应用卡托普利治疗老年收缩期高血压疗效观察

目的观察卡托普利(Captopril)治疗老年性收缩期高血压的降压效果及其副作用.方法卡托普利6.25～50 mg治疗老年性收缩期高血压患者25例,疗程14 d.结果14 d后收缩压明显降低(t=4.269,P＜0.01),收缩压降压幅度明显大于舒张压,下降幅度(t=3.024,P＜0.01),治疗总有效率96%.结论卡托普利治疗老年性收缩期高血压安全有效.     

长期饮酒对男性高血压降压疗效和血压昼夜节律的影响

目的探讨长期饮酒对男性高血压患者药物降压疗效和血压昼夜节律的影响。方法91例男性原发性高血压患者,根据饮酒情况分为饮酒组45例、戒酒组15例和不饮酒组31例。缬沙坦治疗8周,观察治疗前后血压和动态血压变化。结果治疗前饮酒组夜间平均收缩压、夜间收缩压负荷高于不饮酒组（P〈0．05～0．01）,治疗后各组血压均有显著降低（P〈0．001）,但饮酒组夜间血压下降幅度低于不饮酒组,24h平均收缩压、日间平均收缩压、日间收缩压负荷高于戒酒组（P〈0．05～0．01）。治疗后饮酒组非杓型血压比例减少（P〈0．05）,人均缬沙坦和双氢克尿噻用量大于戒酒组和不饮酒组（P〈0．05～0．01）。结论长期饮酒可使异常血压昼夜节律增加,降低疗效,增加药量,因此应加强高血压患者健康宣教,限制酒精的摄入。     

静安区江宁路街道老年高血压患者秋冬季晨起血压变化

目的 研究老年高血压患者秋冬季节晨起血压变化的特点,为高血压患者的管理提供依据。 方法 在2012年秋、冬季对上海市静安区江宁街道所管辖的的老年高血压患者104例,非高血压人群116例连续测量5 d晨起坐位肱动脉血压,分析血压随季节变化的特点和差异。 结果 高血压患者冬季晨起收缩压、舒张压均显著高于秋季[分别为(137.2±8.5)mmHg vs.(132.3±8.7)mmHg、(83.5±6.3)mmHg vs.(79.7±5.9)mmHg,均P=0.0001)],非高血压患者仅舒张压冬季显著高于秋季[(77.8±4.3)mmHg vs.(76.7±5.3)mmHg, P=0.0031)];校正了年龄、BMI、体力活动、吸烟史、糖尿病史和高血脂史等数据的协方差分析表明,高血压患者舒张压增高的幅度[3.7(-9.4,28.4)mmHg]显著大于非高血压人群[1.0(-13.6,16.2)mmHg](P<0.001),收缩压增高的幅度[4.0(-16.4,26.8)]与非高血压人群[3.0(-11.2,21.2)mmHg]比较差异无统计学意义(P=0.107)。 结论 高血压患者冬季血压较秋季升高,舒张压增高幅度明显大于非高血压人群。应在冬季加强高血压患者的管理,减小血压波动。     

拉萨1370名藏族群众高血压患病情况及影响因素的Logistic回归分析

目的 调查西藏拉萨市1 370名藏族居民高血压的患病情况和影响因素.方法 采用系统分层随机抽样方法,对西藏拉萨3县1区中1 370例18岁以上的常住居民进行调查,结果使用SPSS 13.0软件进行卡方检验、单因素和多因素Logistic回归等方法分析高血压的患病情况和影响因素.结果 高血压的患病率为51.20％,其中男性显著高于女性(P=0.004),随着年龄的增长患病率增高.平均收缩压和舒张压分别为(136.96±30.24)和(89.34±24.48) mmHg,男性高于女性(P＜0.001).单因素Logistic回归分析结果显示高血压患病率在年龄、文化程度、职业、收入、是否吸烟、吸烟时间、饮酒、饮用酥油茶量、每日饮水量、食用水果、肉类以及油脂摄入量等差异有统计学意义(P＜0.001),在性别、城乡来源、体重指数、婚姻状况、食用蔬菜量、食用奶制品量上差异有统计学意义(P＜0.05),在食用蛋类量上差异无统计学意义(P=0.068),高海拔与高血压患病率无明显相关.多因素Logistic回归分析结果显示男性、高龄、吸烟时间、每日饮用酥油茶量和每月食用油脂量为危险因素.每日饮用水量、每天食用奶制品量为保护因素.结论 高血压在拉萨地区发病率较高,影响因素众多.提示要加强对高血压的健康宣教,提高人群健康知识水平和健康意识,对重点人群进行干预,提高自我防病意识.     

高血压危象致急性左心衰竭的救治

高血压危象(Hypertension Crises)是常见的急诊之一,它是指原发性和继发性高血压患者,在某些诱因作用下,血压突然或显著升高,伴有症状或有心、脑、肾等靶器官的急性损害.通常收缩压大于180mmHg(1mmHg=0.133kPa)或舒张压大于120mmHg.而急性左心衰竭并发肺水肿是高血压危象中较为常见的临床类型,病情进展快,必须快速诊疗.     

不同类型降压药物对老年高血压患者动脉僵硬度的影响

目的 评价不同类型降压药物对老年原发性高血压患者动脉僵硬度的影响.方法 60例老年男性原发性高血压患者,随机分为缬沙坦组(80 mg,1/d)、贝那普利组(10 mg,1/d)、硝苯地平缓释片组(20 mg,2/d)各20例,疗程共3个月.分析治疗前后肱-踝脉搏波速度(baPWV)及血压.结果 治疗3个月后各组血压均有显著降低,硝苯地平缓释片组舒张压的下降幅度(△DBP)、脉压下降幅度(△PP)与另两组差异显著(分别为-40.1±11.3 vs -16.6±5.5、-14.6±4.2 mmHg和 -10.0±19.3 vs -28.8±6.6、-25.7±6.5 mmHg,P＜0.01).缬沙坦组及贝那普利组治疗前后baPWV均显著下降,其下降幅度(△baPWV)分别为-401±90、-280±97 cm/s,显著大于硝苯地平缓释片组的-11±127 cm/s(P＜0.01).△baPWV与△PP在总体患者中呈显著正相关(r=0.64,P＜0.001),贝那普利组或硝苯地平缓释片组△baPWV至少与一项血压参数(△PP,△SBP,△DBP)相关,而在缬沙坦组均不相关.结论 与贝那普利或硝苯地平缓释片相比,缬沙坦对老年原发性高血压患者具有独立于降压功效外的减低动脉僵硬度的作用.     

老年原发性高血压合并慢性肾脏病的影响因素

目的了解老年原发性高血压(EH)患者合并慢性肾脏病(CKD)情况,并探讨其影响因素。方法收集2018年3～9月在上海金山工业区社区卫生服务中心参加≥60岁居民健康体检的829例EH患者资料,根据是否合并CKD,分为合并CKD组和非合并CKD组,采用单因素和多因素Logistic回归模型分析EH并发CKD的影响因素。结果老年EH患者中蛋白尿、eGFR下降、CKD检出率分别为23.64%、13.15%、30.64%,女性eGFR下降检出率高于男性,差异有统计学意义(P0.05)。老年EH合并CKD和非合并CKD患者在糖尿病、超重/肥胖、高尿酸血症发生率和收缩压、舒张压、HDL-C、尿素氮、血清肌酐、血尿酸、eGFR水平及年龄方面比较,差异均有统计学意义(P0.05)。多因素Logistic回归分析显示:年龄(OR=3.50,95%CI:2.57～4.78)、糖尿病(OR=1.80,95%CI:1.28～2.53)、收缩压≥140 mmHg(OR=2.07,95%CI:1.53～2.81)、高尿酸血症(OR=2.75,95%CI:2.00～3.78)是EH合并CKD的危险因素。结论老年原发性高血压患者的CKD患病率较高,年龄、糖尿病、血压水平、高尿酸血症是CKD的危险因素,因此需要重视CKD早期防治,控制危险因素,遏制CKD进展。     

他汀类药物对颈动脉斑块形成患者血压的影响

目的探讨他汀类降脂药物对有颈动脉斑块形成的高血压患者血压的影响,为临床更好地控制血压、预防心脑血管事件的发生提供依据。方法将74例高血压合并颈动脉斑块形成的患者分为两组,观察组使用阿托伐他汀(立普妥)20 mg/d和苯磺酸氨氯地平(络活喜)5 mg/d,对照组仅使用氨氯地平5 mg/d,观察6个月后进行降压疗效比较。结果观察组收缩压平均下降21.3 mmHg,对照组收缩压平均下降17.2 mmHg,差异有统计学意义(P0.05),观察组舒张压平均下降7.9 mmHg,对照组舒张压平均下降8.1 mmHg,差异有统计学意义(P0.05)。结论他汀类降脂药物与氨氯地平合用比单纯应用氨氯地平对高血压合并颈动脉斑块形成的患者降压(尤其是收缩压)效果更好。     

左旋氨氯地平联合美托洛尔缓释片治疗轻中度原发性高血压34例临床分析

目的观察左旋氨氯地平联合美托洛尔缓释片治疗轻中度原发性高血压的临床效果。方法选择2013年4月—2014年3月在门诊就诊的68例原发性高血压患者,随机分为对照组和观察组各34例,对照组口服苯磺酸左旋氨氯地平5 mg,每天1次;治疗组在对照组的基础上联合服用琥珀酸美托洛尔缓释片23.75~47.5 mg,每天1次。8周为1个疗程,用台式水银柱血压计测量坐位右上臂血压,并计数心率,每周上午1次,连续测量8周。计量资料采用t检验,计数资料采用χ2检验,P0.05为差异有统计学意义。结果治疗后对照组收缩压为(132.2±9.8)mm Hg(1mm Hg=0.133k Pa),舒张压为(80.7±8.5)mm Hg,心率为(72.2±11.4)次/min,治疗组分别为(137.6±10.5)mm Hg,舒张压为(87.2±11.2)mm Hg,心率为(80.6±12.6)次/min,两组患者收缩压与舒张压均显著低于治疗前,差异均有统计学意义(均P0.05)。治疗组收缩压下降幅度和心率减慢幅度大于对照组,差异有统计学意义(P0.05)。治疗组总有效率为85.3%,对照组为61.8%,两组总有效率比较差异有统计学意义(χ2=4.84,P0.05)。结论左旋氨氯地平联合美托洛尔缓释片治疗原发性高血压的临床疗效显著,优于单用左旋氨氯地平。     

贝那普利降压疗效与校正QT间期的关系

目的探讨原发性高血压患者心电图心率校正QT间期(QTc)和贝那普利降压疗效之间的关系.方法采用前瞻性队列研究方法调查安徽A县899名高血压病患者的基线心电图、治疗15 d前后的血压变化及相关临床和流行病学特点等情况.结果 QTc和血压下降呈负相关.QTc每增加0.1秒1/2,收缩压和舒张压的下降值分别减少3.6 mmHg和3.3 mmHg,且差异均有显著性(P＜0.05).将QTc三等分后,随着QTc等分的增加,收缩压和舒张压的下降值均逐渐减少,且差异具有显著性(P＜0.05);将QTc等分后的变量放入方程中进行趋势性分析,发现在收缩压和舒张压组中的负相关关系具有显著性(P＜0.05).随着QTc等级的增加,舒张压有效率逐渐降低,且有显著性差异(P＜0.05),收缩压的效应关系不如舒张压明显.结论 QTc和贝那普利降压疗效呈负相关,对贝那普利短期降压疗效具有重要的预测价值.     

泸州市成年居民饮酒与慢性病患病关系

目的了解四川省泸州市成年居民饮酒与慢性病患病率的关系。方法利用2009年泸州市健康城市建设项目的调查资料,对泸州市11 425名成年居民的饮酒和慢性病现状进行分析,并采用多因素非条件Logistic回归分析是否饮酒与慢性病患病率的关系。结果泸州市成年居民慢性病患病率为24.4%,女性(26.2%)高于男性(22.1%),饮酒率为13.2%,且男性(28.2%)明显高于女性(1.3%);1 505名饮酒者中,每次酒精量<40 g者占50.9%,40～100 g者占40.5%,≥100 g者占6.1%;饮酒频率越高(χ2趋势=8.305,P=0.004),饮酒年限越长(χ2趋势=101.345,P<0.001),饮用的总酒精量越多(χ2趋势=17.651,P<0.001),慢性病患病率越高;多因素分析显示,是否饮酒与慢性病患病率之间呈负相关(β=-0.424),饮酒者患慢性病的危险低于不饮酒者,OR值为0.654(95%CI=0.559～0.766)。结论泸州市大部分饮酒者为长期、经常饮酒,应加强高饮酒率人群的健康教育,控制过量饮酒,以降低与饮酒有关的慢性病患病率。     

Alcohol consumption, %CDT, GGT and blood pressure change during alcohol treatment

AIMS: Blood pressure (BP) changes in alcohol-dependent individuals during a 12-week alcohol relapse prevention study were examined in light of drinking status and biomarkers of alcohol consumption [carbohydrate-deficient transferrin (%CDT) and gamma-glutamyl transpeptidase (GGT)]. METHODS: Of 160 randomized alcoholic individuals, 120 who had hypertension and in whom daily drinking data was available, at 6 and 12 weeks of treatment were included. The impact of alcohol consumption on change in systolic BP (SBP) and diastolic BP (DBP) was examined. Further analysis determined the relationship between BP and alcohol-use biomarkers. RESULTS: A significant effect of complete abstinence on both SBP (-10 mmHg; P = 0.003) and DBP (-7 mmHg; P = 0.001) when compared to any drinking (SBP and DBP = -1 mmHg) was observed. At week 12, participants with a positive %CDT (> or =2.6) had 7 mmHg greater SBP (P = 0.01) and DBP (P < 0.001) than those with negative %CDT. Participants with positive GGT (> or =50 IU) had 10 mmHg greater SBP (P = 0.12) and 9 mmHg greater DBP (P = 0.03) than those with negative GGT. The percent change in SBP was correlated with percent change in %CDT (P = 0.003) but not GGT (P = ns). The percent change in DBP was correlated with both percent change in %CDT (P < 0.0001) and GGT (P = 0.03). CONCLUSIONS: Abstinence from alcohol significantly decreased the BP and a positive relationship between BP and both alcohol-use biomarkers was illustrated. Since %CDT is more specific than GGT for heavy alcohol consumption, clinicians may monitor the role of alcohol in hypertension using %CDT as a supplemental aid, providing an objective assessment of drinking to influence BP treatment decisions.     

Persistent insomnia is a predictor of hypertension in Japanese male workers

Insomnia is one of the most common complaints at worksites, as well as in the general population. This study aims to assess the effect of insomnia on the development of hypertension in Japanese male workers. Using the annual health examination database of a Japanese telecommunication company, eligible middle-aged male participants in the 1994 health examination were followed up until 1998 or the development of hypertension (either initiation of antihypertensive therapy or a systolic blood pressure > or = 140 mmHg and/or a diastolic blood pressure > or = 90 mmHg). The effect of difficulty initiating sleep (DIS) was assessed with a DIS dataset (n=4,794), which included non-DIS (n=4,602) and persistent-DIS (n=192) subjects. That of difficulty maintaining sleep (DMS) was assessed with a DMS dataset (n=4,443), which included non-DMS (n=4,157) and persistent-DMS (n=286) subjects. The incidence of hypertension among persistent-DIS (40.1%; 130.7 per 1,000 person-yr) was significantly higher than that among non-DIS (30.6%; 89.9 per 1,000 person-yr). The incidence of hypertension among persistent-DMS (42.3%; 136.7 per 1,000 person-yr) was significantly higher than that among non-DMS (30.7%; 90.8 per 1,000 person-yr). After adjusting for potential confounding factors (i.e. age, body mass index, smoking, alcohol drinking, and job stress), persistent complaints of DIS and DMS were significantly associated with an increased risk of hypertension (OR=1.96; 95%CI: 1.42-2.70 and OR=1.88; 95%CI: 1.45-2.45, respectively). Persistent insomnia may be a useful predictor of hypertension in Japanese male workers.     

ACE inhibitor-based treatment and antihypertensive effects in patients with type 2 diabetes

AIM: The presence of hypertension significantly increases cardiovascular risk in diabetic patients. Different classes of antihypertensive drugs, by targeting different pathophysiological mechanisms and therapeutic targets, might provide different antihypertensive effects. The authors speculated that drugs specifically targeting the renin-angiotensin-aldosterone system provide better antihypertensive control than other therapeutic agents. METHODS: Fifty consecutive type 2 diabetic patients with hypertension (M:F 29:21) were followed for 3-9 yrs. Antihypertensive treatment was stable for the last 12 months and included angiotensin convertying enzyme (ACE) inhibitors (ACEI) alone in 8 patients (group IA), ACEI combined with other drugs in 11 patients (group IB) and non-ACEI treatment in 31 patients (group II), 23 of whom were treated with Ca-channel blockers and 8 were treated with beta-blockers alone or with diuretics. During the last month of the study a 3-7 days antihypertensive drugs wash-out was performed. Measurements were performed in sitting position in the same ambulatory conditions, in supine position after 20 min of absolute rest, and in motionless standing station after quickly rising up from sitting rest. RESULTS: Groups IA, IB, and II had similar blood pressure values during antihypertensive therapy within the last year. However, blood pressure values after antihypertensive drug wash-out were significantly higher in groups IA and IB vs. group II (SBP and DBP resting sitting position, P=0.039 and P=0.014 respectively; SBP and DBP in standing position, P=0.001 and P=0.016, respectively). CONCLUSION: These data show that the underlying condition in terms of pathophysiologic mechanisms is more severe in groups IA and IB, including a greater increase of peripheral resistance. Thus we may conclude that the antihypertensive effect of ACEI is greater than other classes of antihypertensive drugs.     

青少年饮酒行为影响因素及教育对策分析

【目的】 探索青少年饮酒行为的影响因素及教育对策。 【方法】 对广州市2 845名初、高中在校学生的饮酒行为及其影响因素进行问卷调查。资料采用单因素分析及多因素Logistic回归分析。 【结果】 高中生饮酒率高于初中生,差异有统计学意义(χ²=19.69,P<0.01)。男生饮酒率高于女生,差异有统计学意义(χ²=46.26,P<0.01)。以责骂作为教育方式、感觉孤独、缺课、晚回宿舍、父母饮酒是青少年饮酒行密切相关的危险因素(OR>1),与父母交流、学习成绩好、父母反对饮酒、认为酒精成瘾能致病是减少饮酒的保护因素(OR<1)。 【结论】 应充分调动各种积极因素,加强中学生健康生活方式的早期干预和教育。     

Risk factors for hypertension. A longitudinal study of middle-aged Japanese male workers

OBJECTIVE: To identify factors related to the development of hypertension among middle-aged Japanese men. METHODS AND RESULTS: A cohort of normotensive male workers aged 30-59 years (n = 6,306) were followed from 1991 through 1998 to observe the development of hypertension, using data from annual health checkups in a Japanese company. With hypertension defined as initiation of antihypertensive therapy or a systolic blood pressure of 140 mmHg or higher and/or a diastolic blood pressure of 90 mmHg or higher, the incidence rate was 33.4/1000 person-years in the 30-39 year old group, 63.8/1000 person-years in the 40-49 year old group, and 75.4/1000 person-years in the 50-59 year old group. Multivariate analysis by using Cox's proportional hazard model indicated that high-normal blood pressure at baseline, obesity (body mass index > or = 25 kg/m2), drinking 5 days/week or more, and no regular exercise were independent factors related to the development of hypertension. Although each age group had a different pattern of risk factors, high-normal blood pressure at baseline was the strongest risk factor in all cases. Glucose intolerance was significantly observed as a hazard only in the 30-39 year old group, hazard rations for obesity and physical inactivity also being highest in this younger age group. CONCLUSIONS: High-normal blood pressure, obesity, glucose intolerance, regular alcohol intake, and physical inactivity are risk factors for hypertension among middle-aged Japanese men. Insulin resistance may play an important role in the development of hypertension in young males.     

Alcohol drinking and high blood pressure: data from a 1980 national cardiovascular survey of Japan.

Many epidemiological cross-sectional studies have confirmed that alcohol drinking is related to high blood pressure. However, the impact of alcohol drinking on high blood pressure in the general population including older people has only been reported on in a few studies. The association between alcohol drinking and blood pressure or the prevalence of hypertension was examined using cross-sectional data of 4795 men and 6102 women aged 30-94, randomly selected from the Japanese population in 1980. The response rates were 74 and 84% for men and women, respectively. The prevalence of hypertension adjusted for body mass index (BMI, kg/m2) was significantly higher in everyday male drinkers than in male non-drinkers from the youngest age group (30-39 years) to oldest age group (70 years and over). A relationship between alcohol and blood pressure was found only in the youngest age group (30-39 years) of female drinkers. In each 10-year age-group of men, the BMI-adjusted systolic and diastolic blood pressures in everyday drinkers were 7-10 and 4-6 mmHg higher than those in non-drinkers. The relationship between alcohol and blood pressure in men was confirmed by multiple regression analysis adjusting for age and BMI in both younger (30-59 years) and older (60-94 years) people. The impact of alcohol drinking on blood pressure in men should be taken into account in the primary prevention of blood pressure related diseases and in the treatment of hypertension in both younger and older people.     

Alcohol-induced macrocytosis and blood pressure.

The effect of alcohol on blood pressure was studied prospectively in consecutive general practice patients with macrocytosis (MCV greater than or equal to 100 fl). The patients were separated into misuser and non-misuser groups on the basis of the Malm? modified Michigan Alcoholism Screening Test. There was no significant difference in the prevalence of antihypertensive medication between the misuser and non-misuser groups. When patients using antihypertensive medication were excluded and the groups were age-adjusted, male misusers (n = 95) compared to control patients (n = 22) had significantly higher diastolic (88 mmHg and 81 mmHg, respectively, P = 0.001) and systolic (146 mmHg and 137 mmHg, respectively, P less than 0.001) blood pressure values. Female misusers (n = 24), as compared to female non-misusers (n = 59) had significantly higher diastolic (83 mmHg and 82 mmHg, respectively, P = 0.04) but not systolic blood pressure values. Thus, alcohol seems to have a pressor effect predominantly among men. As 72% of men with macrocytosis were alcohol misusers and 41% of them either had elevated systolic or diastolic blood pressure, all patients with macrocytosis should be asked about their alcohol consumption and at least the males should have blood pressure measured.     

Birth cohort analysis of obesity in an occupational setting

PURPOSE: The purpose of this study was to analyze the transition of body mass index (BMI) by birth cohort and to determine the relationship between BMI and high blood pressure, for the health management of workers in an industry. SUBJECTS AND METHODS: The eligible study subjects were 3,043 male workers at printing and papermaking plants who were 20 to 49 years of age in 1986 and whose annual health checkup information was available for both 1991 and 1996. First, we analyzed the transition of BMI by 5-year birth cohort. Second, we analyzed the relationship between BMI and high blood pressure (systolic blood pressure > = 140 mmHg or diastolic blood pressure > = 90 mmHg) using multiple logistic regression models. In this analysis, we excluded 596 subjects who were diagnosed as having high blood pressure in 1986 and 17 subjects whose alcohol drinking habits were unknown. Consequently, we had 2,430 study subjects. RESULTS: (1) All the birth cohorts showed that the proportion of obese subjects (BMI > = 26.4) became higher as age advanced. The proportion was higher for younger cohort. (2) By multiple logistic regression models, age at the beginning of the study, BMI, change of BMI in 5 or 10 years, and alcohol drinking habits were related to the risk of having high blood pressure. CONCLUSION: In the health management of workers, it is necessary to evaluate the risk by birth cohort. Also, we consider that we need to initiate obesity counseling before the workers become 30 years of age.