上海市心血管病主要危险因素变化趋势分析

目的：评价上海地区人群心血管病主要危险因素的变化趋势。方法：采用重复横断面调查的方法,1992、1995、1996和1999年共4次对上海市某工厂人群进行心血管病主要危险因素调查,共1118人,对收缩压、舒张压、体重指数、高血压的患病率和吸烟情况的变化趋势进行了分析。结果：（1）1992年人群基线心血管病危险因素如血压、吸烟率、血清总胆固醇、甘油三酯、HDL－胆固醇、腰臀比、体重指数结果与MONICA北京的地区监测结果相近。（2）无论男性或女性,收缩压和舒张压水平均呈上升趋势。男性收缩压平均升高12.3mmHg, 舒张压平衡升高6.4mmHg;女性依次为11.5mmHg和4.9mmHg;（3）男性高血压患病率呈上升趋势;女性变化趋势不明显。（4）男性与女性体重指数各年度比较均无显著性差异,无逐渐肥胖的倾向。（5）男性吸烟率一直维持在较高水平,1996年较1992年有明显下降,1996至1999年下降趋势不明显;女性吸烟率维持在较低水平,趋势平稳。结论：上海地区应重视吸烟和高血压的预防控制。     

急性心肌梗死并发急性脑梗死危险因素及临床特点

目的 分析急性心肌梗死（AMI）并发急性脑梗死（AIS）的危险因素及临床特点。 方法 回顾性分析2010年1月~2015年4月我院收治住院的75例AMI并发AIS患者为病例组,随机选择同期住院的单纯AMI和单纯AIS患者各80例为对照组,对比分析3组临床资料。 结果 单因素分析显示,AMI并发AIS组与单纯AMI组比较,既往脑梗死病史、外周血管病史、血肌酐水平显著高于对照组,高密度脂蛋白胆固醇（HDL-C）显著低于对照组,差异有统计学意义（P<0.05）;与单纯AIS组比较,男性、既往心肌梗死病史、外周血管病史、血肌酐水平显著高于对照组,入院收缩压与舒张压显著低于对照组,差异有统计学意义（P<0.05）;多因素Logistic回归分析表明,男性、既往脑梗病史、血肌酐为AMI并发AIS的独立危险因素（P<0.05,OR>1）,入院舒张压为其保护性因素（P<0.01,OR<1）。临床特点分析表明,KILLIP分级≥Ⅱ级高于两对照组（44% vs. 16% vs. 1%,P<0.01）,多发脑梗死高于单纯AIS 组（46% vs. 16%,P<0.01）,PCI患者冠状动脉3支病变显著高于单纯AMI组（76% vs. 52%,P<0.05）。 结论 男性、入院舒张压降低、既往脑梗病史、血肌酐水平升高为AMI并发AIS的独立危险因素,心功能不全、多发脑梗死为其临床特点,冠状动脉3支病变为PCI术后并发急性脑梗死患者的临床特点。     

老年高血压病患者动态血压特点及临床分析

目的探讨老年高血压病患者血压昼夜节律变化特点。方法对我院老年病科2008年2月～7月住院的100例老年人行24h动态血压监测，将血压正常的定为对照组（42例），将高血压病患者定为观察组（58例）。分析观察血压水平、靶器官损害发生率、血压昼夜节律等指标进行分析。结果观察组的24h平均收缩压、舒张压，白天平均收缩压、舒张压，夜间平均收缩压、舒张压，昼夜下降比和靶器官损害发生率明显高于对照组（P〈0.05）。结论老年高血压病患者血压昼夜节律消失更容易损害靶器官，夜间舒张压越高，靶器官损害越重。     

我国华中地区大气PM_(2.5)长期暴露与成人血压水平的相关性分析

目的:探索华中地区大气PM_(2.5)长期暴露与成人血压(收缩压、舒张压、平均动脉压、脉压)水平的相关性。方法:研究基于心血管病高危人群早期筛查与综合干预项目在华中地区(河南省,湖北省,湖南省)18个城市的横断面调查数据,同时收集该地区研究期间PM_(2.5)日均浓度以估计调查对象PM_(2.5)的长期暴露水平。利用多水平线性回归模型研究华中地区人群PM_(2.5)长期暴露与血压(收缩压、舒张压、平均动脉压、脉压)水平的相关性,并通过交互检验进一步探索个体因素对此相关关系的影响。结果:研究共纳入243 904例调查对象,92 819例(38.1%)为男性。PM_(2.5)每增高10μg/m3,收缩压、舒张压、脉压和平均动脉压分别增加2.47(95%CI:2.34～2.61)mmHg(1mmHg=0.133kPa)、0.69(95%CI:0.62～0.77)mmHg、1.79(95%CI:1.68～1.89)mmHg和1.28(95%CI:1.19～1.37)mmHg。老年人(年龄≥60岁)、男性、高血压患者PM_(2.5)长期暴露与收缩压升高的关联程度更高(P交互0.05)。结论:PM_(2.5)长期暴露与华中地区人群血压水平显著相关。老年人、男性、患高血压者PM_(2.5)长期暴露后收缩压升高更为显著。     

血压控制不达标患者血压特征及与缺血性脑卒中的关系

目的：了解血压控制不达标高血压患者收缩压、舒张压、脉压、平均动脉压、血压控制不达标类型以及血压分级等血压特点及其与脑卒中患病情况的关系。方法：2012年3月至12月在北京安贞医院门诊及所属社区卫生服务中心门诊筛查血压控制不达标的高血压患者,共收集血压控制不达标高血压患者3909人。结果：研究对象男性占49.4%,女性占50.6%。62.2%患者服用一种降压药,37.8%联合用药。144例患缺血性脑卒中,患病率为3.68%。多因素回归分析发现,和收缩压及舒张压均未控制的患者相比,单纯舒张压控制不达标者脑卒中的患病危险低,OR=0.339(95%CI:0.124-0.923)。和收缩压＜140 mmHg者相比,收缩压高于150mmHg者缺血性脑卒中的患病危险增加,收缩压150~159mmHg以及≥160mmHg者相对危险度分别为2.532 (95%CI:1.266-5.067),和2.004(95%CI:1.010-3.979)。而脉压差、平均动脉压、舒张压以及血压分级在多因素分析中均为显示与缺血性脑卒中的相关关系。结论：单纯舒张压控制不达标类型以及收缩压水平与缺血性脑卒中的患病危险相关。单纯舒张压控制不达标的患者以及收缩压高于150 mmHg者缺血性脑卒中的患病危险增加。     

比索洛尔对高血压病并发慢性心力衰竭患者脑钠尿肽前体的影响

目的 探讨比索洛尔对高血压病并发慢性心力衰竭（CHF）患者脑钠尿肽（BNP）前体（Pro-BNP)的影响。方法 选取我院收治的高血压病并发CHF的患者102例,随机分为试药组和对照组各51例。对照组按照高血压病并发CHF的常规治疗方案进行干预,试药组在对照组治疗方案的基础上,加用比索洛尔口服治疗。治疗3个月后对比两组患者的心功能改善情况,同时对比两组患者治疗前后的心率、血压、左室射血分数(LVEF)以及pro-BNP的变化情况。结果 试药组的显效率为49%,总有效率为96%,均显著高于对照组（分别为29%,76%,均P<0.05）;两组患者治疗后的心率、收缩压和舒张压均显著低于治疗前,而LVEF显著高于治疗前（均P<0.05）;试药组治疗后的LVEF为（44±4）%,显著高于对照组〔（35±4）%,P<0.05〕;试药组治疗后的Pro-BNP水平为（733±58） ng/L,对照组治疗后的Pro-BNP水平为（802±63） ng/L,两组患者治疗后的Pro-BNP水显著低于治疗前（均P<0.05）;试药组治疗后的Pro-BNP水平显著低于对照组（P<0.05）。结论 比索洛尔可有效降低高血压病并发CHF患者的Pro-BNP水平,提高临床疗效。     

“国人缺血性心血管病十年发病危险评估方法”在北京朝阳社区的应用

目的：探讨我国自行开发的＂国人缺血性心血管病10年发病危险度评估方法＂的临床应用价值。方法：采用中国医学科学院心血管病研究所开发的＂国人缺血性心血管病10年发病危险评估方法＂对北京朝阳区2465名社区居民的心血管病发病危险度进行评估,并进行相关分析。结果：（1）与女性组比较,男性组收缩压[（122.84±16.42）mm-Hg∶（126.83±16.36）mmHg],舒张压[（80.67±9.51）mmHg∶（84.54±9.89）mmHg]和总胆固醇[（4.86±1.06）mmol/L∶（5.01±0.97）mmol/L]水平显著升高,P均〈0.001;（2）10年缺血性心血管病发病危险度≥10%者（高危者）所占的比例,男性为3.28%,显著高于女性的1.59%（P〈0.05）;这一结果与我国＂十五＂攻关课题组对9903名国人调查,随访15.1年缺血性心血管病绝对危险数据是一致的。结论：国人10年缺血性心血管病发病危险评估方法能较准确地检测人群的发病分布情况,有利于对高危人群的简单筛选。     

新疆多民族地区中老年脉压与心血管危险因素的分析

目的 探讨维哈蒙汉族中老年自然人群脉压水平、心血管危险因素聚集情况及两者之间的关系。方法 采用随机整群抽样的方法对新疆博州40岁以上的蒙哈维汉四民族居民共2648人进行流行病学调查。结果 （1）男女脉压水平与年龄、收缩压、舒张压、血糖、体重指数和腹围等呈正相关，男性脉压还与血胆固醇和血甘油三酯呈正相关。（2）心血管危险因素聚集为77．24％，有随年龄增长的趋势，四民族间无叽显差异，但维族女性远高于男性，而蒙族男性高于女性。（2）脉压≤60mmHg组者中高血压、高血糖和危险因素聚集评分的异常检出率低于其他组。结论 新疆博州中老年人群心血管病的主要危险因素高血压、高脂血症、超重腹型肥胖、糖尿病和心血管危险因素聚集的流行程度均已达到较高水平，脉压〉60mmHg者心血管危险因素聚集明显增加。     

人群血清尿酸水平与高血压发病相关性的探讨

目的：本研究将探讨人群中血尿酸水平与高血压发病之间的关系,血清尿酸水平是否是高血压发病的独立影响因素。资料与方法：在中美心肺血管病合并研究项目的南方队列人群中,选择广州市城乡1987－1988年和1993年－1994年均参加心血管病危险因素调查,基线血压值低于正常高限（收缩压＜130mmHg和舒张压＜85mmHg),且两周内未服降压药共3041人（含男性1426人,女性1615人）平均年龄46．4岁（35－64岁,测量血压,血清尿酸浓度及其他心血管病危险因素。数据处理使用SAS系统,结果：该研究人群血尿酸水平表现为男性高于女性,以四分位数法分层。随着血尿酸水平增高,男女两性的六年高血压发病率也增高,Logistic回归分析显示,该人群六年高血压发病率与基线血尿酸水平呈正相关关系,逐步加入年龄,体重指数,甘油三酯,饮酒,收缩压和舒压等因素后,其相关强度逐步减弱至消失。结论：血清尿酸水平与高血压发病率有一定的正相关关系。但尚缺乏足够证据说明血清尿酸水平是影响高血压发病的独立的危险因素。     

老年重症患者无创与有创血压测量的比较

目的 观察老年重症患者有创(IBP)和无刨血压(NBP)监测值的差异,探讨老年重症患者血压监测的最佳方法 .方法 对63例老年重症患者进行挠动脉IBP和肱动脉NBP监测,将所得数据进行对比分析.结果 非休克状态的老年重症患者,当收缩压≥120 mmHg时,有创收缩压显著高于无创收缩压(P<0.01);而有创舒张压显著低于无创舒张压(P<0.05).收缩血压90～120mmHg时.IBP及NBP无显著性差异(P>0.05).而在老年休克患者中,有创收缩压显著低于无创收缩压(P<0.01);有创舒张压亦显著低于无创舒张压(P<0.05).结论 在不同病理状态下,老年危重患者的IBP与NBP存在一定差别,1BP可能更准确反映血压的真实情况以及组织灌注状态.     

原发性高血压并发心脑血管疾病患者的危险因素分析

目的：研究原发性高血压（EH）伴冠心病和／或脑血管病患者的临床特点，分析其相关的危险因素。方法：对55例EH伴冠心病和／或脑血管病患者，进行动脉硬化指数（ASI）测定，并检测患者的血尿酸、血糖、血脂、肌酐、尿素氮等血液生化指标及一般情况。另选不伴有冠心病、脑血管病的高血压患者63例作为对照。结果：与单纯高血压对照组比较，EH伴冠心病和／或脑血管的年龄大、病史时间长，ASI、脉压、血尿素氮水平明显升高（均P〈0.01）；收缩压、血尿酸、总胆固醇、肌酐水平也升高（均P〈0．05）；而舒张压（P〈0．01），心率（P〈0．05）却较低。多因素logistic回归分析显示：EH并发心脑血管疾病的相关危险因素有脉压、血肌酐、年龄（OR=1．204，1．120，1．099,P=0．028，0．045，0．039）；而血尿酸是负相关因素（OR=0．974，P=0．022）。结论：脉压、血肌酐水平和年龄可能是高血压患者并发心脑血管疾病的危险因素；血尿酸可能是一种保护因素。     

Diabetes, hypertension, and cardiovascular disease: an update

Cardiovascular diseases (CVDs) are the major causes of mortality in persons with diabetes, and many factors, including hypertension, contribute to this high prevalence of CVD. Hypertension is approximately twice as frequent in patients with diabetes compared with patients without the disease. Conversely, recent data suggest that hypertensive persons are more predisposed to the development of diabetes than are normotensive persons. Furthermore, up to 75% of CVD in diabetes may be attributable to hypertension, leading to recommendations for more aggressive treatment (ie, reducing blood pressure to <130/85 mm Hg) in persons with coexistent diabetes and hypertension. Other important risk factors for CVD in these patients include the following: obesity, atherosclerosis, dyslipidemia, microalbuminuria, endothelial dysfunction, platelet hyperaggregability, coagulation abnormalities, and "diabetic cardiomyopathy." The cardiomyopathy associated with diabetes is a unique myopathic state that appears to be independent of macrovascular/microvascular disease and contributes significantly to CVD morbidity and mortality in diabetic patients, especially those with coexistent hypertension. This update reviews the current knowledge regarding these risk factors and their treatment, with special emphasis on the cardiometabolic syndrome, hypertension, microalbuminuria, and diabetic cardiomyopathy. This update also examines the role of the renin-angiotensin system in the increased risk for CVD in diabetic patients and the impact of interrupting this system on the development of clinical diabetes as well as CVD.     

老年2型糖尿病患者合并心脑血管疾病的危险因素分析

目的　探讨老年 2型糖尿病 (diabetesmellitus ,DM)患者心脑血管病变的特点及相关危险因素。方法　通过回顾性分析方法 ,将 2 12例老年 2型DM患者分为心脑血管病变组 (病变组 )和无血管病变组 (无病变组 )各 10 6例。病变组含缺血性心脏病 (ischemicheartdisease ,IHD)患者组 72例和 (或 )脑血管病变 (cerebrovasculardisease,CVD)患者 5 0例。其中 ,两者并存者 16例。对两组间患者的临床数据进行比较及回归分析。结果　病变组的年龄、高血压患病比率、DM病程、尿微量白蛋白排泄率异常比无病变组明显增高 ;各亚组与无病变组的比较也有相似的趋势。回归分析显示 ,年龄、高血压是老年 2型DM患者总的心脑血管病变的独立危险因素 ,同时也分别是IHD和CVD的独立危险因素 ;另外 ,高甘油三酯血症与病变组和IHD分别独立相关 ;吸烟史是IHD的独立危险因素。结论　对于老年2型DM患者 ,除了年龄、高血压外 ,高甘油三酯血症是心脑血管病变的独立危险因子     

The DASH diet and blood pressure

High blood pressure (also called hypertension) is one of the most important and common risk factors for atherosclerotic cardiovascular disease (CVD) and other chronic diseases. National guidelines recommend that all individuals with blood pressure readings of 120/80 mm Hg or higher adopt healthy lifestyle habits, including the Dietary Approaches to Stop Hypertension (DASH) diet, to manage their blood pressure. The DASH diet, which is high in fruits, vegetables, and low-fat dairy products and reduced in fat, has been shown in large, randomized, controlled trials to reduce blood pressure significantly. The DASH diet also has been shown to reduce blood cholesterol and homocysteine levels and to enhance the benefits of antihypertensive drug therapy. The DASH diet should be promoted, along with maintaining healthy weight, reducing sodium intake, increasing regular physical activity, and limiting alcohol intake, for lowering blood pressure and reducing the risk of CVD.     

Treatment of hypertension in patients with diabetes

At least 17 million people in the United States have diabetes mellitus, and another 50 million have hypertension. These chronic diseases increasingly coexist in our aging population. Both diseases are important predisposing factors for the development of cardiovascular disease (CVD) and renal disease, and the coexistence of these risk factors is a very powerful promoter of CVD and renal disease. There is accumulating evidence that the rigorous treatment of hypertension and other risk factors such as dyslipidemia and hyperglycemia considerably lessens the burden of CVD and renal disease in patients with diabetes mellitus. There is considerable evidence that strategies addressing diet and exercise reduce the development of diabetes and are an important component of treatment in persons who have established diabetes. There are also considerable data suggesting that the treatment strategies that interrupt the renin-angiotensin system have special benefits in patients with diabetes and may prevent the development of clinical diabetes in hypertensive patients with impaired glucose tolerance. Data from a recent study indicate that the control of systolic blood pressure, using a diuretic agent as part of antihypertensive therapy, reduces the risk of stroke and other CVD end points. Recent reports indicate that angiotensin receptor-blocking agents decrease the rate of development of proteinuria and diabetic renal disease. These observations will likely have a significant impact on treatment of hypertension in patients with type 2 diabetes mellitus.     

Increased risk of cardiovascular disease in newly diagnosed type 2 diabetic patients in a primary health care center in Trinidad

The prevalence of cardiovascular diseases (CVD) has increased sharply in the developing countries and because Type 2 diabetic patients are at increased risk for CVD, we assessed CVD risk factors in newly diagnosed Type 2 diabetic patients presenting in a primary health care center in Trinidad. Fasting and 2 h postprandial blood samples were collected from 387 (269 females, 118 males) newly diagnosed Type 2 diabetic patients (mean age: 53.1+/-6.6 years) for the determination of plasma glucose, creatinine, cholesterol (chol), triglyceride (TG) and % glycated hemoglobin (HbA(1c)) concentrations. Blood pressure and anthropometric indices were also measured. There were high prevalence rates of obesity (37%), overweight (35%), hypertension (21%), hypercholesterolemia (25%) and hypertriglyceridemia (22.3%) among the patients and these were significantly higher in women than men (P<0.001). Patients of Indian descent had a significantly higher prevalence of diastolic hypertension and hypertriglyceridemia compared with patients of African origin or mixed race (P<0.001). In comparison with males, female diabetic patients were at greater risk of cardiovascular morbidity and mortality. Early detection of CVD risk factors and treatment, particularly in women, may be beneficial management strategy in all local diabetic clinics in Trinidad.     

类风湿关节炎治疗药物对心血管病变影响的研究进展

类风湿关节炎(RA)是一种常见的慢性自身免疫性疾病,各个系统都可受累。RA患者患心血管系统疾病(CVD)的风险要明显高于一般人群,其危险因素包括常见的心血管病变危险因素,如肥胖、高血压、糖尿病及吸烟等,同时亦与RA的慢性炎症、抗风湿药物的应用有关。众多研究表明,抗风湿药物的应用可提高疾病缓解率,但有些药物可能会增加CVD的风险,还有一些不改变或者可降低CVD风险。本文主要综述了治疗RA常用药物对CVD风险的影响,以期为临床用药提供参考。     

Ambulatory blood pressure is a better marker than clinic blood pressure in predicting cardiovascular events in patients with/without type 2 diabetes

BACKGROUND: The prognostic significance of ambulatory blood pressure (ABP) has not been established in patients with type 2 diabetes (T2DM). METHODS: In order to clarify the impact of ABP on cardiovascular prognosis in patients with or without T2DM, we performed ABP monitoring (ABPM) in 1,268 subjects recruited from nine sites in Japan, who were being evaluated for hypertension. The mean age of the patients was 70.4 +/- 9.9 years, and 301 of them had diabetes. The patients were followed up for 50 +/- 23 months. We investigated the relation between incidence of cardiovascular diseases (CVDs) and different measures of ABP, including three categories of awake systolic blood pressure (SBP <135, 135-150, and >150 mm Hg), sleep SBP (<120, 120-135, and >135 mm Hg), and dipping trends in nocturnal blood pressure (BP) (dippers, nondippers, and risers). Cox regression models were used in order to control for classic risk factors. RESULTS: Higher awake and sleep SBPs predicted higher incidence of CVD in patients with and without diabetes. In multivariable analyses, elevated SBPs while awake and asleep predicted increased risk of CVD more accurately than clinic BP did, in both groups of patients. The relationships between ABP level and CVD were similar in both groups. In Kaplan-Meier analyses, the incidence of CVD in nondippers was similar to that in dippers, but risers experienced the highest risk of CVD in both groups (P < 0.01). The riser pattern was associated with a approximately 150% increase in risk of CVD, in both groups. CONCLUSIONS: These findings suggest that ABPM is a better predictor of cardiovascular risk than clinic BP, and that this holds true for patients with or without T2DM.     

脑血管病再发相关危险因素

目的探讨高血压病、糖尿病、血脂异常与脑血管病再发的关系。方法对686例60岁以上脑血管病患者的临床资料进行回顾性分析,其中再发病例221例(再发组),初次发病者465例(初次发病组)。收集患者的血压、糖化血红蛋白水平、是否患有血脂异常等因素,与同期因脑血管病入院的初次发病者进行比较。结果脑血管病再发患者存在明显的高血压病(OR=5.37)和血糖控制不良(OR=7.96),但血脂异常在脑血管病再发中差异无显著性意义。结论高血压病和糖尿病控制不良是脑血管病再发的主要危险因素,应在脑血管病二级预防中充分重视,同时血脂异常亦是不能忽视的因素。     

北京住院高血压患者心脏结构功能及治疗达标情况的分析

目的回顾性分析北京市三级医院住院的高血压患者的心脏结构功能改变的相关因素,为临床治疗提供依据。方法采用回顾性调查的方法,通过超声诊断技术分析高血压患者的心脏结构及功能的参数,并对患者的年龄、血压水平、合并的危险因素及疾病、降压药物使用情况进行相关分析。结果共分析住院的原发性高血压患者5106例,平均年龄63．78岁,平均血压145．97／84．23mmHg（1mmHg=0．133kPa）。75．5％的患者至少合并一种心血管危险因素,随着血压水平的升高,合并左心室肥厚的患者比例明显增高。有近30％的患者合并不同程度的心功能不全。调查中发现,左房扩大和左心室舒张功能不全是高血压患者最常见的心脏损害。多因素分析显示,较高的收缩压、舒张压、血肌酐水平、老年和低高密度脂蛋白胆固醇是高血压合并左心室肥厚的危险因素。所有患者血压达标率（血压〈140／90mmHg）为32．1％,单药治疗达标率为38．1％。钙拮抗剂和利尿剂是使用最多的两类降压药。结论要重视血压的治疗达标和多重危险因素共同干预以延缓或逆转高血压心脏损害的发生发展,原发性高血压的防治仍任重而道远。