艾克地平与心痛定对高血压患者血压变异性的影响

个体在一定时间内血压波动的程度称为血压变异性,业以证实高血压患者的血压变异性增高,且增高的血压变异性与靶器损害相关,理想的降压药物应既能有效地降低血压值,又能降低血压变异性,钙拮抗剂的降压作用十分肯定,但中、短效制剂的降压作用不同,对血压变异性的影响也可能不一样,为此我们选择中效制剂艾克地平及短效制硝苯地平两种钙拮抗剂分别对原发性高血压患者进行治疗,观察用药第７天时血压变异性的变化,现报告如下。     

原发性高血压患者的血压变异性与血尿酸水平的相关性研究

目的 探讨新发原发性高血压患者血压变异性和血尿酸水平的关联性。方法 纳入2019年9月至2021年12月因首次确诊为原发性高血压在宣城市人民医院心血管内科住院的患者385例,并完善动态血压监测。根据三分位方法将纳入患者分为低血尿酸组(≤305 mmol/L)128例,中血尿酸组(305～386 mmol/L)130例,高血尿酸组(>386 mmol/L)127例。基于多变量回归分析新发的原发性高血压患者中血尿酸水平与收缩压变异系数以及舒张压变异系数的关系。结果 与低血尿酸组比较,中、高尿酸组患者的白天收缩压血压负荷、白天收缩压平均值、24 h收缩压标准差、24 h舒张压标准差、24 h收缩压变异系数和24 h舒张压变异系数更高(P<0.05)。多因素回归分析显示,年龄、糖尿病、中高血尿酸分组是24 h收缩压变异系数独立的影响因素(P<0.05)。年龄及中、高血尿酸分组是24 h舒张压变异系数独立的影响因素(P<0.05)。结论 在新发原发性高血压患者中,血尿酸是24 h收缩压变异系数及24 h舒张压变异系数的影响因素。     

针刺治疗对原发性高血压患者血压和心率变异性的影响

目的:探讨针刺治疗对原发性高血压患者血压变异性和心率变异性的影响。方法:选择符合条件的60例原发性高血压患者进行针刺治疗,疗程为30 d,采用自身前后对照,分别于治疗前后完善24 h动态血压及24 h动态心电图检查。结果:针刺治疗后血压变异性各指标(24 h平均收缩压、24 h平均舒张压、24 h收缩压标准差、24 h舒张压标准差、白昼收缩压标准差、白昼舒张压标准差、夜间收缩压标准差、夜间舒张压标准差)均较治疗前降低,差异具有统计学意义(P0.05);心率变异性各指标(连续RR间期标准差、平均5 min RR间期标准差、平均5 min RR间期标准差的平均值、连续RR间期差值的均方根值、相邻RR间期大于50ms的百分数)均较治疗前有所改善,差异具有统计学意义(P0.05)。结论:针刺治疗能显著降低原发性高血压患者的血压变异性,改善心率变异性,从而可能改善高血压患者的靶器官损害。     

高血压性脑出血72小时收缩压变异性与微创穿刺引流术预后的相关性分析

目的探讨72h收缩压变异性与高血压脑出血(hypertensive intracerebral hemorrhage,HICH)微创穿刺引流术预后的关系。方法选取2018年1月至2020年10月江苏省淮安市第一人民医院分院收治的103例HICH患者为研究对象,所有患者均行微创穿刺引流术,术后随访6个月。分析影响HICH患者微创穿刺引流术预后的因素;HICH患者72h收缩压变异性对微创穿刺引流术预后的预测价值。结果 103例HICH患者中有29例预后不良。Logistic多因素回归分析显示,72h收缩压变异系数、格拉斯哥昏迷评分是影响HICH微创穿刺引流术患者预后的独立因素(P<0.05)。Pearson相关性分析显示,72h收缩压变异系数与格拉斯哥昏迷评分呈正相关(P<0.05)。受试者工作特征曲线显示,72h收缩压变异系数预测HICH微创穿刺引流术患者预后的灵敏度、特异度、曲线下面积分别为75.86%、86.49%、0.759。结论 HICH微创穿刺引流术患者预后不良发生风险高,72h收缩压变异系数预测HICH微创穿刺引流术患者预后的效能良好。     

血压变异及抗高血压药对血压变异的影响

早在18世纪,人们就发现血压不是恒定不变的,而是在一定范围内波动。血压的变异性（bloodpressure variability,BPV）,也称血压的波动性,是描述血压在一段时间内波动程度的量化指标。BPV是血压最基本的生理特征之一,根据其发生的原理,     

健康教育对高血压患者血压变异性的影响

目的:探讨健康教育对高血压患者血压变异性的影响.方法:将50例原发性高血压患者随机分为实验组和对照组各25例,实验组在药物治疗的基础上实施健康教育,对照组单纯给予药物治疗,在药物治疗前后对患者的血压变异性与健康知识认知度进行评定.结果:治疗后实验组收缩压、舒张压变异性及平均血压变异性与对照组比较差异有显著性(P＜0.01).结论:实施健康教育可降低高血压患者的血压变异性.     

高血压患者血压变异与心率变异性的相关性研究

本研究对高血压患者做了血压变异和心率变异性的相关性比较研究。１资料与方法１１一般资料患者均为我院门诊及住院患者,检测前３天停用任何药物,经询问病史,体检,心电图及一般实验室检查排除继发性高血压,符合ＷＨＯ标准的高血压病人３５例,男２８例,女７例,年...     

有氧运动对老年高血压患者心率变异性的影响

心率变异性是反映体内交感神经、迷走神经活动的方法，在临床上已得到广泛的应用。原发性高血压患者心率变异性减低，从而发生心血管事件几率及猝死的危险性增大。因此，增加原发性高血压患者心率变异性，具有重要意义。有报道有氧运动可使正常老年人心率变异性增高，亦有报道抗高血压药物对高血压患者心率变异性有影响，本研究主要探讨有氧运动联合抗高血压药物对原发性高血压患者心率变异性的影响及其临床意义，为老年高血压的治疗和愈后提供有价值的临床指标。     

苯磺酸氨氯地平对老年高血压患者血压变异性影响的临床观察

目的观察苯磺酸氨氯地平片对老年高血压病患者血压及血压变异性的影响。方法 112例高血压患者停药2周后,用苯磺酸氨氯地平片治疗8周,采用无创性携带式动态血压监测仪监测动态血压及血压变异性。同时选取56例健康人作对照组观察血压及血压变异性。结果治疗前原发性高血压组血压及血压变异性明显比对照明组高（P〈0.05）,服用苯磺酸氨氯地平片后,原发性高血压患者的血压及血压变异性与用药前比较均明显降低（P〈0.05）。结论原发性高血压患者血压变异性增高,苯磺酸氨氯地平在稳定降压的同时可降低血压变异性。     

老年单纯收缩期高血压患者血压变异性与左心室肥厚的关系

目的：研究老年单纯收缩期高血压患者血压变异性与左心室肥厚（LVHC）的关系,。方法：对31例老年收缩期高血压患者和24例老年正常血压组,分别进行动态血压测定,计算出平均血压、24小时、白天、夜间收缩压和舒张压变异性,超声心动图测量左室内径、室间厚度、左室后壁厚度、计算出左室重量指数（LVMI）。结果：老年收缩期高血压组血压变异性,LVM和LVMI大于老年正常血压组,结论血压变异性和平均血压水平与左室肥厚有关。     

原发性高血压患者早期降压治疗后血压变异性、血压昼夜节律及靶器官损伤的变化

目的评估初诊未经治疗的原发性高血压患者经过早期正规降压治疗后能否改善血压变异性、血压昼夜节律以及靶器官损伤。方法选取2017年8月至2018年8月于安徽省立医院心血管内科门诊或体检中心初步确诊未经降压治疗的原发性高血压患者100例。根据每个患者的特点选用合适的药物进行降压治疗,按3个月内血压能否降至<130/80 mmHg将研究对象分为达标组(87例)和未达标组(13例)。分析入组前以及1年后两组患者的一般生化检查、血压变异性、血压昼夜节律、肱踝脉搏波传导速度(BaPWV)、左心室质量指数(LVMI)及尿微量白蛋白。结果治疗后,两组的SBP、DBP均可控制达标(P<0.05),但组间比较,差异无统计学意义(P>0.05);治疗后,两组的24 h SSD、dSSD、nSSD均改善,且达标组优于未达标组,差异具有统计学意义(P<0.05);治疗后,两组的24 h DSD、dDSD、n DSD比较,差异无统计学意义(P>0.05);治疗后,达标组杓型血压占比明显高于治疗前及未达标组,差异具有统计学意义(P<0.05);治疗后,两组的BaPWV、LVMI、尿微量白蛋白均改善,且达标组优于未达标组,差异具有统计学意义(P<0.05)。达标组靶器官损伤改善率高于未达标组,差异具有统计学意义(P<0.05)。结论经过1年的降压治疗后,高血压患者的血压变异性、血压昼夜节律以及靶器官损伤可被改善,早期降压,早期获益。     

Clinical significance of central blood pressure measurement in antihypertensive treatment

Evaluation of: Miyashita H, Aizawa A, Hashimoto J et al. Cross-sectional characterization of all classes of antihypertensives in terms of central blood pressure in Japanese hypertensive patients. Am. J. Hypertens. 23(3), 260–268 (2010).

Central blood pressure (CBP) more directly imposes mechanical stress on the left ventricle, large arteries and the vital organ vasculature than peripheral blood pressure. Although CBP is most accurately measured using invasive devices, several methods have been developed recently to derive CBP by noninvasive techniques. Several studies have demonstrated that CBP is superior to peripheral blood pressure as a cardiovascular predictor in hypertensive patients, but the clinical significance of CBP measurement has not been fully examined. The paper under evaluation offers cross-sectional observational results assessing all classes of antihypertensive drugs in relation to CBP measured by a noninvasive technique. This study demonstrates that vasodilatory antihypertensives lower CBP independently of peripheral blood pressure levels without evident class-specific differences, whereas nonvasodilators may raise CBP. Thus, this study establishes the clinical significance of CBP measurement by demonstrating differences in the effects of various antihypertensive drugs on CBP and peripheral blood pressure, the more common clinical measure.     

脉压、收缩压与冠状动脉病变程度相关性研究

目的 探讨冠心病患者脉压（PP）、收缩压（SBP）与冠状动脉病变程度相关性。方法选择心内科行冠状动脉造影的患者241例,根据冠状动脉造影结果分为冠状动脉狭窄组（n=135）与非冠状动脉狭窄组（n=106）。比较冠状动脉狭窄组与非冠状动脉狭窄组以及不同病变支数患者的血压参数。分析各血压参数与冠状动脉狭窄发生率的关系,各血压参数与冠状动脉病变程度的相关性。结果 ①冠状动脉狭窄组冠状动脉狭窄评分、年龄、收缩压、脉压显著高于非冠状动脉狭窄组（P〈0．05～0．01）,且年龄、冠状动脉狭窄评分、SBP、PP随着狭窄支数的增加而逐渐增高,尤其以3支病变患者更为显著（P〈0．05）。而DBP低于非冠状动脉狭窄组（P〈0．05）。且随着狭窄支数的增加有逐渐降低趋势,但没有统计学意义（P〉0．05）。②Pearson直线相关分析：年龄、糖尿病史、吸烟、SBP、PP、总胆固醇、低密度脂蛋白胆固醇与冠状动脉病变支数、冠状动脉狭窄记分呈正相关（r分别为：0．325,0．241,0．227,0．385,0．517,0．087,0．053,P〈0．05～0．01）。③多因素Logistic逐步回归分析：SBP、PP、年龄、糖尿病史、吸烟与冠状动脉3支病变的发生有相关性（OR分别为：1、283,1．787,1．535,1、950,1．779,P〈0．05）。④多元线性回归分析显示：年龄、SBP、PP、吸烟、与冠状动脉狭窄记分呈正相关（β=0．301,1．955,0．107,0．240,P〈0．05～0．01）。结论 PP、SBP增高,冠状动脉狭窄性病变的发生率增加,冠状动脉狭窄程度加重。冠状动脉狭窄程度与PP、SBP呈正相关,PP是冠状动脉病变程度的独立预测因子。     

个体化治疗模式对高血压维持性血液透析患者居家血压变异度的影响

目的 了解高血压血液透析（hemodialysis,HD）患者居家血压变异度状况,并观察根据HD患者高血压发病机制进行个体化治疗后,HD患者居家血压变异度的变化情况.方法 选取北京朝阳医院肾内科透析室部分稳定维持性HD患者进行家庭血压（Home-BP）监测,了解HD患者居家血压变异度情况,以居家血压的变异系数表示血压变异度.并以家庭收缩压≥150mmHg （1mmHg=0.133kPa）为未控制的高血压的诊断标准,对未控制的高血压患者进行生物电阻抗监测、透析前后血清钠测定、药物使用情况调查,了解水、钠负荷及药物应用合理性情况,进而针对性地分别进行降低干体质量、应用低钠透析液和合理使用降压药物的干预措施.随访2个月,观察患者血压及血压变异度情况. 结果 共有105例稳定维持HD患者进行家庭血压监测,患者居家血压变异度为（4.8±2.2/5.0±2.4）％.未控制的高血压患者有60例（57.1％）,经个体化降压治疗后,居家血压从（166.3±12.6/87.5±11.7） mmHg降至（154.1±14.2/82.6±11.4）mmHg（P＜0.001,t=7.223; t=4.796,P＜0.001）,收缩压变异度由（4.9±2.2）％降至（4.6±2.5）％ （P=0.340,t=0.961）.其中30例容量超负荷患者,予降低干体质量后,家庭收缩压和舒张压明显降低,变异系数分别下降0.4％和0.1％（P=0.027,t=2.329;P=0.041,t=2.138）.12例患者应用低钠透析液（136mmol/L）后,居家血压下降,血压变异度无明显改变.其余18例容量负荷正常、未使用低钠透析的患者通过增加肾素-血管紧张素抑制剂和αβ受体阻滞剂等,居家血压下降,血压变异度减小,但未达统计学差异.结论 针对高血压HD患者高血压的病因进行治疗,能够有效地改善患者的家庭血压及血压变异度.     

Effect of local cold provocation on systolic blood pressure and skin blood flow in the finger

Demonstration of increased vascular cold reactivity in patients with Raynaud’s syndrome is difficult. For medico‐legal reasons, it is important to get objective measures of vasospasm in these patients. Evaluation of the degree of vasospasm also provides prognostic information which is useful for patient management. In this study, we compare two methods of arterial circulation measurement. The laser Doppler scanning is a new method, which uses the recently developed laser Doppler perfusion imaging (LDPI) instrument. The aim of the present study was to compare the effect on finger skin blood flow measured with LDPI with changes in finger systolic blood pressure during local cold provocation. The effect of such provocation, skin blood flow and systolic blood pressure, were studied in 15 healthy controls. Six patients with known traumatic vasospastic disease (TVD) were also tested with both methods. Finger skin blood flow was measured with LDPI on the distal phalanx of the index finger of the left hand, every minutes during 6 min of local heating at 40°C followed by local cooling for 3 min at 15°C and then for 3 min at 10°C. Finger systolic blood pressure was measured with strain‐gauge method before and after local cooling to 10°C with a cuff perfused with water of desired temperature. The test was performed in the same finger within a week of the laser Doppler scanning. Local finger cooling to 15°C and 10°C caused a significant decrease in blood flow, most marked at 10°C. There was, however, no correlation between the decrease in blood flow and blood pressure. In the TVD‐patients decreases in skin blood flow were similar compared with the healthy controls. In contrast, the changes in systolic blood pressure, were outside normal range (systolic quotient <0·65) in five of the six patients (83%), and also in 11 of the 15 healthy controls (73%). In conclusion, there is no correlation between the decrease in finger skin blood flow and systolic blood pressure during local cold provocation. For diagnosis of traumatic vasospastic disease (TVD), local cold‐induced changes in finger systolic blood pressure seems superior to changes in skin blood flow, but the ideal clinical method for demonstrating increased cold‐induced vasospasm is, however, still lacking.     

Age effect on phase relations between respiratory oscillations of the RR interval and systolic pressure

Spectral analysis may allow the evaluation of (baroreflex) gain and phase between the RR interval and systolic pressure oscillations synchronous with respiration but, unlike baroreflex gain, the determinants of phase are not completely understood. We evaluated the correlates of spectral phase in 92 healthy subjects (44 men) aged 10-80 years. To do so, the cardiorespiratory signals during paced breathing at 16 breaths/min were continuously recorded and analyzed. In addition, respiratory sinus arrhythmia and baroreflex gain (two indices of cardiac vagal activity) and phase were calculated by using an autoregressive spectral technique. At univariate analysis, the phase correlated with age (r = 0.48, P < 0.001), the RR interval (r = 0.32, P < 0.01), respiratory sinus arrhythmia (r = -0.3, P < 0.01), baroreflex gain (r = -0.29, P < 0.01), and body mass index (r = 0.25, P < 0.05). At multivariate analysis, age was the most important physiological correlate of phase, accounting for 23% of interindividual phase variation. Cardiac vagal activity measures (which were higher in women than men) and the RR interval were also significant independent correlates of phase. We conclude that in addition to the RR interval and cardiac vagal activity, age has a significant impact on the phase relationship between respiratory related oscillations of the RR interval and systolic blood pressure. This spectral measure may contain additional information concerning the mechanisms that influence cardiovascular rhythms.     

诊室血压与家庭自测血压对降压疗效判定的影响

目的比较诊室血压与家庭自测血压(HBPM)两种方法监测结果的异同及对降压疗效判定的影响。方法分析46例门诊高血压患者在应用厄贝沙坦/厄贝沙坦氢氯噻嗪治疗中,诊室血压与HBPM监测8周的血压变化。结果两种血压监测方法观察厄贝沙坦/厄贝沙坦氢氯噻嗪的降压效果表现了良好的相关性,但HBPM的收缩压和舒张压的平均值均低于诊室血压,8周治疗血压下降的平均值略大于诊室血压的平均值,HBPM能够更加准确地评估患者血压水平,评价降压疗效,增加血压达标率。结论 HBPM作为高血压患者长期监测方法,简便易行,更能反映患者实际血压水平,是值得推荐的方法。