妊娠期高血压病患者产后降压治疗的效果分析

目的 分析妊娠期高血压疾病患者产后抗高血压治疗的临床效果。方法 回顾性分析2013年6月~2016年6月我院收治的124例妊娠期高血压疾病患者,按照是否进行抗高血压治疗分为观察组和对照组,观察组64例,对照组60例。观察组患者产后采用抗高血压治疗,对照组患者产后未进行治疗或者进行不规范的降压治疗,对两组患者血压水平进行比较。结果 相对于对照组,观察组患者产后血压接近正常的时间更短,尿蛋白转阴更快,高血压遗留率相更低,差异具有统计学意义（P＜0.05）。结论 妊娠期高血压疾病的患者若产后血压和蛋白尿仍未正常,积极抗高血压治疗,能有效降低高血压的遗留率,促进恢复。     

Treatment of hypertension in black patients with angiotensin-converting enzyme inhibitors

The prevalence of hypertension and the incidence of complications from uncontrolled elevated blood pressure in blacks is much greater than in the white population. In general, blacks have underlying differences in the factors relating to blood pressure level, including low plasma renin, and, in certain instances, a decreased ability to excrete sodium. The stepped-care approach in the management of the black hypertensive patient is similar to that taken with white patients, but racial differences in response to antihypertensive drugs exist that require careful consideration when choosing a treatment regimen. Thiazide diuretics are effective in blacks and are often used as initial therapy. Blacks tend to respond less well to β-blockers, but when combined with a diuretic, they are also effective. Encouraging data are available on the use of calcium channel blockers in blacks. When combined with a diuretic, the angiotensin-converting enzyme (ACE) inhibitors also provide an alternative to therapy for black patients. The use of low doses of ACE inhibitors has reduced the high incidence of adverse effects associated with this group of drugs in earlier studies.     

Ontogenetic aspects of hypertension development: analysis in the rat.

In this review, we attempt to outline the age-dependent interactions of principal systems controlling the structure and function of the cardiovascular system in immature rats developing hypertension. We focus our attention on the cardiovascular effects of various pharmacological, nutritional, and behavioral interventions applied at different stages of ontogeny. Several distinct critical periods (developmental windows), in which particular stimuli affect the further development of the cardiovascular phenotype, are specified in the rat. It is evident that short-term transient treatment of genetically hypertensive rats with certain antihypertensive drugs in prepuberty and puberty (at the age of 4-10 wk) has long-term beneficial effects on further development of their cardiovascular apparatus. This juvenile critical period coincides with the period of high susceptibility to the hypertensive effects of increased salt intake. If the hypertensive process develops after this critical period (due to early antihypertensive treatment or late administration of certain hypertensive stimuli, e.g., high salt intake), blood pressure elevation, cardiovascular hypertrophy, connective tissue accumulation, and end-organ damage are considerably attenuated compared with rats developing hypertension during the juvenile critical period. As far as the role of various electrolytes in blood pressure modulation is concerned, prohypertensive effects of dietary Na+ and antihypertensive effects of dietary Ca2+ are enhanced in immature animals, whereas vascular protective and antihypertensive effects of dietary K+ are almost independent of age. At a given level of dietary electrolyte intake, the balance between dietary carbohydrate and fat intake can modify blood pressure even in rats with established hypertension, but dietary protein intake affects the blood pressure development in immature animals only. Dietary protein restriction during gestation, as well as altered mother-offspring interactions in the suckling period, might have important long-term hypertensive consequences. The critical periods (developmental windows) should be respected in the future pharmacological or gene therapy of human hypertension.     

A new antihypertensive strategy for black patients: low-dose multimechanism therapy.

Hypertension poses serious health risks for blacks because this population presents with earlier onset and more severe forms of the disease than do nonblacks. Although diuretics are the cornerstone of antihypertensive therapy In the black population, investigators have expressed concern about adverse metabolic effects, such as hypokalemia, produced by the high doses of diuretics traditionally prescribed for blacks. Recent evidence suggests that black patients may respond equally well to the new generation of cardioselective beta-blockers and angiotensin-converting enzyme inhibitors, particularly when these agents are used together with a diuretic. A new low-dose multimechanism agent that combines the cardioselective beta-blocker bisoprolol fumarate with hydrochlorothiazide, a benzothiazine diuretic, is now available for first-line therapy for hypertension. Results of two US multicenter trials--including a subset analysis of black patients--indicate that the once-daily agent is highly effective in reducing diastolic and systolic blood pressure throughout a 24-hour period in both black and nonblack patients. The agent is well tolerated in blacks and non-blacks and has a side-effect profile comparable to placebo. Because of its efficacy and safety in black patients, bisoprolol fumarate/-hydrochlorothiazide is an appropriate therapeutic option for first-line therapy of hypertension in the black population.     

Antihypertensive Drugs and Inflammation in Acute Ischemic Stroke as a Predictor Factor of Future Cardiovascular Mortality

The beneficial effects of antihypertensive drugs in secondary stroke prevention could not be based on their effects on lowering hypertension only.In this prospective study, the status of blood pressure, treatment regimens, new atherothrombotic event, blood sampling for hs-CRP and fibrinogen were asked at initial visit, 6th, and 12th months in 226 patients with atherothrombotic stroke.Eighty-seven percent of patients had an antihypertensive regimen, but hypertension control was achieved in 34.1% of patients.Neither use of six different antihypertensive drug regimens nor the change in blood pressure levels showed any difference on new atherothrombotic events, outcomes or survival rates.On the other hand, the higher levels of hs-CRP at baseline were found to be associated with higher mortality rates(p = 0.020).Our findings emphasize the predictive role of inflammation in future cardiovascular mortality in patients with acute ischemic stroke, indicating that inflammatory mediators underlying the atherothrombotic process play a more important role than it is assumed.     

Guidelines for the management of hypertension in Japan

Hypertension is one of the most significant risk factors for cerebrovascular and heart diseases, which rank as the second and third most frequent causes of death in Japan. Two guidelines, Guidelines for the Management of Hypertension for General Practitioners(JSH2000) and Guideline for Treatment of Hypertension in the Elderly(2002 Revised Version), are currently available for treatment of hypertension in Japan. Both guidelines include indications for the treatment of hypertension, classification and evaluation of blood pressure(diagnosis), treatment strategy, modification of lifestyle and treatment with antihypertensive drugs. The guidelines are coming into clinical practice as useful references for the control and treatment of hypertension in Japan. They have advantages based on evidence from many recent studies in Japan and on consideration of the unique life style of Japanese, since the treatment guidelines for hypertension previously referenced are essentially guidelines for individuals in Western countries, primarily Caucasians. In Guideline for Treatment of Hypertension in the Elderly(2002 Revised Version), the opinions and criticisms of the Japanese hypertension experts are also incorporated. In future research, there is a need for further observational epidemiological studies and intervention trials in Japanese patients to provide direct evidence about the risks associated with blood pressure and other risk factors, as well as the antihypertensive drug effects.     

Surveillance study of diltiazem use in black and nonblack angina patients

Diltiazem hydrochloride was studied in 133 patients with angina to determine whether differing effects were produced in black patients (39 percent of patients) as compared with nonblack patients. The antihypertensive effect of the drug was also assessed. No statistically significant differences between the responses of blacks and nonblacks were found in the reduction of angina frequency (54 percent of blacks improved, 58 percent of nonblacks), nitroglycerin consumption (60 percent of blacks used less, 66 percent of nonblacks), and changes in lifestyle, as measured with the New York Heart Association scale (55 percent of blacks improved, 63 percent of nonblacks). The antihypertensive effects (not analyzed by race) were greatest in patients with uncontrolled hypertension. Average decreases in this group were 18 mmHg in supine systolic pressures and 14 mmHg in supine diastolic pressures, as compared with decreases of only 4 and 3 mmHg in normotensives. Study results suggest that there is a difference in the type of angina afflicting blacks and nonblacks, that hypertension more often accompanies angina in blacks, and that diltiazem is equally effective in treating angina in blacks and nonblacks.     

Predictors for the white coat effect in general practice patients with suspected and treated hypertension.

BACKGROUND: Ambulatory blood pressure monitoring was introduced more than 40 years ago and is accepted as a clinically useful method to evaluate the white coat effect in patients with suspected and established hypertension. AIM: To study the differences between blood pressure readings taken in the physician's office in the primary healthcare setting, and ambulatory readings, and to find possible predictors. DESIGN OF STUDY: Prospective study. SETTING: Two primary healthcare centres in Norway. METHOD: The study included 221 patients, 107 of whom were on antihypertensive treatment, and 114 of whom were under investigation for possible hypertension. Differences between blood pressure readings taken in the physician's office and ambulatory readings were calculated. Independent predictors for the white coat effect were calculated using linear regression analysis. RESULTS: The difference between blood pressure readings taken in the office and ambulatory readings was 27 mmHg systolic and 11 mmHg diastolic. For the systolic readings, the following factors were independent predictors of the amount of the white coat effect: mean blood pressure, age, history of smoking, family history of cardiovascular disease, and antihypertensive treatment. For the diastolic readings, they were: mean blood pressure, history of smoking, and sex of the patient (with this being most significant for women). CONCLUSION: Ambulatory blood pressure measurement is of significant value in identifying patients with white coat hypertension. It can be an important supplement for use in the diagnosis and follow-up of patients with hypertension in general practice.     

Safe pharmacologic treatment strategies for osteoarthritis pain in African Americans with hypertension, and renal and cardiac disease

Arthritis is the leading cause of disability in the United States. Osteoarthritis, the most common form of arthritis, is a degenerative joint disease affecting both whites and African Americans similarly. African Americans have a high incidence rate of comorbidities, including hypertension, cardiovascular disease (CVD) risk factors and diabetes. Treatment of osteoarthritic pain in patients with comorbidities is often complicated by potential safety concerns. Traditional nonsteroidal antiinflammatory drugs (NSAIDs) and cyclooxygenase 2 (COX-2) specific NSAIDs have been shown to increase blood pressure in hypertensive patients taking antihypertensive medications. Patients with CVD risk factors taking low-dose aspirin for secondary prevention may be at increased risk for gastrointestinal bleeding with NSAIDs. Diabetics face an increased risk of renal complications. Because NSAIDs are associated with adverse renal effects, they should be used cautiously in patients with advanced renal disease. Acetaminophen is the most appropriate initial analgesic for African Americans with chronic osteoarthritic pain and concurrent hypertension, CVD risk factors or diabetes, and is recommended by the American College of Rheumatology as first-line treatment. Many of the adverse effects commonly associated with NSAIDs are not associated with acetaminophen. Safety concerns surrounding pharmacologic treatment of osteoarthritis in African Americans are reviewed.     

Renal denervation as an option for the management of hypertension

Hypertension is a multifactorial condition which makes the development of treatment approaches difficult.The vast majority of patients are treated with lifestyle measures either alone or in combination with antihypertensive drugs,and this approach is largely successful in controlling blood pressure.However,for a subgroup of patients,control of blood pressure remains resistant to this approach and therefore the development of new strategies is imperative.The sympathetic nervous system has been known to be implicated in hypertension for many decades,and evidence from studies in the past has revealed the benefit of reducing sympathetic nerve activity in the control of blood pressure albeit with severe side effects.Recent technological advances have allowed for specific targeting of the renal sympathetic nerves by catheter ablation.The Symplicity HTN-1 and HTN-2 trials have provided strong evidence for renal denervation giving rise to considerable blood pressure reductions in treatment-resistant hypertensives and,due to the high incidence of hypertension worldwide,this carries the promise of further reducing the global burden of hypertension and its attendant complications.Here we review the evidence for renal denervation in the management of hypertension.     

Minoxidil and captopril in severe hypertension

Summary The antihypertensive efficacy of minoxidil and captopril was compared in 23 males with essential or renal parenchymatous hypertension refractory to conventional antihypertensive drug therapy. Following a pretreatment period the patients were randomly assigned to receive either minoxidil, 2.5 mg twice daily (n=12), or captopril, 25 mg twice daily (n=11). In patients with diastolic blood pressure >95 mmHg, doses of minoxidil and captopril were increased in 2-week intervals. Patients who maintained diastolic pressure >95 mmHg and/or those with intolerable side effects were switched over to the alternative substance. After a mean observation period of 12 weeks a significant decrease in systolic and diastolic blood pressure was observed (179/114 vs 148/92 mmHg in the minoxidil group; 176/111 vs 158/97 mmHg in the captopril group). The primary response rate was 75% in patients treated with minoxidil and 55% in those with captopril (not significant). After the change to the alternative substance two of the four non-responders on captopril and one of the two non-responders on minoxidil became responders. Side effects occurred significantly more often during minoxidil than captopril (p<0.05). The high efficacy of minoxidil and captopril in the treatment of severe hypertension refractory to conventional drugs was confirmed. Minoxidil lowered blood pressure slightly more than captopril, but it had a higher incidence of side effects than captopril.     

Chronic 5-HT2-receptor blockade by ritanserin does not reduce blood pressure in patients with essential hypertension

The selective 5-HT2-receptor-blocking agent ritanserin is an analogue of the antihypertensive agent ketanserin. By evaluating the antihypertensive effects of ritanserin the aim of this investigation was to indirectly elucidate the mechanism of action of ketanserin. Thirteen patients with essential hypertension were treated with placebo and ritanserin, 10 mg b.i.d., in a double-blind, cross-over design (4-week periods). At the end of the treatment periods blood pressure as well as plasma concentrations of ritanserin were evaluated for 24 hours. Despite high steady state and peak plasma concentrations of ritanserin the compound did not lower the blood pressure compared with placebo. Since chronic selective 5-HT2-receptor blockade by means of ritanserin did not lower the blood pressure, it is concluded that the 5-HT2 blocking properties of ketanserin cannot alone be responsible for the antihypertensive effects of ketanserin.     

Long-term effects of a complex behavioral treatment of essential hypertension

A multidimensional behavioral program was developed for the treatment of essential hypertension. Over a course of 6 weeks, 108 patients of a rehabilitation center were treated with this program consisting of health education, self-monitoring of blood pressure, relaxation techniques, and a social skill training in addition to standard medical treatment alone. Blood pressure and other cardiovascular risk factors were monitored for a period of 12 months. Blood pressure levels became normotensive in both groups at the end of the 6-week training program. However, the blood pressure reduction in the behavioral treatment group was achieved with fewer patients taking antihypertensive medication than in the control group. The number of patients taking antihypertensive drugs in the treatment group was 60.2% prior to treatment and 44.4% after treatment; figures for the control group were 68% and 73.8%, respectively (p less than or equal to 0.01). Almost identical data were obtained at the 6- and 23-month follow-up examinations. No consistent changes were observed in weight, smoking, or blood lipids. These results demonstrate beneficial and long-lasting effects of a combined medical and psychologic treatment of essential hypertension as compared to medical treatment alone.     

Antihypertensive treatment with cerebral hemodynamics monitoring by ultrasonography in elderly hypertensives without a history of stroke may prevent or slow down cognitive decline. A pending issue

The role of the antihypertensive therapy in preventing cognitive disorders in elderly persons without a history of stroke is still a matter of debate. This article focuses on the pathogenesis of vascular cognitive disorders in hypertension and on the impact of antihypertensive treatment in their prevention. Cerebral white matter lesions, caused by small vessel disease and cerebral hypoperfusion, have been found in the majority of elderly hypertensives. They correlate with cognitive disorders, particularly impairments of attention and executive functions. Excessive blood pressure lowering in elderly patients with long-standing hypertension below a certain critical level, may increase the risk of further cerebral hypoperfusion because of disrupted cerebral blood flow autoregulation. As a result, worsening of the cognitive functions could occur, especially in cases with additional vascular risk factors. Five randomized, placebo-controlled trials have focused on the efficacy of antihypertensive treatments in preventing cognitive impairments in elderly patients without a prior cerebrovascular disease. Four of them have not found positive effects. We suggest that repeated neuropsychological assessments and ultrasonography for evaluation of carotid atherosclerosis, as well as cerebral hemodynamics monitoring could adjust the antihypertensive therapy with the aim to decrease the risk of cerebral hypoperfusion and prevent or slow down cognitive decline in elderly hypertensives. Prospective studies are needed to confirm such a treatment strategy.     

The effect of balloon angioplasty on hypertension in atherosclerotic renal-artery stenosis. Dutch Renal Artery Stenosis Intervention Cooperative Study Group

BACKGROUND: Patients with hypertension and renal-artery stenosis are often treated with percutaneous transluminal renal angioplasty. However, the long-term effects of this procedure on blood pressure are not well understood. METHODS: We randomly assigned 106 patients with hypertension who had atherosclerotic renal-artery stenosis (defined as a decrease in luminal diameter of 50 percent or more) and a serum creatinine concentration of 2.3 mg per deciliter (200 micromol per liter) or less to undergo percutaneous transluminal renal angioplasty or to receive drug therapy. To be included, patients also had to have a diastolic blood pressure of 95 mm Hg or higher despite treatment with two antihypertensive drugs or an increase of at least 0.2 mg per deciliter (20 micromol per liter) in the serum creatinine concentration during treatment with an angiotensin-converting-enzyme inhibitor. Blood pressure, doses of antihypertensive drugs, and renal function were assessed at 3 and 12 months, and patency of the renal artery was assessed at 12 months. RESULTS: At base line, the mean (+/-SD) systolic and diastolic blood pressures were 179+/-25 and 104+/-10 mm Hg, respectively, in the angioplasty group and 180+/-23 and 103+/-8 mm Hg, respectively, in the drug-therapy group. At three months, the blood pressures were similar in the two groups (169+/-28 and 99+/-12 mm Hg, respectively, in the 56 patients in the angioplasty group and 176+/-31 and 101+/-14 mm Hg, respectively, in the 50 patients in the drug-therapy group; P=0.25 for the comparison of systolic pressure and P=0.36 for the comparison of diastolic pressure between the two groups); at the time, patients in the angioplasty group were taking 2.1+/-1.3 defined daily doses of medication and those in the drug-therapy group were taking 3.2+/-1.5 daily doses (P<0.001). In the drug-therapy group, 22 patients underwent balloon angioplasty after three months because of persistent hypertension despite treatment with three or more drugs or because of a deterioration in renal function. According to intention-to-treat analysis, at 12 months, there were no significant differences between the angioplasty and drug-therapy groups in systolic and diastolic blood pressures, daily drug doses, or renal function. CONCLUSIONS: In the treatment of patients with hypertension and renal-artery stenosis, angioplasty has little advantage over antihypertensive-drug therapy.     

Long-term effects of captopril and atenolol in essential hypertension

Fifty patients with mild or moderate essential hypertension were randomized (double-blindly) to treatment with either captopril (n = 26) or atenolol (n = 24). Their mean supine diastolic blood pressure after placebo was 100-125 mmHg. The study included an initial dose finding phase (12 weeks) during which the dosages of captopril and atenolol were increased stepwise every second week in order to obtain normotension (supine diastolic blood pressure less than 95 mmHg). Hydrochlorothiazide was added when necessary. During the second phase of the study the patients were followed on active treatment for 2 years. After the initial 12 weeks of active treatment, recumbent and standing blood pressures had fallen significantly both in the captopril group (by 31/20 and 33/19 mmHg, p less than 0.001) and in the atenolol group (by 24/18 and 30/20 mmHg, p less than 0.01 (systolic), p less than 0.001 (diastolic)). The antihypertensive effect was maintained in both groups during long-term treatment. The antihypertensive effect of both agents was potentiated to the same extent by addition of hydrochlorothiazide. Side-effects were few and mild. It can be concluded that both captopril and atenolol are safe and effective antihypertensive drugs.     

Characteristics of patients with uncontrolled hypertension in the United States

BACKGROUND: Treatment of hypertension is one of the most common clinical responsibilities of U.S. physicians, yet only one fourth of patients with hypertension have their blood pressure adequately controlled. METHODS: We analyzed data from the third National Health and Nutrition Examination Survey to assess the role of access to and use of health care in the control of hypertension. We assessed demographic characteristics, clinical data, health insurance status, and awareness and treatment of hypertension in subjects with hypertension (defined as a blood pressure of at least 140/90 mm Hg or the use of antihypertensive medication) and subjects without hypertension. RESULTS: The study sample consisted of 16,095 adults who were at least 25 years old and for whom blood-pressure values were known. We estimated that 27 percent of the population had hypertension, but only 23 percent of those with hypertension were taking medications that controlled their condition. Among subjects with untreated or uncontrolled hypertension, the pattern was an elevation in the systolic blood pressure with a diastolic pressure of less than 90 mm Hg. The great majority had health insurance. Independent predictors of a lack of awareness of hypertension were an age of at least 65 years, male sex, non-Hispanic black race, and not having visited a physician within the preceding 12 months. The same variables, except for non-Hispanic black race, were independently associated with poor control of hypertension among those who were aware of their condition. An age of at least 65 years accounted for the greatest proportion of the attributable risk of the lack of awareness of hypertension and the lack of control of hypertension among those who were aware of their condition. CONCLUSIONS: Most cases of uncontrolled hypertension in the United States consist of isolated, mild systolic hypertension in older adults, most of whom have access to health care and relatively frequent contact with physicians.     

基于Meta分析的CPAP联合常规降压药物对OSAHS合并高血压患者的综合疗效分析

目的利用Meta分析评价持续气道正压通气(continuous positive airway pressure,CPAP)联合常规降压药物对阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)合并高血压患者的综合疗效,为临床治疗提供参考。方法计算机检索中国生物医学文献数据库(Chinese Bio Medical Literature Database,CBM)、Cochrane Library、Pub Med、中国学术期刊全文数据库(China National Knowledge Infrastructure,CNKI)、万方数据知识服务平台,维普中文期刊服务平台等电子数据库并手工检索相关期刊,查找CPAP治疗对OSAHS合并高血压患者综合疗效影响的临床随机对照试验(randomized controlled trial,RCT),对符合条件的RCT,逐一评价纳入研究的质量,提取入选文献资料,采用Rev Man5.3软件进行Meta分析,以Meta分析中的合并效应统计参数探讨CPAP联合常规降压药物的治疗效果。结果共纳入13篇文献。Meta分析数据显示:各项指标差异均具有统计学意义[AHI:WMD=-25.19,95%CI(-34.05,-16.33),P0.00001;LSa O2:WMD=17.57,95%CI(11.16,23.98),P0.00001。白天平均收缩压:WMD=-8.26,95%CI(-11.18,-5.34),P0.00001;白天平均舒张压:WMD=-6.42,95%CI(-8.25,-4.60),P0.00001;夜间平均收缩压:WMD=-12.92,95%CI(-19.65,-6.19),P0.0002;夜间平均舒张压:WMD=-6.31,95%CI(-8.53,-4.09),P0.00001;24h平均收缩压:WMD=-10.28,95%CI(-14.08,-6.48),P0.00001;24h平均舒张压:WMD=-6.99,95%CI(-8.88,-5.09),P0.00001]。分析数据提示CPAP联合常规降压药物治疗后OSAHS合并高血压患者各项指标改善程度较对照组(常规药物治疗)均有明显提升。漏斗图基本对称,存在发表偏倚可能性小。结论 CPAP联合常规降压药物治疗对我国OSAHS合并高血压患者有确切的疗效。     

Hypertension in type II diabetes mellitus

Treatment of hypertension in patients with NIDDM should be administered with special attention not to increase insulin resistance nor to impair insulin secretion capacity. The coexisting risk for coronary artery disease and myocardial infarction should not be increased by undesired drug effects on the plasma lipoprotein profile. Late lesions of diabetes mellitus (nephropathy, neuropathy) have also to be taken into account. Consequently angiotensin converting enzyme inhibitors, if necessary combined with calcium channel blockers, should be administered first. If blood pressure is thus not sufficiently controlled, alpha-adrenergic blockers, vasodilating agents or sympatholytics may be added. Once insulin treatment is installed, or if required for other reasons (nephropathy, congestive heart failure, cardiac arrhythmia), also diuretics and beta-adrenergic blockers are indicated in antihypertensive treatment of diabetic patients.