hypertensive patients, and the different changes with different ages, especially to the hypertensive patients more than 65 years old. Methods： Collected the mesenteric artery tissues of essential hypertensive patients（ 〉 65 years old group and 〈 65 years old group）and patients with normal blood pressure, using immunohistochemical analysis and image acquiring and analysis system to detect the expression of PPARγ in the artery tissues. Results： the expression of PPARγ in the artery tissues of essential hypertensive patients is higher than that in the patients with normal blood pressure（ P 〈 0.05）, and to the group of hypertensive patients, the expression of PPARγ in 〉 65 years old group is higher than that in 〈65 years old group （P〈0.05）. Conclusion： the expression of PPARγ in artery tissues is increased in hypertensive patients than in the patients with normal blood pressure, and increased with aging in hypertensive patients, suggesting that PPARγ has great relationship with hypertension.     

The Different Expression of PPARγ in the Artery Tissues of Hypertensive Patients with Different Ages

Objective: To study the expression of the peroxisome proliferator-activated receptor γ(PPARγ) in the artery tissues of essential hypertensive patients, and the different changes with different ages, especially to the hypertensive patients more than 65 years old.Methods: Collected the mesenteric artery tissues of essential hypertensive patients( ＞65 years old group and ＜65 years old group)and patients with normal blood pressure,using immunohistochemical analysis and image acquiring and analysis system to detect the expression of PPARγ in the artery tissues. Results: the expression of PPARγ in the artery tissues of essential hypertensive patients is higher than that in the patients with normal blood pressure( P ＜ 0.05), and to the group of hypertensive patients, the expression of PPARγ in ＞ 65 years old group is higher than that in ＜ 65 years old group ( P ＜ 0.05). Conclusion: the expression of PPARγ in artery tissues is increased in hypertensive patients than in the patients with normal blood pressure, and increased with aging in hypertensive patients, suggesting that PPARγhas great relationship with hypertension.     

Linkage analysis of chromosome 14 and essential hypertension in Chinese population

Background Hypertension is a complex biological trait that influenced by multiple factors. The encouraging results for hypertension research showed that the linkage analysis can be used to replicate other studies and discover new genetic risk factors. Previous studies linked human chromosome 14 to essential hypertension or blood pressure traits. With a Chinese population, we tried to replicate these findings.Methods A linkage scan was performed on chromosome 14 with 14-microsatellite markers with a density of about 10 centi Morgen (cM) in 147 Chinese hypertensive nuclear families. Multipoint non-parametric linkage analysis and exclusion mapping were performed with the GENEHUNTER software, whereas quantitative analysis was performed with the variance component method integrated in the SOLAR package.Results In the qualitative analysis, the highest non-parametric linkage score is 1.0 (P=0.14) at D14S261 in the single point analysis, and no loci achieved non-parametric linkage score more than 1.0 in the multipoint analysis. Maximum-likelihood mapping showed no significant results, either. Subsequently the traditional exclusion criteria of the log-of-the-odds score-2 were adopted, and the chromosome 14 with λs≥2.4 was excluded. In the quantitative analysis of blood pressure with the SOLAR software, two-point analysis and multipoint analysis suggested no evidence for linkage occurred on chromosome 14 for systolic and diastolic blood pressure. Conclusion There was no substantial evidence to support the linkage of chromosome 14 and essential hypertension or blood pressure trait in Chinese hypertensive subjects in this study. Chin Med J 2005; 118(23):1939-1944     

Differential protein expression in hypertrophic heart with and without hypertension in spontaneously hypertensive rats

Although cardiac hypertrophy in hypertension has been well recognized, the molecular mechanisms for the development of hypertrophy are still largely unknown. In this study, the protein expression profiles of left ventricular myocardia in spontaneously hypertensive rats （SHR） and Wistar-Kyoto （WKY） rats at different ages were analyzed using 2-DE in combination with MALDI-TOF/TOF MS/MS. The results showed that 20 proteins were modulated in the hypertrophic myocardium. Out of these modulated proteins, 13 proteins presented significant changes in SHR at an early stage prior to the development of sustained hypertension, while the changes of the other 7 protein expres- sions occurred only at a late stage in SHR when the blood pressure was significantly elevated, and were largely reversible by treatment with rennin-angiotensin-aldosterone system inhibitors losartan or enalapril. These data demonstrate that the changes in energy metabolism in the hypertrophied heart favor an increase in glycolysis and a decrease in oxidation of fatty acid and glucose, which occur at an early stage in SHR without hypertension. Our results also provide evidence to support the hypothesis that oxidative stress plays an important role in the development of hypertensive cardiac hypertrophy.     

Prevalence and risk factors for left ventricular hypertrophy and left ventricular geometric abnormality in the patients with hypertension among Han Chinese

Background  Left ventricular hypertrophy (LVH) and geometric abnormality are associated with morbidity and mortality of cardiovascular disease and stroke. Hypertension is the major cause of LVH. Yet the prevalence and other risk factors of LVH and geometric abnormality in Chinese hypertensive population are unknown. The objective of this study was to investigate the prevalence and risk factors of LVH and geometric abnormality in community-based Chinese hypertensive population.

Methods  The study was a community-based cross-sectional study, and comprised 4270 hypertension patients with integrated clinical and echocardiographic data. Left ventricular mass was measured by transthoracic echocardiography. LVH was diagnosed by using the criteria of over 49.2 g/m^2.7 for men and 46.7 g/m^2.7 for women. LV geometric patterns (normal, concentric remodeling, concentric or eccentric hypertrophy) were calculated according to LVH and relative wall thickness. Logistic regression model was used to determine the odds ratio (OR) and 95% confidence intervals (CI) of the risk factors of LVH.

Results  The prevalence of LVH was 42.7% in 4270 hypertensive patients, with 37.4% in males and 45.4% in females, respectively. The prevalence of concentric remodeling, concentric or eccentric hypertrophy was 24.7%, 20.2%, and 22.6%, respectively. In Logistic regression model, female (OR 1.3, 95%CI 1.1–1.5, P <0.01), age (OR 1.02, 95%CI 1.01–1.03, P <0.01), body mass index (OR 1.2, 95%CI 1.15–1.20, P <0.01), systolic blood pressure (OR 1.02, 95%CI 1.01–1.03, P <0.01), and serum triglyceride (OR 1.10, 95% CI 1.00–1.20, P <0.01) were risk factors of LVH. Female, age, body mass index, systolic blood pressure and serum triglyceride were also risk factors of left ventricular geometric abnormality.

Conclusions  The echocardiographic LVH is the major complication of patients with hypertension in rural area of China, especially for women. To effectively treat hypertension, weight loss and control of serum triglyceride may help to prevent LVH in hypertensive population.

     

Variants of tumor necrosis factor-induced protein 3 gene are associated with left ventricular hypertrophy in hypertensive patients

Background  Tumor necrosis factor-induced protein 3 (TNFAIP3) gene has been shown important in cardiac remodeling. The aim of the present study was to investigate whether the variants of TNFAIP3 gene are associated with left ventricular hypertrophy (LVH) in hypertensive patients.

Methods  Four representatives of all the other single nucleotide polymorphisms (SNPs) in TNFAIP3 gene were tested for association with hypertrophy in two independent hypertensive populations (n=2120 and n=324).

Results  We found that only the tag SNP (rs5029939) was consistently lower in the hypertensives with cardiac hypertrophy than in those without cardiac hypertrophy in the two study populations, indicating a protective effect on LVH (odds ratio (OR) (95% confidence interval (CI))0.58 (0.358–0.863), P=0.035; OR (95% CI)=0.477 (0.225–0.815), P <0.05, respectively). Multiple regression analyses confirmed that the patients with G allele of rs5029939 had less thickness in inter-ventricular septum, left ventricular posterior wall, relative wall thickness and left ventricular mass index than did those with CC allele in the hypertensive patients in both study populations (all P <0.01).

Conclusion  These findings indicate that the SNP (rs5029939) in the TNFAIP3 gene may serve as a novel protective genetic marker for the development of LVH in patients with hypertension.

     

天津市区成人高血压患者亚临床靶器官损害的流行病学特征及与肾素-血管紧张素-醛固酮系统的关系

目的 了解天津市区成人高血压患者亚临床靶器官损害(TOD)的流行病学特征,探讨其与循环肾素-血管紧张素-醛固酮系统(RAAS)的关系.方法 采用整群随机抽样方法,抽取天津市区成人常住居民进行高血压流行病学调查,推荐无临床合并症的高血压患者进行亚临床TOD[左心室肥厚(LVH),颈动脉内-中膜厚度(IMT)增厚或斑块,微量白蛋白尿(MAU)和肾小球滤过率(eGFR)]的评估.采用多因素Logistic回归分析亚临床TOD与血浆肾素活性、血管紧张素Ⅱ和血清醛固酮水平的关系.结果 1547例无临床合并症的高血压患者参加了亚临床TOD的评估,LVH、颈动脉斑块、颈动脉IMT增厚、MAU和eGFR＜60ml·min-1·(1.73m2)-1的患病率分别为37.7%、38.2%、35.4%、33.7%和4.4%;共有1509例患者完成了所有亚临床TOD的评估,其中20.5%的患 者无TOD、34.7%有1个TOD、33.7%有2个TOD,11.1%有3个TOD.Logistic回归分析显示,在校正年龄、性别、吸烟、饮酒、高血压史、体质指数、收缩压、舒张压、高血压持续时间等因素后,血浆血管紧张素Ⅱ水平(OR1.005,95%CI 1.001～1.009,P=0.021)、肾素活性水平(OR 0.870,95%CI0.791～0.958,P=0.005)与LVH独立相关,血清醛固酮水平与颈动脉IMT增厚或斑块(OR 1.025,95%CI 1.000～1.050,P=0.048)及MAU(OR 1.049,95% CI 1.024～1.074,P＜0.001)独立相关.结论 天津市区成人高血压患者亚临床TOD是相当普遍的,RAAS在亚临床TOD中发挥重要作用.

Abstract：

Objective To investigate the epidemiological characteristics of subclinical target organ damage (TOD) among urban adult residents with hypertension in Tianjin and evaluate its relationships with circulating renin-angiotensin-aldosterone system (RAAS). Methods An epidemiological survey was conducted on urban adult residents in Tianjin. The participants with uncomplicated hypertension were followed up to examine for target organ involvement, including left ventricular hypertrophy ( LVH), carotid plaque or intima-media thickening ( IMT),microalbuminuria (MAU) and estimated glomerular filtration rate (eGFR). Multivariate logistic regression was used to evaluate the relations between subclinical TOD and RAAS. Results A total of 1547 subjects with uncomplicated hypertension underwent further examinations for target organ involvement. The prevalence rates of LVH, carotid plaque, carotid IMT, MAU and eGFR ＜60 ml · min-1 · (1.73 m2)-1 were 37.7%, 38.2%, 35.4%, 33.7% and 4.4%, respectively. The prevalence rates were categorized according to the absence or presence of one marker, two or three markers of TOD at 20.5%, 34.7%, 33.7% and 11.1% respectively. According to the logistic regression analysis adjusting for age, gender, current smoking, current drinking, previous antihypertensive treatment, body mass index, mean systolic blood pressure, mean diastolic blood pressure, duration of hypertension and other risk factors, plasma renin activity ( OR 0.870, 95 % CI 0.791 -0.958, P = 0. 005 ) and plasma angiotensin Ⅱ (OR 1.005, 95% CI 1.001 -1.009, P =0.021 ) levels were independently associated with LVH,serum aldosterone level was independently associated with carotid IMT or plaque ( OR 1. 025, 95% CI 1. 000- 1. 050, P = 0. 048 ) and MAU ( OR 1. 049, 95% CI 1. 024 - 1. 074, P ＜ 0. 001 ). Conclusion Subclinical TOD is fairly common among urban adult residents with hypertension in Tianjin. And RAAS plays an important role in the pathogenesis of subclinical TOD.     

原发性高血压患者血压晨峰与心律失常及心肌缺血的关系

目的 探讨原发性高血压患者血压晨峰对心脏重构以及心血管事件的影响。方法2006年2月至2009年1月在本院就诊的高血压病患者中,按就诊顺序连续入选386例高血压患者,根据动态血压检测结果,分为晨峰组（146例）和非晨峰组（240例）,均同步记录24h动态血压和动态心电图,观察24h动态血压参数,24h动态心电图检出的房性、室性心律失常及ST段偏移;行超声心动图检测左室质量指数（LVMI）、左房内径等指标。结果晨峰组与非晨峰组LVMI分别为（119±21）g／m^2和（93±12）g／m^2（P〈0．01）;左房内径分别为（46±11）mm与（38±10）mm（P〈0．05）;房性早搏检出率分别为98．6％与84．2％（P〈0．05）;房性心动过速检出率分别为54．1％与20．8％（P〈0．01）;心房颤动检出率分别为24．0％与0（P〈0．01）;室性早搏和室性心动过速的检出率分别为79．5％与57．9％（P〈0．05）和6．8％与2．5％（P〈0．05）;检出ST段水平型压低率分别为33．6％与13．8％（P〈0．01）。两组左室肥厚的检出率分别为67．1％与30．4％（P〈0．01）。53．2％的心律失常和57．6％的ST段压低发作出现在清晨6：00～8：00。相关分析表明,清晨血压和血压晨峰升高与对应时域ST段压低呈正相关。结论与无血压晨峰的高血压病患者相比,具有血压晨峰的高血压患者左心室肥厚更显著,心律失常和心肌缺血更常见,且多出现在清晨。     

高龄老年高血压患者左室肥厚的相关因素研究

目的对高龄老年高血压患者左室肥厚的相关因素进行分析。方法对168例高龄老年高血压患者〔年龄(85.4±5.0)岁〕进行超声心动图检查和动态血压监测,按Devereux公式计算左心室质量指数(LVMI)。将患者分为左室肥厚组(n=74)和非左室肥厚组(n=94),对比分析两组间临床资料和动态血压参数的差异。以LVMI为因变量,进行多元逐步回归分析。结果 (1)左室肥厚组的高血压病程、三酰甘油、空腹血糖、空腹胰岛素、血尿酸、平均收缩压(24 h、白天、夜间)、脉压和24 h收缩压变异系数均明显高于非左室肥厚组,差异有统计学意义(P<0.05);两组非杓型血压节律者分别为56.7%和31.9%,差异有统计学意义(P<0.05);两组间血脂、平均舒张压和24 h舒张压变异系数比较,差异均无统计学意义(P>0.05)。(2)多元线性逐步回归分析显示,LVMI依次与白天平均收缩压、夜间平均收缩压、24 h收缩压变异系数、空腹胰岛素密切相关(R2=0.511,P<0.05)。结论高龄高血压病患者LVMI与多种因素相关,有效控制白天和夜间的收缩压,降低血压变异性和胰岛素抵抗,可能对改善左室肥厚有益。     

缬沙坦治疗原发性高血压患者左室肥厚的疗效观察

目的:观察缬沙坦对原发性高血压(EH)患者的降压作用和对左室肥厚(LVH)的影响。方法:58例EH患者(其中有LVH者32例),口服缬沙坦80~160mg/d,共8个月。观察血压、不良反应,治疗前后测血脂、血糖及肝肾功能,并行超声心动图检查。结果:EH患者经缬沙坦治疗后收缩压、舒张压均有显著下降(P<0.01),其中有LVH者左心室舒张末期内径(LVDd)及左室重量均有明显下降(P<0.05),舒张末期左室后壁厚度(LVPWd)、室间隔厚度(IVSd)及左室重量指数(LVMI)也有明显下降(P<0.01)。结论:缬沙坦在降压的同时可逆转LVH,且安全、有效。     

高血压病左室壁增厚50例超声心动图与心电图对比分析

目的：比较超声心动图和心电图检查的诊断价值。方法：对高血压患者进行超声心动图与心电图对比检查。结果：超声心动图提示左室肥厚、左室肥大、单纯室间隔增厚的患者,其心电图阳性符合率分别为66.7%、77.7%和29.4%。结论：超声心动图对高血压的诊断价值明显优于心电图检查,心肌肥厚形态学改变早于电生理改变,尤其对于单纯室间隔增厚的患者,认为左室后负荷增加首先作用于左室流出道,是室间隔较早肥厚的原因。诊断高血压心脏病必须结合超声心动图检查以求确诊。     

动态动脉硬化指数与老年原发性高血压病患者左心室肥厚及尿微量白蛋白的关系研究

目的:探讨老年高血压病患者动脉硬化指数与左心室肥大及早期肾脏损害征象之间的关系。方法:随机检测137例高血压病患者的动态动脉硬化指数(AASI)、24 h动态血压、心脏重量指数(LVMI)、肌酐、尿微量白蛋白(MAU)及其他血脂等血生化指标。按照患者的AASI分为两组:AASI低水平组(AASI≤0.51)76例,AASI高水平组(AASI>0.51)61例。比较两组各参数指标的差别;并对各参数指标与AASI进行线性相关性分析和多因素Logistic回归分析。结果:与AASI低水平组相比,AASI高水平组尿微量白蛋白量增高(P=0.007)。线性回归结果显示,AASI增加可升高与尿微量白蛋白(β=0.761,P=0.001)及心脏质量指数(β=0.466,P=0.004)。校正可能的混杂因素后,AASI升高可增加左心室肥大(OR=1.96,95%CI=1.67~3.98,P=0.003)及早期肾脏功能损害(OR=2.28,95%CI=1.76~4.44,P=0.008)的患病风险。结论:AASI是老年高血压患者左心室肥大及早期肾损害的独立危险因素。     

缬沙坦与氨氯地平联合治疗中、重度高血压伴左心室肥厚的临床观察

目的：探讨缬沙坦联合氨氯地平治疗中、重度原发性高血压伴左心室肥厚的临床疗效。方法：72例中、重度原发性高血压伴左心室肥厚患者给予缬沙坦联合氨氯地平口服治疗,疗程6个月。治疗期间监测血压和心率,超声心动图检测左室舒张末期内径（LVDd）、舒张末期室间隔厚度（IVSd）、左室后壁厚度（LVPWd）、左室重量指数（LVMI）、射血分数（EF）、二尖瓣口舒张早期最大峰值流速与舒张晚期最大峰值流速比值（E／A）,并进行治疗前后对比分析。结果：患者血压较前均明显好转,总有效率93．06％;超声心动图复查IVSd、LVPWd及LVMI均降低,EF及E／A均增高,与治疗前相比差异均有统计学意义（P〈0．05）。结论：缬沙坦联合氨氯地平可以有效地降低中、重度原发性高血压及改善左心室肥厚。     

原发性高血压左室肥厚与血压变异性的关系

目的:探讨原发性高血压(EH)患者左室肥厚(LVH)与血压变异性(BPV)的关系。方法:143例EH患者根据超声心动图测定的左室重量指数(LVMI)分为LVH组及不伴LVH(单纯高血压)组,运用24h动态血压(ABPM)监测技术,与正常对照组分别计算BPV。比较各组之间的差异,并分析BPV与LVMI之间的关系。结果:与对照组相比,LVH组及不伴LVH组均显示BPV明显升高,LH组BPV较不伴LVH组明显升高。结论:EH患者体内自主神经功能失衡,交感与副交感神经的双重损害参与了高血压的左室重构机制,可能伴随左室重构过程。BPV是评价心血管自主神经活动的无创指标与高血压靶器官损害关系密切。