老年原发性高血压患者血压昼夜节律与尿钠、尿钾排泄的关系

观察老年原发性高血压患者24 h血压动态变化情况,探讨昼夜节律异常与尿钠、尿钾排泄的变化规律。选取2016年10月至2017年10月重庆市第十三人民医院心内科住院的老年原发性高血压患者59例。根据患者24 h动态血压监测的血压波动情况,分为昼夜节律正常组（杓型组）31例和血压昼夜节律消失组（非杓型组）28例,收集患者24 h尿液并分析24 h尿钠和尿钾水平。非杓型组的24 h收缩压、24 h舒张压、夜间收缩压、夜间舒张压及夜间尿钠排泄量均高于杓型组（P＜0.05或P＜0.01）,同时非杓型组24 h尿钾低于杓型组（P＜0.05）。血压昼夜节律消失的老年原发性高血压患者的尿钠、尿钾排泄呈现明显异常。     

老年原发性高血压与骨密度的关系

目的探讨60岁以上老年人原发性高血压与骨密度的关系。方法选取60岁以上人群162例,其中原发性高血压患者82例,对照组80例,分别测量身高、体重、计算体重指数,血压。用双能X线骨密度仪检测左前臂中段、左股骨颈、腰椎(L1~4)及全身骨密度。结果高血压组的上肢、下肢、腰椎及全身骨密度均低于对照组(P0.05)。校正年龄、身高、体重、BMI后收缩压与上肢、下肢、腰椎及全身骨密度呈负相关(P0.05),舒张压与骨密度无关。检测人群中骨量异常组收缩压及舒张压均高于骨量正常组(P0.05)。结论老年人群中高血压与骨密度有关,老年高血压患者各部位骨密度均减低,收缩压与骨密度呈负相关,控制收缩压可能对于老年人预防骨质疏松有一定作用,同时对老年高血压人群积极防控骨质疏松可能有助于血压的控制。     

原发性高血压患者24-h尿钠、尿钾水平与高血压等级的关系

目的探讨原发性高血压患者24-h尿钠、尿钾水平与高血压等级的关系。方法根据《中国高血压防治指南(2018年修订版)》(简称2018指南)和《ISH 2020国际高血压实践指南》(简称2020指南)对50例原发性高血压患者进行高血压分级,检测24-h尿钠、尿钾水平,计算24-h尿钠/钾比值。结果 2018指南分组中,高血压1级患者24-h尿钠和24-h尿钠/钾比值均低于高血压3级患者,而24-h尿钾高于高血压3级患者(P<0.05)。2020指南分组中,高血压1级患者24-h尿钠和24-h尿钠/钾比值均低于高血压2级患者,而24-h尿钾高于高血压2级患者(P<0.05)。2018指南分组,24-h尿钠和24-h尿钠/钾比值均与高血压等级呈正相关(r_s=0.813和0.835,P<0.01),24-h尿钾与高血压等级呈负相关(r_s=-0.352,P<0.05)。2020指南分组,24-h尿钠和24-h尿钠/钾比值均与高血压等级呈正相关(r_s=0.574和0.689,P<0.01),24-h尿钾与...     

富钾食物知多少

有研究表明，血压与膳食钾、尿钾和血清钾呈负相关关系；高钾膳食可降低血压，对轻症高血压以及有高血压危险因素的正常血压者有降压作用。因此，“限盐补钾”成为防治高血压的基础措施。而且，通常在对高血压患者进行饮食治疗的时候，增加钾的摄入比限制钠的摄入更容易施行，也更受欢迎。     

再谈镁剂在心血管疾病中的应用

<正> 镁剂在临床上主要用于利胆、导泻、治疗高血压危象及癫病。近年研究发现,镁剂还具有多种药理作用,可用于预防和治疗许多疾病。如: 1.高血压病 镁剂可刺激钠—钾—ATP酶,使其活性增加,血压下降,镁阻碍依赖性肌收缩过程,抑制平滑肌纤维与钙离子结合,对抗钙的肌纤维收缩过程;镁促进血管内质细胞内的PGI_2产生,使血压下降。在临床上,除以镁剂静注治疗高血压急症外,还可口服镁剂治疗轻度、中度、高血压。     

胰岛素抵抗与高血压患病率及血压水平的关系

目的　探索中国人群胰岛素抵抗与高血压患病率及血压水平的关系。方法　对北京石景山农民、首钢工人 ,年龄 45～ 6 4岁 ,共 3899人的空腹胰岛素与血压之间的关系进行现况调查。用方差分析方法判断不同胰岛素四等分组之间收缩压 ( SBP)、舒张压 ( DBP)均值的差别 ;以简、复相关分析法估计胰岛素对数值与收缩压、舒张压之间的相关系数 ;用 L ogistic回归分析法估计不同胰岛素四等分组的高血压发生的 OR值及其 95 %可信区间。结果　收缩压、舒张压均随着空腹胰岛素水平的升高而上升 ( P<0 .0 0 1) ,城市女性、乡村男性的收缩压、舒张压与血胰岛素水平呈极显著正相关 ,年龄调整后相关性依然存在 ,而年龄、体重指数调整后相关性消失。城市男性、乡村女性 SBP、DBP与血胰岛素水平无相关性。胰岛素四等分组的第 2、3、4等分组与第 1组比较的 OR及其95 %可信区间分别为 :1.16 9,0 .945～ 1.44 8;1.473,1.189～ 1.86 2 ;1.5 84,1.2 82～ 1.96 0。结论　在中国人群中胰岛素抵抗与高血压患病率有关 ,且随着胰岛素抵抗程度的升高 ,患病的风险性逐渐增高     

非糖尿病患者胰岛素水平与冠心病危险因子的关系

对非糖尿病人群分析发现高胰岛素血症者体重指数、血脂（CH、TG）、收缩压（SBP）、舒张压（DBP）、血糖值明显升高，钠拥泵活性明显下降；在非肥胖人群高胰岛素血症者DBP、CH、TG、血糖值明显升高，钠钾系活性明显下降。作者认为高胰岛素血症与高血脂、肥胖、糖耐量异常、血压存在密切关系，都是引起冠心病发生的危险因子，高胰岛素血症致高血压机理可能是胰岛素抵抗影响了纳钾泵活性。     

老年高血压患者7d家庭自测收缩压变异性与血管内皮功能的相关性

目的：探讨老年原发性高血压患者7 d 家庭自测血压变异性与血管内皮之间的相关性。方法对来自于健康体检中心体检的142例老年原发性高血压患者进行7 d 家庭自测血压监测及内皮细胞依赖性血管舒张功能（FMD）和内皮非依赖性血管舒张功能（NMD）检测。根据7 d 家庭自测血压变异性（用标准差表示）的三分位,将所有患者分为低变异性组、中变异性组及高变异性组3组。结果高变异性组 FMD 和 NMD 明显低于中及低变异性组,中变异性组明显低于低变异性组,P ＜0．05。FMD 及 NMD 与收缩压变异性（r 分别为－0．635及－0．448,P 均＜0．001）、舒张压变异性（r 分别为－0．187及－0．186,P 均＜0．001）呈负相关。多元线性回归分析显示,在用家庭自测平均收缩压及家庭自测平均舒张压进行校正后,收缩压变异性仍与 FMD 及 NMD 呈显著负相关。结论家庭自测血压变异增高可能是影响血管内皮功能失调的重要因素。     

缺钙与高血压

引起高血压的原因很多,但近年来科研人员发现,人体缺钙也会引起高血压。每日食钙量少于0.5克的孕妇,与食钙量大于1克的孕妇相比,前者高血压的发病率高于后者10-20倍。对一般人群调查结果是,每日食钙量小于300毫克者,高血压的发病率是每日食钙量大于1200毫克者的2-3倍。我国流行病学也证实,人群平均每日钙摄入量与血压水平呈显著负相关,也就是说,日钙摄入量多者血压低,少者则反之。人群日均摄钙量每增加100毫克,平均收缩压水平可     

降压治疗后短时血压变异与动态动脉僵硬指数的关系

目的了解高血压患者经药物治疗后血压变异性(BPV)与动态动脉僵硬指数(AASI)的关系。方法入选2012年1月至2013年2月在我院心血管内科就诊的已诊断为高血压并服用降压药物治疗患者的233例,对其进行24 h动态血压监测,依据动态血压的监测结果将患者分为控制组和未控制组。结果 (1)高血压未用药组和高血压药物未控制组的夜间收缩压变异性,夜间舒张压变异性和AASI与正常组之间的差异有统计学意义(P<0.05),而全天收缩压变异性、舒张压变异性,白天收缩压变异性、舒张压变异性的差异没有统计学意义;(2)相关性分析显示,高血压未用药组和高血压药物未控制组的全天、白天和夜间舒张压变异性与AASI呈负相关(P<0.01),而全天、白天和夜间收缩压变异性与AASI的相关性无统计学意义;正常组和高血压药物控制组的全天、白天和夜间的收缩压变异性、舒张压变异性与AASI之间的相关性均无统计学意义。结论正常血压和高血压经药物控制后AASI与BPV不相关,高血压药物未控制者AASI与BPV相关。     

地佐辛超前镇痛用于高血压患者全身麻醉诱导期30例

目的：观察地佐辛超前镇痛应用在高血压患者全身麻醉诱导期的临床效果。方法选取60例合并高血压拟行全麻择期手术的患者,美国麻醉医师协会（ASA）分级Ⅱ~Ⅲ级,随机分为地佐辛超前镇痛组（D 组）和0.9%氯化钠注射液对照组（S 组）,各30例。诱导前10 min D 组静脉滴注地佐辛0.1 mg / kg,S 组静脉滴注等量0.9%氯化钠注射液。两组均采用相同的全麻诱导方式。记录两组患者在全麻诱导过程中呛咳、肌颤发生例数及诱导前（T0）、插管前即刻（T1）、插管后即刻（T2）、插管后1 min（T3）、插管后3 min（T4）、插管后5 min （T5）5个时间点的收缩压（SBP）、舒张压（DBP）、心率（HR）。结果 D 组的肌颤、呛咳发生例数明显低于 S 组（ P ﹤0.05）;与 T0比较,两组T1时 SBP,DBP,HR 均降低（ P ﹤0.05）,但组间比较,差异无显著性;T2、T3时两组 SBP,DBP,HR 均升高,但 D 组上升幅度小于 S 组（ P ﹤0.05）;T4、T5时两组间 SBP,DBP,HR 比较,差异无统计学意义。结论地佐辛超前镇痛可减轻高血压患者全麻诱导期呛咳、肌颤等不良反应,提供稳定的血流动力学。     

Efficacy and tolerance of cicletanine, a new antihypertensive agent: overview of 1226 treated patients

The data gathered from 1226 patients for 20 controlled therapeutic studies performed during the phase-III development of cicletanine, a new antihypertensive agent, were pooled in a computerized database. An extensive statistical analysis of these data collected over 1-2 years was performed to give a clear interpretation of long-term efficacy and tolerance of this drug. In mild to moderate hypertension, the dose-response relationship observed after one month of treatment on diastolic (DBP) and systolic (SBP) blood pressure disappeared during the third month. After a 3-month treatment in monotherapy with the recommended dosage (50-100 mg/day) we observed a mean decrease of 29.7 +/- 17.8 mmHg for SBP and 23.3 +/- 13.2 mmHg for DBP. At this stage 70.9% of patients were stabilized (SBP less than 160 mmHg and DBP less than 95 mmHg) with cicletanine. After this initial regular decrease of blood pressure values, an additional decrease of several mmHg was observed during the 24 months of treatment, thus significantly augmenting the number of stabilized patients. No significant difference in efficacy was observed in adult and elderly (65 to 95 years) patients. The clinical tolerance was very good, only a few slight and transitory side-effects have been reported. Biological tolerance was also very good. Depending on the dosage used, only a slight and transitory variation in sodium and potassium levels was observed. Glucose, creatinine and lipids either remained stable or were improved during treatment. This analysis demonstrates the beneficial effect and the good tolerance of cicletanine (50-100 mg/day) in the treatment of hypertension, which can be explained by its special mode of action.     

Antihypertensive effect of carteolol in thiazide-treated hypertensive subjects

The antihypertensive effect of carteolol, a new potent nonselective beta-adrenergic antagonist, was investigated in a double-blind, parallel study of 35 patients with mild-to-moderate, essential hypertension whose blood pressures were not adequately controlled with a diuretic. Patients were randomly assigned to receive placebo, carteolol 5 mg, or carteolol 20 mg once a day in addition to hydrochlorothiazide 50 mg for six weeks. Thirty-four patients completed the study: 11 patients received placebo (group 1), 12 patients received carteolol 5 mg (group 2), and 11 patients received carteolol 20 mg (group 3). After six weeks of treatment, the two groups that received carteolol had significant reductions in systolic (SBP) and diastolic (DBP) blood pressure from baseline in both the supine and standing positions. In group 2, mean SBP decreases for supine and standing positions were 11 +/- 2.1 and 11 +/- 1.9 mm Hg, respectively (P less than .01) and 8 +/- 1.2 and 9 +/- 1.3 mm Hg, respectively, for DBP (P less than .01); whereas in group 3, values were 8 +/- 2.8 and 12 +/- 3.0 mm Hg for SBP, in 5 +/- 1.9 and 9 +/- 3.1 mm Hg, respectively, for DBP (P less than .01). The hypotensive effect was associated with slight but significant decreases in heart rate (P less than .01 in group 2 and P less than .05 in group 3). Reductions in SBP and DBP with the 20-mg dose were not significantly different from those with the 5-mg dose.2+ moderate hypertension.     

EFFECTS OF INDOMETHACIN ON STEROID-INDUCED CHANGES IN PRESSOR RESPONSIVENESS IN MAN

1. It has been shown previously that hydrocortisone (F) increases pressor responsiveness in normal subjects. The present study examined the role of vasodilator prostanoids in determining these changes. 2. Pressor responsiveness to angiotensin II (AII) (1-8 ng/kg per min) and phenylephrine (PE) (0.3-0.9 microgram/kg per min) was examined in six normal men receiving: no treatment (day 1); 100 mg indomethacin p.o. (INDO) in three divided doses over 20 h (day 2); 200 mg F for 5 days, 50 mg 6 hourly p.o. (day 6); F plus 100 mg INDO (day 7). 3. Blood pressure, body weight and plasma glucose rose with F and plasma potassium fell. F alone produced significant increases in response to AII at 2 ng/kg per min, for systolic pressure (SBP), diastolic pressure (DBP) and mean arterial pressure (MAP), and at 1 ng/kg per min for DBP. The threshold for SBP, DBP and MAP rises with AII was decreased by F. Responses to PE following F were greater at 0.6 microgram/kg per min for SBP, DBP and MAP and the threshold for all parameters fell. 4. INDO alone had no significant blood pressure or metabolic effects and no effect on the magnitude of the blood pressure rise with AII, but decreased the threshold dose for effects on MAP. INDO had no effect on the magnitude of the pressure rise with PE, but decreased the threshold dose for effects on SBP. 5. INDO did not modify responsiveness or threshold to AII following F. Responsiveness to PE was unchanged and threshold fell for SBP only during INDO.(ABSTRACT TRUNCATED AT 250 WORDS)     

厄贝沙坦治疗192例高血压患者疗效分析

目的探讨厄贝沙坦对高血压患者治疗效果。方法192例高血压患者应用厄贝沙坦治疗12周,比较治疗前、后24h收缩压、舒张压、血压变异性及左心室质量变化。结果24h平均收缩压（24hSBP）、白天平均收缩压（dSBP）、白天平均舒张压（dDBP）、夜间平均收缩夺（nSBP）及24h收缩压变异性（24hSBPV）、24h舒张压变异性（24hDBPv）较治疗前明显下降（P〈0．05）;左心室质量较治疗前减轻。结论厄贝沙坦可降低高血压患者的血压变异性,减轻左心室质量。     

IS ISOLATED SYSTOLIC HYPERTENSION A WHITE COAT’ PHENOMENON IN THE ELDERLY?

1. Repeated clinic blood pressure measurement was compared with non-invasive ambulatory blood pressure (ABP) monitoring in 10 elderly subjects with isolated systolic hypertension (ISH) and 11 normotensive controls (NT). 2. Subjects were assessed on four occasions at weekly intervals. None was receiving antihypertensive or vasoactive medication. 3. Mean clinic blood pressure was consistently higher than mean daytime ABP in both clinical groups. This effect was greater for systolic (SBP) than diastolic blood pressure (DBP) and in the ISH group compared with the NT group. The reproducibility of the clinic minus ABP difference was high in both groups; the mean +/- s.d. of the differences was 26 +/- 15/9 +/- 2 mmHg in the ISH group and 7 +/- 18/8 +/- 9 mmHg in the controls. 4. ABP readings were normally distributed for both SBP and DBP in both groups. In the ISH group, the frequency distribution of SBP readings was shifted to the right whilst the distribution of DBP readings overlapped that of the NT subjects. 5. These results suggest a pressor response may largely account for the elevated SBP seen in elderly subjects with sustained ISH based on casual readings.     

氯沙坦钾氢氯噻嗪片治疗老年原发性高血压的临床效果观察

目的分析老年原发性高血压患者应用氯沙坦钾氢氯噻嗪片治疗的效果。方法 96例老年原发性高血压患者,随机分为对照组和观察组,每组48例。对照组采用氢氯噻嗪片治疗,观察组采用氯沙坦钾氢氯噻嗪片治疗。比较两组患者治疗效果及治疗前后血压水平。结果观察组患者的治疗总有效率97.92%高于对照组的85.42%,差异具有统计学意义(P<0.05)。治疗前,两组患者的清晨收缩压(SBP)、舒张压(DBP)及24 h动态SBP、DBP水平比较差异无统计学意义(P>0.05);治疗后,两组患者的清晨SBP、DBP及24 h动态SBP、DBP水平均较治疗前降低,且观察组患者的清晨SBP(135.14±7.04)mm Hg(1 mm Hg=0.133 kPa)、DBP(86.53±6.78)mm Hg及24 h动态SBP(134.24±9.61)mm Hg、DBP(84.81±8.80)mm Hg低于对照组的(140.26±8.17)、(92.06±7.36)、(142.36±9.16)、(89.03±8.05)mm Hg,差异具有统计学意义(P<0.05)。结论老年原发性高血压患者应用氯沙坦钾氢氯噻嗪片治疗的效果比较好,可以明显改善血压水平,具有较高的应用价值。     

三物降压汤、通经调脏法推拿联合对眩晕合并高血压患者控压效果的影响

目的 探析三物降压汤、通经调脏法推拿联合对眩晕合并高血压患者控压效果的影响.方法 选取眩晕合并高血压患者300例作为研究对象,按照随机数字表进行编号,奇数号纳入观察组(n=153)、偶数号纳入对照组(n=147).对照组应用苯磺酸氨氯地平片和(或)厄贝沙坦片进行治疗,观察组在对照组基础上联合三物降压汤、通经调脏法推拿治疗.比较两组治疗前后收缩压(SBP)、舒张压(DBP)、血浆内皮素(ET)、一氧化氮(NO)差异,记录眩晕证候总有效率,另分组记录两组生活质量、不良反应发生率.结果 观察组眩晕证候总有效为91.5％,高于对照组82.3％,差异有统计学意义(P<0.05).两组治疗前SBP、DBP、ET、NO、生活质量各项评分的差异无统计学意义(P>0.05);治疗后两组SBP、DBP、ET、生活质量各项评分均降低、NO升高(P<0.05),观察组治疗后的SBP、DBP、ET分别降低至(118.7±7.9)mmHg、(78.3±5.2)mmHg、(50.4±6.1)pg·L-1,低于对照组(P<0.05),生活质量各项评分也低于对照组(P<0.05);NO为(171.4±16.0)μmol·L-1,高于对照组(P<0.05).结论 三物降压汤可有效清肝降火、降脂降压,通经调脏法推拿则可通经调脏改善血管内皮活性,调节ET与NO的合成与释放,控压效果良好,眩晕症状改善明显.     

右美托咪定对七氟醚诱导气管插管时血流动力学及镇静深度的影响

目的 观察右美托咪定对七氟醚诱导气管插管时血流动力学及镇静深度的影响.方法 全麻下行择期耳鼻喉手术患者36例,随机分为F2组、F4组、DF2组.连续监测心率、动脉血压、脉氧饱和度、脑电双频指数.记录给右美托咪定或0.9%氯化钠溶液之前(T0)、麻醉诱导前即刻(T1)、吸入七氟醚麻醉诱导后2 min时(T2),气管插管前即刻(T3),气管插管后即刻(T4)患者的心率(HR)、收缩压(SBP)、舒张压(DBP)、脑电双频指数(BIS);并于T0、T1、T3、T4时抽取静脉血,测量血糖值(BG).结果 在F2和F4组内,SBP、DBP、HR、BIS在T2时与T1时比较,显著降低(P<0.05);SBP、DBP、HR、BIS在T4时与T3时比较,显著升高(P<0.05);血糖在T4时与T2时比较,显著升高(P<0.05).在DF2组内,SBP、HR、BIS在T1时与T0时比较,显著降低,血糖显著升高(P<0.05);SBP、BIS在T2时与T1时比较,显著降低(P<0.05).与DF2组比较,F2组T1时刻HR、BIS较高(P<0.05),T2、T3时刻SBP较低(P<0.05),T4时刻SBP、DBP、HR、BIS较高(P<0.05);F4组T1时刻HR、BIS较高(P<0.05),T2、T3时刻SBP、DBP较低(P<0.05);F2组和F4组在T1、T3、T4时刻血糖较低(P<0.05).与DF2组比较,F2组和F4组麻醉诱导引起的SBP、DBP、HR下降幅度较大(P<0.05),F2与F4组间比较差异无统计学意义(P>0.05).与DF2组比较,F2组气管插管导致的SBP、DBP、HR升高幅度较大(P<0.05);F4组SBP、DBP升高幅度较大(P<0.05);与F2组比较,F4组SBP、DBP、HR升高幅度较小(P<0.05).结论 右美托咪定可维持七氟醚麻醉诱导后血流动力学平稳,抑制气管插管导致的心血管反应,使诱导插管过程血流动力学更加平稳.右美托咪定还可降低BIS值,产生明显镇静效应.     

Use of statins and blood pressure control in treated hypertensive patients with hypercholesterolemia

High serum cholesterol has been frequently reported in patients with arterial hypertension in whom it might influence the blood pressure control. The aim of this study was to compare the extent of blood pressure changes in 41 patients with hypertension and hypercholesterolemia, taking antihypertensive drugs and treated for 3 months with statins (HC-S; pravastatin or simvastatin) and compared with matched controls with high (HC-D; 44) or normal serum cholesterol (NC-D; 45) undergoing antihypertensive treatment combined with dietary treatment alone. After 3 months of follow-up, a greater reduction of systolic (SBP) and diastolic (DBP) blood pressure values was observed in HC-S patients (ASBP/DBP, -11.3 +/-3/-10.6 +/- 2%) when compared with both HC-D (deltaSBP/DBP, -6.6 +/- 2/-6.1 +/- 2%; p < 0.05) and NC-D (deltaSBP/DBP, -6.9 +/- 2/-6.8 +/- 1.5%; p < 0.05). In statin-treated patients, a slight linear relation has been found between the percentage changes in DBP and those in plasma total cholesterol (R = 0.37, p = 0.043), whereas no relation was found with SBP changes (R =0.11; p = 0.35). In conclusion, the results of this study demonstrate that the use of statins in combination with antihypertensive drugs can improve blood pressure control in patients with uncontrolled hypertension and high serum cholesterol levels. The additional blood pressure reduction observed in patients treated with statins is clinically relevant and only partially related to the lipid-lowering effect.