培哚普利治疗对防治高血压合并脑卒中患者并发症的临床试验

目的 探讨培哚普利降压治疗对预防高血压合并脑卒中患者并发症的研究。方法 对155例既往有脑卒中病史的轻中度高血压病患者随机分组,进行三年的培哚普利及安慰剂的双盲对照临床试验,观察三年的治疗组及安慰剂组的血压、心脑血管并发症的发生率及病死率,在研究结束时给予连续3日动态血压监测(ambulatory blood pressuremonitoring,ABPM)。结果 与安慰剂组比较,治疗组3日动态血压监测示血压控制满意,三年心脑血管并发症的发生率和死亡率(分别为6.85％和2.74％)明显低于安慰剂组(17.10％和9.21％)。结论 培哚普利降压有效、平稳、持久,持续降压治疗对预防高血压合并脑卒中患者心脑血管并发症具有重要作用。     

Blood pressure goal and choice of antihypertensive treatment in patients with mild hypertensive cardiovascular disease

Guidelines for the management of hypertension are established to reduce hypertension-related morbidity and mortality. Fundamental aims of interventions are designed to prevent and/or slow the development of cardiovascular diseases such as myocardial ischemia, heart failure and left ventricular hypertrophy by effecting favorably the natural history. In clinical trials, antihypertensive therapy has been associated with reductions in cardiovascular events even in patients with mild hypertension. Several classes of medications are recommended to achieve target blood pressure in patients with mild hypertensive cardiovascular diseases.     

Blood pressure lowering by pioglitazone. Evidence for a direct vascular effect.

To examine potential mechanisms for the blood pressure-lowering action of the thiazolidinedione compound, pioglitazone (PIO), we studied the effects of the drug on blood pressure and insulin action in vivo and on vascular tissue in vitro. In vivo, PIO lowered blood pressure in fructose-fed and chow-fed rats to an extent that could not be explained by alterations in fasting plasma insulin or free magnesium concentrations or by alterations in whole-body insulin sensitivity. In vitro, PIO caused significant blunting of the contractile responses of aortic rings to NE, arginine vasopressin (AVP), and potassium chloride; the blunting of responses to NE was maintained after removal of the endothelium. To assess the potential importance of extracellular calcium to the vasodepressor effect of PIO, we measured contractile responses to NE in the absence of calcium, and then after acute restoration of calcium in the presence of NE. PIO had no effect on the contractile response in the absence of calcium. By contrast, PIO blunted by 42% the contractile response that occurred when the extracellular calcium supply was acutely restored in the presence of NE, suggesting that the blunting was mediated by blockade of calcium uptake by vascular smooth muscle. Such an effect was confirmed in cultured a7r5 vascular smooth muscle cells, which exhibited a brisk increase in intracellular calcium in response to AVP that was blocked by PIO in a dose-dependent fashion. Our data indicate that PIO has a direct vascular effect that appears to be mediated at least in part by inhibition of agonist-mediated calcium uptake by vascular smooth muscle. The direct vascular effect may contribute to the blood pressure-lowering actions of PIO in vivo, because that effect could not be explained by alterations in whole-body insulin sensitivity.     

Cerebrovascular risks with rapid blood pressure lowering in the absence of hypertensive emergency

Study objectiveIn the Emergency Department (ED) setting, clinicians commonly treat severely elevated blood pressure (BP) despite the absence of evidence supporting this practice. We sought to determine if this rapid reduction of severely elevated BP in the ED has negative cerebrovascular effects.MethodsThis was a prospective quasi-experimental study occurring in an academic emergency department. The study was inclusive of patients with a systolic BP (SBP) > 180 mm Hg for whom the treating clinicians ordered intensive BP lowering with intravenous or short-acting oral agents. We excluded patients with clinical evidence of hypertensive emergency. We assessed cerebrovascular effects with measurements of middle cerebral artery flow velocities and any clinical neurological deterioration.ResultsThere were 39 patients, predominantly African American (90%) and male (67%) and with a mean age of 50 years. The mean pre-treatment SBP was 210 ± 26 mm Hg. The mean change in SBP was ?38 mm Hg (95% CI ?49 to ?27) mm Hg. The average change in cerebral mean flow velocity was ?5 (95% CI ?7 to ?2) cm/s, representing a ?9% (95% CI ?14% to ?4%) change. Two patients (5.1%, 95% CI 0.52–16.9%) had an adverse neurological event.ConclusionWhile this small cohort did not find an overall substantial change in cerebral blood flow, it demonstrated adverse cerebrovascular effects from rapid BP reduction in the emergency setting.     

Blood pressure-lowering drugs: essential therapy for some patients with normal blood pressure

The risk of increasing blood pressure on the incidence of cardiovascular disease starts at 115/75 mmHg and roughly doubles for every 10 years increase in age, 20 mmHg increase in systolic blood pressure, 10 mmHg increase in diastolic blood pressure, or in the presence of comorbidities, such as diabetes or any evidence of cardiovascular disease. To lower blood pressure in patients with normal blood pressure and diabetes, or heart failure, or with any evidence of atherosclerotic disease in the coronary, cerebral and peripheral territories, reduces the incidence of major cardiovascular events by 18 to 42%. The diagnosis of hypertension in patients with these conditions is therefore irrelevant. The drugs that have mainly been tested in such conditions are the angiotensin-converting enzyme inhibitors, but their efficacy probably derives from their blood pressure-lowering effect, instead of a primary antiatherosclerotic effect.     

Blood pressure-lowering drugs: essential therapy for some patients with normal blood pressure

The risk of increasing blood pressure on the incidence of cardiovascular disease starts at 115/75 mmHg and roughly doubles for every 10 years increase in age, 20 mmHg increase in systolic blood pressure, 10 mmHg increase in diastolic blood pressure, or in the presence of comorbidities, such as diabetes or any evidence of cardiovascular disease. To lower blood pressure in patients with normal blood pressure and diabetes, or heart failure, or with any evidence of atherosclerotic disease in the coronary, cerebral and peripheral territories, reduces the incidence of major cardiovascular events by 18 to 42%. The diagnosis of hypertension in patients with these conditions is therefore irrelevant. The drugs that have mainly been tested in such conditions are the angiotensin-converting enzyme inhibitors, but their efficacy probably derives from their blood pressure-lowering effect, instead of a primary antiatherosclerotic effect.     

Blood pressure management in a cohort of hypertensive patients in Germany treated by cardiologists

Background  

In Germany, an estimated 20–25 million patients suffer from hypertension. Blood pressure control rates are, however, lower than in many other European countries and the USA. The present analysis reports blood pressure treatment and control rates in Germany in patients with hypertension treated by cardiologists.     

音乐疗法对高血压病患者血压的影响

目的探讨音乐疗法对高血压病患者血压的影响效果。方法将加例高血压病患者随机分为实验组和对照组各20例。两组患者基础治疗方法相同,观察组增加音乐疗法。结果两组患者治疗后血压结果比较,经统计学分析,均P<0.05,差异有统计学意义。结论对高血压病患者在应用药物治疗的同时增加音乐疗法,对降压药物起到明显的增效作用。     

高血压家族史对高血压患者血压变异性的影响

目的探讨高血压家族史对直系亲属血压变异性及靶器官的影响。方法 102例患者分为两组,有高血压家族史(HF+)组45例,无高血压家族史(HF-)组57例,完成体格检查、生化检查、心脏彩超、动态血压监测。结果两组患者在多种心血管危险因素等指标水平比较,差异无统计学意义。HF+组年龄[平均(40.02±12.08)岁]低于HF-组[平均(60.75±12.65)岁],差异有统计学意义。在白昼平均舒张压、白昼舒张压标准差、白昼平均动脉压标准差、24h平均舒张压、24h舒张压的标准差、24h平均动脉压标准差,HF+组均值显著高于HF-组,差异有统计学意义(P<0.05);在白昼平均收缩压、白昼平均收缩压标准差、夜间平均收缩压、夜间收缩压标准差,两组均值比较,差异无统计学意义(P<0.05)。HF+组中出现非勺型血压节律比例显著高于HF-组(51.11%vs.26.31%,P=0.010),差异有统计学意义;HF+组发生左心室肥厚比例显著高于HF-组(68.89%vs.42.10%,P=0.007),差异有统计学意义。完成上述检查后,予以口服降压药物,为使患者血压控制达标,HF+组使用3种或3种以上一线降压药物比例显著高于HF-组(53.33%vs.29.82%,P=0.016)。结论有高血压家族史患者发病年龄提前,血压变异性增大,可能更易发生靶器官损害。     

Evaluating a community‐based stroke nursing education and rehabilitation programme for patients with mild stroke

This study evaluated whether mild stroke patients who received a community‐based stroke nursing intervention had better stroke knowledge, behaviour and self‐efficacy than those who were exposed to traditional education programmes. The intervention group consisted of sixty five stroke patients randomly selected from seven communities who received three 2‐hour stroke interventions per week for 8 weeks. The normal care group consisted of sixty two stroke patients randomly selected from a medical centre who received a general stroke education programme. The stroke patients in two groups were assessed at baseline, after intervention and at the 6‐month follow‐up. At the 6‐month follow‐up, the intervention group demonstrated an improvement in the knowledge of stroke risk factors compared with the normal care group. Three months after education, the intervention group exhibited changes in the knowledge of stroke, social participation and self‐efficacy compared with those at baseline. Also, self‐efficacy was correlated with the knowledge of stroke risk factors after intervention and at the 6‐month follow‐up; self‐efficacy was correlated with social participation after the 6‐month follow‐up. A community‐based stroke nursing intervention might have effects on changes in the knowledge of stroke risk factors, social participation and self‐efficacy.     

Retrospective analysis of comorbidities in stroke patients with a history of obstructive sleep apnea treated with thrombolytic therapy

BackgroundThe eligibility criteria for thrombolytic therapy may differ between acute ischemic stroke patients (AIS) patients with and without incidence of obstructive sleep apnea (OSA). In this study, we determine the effect of specific comorbidities in the exclusion and inclusion for recombinant tissue plasminogen activator (rtPA) administration in the AIS population with OSA.MethodsRetrospective data from a stroke registry were analyzed for baseline clinical and demographic factors in AIS patients with OSA for rtPA therapy from January 2010 to June 2016. The logistic regression model was developed to identify each of the variables predicting inclusion for or exclusion from rtPA. We estimated the odds of the inclusion or exclusion of a particular demographic and clinical risk factor in AIS with and without OSA for rtPA therapy. The validity of the model was tested using a Hosmer-Lemeshow test and the sensitivity of the model was determined using a Receiver Operating Curve (ROC).ResultsA total of 170 AIS patients with OSA were identified, of which, 125 did not receive rtPA while 45 received rtPA. Adjusted analysis showed that in the AIS population with OSA, administration of rtPA was associated with a history of dyslipidemia (OR=3.192, 95% CI, 1.148-8.88, p=0.026), direct admission into a Comprehensive Stroke Center (OR=3.248, 95% CI, 1.06-9.95, p=0.039), and ambulatory improvement (OR=3.556, 95% CI, 1.428-8.86, p=0.006). There were no significant factors associated with rtPA exclusion in the AIS population with OSA.ConclusionThe prevalence of OSA in our AIS population was low and no clinical risk factor was associated with the exclusion of patients with AIS and OSA from thrombolytic therapy. Future studies are necessary to explore the effect of OSA in AIS patients to improve eligibility for rtPA therapy for more patients.     

Blood pressure management in acute stroke

The optimal management of arterial blood pressure in the setting of acute stroke has not been firmly defined. The different types of stroke--ischemic, intracerebral hemorrhage, and subarachnoid hemorrhage--have different pathophysiologies and require different approaches in terms of blood pressure management in the acute setting. This article reviews the current literature and experience at the authors' institution.     

Non-pharmacological correction of arterial pressure in hypertensive patients with a pacemaker

Frequency-dependent hypotensive effect of cardiac pacing (CP) regarding type of circulation and stimulation regime under programmed changes of impulse frequency from 50 to 90 imp/min was studied in 92 patients (53 males, 39 females) with essential hypertension of the first, second and third degree and isolated systolic arterial hypertension. The rise of the above frequency over 80 imp/min was accompanied with a significant fall in systolic arterial pressure (SAP) in patients with hyperkinetic circulation while heart rhythm under 60 imp/min resulted in a significant lowering of diastolic arterial pressure (DAP) in patients with eukinetic and hypokinetic type of circulation. In regime VVI both SAP and DAP lowering was more pronounced than in AAI regime. The most prominent hypotensive effect was seen in VVI-stimulation complicated by ventriculoatrial conduction. Reprogramming of impulse frequency normalized arterial pressure in 43.3% patients with hyperkinetic type of circulation. Thus, a frequency-dependent hypotensive effect of programmed CP can be used for non-pharmacological correction of arterial hypertension and optimization of effectiveness of anti-hypertensive treatment in paced patients.