老年高血压患者血压变异性对左心室肥厚的影响

目的观察血压变异性(BPV)对老年性高血压患者左心室肥厚的影响 .方法老年性高血压患者100例,根据左室重量指数[LVMI]分为两组: 左室肥厚组和非左室肥厚组,进行24小时动态血压监测,以各时段(日间、夜间及24小时)血压的标准差作为血压变异性的量化指标.结果左室肥厚组日间、夜间及24小时收缩压BPV显著高于非左室肥厚组(p<0.01),日间、夜间及24小时收缩压 BPV与LVMI呈正相关,舒张压BPV与LVMI无相关性.结论收缩压B PV与高血压左室肥厚的发生和肥厚程度有关,老年性高血压患者更容易出现左室肥厚,在治疗老年性高血压时,要注意平稳降压.     

老年高血压患者血压变异性对左心室肥厚的影响

目的　观察血压变异性 (BPV)对老年性高血压患者左心室肥厚的影响 .方法　老年性高血压患者 10 0例 ,根据左室重量指数 [LVMI]分为两组 :左室肥厚组和非左室肥厚组 ,进行 2 4小时动态血压监测 ,以各时段 (日间、夜间及 2 4小时 )血压的标准差作为血压变异性的量化指标 .结果　左室肥厚组日间、夜间及 2 4小时收缩压BPV显著高于非左室肥厚组 (p <0 .0 1) ,日间、夜间及 2 4小时收缩压BPV与LVMI呈正相关 ,舒张压BPV与LVMI无相关性 .结论　收缩压BPV与高血压左室肥厚的发生和肥厚程度有关 ,老年性高血压患者更容易出现左室肥厚 ,在治疗老年性高血压时 ,要注意平稳降压     

原发性高血压血压变异性与血脂异常的相关性研究

目的 研究原发性高血压血压变异性（BPV）和血脂异常之间的相关性及其意义。方法 原发性高血压患者135例，根据总胆固醇水平分为两组：高胆同醇组和非高胆固醇组，进行24h动态血压监测，以日间、夜间及24h各时段收缩压、舒张压的标准差作为血压变异性的量化指标。结果 日间、夜间、24h收缩压血压变异性及日间、24h舒张压血压变异性与胆固醇具有正相关性，高胆固醇组日间、夜间及24小时收缩压变异性大于非高胆固醇组。结论 血压变异性与血脂异常具有正相关性，高血压和血脂异常都是心脑血管疾病的重要危险因素，两者间存在密切关系。对两者联合干预治疗对减少心脑血管疾病的发生、发展、预后有重要意义。     

老年高血压状态下左心室构型与左心房和左心室容积

背景：研究表明,左心房容积可反映左心室充盈压、心房结构重塑及神经激素的活动,左心房容积扩大是预测慢性心力衰竭不良预后的一个强有力的标志。 目的：观察老年原发性高血压患者在不同左心室构型情况下左心房容积和左心室容积的变化。 方法：采用超声心动图对129例老年原发性高血压患者(高血压组)和125名体检血压正常的老年人(对照组)的左心房容积和左心室容积相关指标进行测量,并依据Ganau标准对左心室几何构型进行分型;同时对老年高血压患者进行动态血压监测,依据血压节律进行分组比较。 结果与结论：与对照组比较,高血压组左心房容积、左心房容积指数、左心室收缩末期容积、左心室舒张末期容积均明显增大(P < 0.05);同时,在高血压组内,病程和动态血压昼夜节律对左心室几何构型的分布有影响,且左心室构型异常者上述指标较左心室构型正常者增大更明显(P < 0.05)。提示,老年原发性高血压患者病程和非杓型血压节律对左心室构型存在重要影响,左心房容积和左心室容积的变化与左心室构型的改变相伴随。     

高血压病左室肥厚与血压昼夜节律及血液流变学的关系

本文观察了８４例高血压病患者左室重量指数与血液流变指标及动态血压昼夜节律的相互关系。结果发现：高血压病左室肥厚组高切粘度、低切粘度和血浆粘度明显升高（ｐ＜０．０１），血压昼夜节律消失率也显著升高（ｐ＜０．００１），提示高血压病左室肥厚与血液流变学指标异常改变和血压昼夜节律消失密切相关。     

皮质下动脉硬化性脑病血压及心率变异性分析

目的和方法：采用动态检测技术观察３１例皮质下动脉硬化性脑病和对照组３１例健康人血压和心率的变异性。结果：患者均存在动态血压异常，其中平均收缩压、平均舒张压超过正常值者２７例（８７％），夜间基底血压异常升高２２例（７１％），血压异常波动２０例（６４％），昼夜节律逆转４例（１３％）。患者心率变异时域指标２４小时内全部正常心动周期的标准差、２４小时内５分钟节段平均正常心动周期的标准差、在一定时间内相邻两正常心动周期差值大于５０毫秒的个数所占的百分比均明显低于对照组，收缩压与心率无显著相关性。结论：提示血压波动及持续的夜间升压现象在该病中起着一定作用，而这种异常可能与患者植物神经系统功能失调有关     

原发性高血压合并微量白蛋白尿患者动态血压观察

目的了解原发性高血压患者微量白蛋白尿(micro-albuminuria,MAU)与动态血压的特征性改变,包括血压变异指数(ABPVs、ABPVd)、血压负荷(BPload)及血压昼夜节律的相关性。方法确诊的141例原发性高血压患者进行24h动态血压和24h尿微量白蛋白检查,分为微量白蛋白尿(MAU)组及尿微量白蛋白正常组(NAU)。结果MAU组血压变异指数及血压负荷较NAU组增大(P<0.05),合并MAU的患者血压昼夜节律不明显。结论微量白蛋白尿的发生与血压变异指数、血压负荷和血压昼夜节律密切相关,有无微量白蛋白尿可一定程度上反映血压控制状况。     

颈动脉粥样硬化与腔隙性脑梗塞患者血压近日节律性的分析

目的：探讨合并颈动脉粥样硬化（CAS）的原发性高血压（EH）患者血压近日节律的特征，及与腔隙性脑梗死（CLI）的关系。方法：高血压患者114名，以彩色多普勒检测患者的颈动脉内膜情况及动态血压仪监测患者24小时血压变化，分为CAS组与CAN（颈动脉正常）组，以差值百分比法分析24小时血压节律变化情况，并进行统计学分析。结果：在CAS组的EH患者中，夜间收缩压和舒张压下降率明显低于CAN组患者（P〈O．05），发生血压近日节律紊乱的患者明显多于CAN组（P〈O．05）。结论：CAS的发生与EH患者血压近日节律的紊乱有密切关系，是缺血性脑卒中发生的危险因素。     

原发性高血压患者血压晨峰的相关因素分析

目的研究原发性高血压患者血压晨峰（MBPS）的发生情况及相关因素。方法采用24h动态血压监测仪（ABPM）分析415例原发性高血压患者的血压,确认晨峰组与非晨峰组,对两组性别、年龄、动态血压、动态心电图及超声心动图、颈动脉彩色多普勒检查结果、血脂、空腹血糖、体重指数（BMI）进行比较分析。结果①有晨峰现象的129例（MBPS组）,发生率为31.1%,与非MBPS组相比较,MBPS组24h平均收缩压、脉压均显著高于非MBPS组（P〈0.001）。②凌晨血压增高与年龄相关（P〈0.01）,调整年龄后,男女MBPS发生率分别为28.5%,16.9%,男性明显高于女性（P=0.0105）。③不论男女,MBPS组的左室肥厚发生率、左室重量指数（LVMI）、颈动脉内膜中层厚度（IMT）、24h平均心率、房性早搏、室性早搏的发生率均高于非MBPS组,差别有统计学意义（P〈0.001）,MBPS与BMI、空腹血糖、血脂无显著关联。结论原发性高血压患者MBPS与年龄、性别、心室重构、心律失常密切相关,MBPS患者有更明显的颈动脉粥样硬化。MBPS可能使清晨心血管事件的风险增加。     

原发性高血压血压变异性与血脂异常的相关性研究

目的研究原发性高血压血压变异性(BPV)和血脂异常之间的相关性及其意义.方法原发性高血压患者135例,根据总胆固醇水平分为两组:高胆固醇组和非高胆固醇组,进行24h动态血压监测,以日间、夜间及24h各时段收缩压、舒张压的标准差作为血压变异性的量化指标.结果日间、夜间、24h收缩压血压变异性及日间、24h舒张压血压变异性与胆固醇具有正相关性,高胆固醇组日间、夜间及24小时收缩压变异性大于非高胆固醇组.结论血压变异性与血脂异常具有正相关性,高血压和血脂异常都是心脑血管疾病的重要危险因素,两者间存在密切关系,对两者联合干预治疗对减少心脑血管疾病的发生、发展、预后有重要意义.     

Determinants of circadian blood pressure rhythm and blood pressure variability in obstructive sleep apnoea

SUMMARY  The prevalence of hypertension in patients with obstructive sleep apnoea (OSA) is high and blood pressure profile is characterized by nocturnal blood pressure (BP) elevation and increased nocturnal BP variability. Ambulatory 24-hour-biood pressure monitoring (ABPM) is a valid, non-invasive method to describe circadian BP variation. Circadian BP profile and nocturnal BP variability were related to OSA severity (apnoea-hypopnoea index, mean low O₂), age and body mass index (BMI) in 73 patients with OSA. Prevalence of hypertension was 75%, and in 59% BMI was greater than 30 kg m^-2. A nocturnal decline of at least 10% from daytime mean BP values (night/day BP ratio <0.9; dipper) was found in only 25% of hypertensive patients and 39% of normotensive patients. Comparison between dippers and non-dippers showed significant differences in apnoea severity (apnoea-hypopnoea index 32 + 19 vs. 50 + 23/h, P <0.01; mean low O₂ 84.5 + 4 vs. 80.2 + 5.8%, P< 0.01) but not for age and BMI. In multiple regression analyses with age, body mass index, apnoea-hypopnoea index and mean low O₂ as independent and BP ratios and BP variability as dependent variables, sleep apnoea severity was the only independent predictor for circadian BP rhythm and nocturnal BP variability. The results presented here suggest that independent of age and obesity the severity of sleep apnoea is an important determinant of circadian BP variation and nocturnal BP variability.     

高血压病血压昼夜节律与心肌缺血的关系

目的 探讨高血压病患者血压昼夜节律改变与心肌缺血之间的关系及临床意义。方法对90例高血压病患者,根据动态心电图上有无心肌缺血(MI)分为MI组(40例)和无MI组(50例),并与20例健康体检者进行对照,观察3组的动态血压变化,同时分析血压昼夜节律正常组和异常组的心肌缺血的发生情况。结果 高血压病伴有MI的患者中,除dSBP、24hDBPL、dSBPL、dDBPL与无MI组比较无统计学差异外,其余各项动态血压指标均明显高于无MI组(P<0.01);高血压病血压昼夜节律异常组发生MI者明显高于血压昼夜节律正常组(P<0.05)。结论 高血压病患者中伴有血压昼夜节律异常者更易导致心肌缺血的发生。对高血压病患者的治疗,除积极控制血压外,还应注意检测和逆转异常的昼夜血压节律,对减少心肌缺血的发生和靶器官损害具有重要意义。     

急性脑血管病的动态血压监测

目的:观察血压异常与急性脑血管病(ACVD)发病的关系。方法:采用动态血压监测技术(ABPM)观察40例ACVD患者和40名正常成人。其中脑梗塞22例,脑出血18例。结果:ABPM监测结果显示:40例ACVD患者ABPM异常者37例(92.5％),其中平均收缩压(MSBP),平均舒张压(MDBP)超过正常值者32例(80.0％),血压波动较大者19例(47.5％)(即每小时之间相差>20.0％),其中多数合并存在MSBP,MDBP升高;低血压状态5例(12.5％);血压正常3例(7.5％)。结论:血压异常包括高血压,低血压、血压波动等,与ACVD发病有密切关系。ABPM优于传统的随测血压,并指导临床用药和估计血压异常的预后。因此,ABPM对于研究血压异常在ACVD发病中的作用有重要价值。     

24-Stunden-Blutdruckmessungen im Verlauf der normalen Schwangerschaft und bei hypertensiven Schwangeren

Summary Noninvasive 24-hour ambulatory blood pressure monitoring was performed in 17 normotensive and 19 preeclamptic pregnant women. The normotensive women showed a significant nightly decline in their systolic and diastolic blood pressure. In contrast, the preeclamptic women demonstrated either an attenuated circadian rhythm or no circadian rhythm at all. This result was even more pronounced in patients with severe hypertension, some of whom had a nocturnal increase in blood pressure in spite of being treated with antihypertensive drugs in an evening dose. The lack of nocturnal blood pressure decrease was also found 24 hours post partum.In summary, these results suggest that preeclamptic women are endangered by hypertensive emergencies mostly during the night. Therefore blood pressure controls should be extended into the night, and antihypertensive drugs should also be given in a sufficient evening dose.

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Abkürzungsverzeichnis H haemolysis - el elevated liver enzymes - lp low platelets - SSW Schwangerschaftswoche - RR Blutdruck Herrn Prof. Dr. med. F. Scheler zum 65. Geburtstag gewidmet. Diese Arbeit enthält Teilergebnisse einer noch nicht eingereichten Inaugural-Dissertation von U. Guhlke     

Influence of ambulatory blood pressure-related indicators within 24 h on in-hospital death in sepsis patients

Background: Sepsis is a serious public health problem worldwide. Blood pressure is one of the indicators that is closely monitored in intensive-care units, and it reflects complex interactions between the internal cardiovascular control mechanism and the external environment. We aimed to determine the impact of indicators related to the ambulatory blood pressure on the prognosis of sepsis patients.Methods: This retrospective study was based on the Medical Information Mart for Intensive Care IV database. Relevant information about sepsis patients was extracted according to specific inclusion and exclusion criteria. Examined parameters included the average blood pressure, blood pressure variability (BPV), and circadian rhythm, and the study outcome was in-hospital death. We investigated the effects of these indicators on the risk of in-hospital death among sepsis patients using Cox proportional-hazards models, restricted cubic splines analysis, and subgroup analysis.Results: This study enrolled 10,316 sepsis patients, among whom 2,117 died during hospitalization. All parameters except the nighttime variation coefficient of the diastolic blood pressure (DBP) were associated with in-hospital death of sepsis patients. All parameters except for fluctuations in DBP exhibited nonlinear correlations with the outcome. The subgroup analysis revealed that some of the examined parameters were associated with in-hospital death only in certain subgroups.Conclusion: Indicators related to the ambulatory blood pressure within 24 h are related to the prognosis of sepsis patients. When treating sepsis, in addition to blood pressure, attention should also be paid to BPV and the circadian rhythm in order to improve the prognosis and the survival rate.     

Association analysis of CA repeat polymorphism of the endothelial nitric oxide synthase gene with essential hypertension in Japanese

The nitric oxide synthase (NOS) gene is thought to be associated with essential hypertension (EH), because NO is implicated in endothelium-mediated vasodilation. We investigated the possible association between the alleles of simple tandem repeat DNA polymorphism of the endothelial constitutive NOS (cNOS) gene and EH in Japanese subjects. In all, 100 patients with EH and 123 subjects with normal blood pressure were studied. Polymerase chain reaction was used to amplify the CA repeat site in the endothelial cNOS gene and alleles based on the CA repeat number were determined. The allele frequencies in the hypertensive group and normotensive group were then compared. Twenty-three alleles were identified in this study of Japanese subjects. The overall distributions of allele frequencies in the two groups were not significantly different. However, comparing the allele frequencies in the EH group without left ventricular hypertrophy (LVH) and the normotensive group, the overall distributions were significantly different (p = 0.019). The 33-repeat allele was found more frequently in the EH group without LVH than in the normotensive group (p = 0.000047, Odds ratio = 3.71). In conclusion, the 33-repeat allele of the endothelial cNOS gene is associated with EH without LVH, and may be a genetic marker of EH in Japanese subjects.     

EH伴左心室肥大患者血浆IMD、血清CysC、CST和Salusin-α测定的临床价值

目的:为探讨原发性高血压(essential hypertension,EH)和EH伴左心室肥厚[EH伴LVH(下分组简称为LVH)]患者的发病机制和测定的临床价值。方法:血浆中叶素(intermedin,IMD)采用放射免疫分析;血清半胱氨酸蛋白酶抑制剂C(CystatinC,CysC)、儿茶酚抑素(catestatin,CST)和新型心血管活性肽Salusin-α测定则应用酶联免疫分析。结果:血浆IMD水平EH组和LVH组均显著地低于正常对照组(P<0.05,P<0.01),且LVH组又显著地低于EH组。血清CysC水平的变化则EH组和LVH组均显著地高于正常对照组(P<0.05,P<0.01),且LVH组又显著地高于EH组。CST水平EH组和LVH组均显著地高于正常对照组(P均<0.05),两组病例比较LVH组略低于EH组(P>0.05)。Salusin-α水平的变化EH组和LVH组均显著低于正常对照组(P均<0.05),两组病例比较LVH组略高于EH组(P>0.05)。结论:四项指标的测定变化,为进一步了解和认识EH和LVH的病理机制可有一定的临床意义。     

Normotension,hypertension and body fluid regulation: brain and kidney

The fraction of hypertensive patients with essential hypertension (EH) is decreasing as the knowledge of mechanisms of secondary hypertension increases, but in most new cases of hypertension the pathophysiology remains unknown. Separate neurocentric and renocentric concepts of aetiology have prevailed without much interaction. In this regard, several questions regarding the relationships between body fluid and blood pressure regulation are pertinent. Are all forms of EH associated with sympathetic overdrive or a shift in the pressure–natriuresis curve? Is body fluid homoeostasis normally driven by the influence of arterial blood pressure directly on the kidney? Does plasma renin activity, driven by renal nerve activity and renal arterial pressure, provide a key to stratification of EH? Our review indicates that (i) a narrow definition of EH is useful; (ii) in EH, indices of cardiovascular sympathetic activity are elevated in about 50% of cases; (iii) in EH as in normal conditions, mediators other than arterial blood pressure are the major determinants of renal sodium excretion; (iv) chronic hypertension is always associated with a shift in the pressure–natriuresis curve, but this may be an epiphenomenon; (v) plasma renin levels are useful in the analysis of EH only after metabolic standardization and then determination of the renin function line (plasma renin as a function of sodium intake); and (vi) angiotensin II‐mediated hypertension is not a model of EH. Recent studies of baroreceptors and renal nerves as well as sodium intake and renin secretion help bridge the gap between the neurocentric and renocentric concepts.