隐性高血压病人中心动脉压及增强指数

目的探讨"隐性高血压"与中心动脉压及动脉硬化的关系.方法采用脉搏波分析仪记录89例临床诊断为血压正常(偶测血压<140/90 mm Hg)及75例高血压(偶测血压≥140/90 mm Hg或正在服用降压药物者)患者的桡动脉脉搏波,经计算机自动转换为相应的中心动脉脉搏波,并分析中心动脉压力及反映全身动脉硬化的增强指数(AIx).结果小样本人群中,隐性高血压的患病率为15.7%.与血压正常(偶测血压<140/90 mm Hg及白昼动态血压<135/85 mm Hg)组相比,隐性高血压组的血浆总胆固醇及低密度脂蛋白胆固醇浓度、饮酒的比例显著增高;中心动脉收缩压、舒张压、收缩末期压及中心动脉增强压分别增加14.8 mm Hg(CI 5.6～24.0 mm Hg)、9.1 mm Hg(CI 3.1～15.1 mm Hg)、14.0mm Hg(CI 5.8～22.2)及4.2(CI 0.6～7.8 mm Hg),增强指数增加11.9%(CI 2.8%～20.9%).虽然隐性高血压组的偶测血压显著低于高血压组,经年龄、性别及身高调整后,两组的白昼动态血压、中心动脉收缩压、舒张压、增强压及增强指数均无显著差异.结论隐性高血压患者的中心动脉压力及增强指数升高,提示动脉顺应性下降,动脉硬化.这些血液动力学的改变可能增加心血管病危险,对其进行评价有助于偶测血压正常者的危险分层.     

正常高值血压中升高的中心动脉压及增强指数的相关性

目的探讨正常高值血压与中心动脉压及动脉硬化的关系。方法采用脉搏波分析仪记录472例受试者(理想血压组167例,正常高值血压组129例,及高血压组176例)的桡动脉脉搏波,经计算机转换函数自动转换为相应的中心动脉脉搏波,并计算中心动脉压力及反映全身动脉硬化的增强指数(AIx)。结果与理想血压者相比,正常高值血压患者体重指数、吸烟及饮酒的比例、血尿酸及总胆固醇、甘油三酯水平显著增高;中心动脉收缩压、收缩末期压及中心动脉增强压分别增加13.39 mmHg(95%CI,9.71～17.08 mmHg)、11.66 mmHg(95%CI,8.37～14.94 mmHg)及1.95 mmHg(95%CI,0.52～3.38 mmHg),增强指数增加3.97%(95%CI,0.27%～7.68%)。虽然正常高值血压组的偶测血压显著低于高血压组,但经年龄、性别及身高、心率等调整后,两组的增强指数无显著差异。结论与理想血压者相比,正常高值血压患者有更多的心血管危险因素,且中心动脉压力及增强指数升高,提示患者左心室负荷加重,动脉顺应性下降。这些血流动力学的改变可能有助于增加心血管病危险,对其进行评价有助于正常高值血压人群的危险分层及防治。     

老年隐性高血压患者中心动脉压与脉搏波传导速度的相关性研究

目的探讨老年隐性高血压患者中心动脉压及增强指数与脉搏波传导速度(PWV)的相关性。方法选择临床诊断血压正常者250例,根据血压诊断标准分为血压正常(正常组)169例和隐性高血压(隐性组)81例,及高血压患者(高血压组)150例。监测24 h动态血压。并采用大动脉测量仪测量中心动脉压及其反射波;采用PWV测定仪测量颈桡动脉PWV(crPWV)。结果隐性组中心动脉收缩压、中心动脉舒张压、中心脉压、平均收缩压、平均舒张压、收缩末压、增强压、crPWV明显高于正常组,明显低于高血压组(P<0.05,P<0.01)。多元线性回归分析显示,中心动脉收缩压、中心脉压、LDL-C是crPWV的主要影响因素(β=0.268、β=0.313、β=0.311,P<0.01)。结论老年隐性高血压患者中心动脉压及增强指数明显升高,提示动脉弹性下降,中心动脉收缩压、中心脉压、LDL-C是影响动脉僵硬度的主要危险因素。     

不同血压水平状态下的中心动脉压与诊室肱动脉血压

目的比较不同血压水平状态下中心动脉压(CAP)与诊室肱动脉血压的差异。方法连续性选取2012年1月至2016年1月就诊于新疆医科大学第一附属医院的原发性高血压患者2647例,另选取同时期在新疆医科大学第一附属医院体检的正常血压者972人。两组研究对象均进行一般情况调查、测定诊室肱动脉血压及无创CAP,比较不同血压水平状态下CAP与诊室肱动脉血压的差异。结果 CAP与诊室血压比较,正常血压组收缩压差值为(12.30±5.00)mm Hg,95%CI为2.50~22.10 mm Hg;舒张压差值为(-1.65±2.12)mm Hg,95%CI为-5.81~2.51mm Hg;脉压差值为(13.97±5.35)mm Hg,95%CI为3.48~24.46mm Hg。高血压组收缩压差值为(13.40±14.19)mm Hg,95%CI为-14.41~40.79mm Hg;舒张压差值为(-1.19±11.87)mm Hg,95%CI为-24.46~22.08mm Hg;脉压差值为(14.52±19.85)mm Hg,95%CI为-24.39~53.40mm Hg。高血压组与正常血压组,中心动脉收缩压(CASP)、中心动脉舒张压(CADP)、中心动脉脉压均随着对应诊室收缩压(OSP)、诊室舒张压(ODP)、诊室脉压的升高而升高(P0.01)。受试者工作特征(ROC)曲线示,对于高血压组1级的诊断,OSP与CASP的曲线下面积分别为0.994(95%CI0.992~0.995)和0.982(0.978~0.986);ODP与CADP的曲线下面积分别为0.925(0.917~0.934)和0.914(0.905~0.923)。若以CAP对高血压进行分级,本研究人群CAP 1,2,3级水平分别为123.5/82.5mm Hg(约登指数=0.869,0.678),136.5/96.5(约登指数=0.323,0.750)和155.5/106.5mm Hg(约登指数=0.553,0.654)。结论 CAP与诊室血压的一致性较好,舒张压的一致性好于收缩压、脉压的一致性。诊室血压仍可作为诊断高血压的较为简便、实用、广泛的方法。     

老老年人群动态血压参数与动脉僵硬度的相关性

目的探讨老老年人群动态血压参数与动脉僵硬度的相关性。方法筛选年龄≥80岁的老老年人238例,以血压≥160/95 mm Hg(1 mm Hg=0.133 kPa)为标准,分为高血压组(134例)和对照组(104例),并进行臂-踝脉搏传导速度(baPWV)和24 h动态血压监测。用Pearson分析动态血压各参数与动脉僵硬度的相关性。结果高血压组baPWV高于对照组(P<0.05)。高血压组偶测收缩压,24 h、昼间和夜间收缩压、舒张压、脉压,收缩压负荷及舒张压负荷均高于对照组.夜间收缩压下降率、舒张压下降率低于对照组,差异有统计学意义(P<0.05,P<0.01)。baPWV与偶测血压;24 h收缩压、舒张压、脉压;昼间收缩压、舒张压、脉压、心率;夜间收缩压、舒张压、脉压;收缩压负荷、舒张压负荷呈正相关(P<0.05,P<0.01),而与夜间收缩压下降率呈负相关(P<0.01)。结论高血压是老老年人群动脉僵硬度增加的一个重要因素,动脉僵硬度与动态血压、脉压、心率及血压负荷相关。     

血清内脂素水平与血压的关系

目的探讨体检人群血清内脂素与血压的关系。方法 2011年3月至5月,收集常州市第二人民医院体检人群769名进行标准流行病学问卷调查,测量血压和心率,测定生化指标及血清内脂素水平。按照《中国高血压防治指南2010》将研究人群分为正常血压组(收缩压120和舒张压80mm Hg,n=294)、正常高值血压组[收缩压120~139和(或)舒张压80~89mm Hg,n=283]、1级高血压组[收缩压140~159和(或)舒张压90~99mm Hg,n=129]和2~3级高血压组[收缩压≥160和(或)舒张压≥100mm Hg,n=63]。结果与正常血压组比较,正常高值血压、1级和2~3级高血压组的血清内脂素水平较高[(37.23±0.75)、(53.17±1.11)、(61.05±1.59)比(22.22±0.73)μg/L],组间两两比较,差异有统计学意义(均P0.01)。多元回归分析结果显示,血清内脂素水平是收缩压、舒张压和平均动脉压的独立影响因素(均P0.01)。结论血清内脂素与血压水平独立相关。     

社区非糖尿病人群血压水平与稳态模型胰岛素抵抗指数及定量胰岛素敏感性指标的相关性研究

目的 探讨社区非糖尿病人群血压测值与稳态模型胰岛素抵抗指数(HOMA-IR)及定量胰岛素敏感性指标(QUICKI)的相关性.方法 2002年8月至2004年3月,在上海交通大学医学院附属仁济医院内分泌科对上海浦东上钢和塘桥社区居民743名(除外糖尿病和糖耐量受损、继发性高血压及有严重肝、肾功能损害者)进行研究检测.以标准法测量血压、身高、体重、腰围和臀围.根据不同血压测值分为非高血压组和高血压组.非高血压组包括(1)理想血压组,收缩压＜120 mm Hg(1 mm Hg=0.133 kPa),舒张压＜80 mm Hg;(2)正常血压组收缩压120～＜130 mm Hg,舒张压80～＜85 mm Hg;(3)正常高值血压组收缩压130～＜140 mm Hg,舒张压85～＜90 mm Hg.高血压组收缩压≥140 mm Hg和(或)舒张压≥90 mm Hg.放免法测定空腹血浆胰岛素,并计算HOMA-IR及QUICKI.采用SPSS 11.5软件进行统计分析.结果 社区743名非糖尿病人群中,正常高值血压组和高血压组与理想血压组之间HOMA-IR及QUICKI比较差异均有显著性意义(P＜0.01).血压值与年龄、体重指数(BMI)、腰围、WHR、空腹胰岛素、血浆总胆固醇、三酰甘油及HOMA-IR呈正相关,与QUICKI呈负相关.在控制年龄及性别之后,HOMA-IR及QUICKI和血压之间仍明显相关(P＜0.001).结论 HOMA-IR和QUICKI指数均是预测正常高值血压人群胰岛素抵抗的独立影响因子.治疗早期高血压,减轻胰岛素抵抗的因素可能更重要.     

血压正常高值者动脉僵硬度与动态血压参数的关系

目的探讨血压正常高值者动脉僵硬度与动态血压参数的关系。方法选择理想血压者63例,血压正常高值者74例,高血压者67例。监测所有入选者24 h动态血压,应用脉搏波传导速度测定仪测定颈动脉-桡动脉脉搏波传导速度。结果血压正常高值组24 h收缩压、24 h舒张压、白昼收缩压、白昼舒张压、夜间收缩压、24 h脉压、白昼脉压及夜间脉压均高于理想血压组,低于高血压组(P<0.05或P<0.01);血压正常高值组夜间舒张压低于高血压组(P<0.05)。血压正常高值组颈动脉-桡动脉脉搏波传导速度(9.67±1.12 m/s)显著高于血压理想组(8.27±0.99 m/s),低于高血压组(10.55±1.71 m/s;P<0.05或P<0.01)。多元线性回归分析显示,24 h收缩压、24 h脉压、夜间收缩压是颈动脉-桡动脉脉搏波传导速度的影响因素(β值分别为0.385、0.351及0.247,P<0.05)。结论血压正常高值者动脉僵硬度增高,24 h收缩压、24 h脉压、夜间收缩压是影响动脉弹性的主要因素。     

老年正常高值血压者动态血压及节律与中心动脉反射波增强指数的关系

目的探讨正常高值血压者动态血压及节律与中心动脉反射波增强指数的关系。方法选择正常血压者(正常组)138例,正常高值血压者(高值组)121例,高血压者(高血压组)100例,采用动态血压监测仪监测动态血压及节律;采用动脉脉搏波分析仪测量中心动脉压及增强指数(AIx)。结果与正常组比较,高值组24h平均收缩压、24h平均舒张压、昼间平均收缩压、昼间平均舒张压、夜间平均收缩压、夜间平均舒张压、中心动脉收缩压、中心动脉舒张压、中心动脉脉压、增强压、AIx均明显升高,夜间收缩压下降率明显降低(P<0.05)。正常高值血压经多元线性逐步回归分析显示,性别、年龄、吸烟、夜间收缩压下降率、非杓型血压发生率为AIx的主要影响因素。经协方差分析,血压水平与非杓型血压发生率对AIx均有影响,且有协同作用(F=12.37,P<0.05)。结论非杓型血压单独对AIx有影响,且与高水平血压有协同叠加效应。     

老年血压正常高值者中心动脉压与颈动脉内膜中层厚度的相关研究

目的探讨血压正常高值者中心动脉压与颈动脉内膜中层厚度(IMT)的关系。方法选择健康体检人群346例,根据血压将患者分为理想血压组151例(血压<120/80 mm Hg,1mm Hg=0.133 kPa)和血压正常高值组195例(血压120～139/80～89 mm Hg),应用大动脉测量仪测量入选者中心动脉压;应用颈动脉超声测量颈动脉IMT。结果血压正常高值组中心动脉收缩压、舒张压、脉压、平均收缩压、平均舒张压、收缩末压及IMT均高于理想血压组(P<0.01);中心动脉增强压及增强指数高于理想血压组(P<0.05)。中心动脉收缩压和脉压是IMT的影响因素(β=0.344,0.296,P<0.05)。结论血压正常高值者的中心动脉压和颈动脉IMT已增加,中心动脉收缩压和脉压是影响颈动脉IMT的主要因素。     

Overview of blood pressure measurement by Brazilian health professionals

Although automated monitors for blood pressure (BP) measurement are used increasingly worldwide, understanding of how such devices are used in Brazil is low. This study analyzed the status of BP measurement by Brazilian health professionals. A questionnaire regarding experience with BP measurement was sent electronically to Brazilian nurses, nursing assistants, and doctors. It had 2004 responses. Previous experience with use of automated monitors was most frequent in men (71.2%), nursing technicians (65.5%), specialists (61.1%), secondary care (71.9%), emergency care (70.6%), or the private sector (66.3%). The least complied aspects of the standardized measurement protocol were availability of various cuff sizes (53.9% and 72.9% for auscultatory and oscillometric methods, respectively) and proper calibration checks (21.5% and 46.8% for auscultatory and oscillometric methods, respectively). Brazilian health professionals report not adequately performing all the necessary aspects to measure BP in accordance with the standardized protocol in both methods, but mainly regarding the oscillometric.     

200例正常中老年人24小时动态血压特征

目的 :动态血压测定值常因地区、种族、时节不同而异。方法 :我们于 1996年～ 1998年对成都地区 2 0 0例中老年人进行了 2 4小时动态血压监测。结果 :平均年龄 5 8.15± 8.19岁 ,昼夜均值 93～ 146 / 5 2～ 93mm Hg,日间均值10 0～ 135 / 5 9～ 92 m m Hg,夜间均值 10 0～ 132 / 5 5～ 83mm Hg,昼夜平均压均值 93± 10 .19mm Hg,血压负荷值 12～ 30 /10～ 15 %。结论 :本组结果可作为成都地区动态血压的参考正常值     

Nocturnal blood pressure surge in seconds is associated with arterial stiffness independently of conventional nocturnal blood pressure variability in suspected obstructive sleep apnea patients

Nocturnal blood pressure (BP) surge in seconds (sec-surge), which is characterized as acute transient BP elevation over several tens of seconds is induced by obstructive sleep apnea (OSA) and OSA-related sympathetic hyperactivity. The authors assessed the relationship between sec-surge and arterial stiffness in 34 nocturnal hypertensive patients with suspected OSA (mean age 63.9 ± 12.6 years, 32.4% female). During the night, they had beat-by-beat (BbB) BP and cuff-oscillometric BP measurements, and brachial-ankle pulse wave velocity (baPWV) was assessed as an arterial stiffness index. Multiple linear regression analysis revealed that the upward duration (UD) of sec-surge was significantly associated with baPWV independently of nocturnal oscillometric systolic BP variability (β = .365, p = .046). This study suggests that the UD of sec-surge, which can only be measured using a BbB BP monitoring device, may be worth monitoring in addition to nocturnal BP level.     

Ambulatory blood pressure phenotypes and isolated elevation of office central or brachial blood pressure

Disagreements in office brachial and central blood pressure (BP) have resulted in the identification of novel hypertension phenotypes, namely isolated central hypertension (ICH) and isolated brachial hypertension (IBH). This study investigated the relationship of ICH and IBH with ambulatory BP phenotypes among 753 individuals (mean age = 47.6 ± 15.2 years, 48% males) who underwent office and 24‐hours brachial and central BP measures using a Mobil‐O‐Graph PWA monitor. Thresholds for elevated office central and brachial BP were 130/90 and 140/90 mm Hg. Results of multivariable analysis adjusted for potential confounders showed that ICH (n = 25) had 3.71‐fold (95% CI 1.48‐9.32; P = .005) greater risk of masked hypertension than normal brachial/central BP (n = 362), while IBH (n = 20) had 4.65‐fold (95% CI 1.76‐12.25; P = .002) greater risk of white coat hypertension compared with combined brachial/central hypertension (n = 346). These findings suggest that the diagnosis of ICH and IBH might be useful in identifying individuals at higher risk of presenting discordant office and ambulatory BP phenotypes.     

高血压患者24小时动态血压分析

对１００例高血压患者进行２４ｈ动态血压监测，结果２４ｈ动态血压波动规律呈双峰双谷状，第一高峰在上午７～１１时左右，第二高峰在下午１６～２１时左右，且收缩压第二高峰值明显高于第一高峰值，２４ｈ动态血压均值昼夜为１３９／８３ｍｍＨｇ，日间为１４０／８６ｍｍＨｇ，夜间为１３６／８０ｍｍＨｇ。血压负荷收缩压为４８％，舒张压为３２％。     

Oscillometric blood pressure: a review for clinicians

Oscillometric devices for the non–invasive estimation of blood pressure (BP) have become the “clinical standard” because of training requirements for determination of BP by auscultation, cost, and the phasing–out/banning of mercury in many states and countries. Analysis of recent publications reveals a lack of understanding of the “meaning” of oscillometric blood pressure (OBP) measurements by authors, journal editors, and clinicians. We were invited to submit a review of OBP methodology written for clinicians. We hope that the material contained herein will clarify how clinicians should interpret OBP values for their patients.     

Dialysis unit blood pressure two hours after hemodialysis is useful for predicting home blood pressure and ambulatory blood pressure in maintenance hemodialysis patients

This study aimed to determine which BP measurement obtained in the HD unit correlated best with home BP and ambulatory BP monitoring (ABPM). We retrospectively analyzed data from 40 patients that received maintenance HD who had available home BP and ABPM data. Dialysis unit BPs were the averages of pre-, 2hr- (2 h after starting HD), and post-HD BP during a 9-month study. Home BP was defined as the average of morning and evening home BPs. Dialysis unit BP and home BP were compared over the 9-month study period. ABPM was performed once for 24 h in the absence of dialysis during the final 2 weeks of the study period and was compared to the 2-week dialysis unit BP and home BP. There was a significant difference between dialysis unit systolic blood pressure (SBP) and home SBP over the 9-month period. No significant difference was observed between the 2hr-HD SBP and home SBP. When analyzing 2 weeks of dialysis unit BP and home BP, including ABPM, SBPs were significantly different (dialysis unit BP > home BP > ABPM; P = 0.009). Consistent with the 9-month study period, no significant difference was observed between 2hr-HD SBP and home SBP (P = 0.809). The difference between 2hr-HD SBP and ambulatory SBP was not significant (P = 0.113). In conclusion, the 2hr-HD SBP might be useful for predicting home BP and ABPM in HD patients.     

Practical Aspects of Home and Ambulatory Blood Pressure Monitoring

Out-of-office blood pressure (BP) monitoring is becoming increasingly important in the diagnosis and management of hypertension. Home BP and ambulatory BP monitoring (ABPM) are the two forms of monitoring BP in the out-of-office environment. Home BP monitoring is easy to perform, inexpensive, and engages patients in the care of their hypertension. Although ABPM is expensive and not widely available, it remains the gold standard for diagnosing hypertension. Observational studies show that both home BP and ABPM are stronger predictors of hypertension-related outcomes than office BP monitoring. There are no clinical trials showing their superiority over office BP monitoring in guiding the treatment of hypertension, but the consistency of observational data make a compelling case for their preferential use in clinical practice.     

Central blood pressure variability is increased in hypertensive patients with target organ damage

We aimed to evaluate the association of aortic and brachial short‐term blood pressure variability (BPV) with the presence of target organ damage (TOD) in hypertensive patients. One‐hundred seventy‐eight patients, aged 57 ± 12 years, 33% women were studied. TOD was defined by the presence of left ventricular hypertrophy on echocardiogram, microalbuminuria, reduced glomerular filtration rate, or increased aortic pulse wave velocity. Aortic and brachial BPV was assessed by 24‐hour ambulatory BP monitoring (Mobil‐O‐Graph). TOD was present in 92 patients (51.7%). Compared to those without evidence of TOD, they had increased night‐to‐day ratios of systolic and diastolic BP (both aortic and brachial) and heart rate. They also had significant increased systolic BPV, as measured by both aortic and brachial daytime and 24‐hours standard deviations and coefficients of variation, as well as for average real variability. Circadian patterns and short‐term variability measures were very similar for aortic and brachial BP. We conclude that BPV is increased in hypertensive‐related TOD. Aortic BPV does not add relevant information in comparison to brachial BPV.     

Effect of Hypotensive Drugs on the Circadian Blood Pressure Pattern in Essential Hypertension: a Comparative Study

To compare the effect of four drug groups on the ambulatorycircadian blood pressure (BP) pattern, amiloride hydrochlorothiazide,atenolol, nifedipine, and perindopril (5/50 mg/d, 100 mg/d, 40mg/d, and 4 mg/d respectively, for 14 days) were alternated in eachof 20 essential hypertension patients. Diuretics induced the largest (P<0.05) drop in mean 24-hour systolic BP (–12 mmHg, P < 0.001).Atenolol reduced only its standard deviation, and nifedipine reduced onlythe mean daytime systolic BP (P < 0.05). The mean 24-hour diastolic BPwas equally reduced by all drugs except nifedipine, which only reduced (P< 0.05) the mean daytime value. The mean 24-hour heart rate wasdecreased by atenolol (P < 0.001), increased by diuretics (P <0.05), and unchanged with perindopril, while nifedipine increased (P < 0.05) only its night-time value. In conclusion, diuretics were the strongest agents in reducing systolic BP, atenolol the only agent thatreduced variability, perindopril the only agent that did not affect theheart rate, and nifedipine reduced only daytime BP values.