妊娠期高血压患者肾素血管紧张素活性与胰岛功能的研究

目的研究妊娠期高血压患者循环血液中肾素血管紧张素系统活性与糖脂代谢及胰岛β细胞功能的相关性。方法 90例妊娠期高血压患者按口服葡萄糖耐量试验(OGTT)分为糖耐量正常组,糖耐量异常组。稳态模型评估法评价胰岛素抵抗及胰岛β细胞功能。结果糖耐量异常患者血浆血管紧张素Ⅱ,胰岛素抵抗指数(HOMA-IR),胆固醇LDLC显著高于糖耐量正常组,血浆血管紧张素Ⅱ活性与OGTT 0min血糖、120min血糖及HOMA-IR呈明显正相关(0.495≤r≤0.671)。结论妊娠期高血压患者伴有糖代谢紊乱时循环中血管紧张素Ⅱ水平较单纯高血压患者明显增高,血管紧张素Ⅱ值与空腹及负荷后120 min血糖呈明显正相关,且独立于高血压的存在,表明了肾素血管紧张素系统活性与胰岛素抵抗状态下的糖代谢紊乱之间的密切关联。     

糖尿病肾病的抗高血压治疗

糖尿病肾病是引发终末期肾病的主要原因之一。严格的抗高血压治疗可以预防和延缓糖尿病肾病的发生与发展。临床上通常需要一种以上的降压药才能将血压控制在低于130／80mmHg的理想范围。血管紧张素转化酶抑制剂(ACEI)不仅可以有效地降低血压，并且具有不依赖于其降压效应的肾脏保护功能。血管紧张素Ⅱ受体阻断剂(ARB)也具有降低血压和保护肾脏的作用。ACEI和ARB同属于治疗糖尿病肾病的一线降压药。β受体阻滞剂和非二氢吡啶类钙通道阻滞剂则属于二线降压药。其次可以选择的一类药物是利尿剂。只有当用上述药物不能将血压控制在理想范围时，才考虑加二氢吡啶类钙通道阻滞剂和α肾上腺素能受体阻滞剂。     

高血压门诊患者降压药的应用及疗效分析

目的分析高血压门诊患者降压药的应用情况及血压控制疗效。方法选择于我院门诊就诊的386例高血压患者为研究对象,建立门诊高血压患者治疗档案,统计患者降压药的应用情况,并评价血压控制效果。结果386例高血压门诊患者中,单药使用比率为73.06%,联合用药比率为26.94%。其中,钙离子拮抗剂31.87%,复方降压制剂16.84%,血管紧张素Ⅱ受体15.54%,血管紧张素I转化酶抑制剂3.11%,α_受体阻断剂2.59%,其他3.11%;二联用药比率为22.54%,三联用药比率为4.40%。高血压门诊患者单药使用的血压控制率为71.99%,联合用药为71.15%。单药使用血压控制率中,钙离子拮抗剂为74.80%,复方降压制剂为53.85%,血管紧张素Ⅱ受体为70%,血管紧张素I转化酶抑制剂为58.33%,α_受体阻断剂为60%,其他为50%;联合用药血压控制率中,二联用药为64.37%,三联用药为64.71%。结论分析高血压门诊患者降压药应用特点,并监测其血压控制疗效对促进合理用药具有重要的意义。     

高血压的药物基因组学的研究进展

本文综述了近几年来关于原发性高血压治疗常用的6种主要降压药物(利尿剂、β肾上腺素能受体阻滞剂、钙拮抗剂、血管紧张素转化酶(ACE)抑制剂、血管紧张素Ⅱ受体拮抗剂和α肾上腺素能受体阻滞剂)的作用机制、代谢途径和药物基因组学候选基因的研究进展,以期获得原发性高血压药物基因组学候选基因相关信息。为原发性高血压的预防和个体化治疗提供参考依据。     

高血压的药物基因组学的研究进展

本文综述了近几年来关于原发性高血压治疗常用的6种主要降压药物(利尿剂、β肾上腺素能受体阻滞剂、钙拮抗剂、血管紧张素转化酶(ACE)抑制剂、血管紧张素Ⅱ受体拮抗剂和α肾上腺素能受体阻滞剂)的作用机制、代谢途径和药物基因组学候选基因的研究进展，以期获得原发性高血压药物基因组学候选基因相关信息。为原发性高血压的预防和个体化治疗提供参考依据。     

血管紧张素转换酶基因型与重庆地区人群原发性高血压药物治疗的关系

目的 探讨重庆地区人群血管紧张素转换酶基因（ＡＣＥ）插入／缺失（Ｉ／Ｄ）多态性与原发性高血压及药物治疗的关系。方法 用多聚酶链反应直接扩增ＡＣＥ基因第１６内含子,对１１４名正常人和７５例原发性高血压患者进行了分析,同时对４９例原发性高血压患者用血管紧张素转换酶抑制剂（ＡＣＥＩ,依拉普利）和钙通道阻滞剂（ＣＣＢ,菲洛地平）进行自身交叉治疗,并比较降压效果。结果 原发性高血压患者ＡＣＥ基因的ＤＤ型频率     

ACEI及ARB对寒冷所致的高血压病人循环系统反应的干预

目的为了探讨血管紧张素转换酶抑制剂(ACEI)和血管紧张素受体阻滞剂(ARB)对寒冷所致的高血压病人循环系统反应的影响. 方法 111例血压控制稳定的高血压病人分成ACEI治疗、ARB治疗组及对照组3组,观察气温骤降前后血压和心率变化. 结果①3组病人气温骤降前血压控制均达到目标血压;②气温骤降后,ARB治疗组收缩压、舒张压无明显上升,其余各组收缩压、舒张压均明显上升;心率3组均无明显变化;③与对照组比较,ARB组寒冷所致的收缩压上升幅度明显减少;④与对照组比较,ACEI及ARB组寒冷所致的舒张压上升均轻度减少(p>0.05),但无统计差异,心率变化亦无差异. 结论 ACEI未能有效地阻断高血压病人寒冷所致的循环系统反应,亦不比其它降压药优胜;但ARB能有效地阻断高血压病人寒冷所致的循环系统反应,且明显优胜于其它降压药.     

ACEI及ARB对寒冷所致的高血压病人循环系统反应的干预

目的 为了探讨血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）对寒冷所致的高血压病人循环系统反应的影响。方法 111例血压控制稳定的高血压病人分成ACEI治疗、ARB治疗组及对照组3组，观察气温骤降前后血压和心率变化。结果 ①3组病人气温骤降前血压控制均达到目标血压；②气温骤降后，ARB治疗组收缩压、舒张压无明显上升，其余各组收缩压、舒张压均明显上升；心率3组均无明显变化；③与对照组比较，ARB组寒冷所致的收缩压上升幅度明显减少；④与对照组比较，ACEI及ARB组寒冷所致的舒张压上升均轻度减少（P＞0．05），但无统计差异，心率变化亦无差异。结论 ACEI未能有效地阻断高血压病人寒冷所致的循环系统反应，亦不比其它降压药优胜；但ARB能有效地阻断高血压病人寒冷所致的循环系统反应，且明显优胜于其它降压药。     

血管紧张素Ⅱ受体拮抗剂的临床研究进展

血管紧张素受体拮抗剂能特异性地与血管紧张素Ⅱ受体结合 ,从而可以阻断所有已知与高血压和心血管并发症有关的血管紧张素Ⅱ作用 ,其治疗高血压的疗效与目前一线降压药物相同 ,但不良反应低。     

H型高血压患者血管紧张素转化酶基因多态性对其活性及血脂水平影响的探究

目的 探究H型高血压患者和普通高血压患者中不同基因型的血管紧张素转化酶的活性差异以及其对血脂水平的影响.方法 实验采用了聚合酶链式反应的方法,分别鉴定68例H型高血压患者和64例普通型高血压患者血管紧张素转化酶的基因型,并且对不同基因型的血管紧张素转化酶的活性和对应的血脂水平进行了检测.结果 利用SPSS19.0对数据进行分析,H型高血压和普通高血压患者的不同基因型的血管紧张素转化酶活性的差异均具有统计学意义(P＜0.01),但血管紧张素水平的差异无统计学意义.血管紧张素转化酶基因多态性对血脂水平影响的研究表明,H型高血压组中缺失型纯合子(DD型)与插入型杂合子(ID型)和插入型纯合子(Ⅱ型)相比较,DD型血脂水平明显偏高,其中胆固醇(TC)(P＜0.01),高密度脂蛋白(HDLD),低密度脂蛋白(LDLC)和载脂B的水平的差异均具有统计学意义(P＜0.05).普通高血压组仅HDLC,LDLC和载脂B的差异具有统计学意义(P＜0.05).结论 在H型高血压和普通型高血压患者中,血管紧张素转化酶的基因多态性与血管紧张素转化酶的活性及血脂含量有关.H型高血压患者的DD型的血管紧张素转化酶的活性最高,并且血脂水平偏高,其中胆固醇含量增高最为明显,更加容易患高血脂症.     

Management of essential hypertension in the black patient: profiling as the initial approach to treatment

The pathophysiology and course of hypertensive cardiovascular disease in the black population differ significantly from those of nonblacks. The hemodynamic and endocrine profiles are different, consequences of hypertension are more severe in blacks, and black patients are often less responsive to standard antihypertensive treatment. Safe and efficacious treatment can be achieved when drug therapy is directed at the specific underlying pathophysiologic abnormality in black patients. By closely matching cardiovascular pathophysiologic findings in a given patient with the pharmacologic effects of an antihypertensive agent, blood pressure can often be controlled with fewer adverse effects. In addition, blood flow to target organs and their function can be maintained or improved. Calcium channel blockers are especially well suited for the treatment of essential hypertension in black patients.     

Aliskiren, the first direct renin inhibitor for treatment of hypertension: the path of its development

Standard treatments available today for treating hypertension is diuretics, β-blockers, angiotensin converting enzyme inhibitors (ACEs), angiotensin receptor blockers (ARBs), calcium channel blockers, a-blockers, vasodilators, and centrally acting drugs. It is difficult to achieve the optimized renin angiotensin aldosterone system suppression with currently available antihypertensive agents, because ACE inhibitors, ARBs, and diuretics all activate the compensatory feedback mechanism that increases renin release and increase plasma renin activity. The first orally active direct renin inhibitors (DRIs) were developed in 1980s, including enalkiren, remikiren, and zankiren. However, poor absorption from the gastrointestinal tract, less bioavailability (<2%), short half life, and low potency hindered the development of these compounds. Aliskiren is the first DRI for the treatment of hypertension. Aliskiren is designed through a combination of molecular modeling techniques and crystal structure elucidation. Aliskiren effectively reduces the blood pressure as a mono therapy as well in combination therapy.     

Endothelial dysfunction: a strategic target in the treatment of hypertension?

Endothelial dysfunction is a common feature of hypertension, and it results from the imbalanced release of endothelium-derived relaxing factors (EDRFs; in particular, nitric oxide) and endothelium-derived contracting factors (EDCFs; angiotensin II, endothelins, uridine adenosine tetraphosphate, and cyclooxygenase-derived EDCFs). Thus, drugs that increase EDRFs (using direct nitric oxide releasing compounds, tetrahydrobiopterin, or l-arginine supplementation) or decrease EDCF release or actions (using cyclooxygenase inhibitor or thromboxane A2/prostanoid receptor antagonists) would prevent the dysfunction. Many conventional antihypertensive drugs, including angiotensin-converting enzyme inhibitors, calcium channel blockers, and third-generation β-blockers, possess the ability to reverse endothelial dysfunction. Their use is attractive, as they can address arterial blood pressure and vascular tone simultaneously. The severity of endothelial dysfunction correlates with the development of coronary artery disease and predicts future cardiovascular events. Thus, endothelial dysfunction needs to be considered as a strategic target in the treatment of hypertension.     

Antihypertensive treatment in diabetic patients. Review of current data

Thirty to 50% of diabetic patients suffer from hypertension, exhibiting increased cardiovascular risk. In the present article we review key studies regarding the current knowledge for blood pressure (BP) goals in people with diabetes, the treatment used and the possible diabetogenic effects of antihypertensive drugs, as well as the beneficial and non-beneficial combinations of antihypertensive drugs in diabetic patients. Early placebo controlled trials proved the beneficial outcome of BP lowering in diabetic patients with initially high BP levels. More recent trials examined the impact of intensive compared to less intensive BP goals in diabetic populations. However, initial BP goals had significant differences from final achieved BP levels. Accordingly, current data support initiation of antihypertensive drug treatment in all patients with diabetes and systolic BP ≥140 mmHg, with the aim to lower it consistently <140 mmHg, although how far below 140 mmHg the systolic BP goal should be is not clear. Available literature indicates that more than one drug is commonly used to achieve target BP. Drugs acting on the renin–angiotensin–aldosterone axis have been shown to act protectively on diabetic nephropathy, while β-blockers and diuretics seem to have a diabetogenic effect. Interestingly, recent studies examining the role of combined use of available renin–angiotensin–aldosterone axis blockers versus its separate use exhibited an increased incidence of adverse outcome in diabetic patients who used combinations of drugs that act against renin–angiotensin–aldosterone system. More studies need to be conducted in order to establish the best combination therapy to reduce diabetic complications.     

Adherence to drug therapy among hypertensive patients attending two district hospitals in Ghana

BackgroundA major drawback to the management of hypertension among patients is poor adherence to pharmacotherapy. Factors that influence non-adherence to antihypertensive drugs could vary, depending on the prevailing condition of patient and setting. Knowledge of adherence patterns and behavior of hypertensive patients to pharmacotherapy could improve health-directed policies towards hypertension management.ObjectiveThe objective of this study was to determine factors that influence adherence to oral antihypertensive drugs among patients attending two district hospitals in the Volta Region of Ghana.MethodsThe study was cross-sectional. Respondents were hypertensive patients attending Krachi West District (n=187) and Hohoe Municipal (n=183) hospitals between March 2016 to May 2016. Data was collected using a structured questionnaire and Morisky 8 Item Measurement of adherence scale.ResultsAdherence to oral antihypertensive drugs was 89.2%. However, more than half of these respondents appeared to have uncontrolled blood pressure; and this may be due to self-response bias, blood pressure being measured only on the day of the interview or use of fake drugs (which was not assessed in this study). The strongest predictors of adherence were; knowledge on hypertension, perception of severity of condition and the amount of alcohol consumed in a day by respondents.ConclusionGood adherence to oral antihypertensive drugs was observed in this population despite uncontrolled hypertension in a number of the respondents. The three independent predictors of adherence to antihypertensive medications in this study were respondent''s knowledge about hypertension, perception of severity of their condition and the amount of alcohol consumed in a day. Regular patient education and counseling by medical practitioners should be encouraged in these settings to improve patient adherence.     

苏州吴江区社区医院2017年降压药使用情况分析

目的 通过收集2017年各类降压药销售金额和患者购买情况,分析各类降压药使用情况,以便进一步优化社区降压药的销售品种。方法 采用回顾性分析的方法,收集社区2017年全年门诊降压药的使用数据。计算各类药物的销售金额、用药频度（DDDs）、药物日均费用（DDDc）,并通过各药的DDDs排序（A）和用药金额排序（B）,计算比值（B/A）。结果 苯磺酸左旋氨氯地平片、厄贝沙坦片、盐酸贝那普利（洛汀新）、缬沙坦分散片（达乐）、非洛地平缓释片（波依定）DDDs值较高,临床对该类药的选择倾向性大,使用频率高。苯磺酸左旋氨氯地平片的B/A值为1.00、尼莫地平胶囊、琥珀酸美托洛尔缓释片、盐酸贝那普利（洛汀新）以及利尿剂的B/A值接近1,这些药同步性较好,药品的价格与患者的接受程度相一致。结论 门诊高血压患者最常用的降压药物是钙拮抗剂,其次为ACEI和ARB,应用最少的是利尿剂。我院降压药的使用情况基本合理,随着医疗卫生体制改革的变化,降压药的使用结构会越发合理。     

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.     

Requirement of drug development for chronic renal disease: Other strategies than blockade of the renin-angiotensin system

The number of patients with chronic renal disease is increasing, hypertension and diabetes being major causes of it. Chronic renal disease progresses to the end-stage, of which a patient requires dialysis or transplantation, and thus prevention of progression of renal disease to the end-stage is a very important issue. Accumulating data indicate that angiotensin-converting enzyme (ACE) inhibitor is more effective than other antihypertensive drugs for treating chronic renal disease, since in addition to an antihypertensive effect, ACE inhibitor has a renoprotective effect. Although ACE inhibitor is more effective than other antihypertensive drugs, it only prevents the progression of chronic renal disease by less than 50%. Thus, in addition to blockers of the renin-angiotensin system, other types of drugs are required. Chronic renal disease progresses through a common pathway, regardless of the type of initial insult. This common pathway includes direct hemodynamic actions, modulation of glomerular cell injury, growth factor actions and induction of apoptosis. Blockade of this common pathway is one of the drug development strategies for chronic renal disease.     

A challenge to the concept that the use of calcium channel blockers causes reversible male infertility

The objective of this study was retrospectively to evaluate both in- vitro fertilization (IVF) and non-IVF cycles in which the male partner had been taking calcium channel blockers, either to confirm or refute previous data from another centre, suggesting that these drugs cause a severe but reversible subfertility problem in the male. These drugs were found to inhibit expression of mannose-ligand binding receptors, thus preventing spermatozoa from attaching to the zona pellucida; they were postulated to cause failed fertilization based on one case having this defect, in whom a return to normal was achieved after stopping the drug. However, the couple did not undergo a cycle with IVF to see if fertilization now occurred. The data presented here demonstrated fertilization in all patients having IVF who were taking calcium channel blockers. The subsequent pregnancy rate per transfer was 17.4%. Also, five out of 11 (45.4%) non-IVF patients conceived after correction of various female factors. Failure of the other six patients to conceive could be explained by other confounding factors, especially oligoasthenozoospermia. Taking into consideration other data suggesting poor fertilization when this mannose-ligand binding receptor abnormality was demonstrated, we propose the possibility that this defect, when not associated with calcium channel blockers, may be associated with some other cryptic factor that causes poor fertilization. According to our hypothesis, calcium channel blockers might cause the problem in mannose expression but also adversely affect some other factor that is deficient when non-drug related abnormalities in mannose-ligand binding expression are found.