住院2型糖尿病患者短期血压控制及影响因素探讨

目的:探讨住院2型糖尿病(T2DM)患者短期血压控制效果及影响因素.方法:169例伴发高血压的T2DM患者给予降压等综合治疗,以出院时血压130/80 mmHg(1 mmHg=0.133 kPa)为界限分为达标组(97例)及未达标组(72例),比较2组入院时临床及实验室指标,并通过回归分析观察各种因素对出院时平均动脉压(MAP)水平的影响.结果:全组T2DM入院时收缩压(SBP)为(143±15)mmHg,舒张压(DBP)为(78±8)mmHg,控制达标率仅17.8%;出院时血压达标率57.4%,降压药物种类平均增加0.8种.未达标组患者入院时SBP[(151±15)∶(137±12)mmHg,P<0.01]、DBP[(80±9)∶(77±7)mmHg, P<0.01]均高于达标组,且TC及24 h尿白蛋白排泄率(UAE)显著升高.回归分析显示MAP与入院时SBP、DBP、TC及高血压病程显著正相关,与年龄呈负相关;MAP与UAE显著正相关(r=0.303, P<0.01).并发糖尿病肾病(DN)患者随UAE增多而SBP显著升高,大量蛋白尿者需要多种降压药物联合且血压难以控制.结论:T2DM患者门诊血压控制达标率低,住院短期治疗明显改善了血压控制水平;住院T2DM患者血压控制受入院时血压水平、高血压病程、高胆固醇血症、高UAE等因素影响;UAE增加可能是并发DN患者血压难以控制的直接原因.     

遵义地区住院老年2型糖尿病患者的血压控制情况及影响因素

目的探讨遵义地区住院老年2型糖尿病(T2DM)患者的血压控制情况及影响因素。方法选择2010年6月至2014年6月该院内分泌科收治入院的94例老年T2DM伴高血压患者予以降压等综合治疗,根据患者出院时血压状况。分为血压达标组及血压未达标组,比较两组患者的临床资料及实验室检查指标,并将单因素分析结果纳入多因素Logistic回归模型中予以分析。结果 94例患者出院时收缩压(SBP)、舒张压(DBP)均低于入院时,血压达标患者比例高于入院时,降压药物使用数量低于入院时(P<0.05)。多因素分析结果发现,影响住院老年T2DM患者的血压控制情况的因素有高血压病程、入院时SBP、入院时DBP、糖化血红蛋白(Hb A1c)、总胆固醇(TC)、及24 h尿蛋白定量。高血压病程越长、入院时血压越高、Hb A1c、TC水平及24 h尿蛋白定量越高的老年T2DM患者其血压控制情况越不良。结论 T2DM患者入院时血压达标率较低,住院治疗明显改善血压水平;住院T2DM伴高血压患者血压控制情况与高血压病程、入院时血压水平、Hb A1c、TC水平及24 h尿蛋白定量等因素密切相关。     

住院2型糖尿病患者血压控制的影响因素

目的探讨住院2型糖尿病(type2diabetes mellitus,T2DM)患者血压控制的影响因素。方法 169例合并原发性高血压(高血压)的T2DM患者给予降压等综合治疗,以出院时血压130/80mm Hg(1mm Hg=0.133kPa)为界限分为达标组(n=97)及未达标组(n=72),比较两组入院时临床及实验室指标,并通过回归分析观察各种因素对出院时平均动脉压水平的影响。结果全组T2DM入院时收缩压为(143±15)mm Hg,舒张压为(78±8)mm Hg,控制达标率仅17.8%;出院时血压达标率57.4%,降压药物种类平均增加1种。未达标组患者入院时收缩压[(151±15)mm Hg vs.(137±12)mm Hg,P0.05)、舒张压[(80±9)mm Hg vs.(77±7)mm Hg,P0.05]均高于达标组,且血清总胆固醇浓度及24h尿白蛋白排泄率显著升高。回归分析显示,平均动脉压与入院时收缩压、舒张压、血清总胆固醇及高血压病程显著正相关,与年龄负相关;平均动脉压与尿白蛋白排泄率显著正相关(r=0.303,P0.01)。合并糖尿病肾病患者随尿白蛋白排泄率增多而收缩压显著升高,大量蛋白尿者需要多种降压药物联合治疗且血压难以控制。结论 T2DM患者门诊血压控制达标率低;住院T2DM患者血压控制受入院时血压水平、高血压病程、高胆固醇血症、高尿白蛋白排泄率等因素影响;尿白蛋白排泄率增加可能是合并糖尿病肾病患者血压难以控制的直接原因。     

原发性高血压患者血压水平与早期肾损害的相关性研究

目的探讨原发性高血压患者脉压(PP)、SBP、DBP及平均动脉压(MAP)与早期肾损害的关系。方法选择180例初诊或停药2周以上的原发性高血压患者进行PP、SBP、DBP和MAP检查,以血β2微球蛋白(β2-MG)水平>2.6mg/L作为肾损害的标准,分为肾损害组和非肾损害组,其中肾损害组84例,非肾损害组96例。将两组血压参数进行比较,并与血β2-MG水平进行相关性分析。结果(1)肾损害组PP[(59±10)mmHg]及SBP[(168±28)mmHg]较非肾损害组[(41±8)mmHg,(151±10)mmHg]明显增高。(2)相关分析显示血β2-MG与PP、SBP呈正相关,尿β2-MG与PP、SBP、DBP、MAP呈正相关。其中与PP、SBP相关性较好。结论PP与SBP、DBP、MAP增高均可导致高血压患者早期肾损害,而PP、SBP增大是导致高血压患者早期肾损害的主要因素。     

氯沙坦对高血压病人24小时血压的影响

目的观察氯沙坦对高血压病人24小时血压的影响,探讨其临床意义。 方法20例Ⅰ-Ⅱ级高血压病人,入院后停药2周,服氯沙坦50mg,qd,疗程12周,1个月后血压若未降至140/90mmHg以下,可加大剂量到100mg,qd,治疗前后复查24小时动态血压。以二次给药间距终末时血压下降数除以给药间距中最大血压下降数值作为药物降压的谷/峰比(T∶P),以夜间血压均值与白昼血压均值比较时下降10%或大于10mmHg者为夜间血压下降或"杓型者",反之为夜间血压不下降者或"非杓型者"。 结果　发现(1)氯沙坦能明显降低高血压病人的24小时平均血压(mmHg)(SBP134±14比113±8,DBP89±12比71±5,P<0.01);有效率为85.0%.(2)氯沙坦降压的SBP和DBPTP比率分别为78.6%(48%～93.9%)和76.2%(46.4%～89.6%).SBP,DBP和MBP的平滑曲线指数分别是1.23±0.32,1.36±0.41和1.32±0.38.(3)对夜间血压高于正常值(120/80mmHg)的高血压患者,氯沙坦明显降低夜间血压(mmHg)(SBP142.6±8.8降至116.3±11.4,DBP89.2±9.6降至74.3±6.8,P<0.01),对夜间血压已属正常者,氯沙坦无进一步降压作用(SBP120.3±3.7比116.3±6.8;DBP78.2±6.1比74.3±7.2,P>0.05).(3)24小时SBP,DBP下降幅度与治疗前SBP,DBP明显相关,r分别为0.803和0.797,P<0.01. 结论　氯沙坦是一种安全有效的降压药,其主要优点是24小时平稳降压,谷峰比满意,夜间无过度降压的危险,晨间血压上升受到明显抑制,基础血压越高,降压效果越好。     

氯沙坦对高血压病人24小时血压的影响

目的　观察氯沙坦对高血压病人 2 4小时血压的影响 ,探讨其临床意义。方法　 2 0例Ⅰ Ⅱ级高血压病人 ,入院后停药 2周 ,服氯沙坦5 0mg ,qd ,疗程 12周 ,1个月后血压若未降至 140 / 90mmHg以下 ,可加大剂量到 10 0mg ,qd ,治疗前后复查 2 4小时动态血压。以二次给药间距终末时血压下降数除以给药间距中最大血压下降数值作为药物降压的谷 /峰比 (T∶P) ,以夜间血压均值与白昼血压均值比较时下降 10 %或大于 10mmHg者为夜间血压下降或”杓型者” ,反之为夜间血压不下降者或”非杓型者”。结果　发现 (1)氯沙坦能明显降低高血压病人的 2 4小时平均血压 (mmHg) (SBP :134± 14比 113± 8,DBP :89± 12比 71±5 ,P <0 0 1) ;有效率为 85 .0 % .(2 )氯沙坦降压的SBP和DBPT :P比率分别为 78.6 % (4 8%～ 93 .9% )和 76 .2 % (4 6 .4%～ 89.6 % ) .SBP ,DBP和MBP的平滑曲线指数分别是 1.2 3± 0 32 ,1.36± 0 41和 1.32± 0 38.(3)对夜间血压高于正常值 (12 0 / 80mmHg)的高血压患者 ,氯沙坦明显降低夜间血压(mmHg) (SBP :142 .6± 8.8降至 116 .3± 11.4,DBP :89.2±9.6降至 74.3± 6 .8,P <0 0 1) ,对夜间血压已属正常者 ,氯沙坦无进一步降压作用 (SBP :12 0 3± 3 .7比 116 .3± 6 .8;DBP :78.2± 6 .     

急性脑卒中：降压或不降压？

急性脑卒中时的降压问题是个临床上很棘手的问题，应当视卒中的性质、血压升高的程度等具体情况而决定是否降压和降压的速度和幅度。高血压脑出血病人血压极度升高时，即当SBP≥200mmHg，和／或DBP≥120mmHg，和／或MAP≥125mmHg时(MAP=SBP 2DBP／3)，     

糖尿病合并高血压患者不同血压水平与心血管事件的相关性研究

目的探讨2型糖尿病(T2DM)合并高血压(EH)患者不同血压水平对心血管事件(CVD)的影响。方法收集T2DM合并EH患者2 8 0例,将患者按收缩压(SBP)水平分为>1 4 0 mmHg(1 mmHg=0.1 3 3 kPa)、≤1 4 0 mmHg、SBP≤1 3 0 mmHg、SBP≤120 mmHg 4组,每组70例。分析不同SBP对患者CVD的影响。结果 CVD(非致死性心肌梗死、需住院治疗的心衰或不稳定型心绞痛、冠状动脉血运重建)发病率在SBP>140 mmHg组高于SBP≤140 mmHg、SBP≤130 mmHg、SBP≤120 mmHg组,差别有统计学意义(P<0.05);在SBP≤140 mmHg、SBP≤130 mmHg、SBP≤120 mmHg 3组间比较,差异无统计学意义(P>0.05)。结论降压治疗可降低T2DM合并EH患者CVD发病率,但并非越低越好,SBP≤140 mmHg是一个合适水平。     

卡托普利与缓释硝苯地平治疗对高血压病患者运动血压的影响

目的探讨原发性高血压(EH)降压治疗后,运动血压反应是否恢复正常及观察卡托普利与缓释硝苯地平治疗有无差异。方法以正常成人22例作为对照,44例EH患者随机分为卡托普利和硝苯地平治疗两组。卡托普利始用12.5mg,2次/d,缓释硝苯地平始用10mg,2次/d,治疗2周,血压未降至正常者,逐渐加至25mg,2次/d或20mg,2次/d;观察3个月。于观察期结束前1周,测定运动前、运动终止后即刻、5、10、15min坐位血压,并计算SBP恢复至运动前水平的时间(血压恢复时间)。结果正常组运动后SBP和DBP升高幅度分别为(12.6±3.3)mmHg和(-0·1±2.6)mmHg,血压恢复时间为(5.9±2.0)min;高血压治疗两组虽然安静血压得到满意控制,但上述参数仍明显高于对照组;与硝苯地平组比较,卡托普利组运动终止即刻SBP/DBP升幅明显更低[(14.9±3.2/8.7±3.3比18.9±7.7/11.6±4.5)mmHg,P均<0·05];血压恢复时间更短[(9.8±4.6比13.3±5.3)min,P<0·05]。结论高血压病患者即使血压得到有效控制,运动血压增幅和血压恢复时间仍明显大于正常血压者;与缓释硝苯地平比较,卡托普利治疗运动血压增幅更小、血压恢复时间更短。     

动态血压监测评价贝尼地平治疗原发性高血压的疗效观察

目的应用动态血压监测(ABPM)的方法评价贝尼地平治疗原发性高血压的降压疗效、谷/峰比值及不良反应.方法采用开放的方法,20例研究对象经2周洗脱期,服用贝尼地平4mg/d一次,2周末坐位舒张压(SeDBP)≥90 mmHg者加量至贝尼地平8 mg/d一次,继续服用6周.于洗脱期末及治疗8周末各行ABPM和实验室检查一次.结果ABPM显示8周末24 h、日间、夜间收缩压(SBP/DBP)较洗脱期末分别下降(9.4±5.4/6.2±4.1)mmHg、(10.7±6.7/6.8±3.8)mmHg、(6.9±9.0/5.1±7.7)mmHg.降压T/P值SBP为58%,DBP为59%.无严重不良反应.结论贝尼地平4～8 mg/d一次为疗效确切的降压药物.     

正常高值血压人群动脉弹性功能的变化

目的　观察正常高值血压人群大小动脉弹性功能指数C1、C2的变化。方法　本研究分三组 ,(1)正常血压组 :收缩压 (SBP) <130mmHg ,且舒张压 (DBP) <85mmHg ,入选 72例 ,男 37例 ,女 35例 ;(2 )正常高值血压组 :SBP130～139mmHg和 /或DBP85～ 89mmHg ,入选 6 0例 ,男 31例 ,女 2 9例 ;(3)高血压组 :SBP≥ 14 0mmHg和 /或舒张压≥ 90mmHg ,入选 6 3例 ,男 31例 ,女 32例。采用HDICVProfilorDO - 2 0 2 0动脉功能检测仪测定大小动脉弹性功能指数C1、C2。结果　正常高值血压人群的C1、C2比正常血压组低 (C1:11 9± 3 4VS 15 3± 4 5 ;C2 :4 0± 2 1VS 5 6± 2 6 ) ,P <0 0 1;比高血压组高 (C1:11 9± 3 4VS 9 4± 3 1;C2 :4 0± 2 1VS 2 8± 1 3) ,P <0 0 1。C1、C2与血压呈负相关 ,即随着血压的升高而下降。结论　正常高值血压人群的动脉弹性功能下降 ,与血压水平呈负相关 ,随着血压的升高而降低     

Intervention at lower blood pressure levels to achieve target goals in type 2 diabetes: PRADID (PResión Arterial en DIabéticos tipo Dos) study

BACKGROUND: Arterial hypertension greatly increases the risk of cardiovascular disease, renal insufficiency, and retinopathy in patients with type 2 diabetes. Epidemiological studies all document a reduced risk for the aforementioned consequences at a blood pressure (BP) lower than 130/80 mmHg. For this reason, lower target BPs are recommended by recent guidelines committees. A lower threshold BP for treatment, also proposed in guidelines, could facilitate the attainment of the recommended target BP. However, little data exist on the efficacy and safety of starting pharmacological therapy in type 2 diabetic patients exhibiting high-normal BP (HNBP) or the first stage of isolated systolic hypertension previously considered as borderline isolated systolic hypertension (BISH). OBJECTIVE: To determine the antihypertensive efficacy and safety of the fixed-dose combination of the non-dihydropiridine calcium channel blocker (CCB) and ACE inhibitor verapamil SR/trandolapril 180/2 mg (V + T), versus trandolapril 2 mg (T), versus placebo (P) in previously untreated type 2 diabetic patients diagnosed as having HNBP or BISH. METHODS: Multicentric, double-blind, placebo-controlled study with a 16-week follow-up in three groups totalling 438 participants. The primary end-point was to attain the recommended guideline goal of a systolic BP (SBP) value lower than 130 mmHg in all patients and a diastolic BP (DBP) value lower than 85 mmHg in HNBP. Participants were randomized (2:2:1) to verapamil V + T, T, or P. Doses were doubled at week 8 if BP was not controlled. RESULTS: Both active groups were more effective than placebo to decrease SBP and DBP. The mean difference in SBP from placebo was 7.1 mmHg (3.3-10.9, 95% confidence interval (CI); P < 0.001) for T and 7.8 mmHg (3.9-11.6, 95% CI; P < 0.001) for V + T, with no statistical difference between both active groups. Combined treatment (V + T) decreased DBP by 4.6 mmHg (2.3-6.9, 95% CI; P < 0.001) more than placebo and 2.1 mmHg (0.3-4.0, 95% CI; P = 0.021) more than T. At the end of the study, 36.5% in the T group, 37.8% in the V + T group, and 14.9% (P = 0.009, P versus V + T and T) had attained the primary end-point. No significant difference was found between T and V + T with regard to the percentage of good control for SBP, but the control rate on the DBP (DBP < 85 mmHg) was significantly higher in the V + T group (88.8%), when compared with T (79.1%) or P (63.5%) (P = 0.002). Withdrawal rates due to adverse effects did not differ among trandolapril alone (9.4%), the combination (11.7%) and placebo (8.1%). CONCLUSION: Antihypertensive treatment is more effective than placebo for controlling SBP and DBP in previously untreated participants with type 2 diabetes exhibiting low threshold BP values. Combination therapy with verapamil SR/trandolapril was more effective than trandolapril alone for controlling DBP.     

Restoring sinus rhythm results in blood pressure reduction in patients with persistent atrial fibrillation and a history of hypertension

Effects of Rhythm Control on Blood Pressure . Introduction: The long‐term effects of atrial fibrillation (AF) on blood pressure (BP) in patients with hypertension (HTN) remain unclear. We hypothesized that restoration of normal sinus rhythm (NSR) results in a decrease in BP despite the expected increase in cardiac output. Methods and Results: Twenty‐four‐hour BP measurements were obtained during AF, and on Day 1 and Day 30 post‐successful cardioversion in 18 patients with AF and HTN (cardioversion group), and another 22 patients with AF and HTN with no immediate plans for cardioversion (control group). Except for the duration of AF, the clinical characteristics and use of medications were similar between the groups. In the cardioversion group, a significant decrease in diastolic blood pressure (DBP) and mean blood pressure (MBP) were noted on Day 1 post‐cardioversion with no significant change in systolic blood pressure (SBP): 117/74/88 ± 13/9/9 mmHg during AF and 116/70/85 ± 13/9/10 mmHg during Day 1 post‐cardioversion (P = 0.68; <0.01 and 0.04 for SBP, DBP, and MBP, respectively). In the 13 subjects who remained in NSR at Day 30, DBP and MBP decreased further on Day 30 when compared to Day 1 with no significant change in SBP: 118/76/90 ± 13/7/8 mmHg during AF; 119/72/88 ± 12/8/9 mmHg during Day 1; and 118/69/86 ± 10/8/7 mmHg during Day 30 post‐cardioversion (P = 0.97; <0.001 and 0.03 for SBP, DBP, and MBP, respectively). In the control group, no significant changes in BP were noted. Conclusion: Restoring NSR in patients with AF and HTN resulted in a sustained decrease in DBP and MBP. To our knowledge, this is the first study to show that maintenance of NSR improves BP control in patients with AF and HTN. (J Cardiovasc Electrophysiol, Vol. 23, pp. 722‐726, July 2012)     

Acute effects of sildenafil on flow mediated dilatation and cardiovascular autonomic nerve function in type 2 diabetic patients

Background Sildenafil, frequently used as on demand medication for the treatment of erectile dysfunction (ED), has been suggested to improve endothelial function but also to alter blood pressure (BP) and induce sympathetic activation. In people with type 2 diabetes mellitus (T2DM), a high‐risk population, the safety profile and the effects on endothelial function of a maximal sildenafil dose (100 mg) have not been investigated and therefore constituted the aim of our study. Methods A double‐blind, placebo‐controlled, cross‐over trial using a single dose of 100 mg sildenafil or placebo has been conducted in 40 subjects with T2DM without known CVD. Haemodynamic parameters, flow mediated dilatation (FMD) in brachial artery, cardiovascular autonomic function tests and spontaneous baroreflex sensitivity (BRS) were measured. Results Sixty minutes after administration of sildenafil but not placebo, a fall of supine systolic blood pressure (SBP) (?5.41 ± 1.87 vs. + 0.54 ± 1.71 mmHg) and diastolic blood pressure (DBP) (?4.46 ± 1.13 vs. + 0.89 ± 0.94 mmHg), as well as orthostatic SBP (?7.41 ± 2.35 vs. + 0.94 ± 2.06 mmHg) and DBP (?5.65 ± 1.45 vs. + 1.76 ± 1.00 mmHg) during standing occurred, accompanied by an increase in heart rate (+1.98 ± 0.69 vs. ? 2.42 ± 0.59 beats/min) (all p < 0.01 vs. placebo). Changes in BP to standing up, FMD, time domain and frequency domain indices of heart rate variability (HRV) and BRS were comparable between sildenafil and placebo. Conclusions Sildenafil administered at a maximum single dose to T2DM men results in a mild increase in heart rate and decrease in BP, but it induces neither an acute improvement of FMD nor any adverse effects on orthostatic BP regulation, HRV and BRS. Copyright © 2008 John Wiley & Sons, Ltd.     

Effects of hypertension and type 2 diabetes mellitus on the risk of total cardiovascular events in Japanese patients with hypercholesterolemia: implications from the Japan Lipid Intervention Trial (J-LIT).

Hyperlipidemia, hypertension, and diabetes mellitus (DM) are well-established risk factors for cardiovascular disease. We analyzed the cardiovascular events in hyperlipidemic patients with or without DM who were administered open-labeled simvastatin in groups stratified by blood pressure level using data from the Japan Lipid Intervention Trial (J-LIT). Hyperlipidemic patients with DM (n=6,288) had significantly more cardiovascular events than those without DM (n=33,933). The incidence rates of total cardiovascular events in the Non-DM and DM groups were 15.40 and 25.76 per 1,000 patients for the 6-year period, respectively. The relative risk of total cardiovascular events in the DM vs. the Non-DM group was 1.68, and the relative risk was significantly higher in the DM than in the Non-DM group. The relative risks of total cardiovascular events were significantly higher in DM and Non-DM patients whose systolic blood pressure (SBP) was greater than or equal to 130 mmHg compared to that of Non-DM patients whose SBP was less than 130 mmHg, and in DM and Non-DM patients whose diastolic blood pressure (DBP) was greater than or equal to 80 mmHg compared to that of Non-DM patients whose DBP was less than 80 mmHg. In all groups stratified by SBP and DBP, relative risks of total cardiovascular events were higher in DM patients than in Non-DM patients. For patients with hypercholesterolemia and DM, blood pressure should be strictly controlled in order to prevent both coronary events and stroke. These results are in good agreement with the JNC 7 and the ESH/ESC guidelines for DM patients, which recommended that the SBP and DBP be less than 130 and 80 mmHg, respectively.     

34例肾上腺醛固酮瘤切除术前安体舒通治疗围手术期血压的临床疗效观察

目的:研究高血压人群中发现的肾上腺醛固酮瘤切除手术前安体舒通治疗围手术期降压的临床疗效。方法:回顾34例肾上腺醛固酮瘤临床资料,分析术前安体舒通试验性治疗效果围手术期血压变化。结果:安体舒通治疗有效组(18例)比无效组(16例)围手术期收缩压和舒张压都显著下降[收缩压:(125.7±7.0)mmHgvs(140.9±15.6)mmHg,舒张压:(75.8±7.0)mmHgvs(86.2±8.9)mmHg,P<0.01]。与安体舒通试验性治疗前的血压相比,安体舒通治疗有效组围手术期收缩压和舒张压都显著下降[收缩压:(144.7±7.5)mmHgvs(125.7±7.0)mmHg,P<0.01,舒张压:(93.6±6.9)mmHgvs(75.8±7.0)mmHg,P<0.01],而无效组则均无统计学差异[收缩压:(144.6±11.3)mmHgvs(140.9±15.6)mmHg,(91.2±10.4)mmHgvs(86.2±8.9)mmHg,P<0.05]。将围手术期血压变化与安体舒通治疗效果进行偏相关分析,控制所有与安体舒通治疗相关和影响围手术期血压的因素,安体舒通试验治疗收缩压和舒张压改变分别与围手术期血压改善呈正相关(r=0.434,P=0.03;r=0.716,P=0.001)。结论:在高血压人群中筛选的肾上腺醛固酮瘤,术前安体舒通治疗(抗醛固酮治疗)的有效性与围手术期血压改善呈正相关。     

新诊断2型糖尿病患者脉压与颈动脉内膜-中层厚度的关系

目的对新诊断2型糖尿病患者血压及脉压水平与颈动脉内膜-中层厚度(IMT)的关系进行分析,以期为2型糖尿病患者预防早期心脑血管疾病提供临床依据。方法对中国糖尿病并发症防治研究——CDCPSⅠ期及Ⅱ期研究中1567例新诊断2型糖尿病患者(年龄30～70岁,其中女性698例,40.9%)行B超检查测量颈动脉IMT,并通过对血压的测量,分析血压及不同脉压(PP)对颈动脉IMT的影响,同时分析内膜增厚组(IMT≥0.8 mm)与内膜正常组(IMT<0.8 mm)血压和PP水平有无差异结果(1)合并高血压组与不合并高血压组比较,颈动脉IMT显著增厚[高血压组(0.76±0.15)mm,非高血压组(0.74±0.14)mm,差异有统计学意义(P=0.0006)]。(2)直线相关分析发现,颈动脉IMT与年龄(r=0.19548)、BMI(r=0.07252)、LDL(r=0.06523)、SBP(r=0.11173)、DBP(r=0.05962)、PP(r=0.10592)显著正相关(均为P<0.05)。(3)以PP 50mm Hg为界限将患者分为两组,脉压≥50mm Hg组颈动脉IMT(0.77±0.14)mm较脉压<50mm Hg组(0.74±0.15)mm显著增厚(P=0.0006);即使在非高血压患者,脉压≥50mm Hg组的颈动脉IMT(0.75±0.14)mm较脉压<50 mm Hg组(0.73±0.14)mm也有增厚(P=0.046);在<60岁的患者脉压≥50 mm Hg组的颈动脉IMT(0.75±0.15)mm较脉压<50 mm Hg组(0.73±0.14)mm也有显著增厚(P=0.008)(4)颈动脉IMT≥0.8 mm组SBP、PP均较IMT<0.8 mm组显著升高(P值分别为0.001和0.002),而两组间DBPIMT增厚组(78 2±9.8)mm Hg,正常组(79.1±10.0)mm Hg]差异无统计学意义(P=0.075)。结论在新诊断的2型糖尿病患者,PP与颈动脉IMT的正相关性与SBP相近,而强于DBP。对于PP≥50mm Hg的患者要尽早行颈动脉超声检查测量颈动脉IMT以早期发现可能存在的亚临床动脉粥样硬化性疾病,尽早进行干预治疗。     

Sources of measurement variation in blood pressure in large-scale epidemiological surveys with follow-up

The Copenhagen City Heart Study (CCHS) is a longitudinal epidemiological study of 19698 subjects followed up since 1976. Variation in blood pressure (BP) measurement in the first three CCHS surveys is evaluated by assessing two components, systematic variation and random variation [daytime and seasonally variation, observer bias, non-response bias, variation with explanatory variables, such as diabetes, hypertension, body mass index (BMI), height, plasma cholesterol and smoking] for the purpose of identifying relevant errors in population surveys. BP was measured in the seated position after a 5 min rest, with the cuff around the non-dominating arm, in accordance with recommended guidelines. The participation rate fell from 74% in survey 1 to 63% in survey 3. Significant non-response bias with respect to BP values was not found. No daytime variability was noted either in systolic (SBP) or diastolic (DBP) BPs. A trend towards a lower BP was seen during the summertime. Random variation, expressed as the standard deviation of the measured values, increased with increasing BP values (SBP: 11.9-13.4 to 21.2- 25.1 mmHg; DBP: 10.6-11.2 to 11.9-13.4 mmHg). SBP was positively correlated to BMI and plasma cholesterol. SBP was 5-10 mmHg higher in diabetics ( p = 0.000-0.04) than in age- and sex-matched nondiabetics. DBP did not differ between the two groups. Smokers from the age of 50 years had a 2-4 mmHg lower SBP ( p = 0.000-0.01) and 1-3 mmHg lower DBP ( p = 0.000-0.005) than had non-smokers. In addition, significantly fewer smokers took antihypertensive medication than did non-smokers ( p = 0.000). In conclusion, judging from the degree of association with BP and/or differences between the three surveys, the most important factors to consider were seasonal variation, BMI, the use of antihypertensive drug therapy, plasma cholesterol, smoking status and diabetes. An inter-survey comparison of BP in population cohorts requires controlling for these factors.