中老年人高血压病控制现状调查

目的：了解中老年人高血压病控制现状。方法：668例高血压病患者化验血脂、血糖，测量身高、体重、血压，进行生活方式调查并与624例血压正常者进行比较。结果：在668例中，收缩压≥140mmHg的占46．4％，舒张压≥90mmHg的占37．6％，伴超重和肥胖的分别占40．7％和39．2％，伴甘油三酯（TG）增高者占40．4名，总胆固醇（TC）增高者占30．7％，血糖增高者占22．8％。与非高血压患者相比差异均有显著性。结论：伴超重、肥胖、高血脂、高血糖者较多，应将改变不健康的生活方式作为高血压预防的基本措施，将干预血压、血脂、血糖并重。     

慢性肾脏病情感障碍及危险因素研究

目的：了解慢性。肾脏病患者焦虑和抑郁的发生情况及其危险因素。方法：采用横断面调查,对住院病人进行SAS和SDS量表测评。结果：慢性。肾脏病患者焦虑和抑郁的发生率分别为53、4％、60．9％,其中。肾功能不全组又明显高于。肾功能正常组,焦虑的发生率分别为72．9％、23．9％;抑郁的发生率分别为74．3％、39．5％。尿毒症患者不同的替代治疗方式对焦虑的发生和抑郁严重程度的分布有影响,。肾移植病人焦虑的发生率最低。多因素分析表明Cer降低(OR=0．911,0．831-0．999)、自费(OR=3．528,95％CI：1．242-10．018)和家庭低收入(OR=3．493,95％CI：1．252-9．747)是抑郁的危险因素;Ccr降低(OR=0．973,0．959-0．981)和家庭低收入是焦虑的危险因素(OR=2．571,95％CI：1．108-5．969)。结论：慢性。肾脏病患者,特别是。肾功能不全患者,焦虑和抑郁的发生率高于普通人群;Ccr降低是焦虑和抑郁的危险因素。医药费来源于属于自费和低家庭收入是抑郁发生的危险因素;低家庭收入是焦虑发生的危险因素。     

老年高血压患者86例临床分析

目的：探讨老年人高血压的临床特点。方法：对86例老年高血压患者的临床特点进行分析，并与62例非老年患者进行比较。结果：单纯收缩期高血压老年组占61．6％，非老年组占19．4％(P＜0．01)。脉压＞60mmHg老年组占70．9％，非老组占17．7％(P＜0．01)；老年组中合并冠心病占64．0％，糖尿病占31．4％，血脂异常占52．3％，慢性呼吸道疾病占25．6％，慢性肾功能不全占10．5％，均明显高于非老年组；采用2～3种降压药联合治疗的老年组(66．3％)多于非老年组(48．4％)，差异有显著性(P＜0．05)。结论：老年高血压以单纯收缩期高血压类型多见，且脉压增宽，同时，老年高血压患者常合并冠心病、糖尿病、血脂异常、慢性呼吸道疾病、慢性肾功能不全等疾病，使老年人高血压的治疗变的复杂。因此，对老年人高血压的治疗应强调个体化原则。     

35岁以上首诊患者32756例血压值与其性别、年龄关系分析

目的：分析35岁及以上首诊患者血压值与其性别、年龄的关系。方法：按正规测血压的要求，对32756例35岁及以上首诊患者测量坐位血压，并对血压分类进行统计。结果：32756例首诊患者平均收缩压为(126．9&;#177;21．7)mmHg(1mmHg=0．133kPa)，舒张压为(78．1&;#177;11．4)mmHg，男性平均血压高于女性(t=10．387，22．424，P&;lt;0．001)。检出高血压11590例，男性检出4776例，女性检出6814例，男性检出的1，2级高血压构成比(38．10％)高于女性(33．70％)(r=65．357，P&;lt;0．001)。高血压构成比随年龄增高而增高(r=2388．55，P&;lt;0．0001)。正常血压、高血压前期、1级及2级高血压的构成比分别为27．44％，37．18％，22．48％及12．91％。结论：医院门诊为35岁及以上首诊患者测量血压，对及早检出高血压患者并进行干预治疗有重要临床意义，是预防和控制高血压，降低心脑血管病发生率的最有效措施之一。     

肾小球疾病患者高血压病患病率的影响因素分析

目的：探讨肾小球疾病患者合并高血压病的发生率及其影响因素。方法：回顾分析3003倒肾活检和临床确诊的肾小球疾病患者的临床、病理及实验室检查资料。结果：（1）合并高血压病的率为48．6％（中度和重度高血压病占36．5％）,其中不同肾病理类型患者高血压发生率糖尿病肾病（DN）最高（84．3％）,微小病变肾病（MCD）最低（26．70o）;不同职业患者高血压痛发生率农民最高（56．7％）,学生最低（16．8％）。高血压病知晓率为49．1％,控制率（血压〈140／90mmHg）为19．4％;（2）伴高血压病者的血钠和心电图异常发生率明显升高;（3）高尿酸血症、高血压痛家族史、超重或肥胖、空腹血糖水平、慢性肾病（CKD）分期、病程、年龄、肾小球硬化、肾内血管病变及间质小管病变均影响高血压病的发生。结论：半数肾小球疾病患者伴高血压病,但高血压病知晓率和控制率均低。高尿酸血症、高血压病家族史、超重或肥胖、糖代谢异常、病程长、增龄、肾功能差及肾组织慢性病变程度重均是发生高血压病的独立危险因素。     

二十年脑卒中住院患者高血压状态3059例回顾性资料分析

目的：探讨脑卒中患者入院时高血压的分布情况及其与意识状态及脑卒中复发的关系。方法：选择广州中山大学第一附属医院1980-01／1999-12住院资料完整的脑卒中患者3059例，回顾性分析脑卒中患者入院时高血压[收缩压≥140mmHg(1mmHg=0．133kPa)和(或)舒张压／&;gt;90mmHg]情况，发病的特点，脑卒中与高血压的关系，脑卒中与高血压病患者性别、年龄的分布情况，与不同程度高血压的关系，与意识状况及脑卒中史的关系。结果：①入院时血压升高者共1970例，占全部脑卒中患者的64．40％，(1970／3059)，其中原有高血压病者1291例，占全部血压升高者的65．53％，占全部原有高血压病者(1645例)的78．48％。②血压升高者性别、年龄的分布：1970例中男1223例(62．08％)，女747例(37．92％)，50岁以上者1771例(90％)。各种类型脑卒中高血压人数均随年龄的增长而增加。③血压升高者的病变类型及与性别的关系：脑出血837例(42．49％，男女比例为1．87：1)，脑梗死1009例(51．22％，男女比例为1．58：1)，蛛网膜下腔出血124例(6．29％，男女比例为0．94：1)。④血压升高与病变类型及病情程度的关系：脑出血血压升高者共837例．其中重度246例占29．39％，脑梗死中血压升高者1009例，重度205例占20．32％，蛛网膜下腔出血中共124例，重度25例占20．16％，脑出血中重度高血压的比例要高于其他类型脑卒中(P&;lt;0.05)。3种类型的脑卒中均为轻度高血压者居多。⑤血压升高者当中意识障碍的发生率：25．08％，(494／1970)，有既往脑卒中史者共343例(17．41％)。结论：脑卒中患者入院时高血压者多出现在50岁以上，男性稍多，血压升高的程度主要以轻度为主。血压高者出现意识障碍者约1／5，既往有脑卒中病史患者≤1／5。     

急性心肌梗死后血压特点及与预后关系分析

目的 分析高血压患者发生急性心肌梗死时血压变化特征及预后的关系。方法 218例急性心肌梗死患者按有、无合并原发性高血压分为A、B2组，合并高血压者116例归入A组，无合并者102例归入B组。对比2组患者发生急性心肌梗死后血压的变化及临床特点。结果 无痛性心肌梗死发生率在A组为31．9％，显著高于B组的14．7％（P〈0．05）。血清肌酸激酶峰值A组为（18±10）×10^2U／L，B组为（13±10）×10^2U／L；心肌型肌酸激酶同功酶A组为（1．5±0．8）×10^2U／L，B组为（1．2±0．9）×10^2U／L，A组显著高于B组（P〈0．05）。心肌梗死后血压下降发生率：A组为83．6％，B组为26．5％，差异有显著性（P〈0．01）；收缩压下降：A组为（36±16）mmHg，B组为（14±10）mmHg，差异有显著性（P〈0．01）。心功能分级构成比：属心功能Ⅰ级患者在A组和B组分别占42．2％和58．8％；心功能Ⅱ级患者例数2组相似；心功能Ⅲ级以上A组为28．5％，高于B组的12．7％，差异有显著性（P〈0．05）。并发症发生率：A组心力衰竭、严重心律失常、心源性休克、再梗死发生率、住院率及病死率均高于B组。结论 高血压并发心肌梗死后血压下降发生率及严重程度、并发症及病死率均较血压正常者高，近期预后差，故高血压是影响心肌梗死预后的重要危险因素。     

慢性肾脏病患者降压药物的合理应用

肾脏是调控血压的重要器官之一。高血压既是导致慢性肾脏病（chronic kidney disease,CKD）的主要病因,又是慢性肾脏病发生发展所致机体系统、器官损害的最常见临床表现。在肾功能正常的CKD患者中,高血压的发生率达50%左右,到终末期肾病（end stage renal disease,ESRD）时,高血压的发生率则超过了95%。长期的高血压、容量负荷过重和贫血导致的左心室肥厚、扩张是CKD患者最常见、最危险的心血管并发症和全因死亡原因。因此,控制血压，减少肾脏损伤，预防心脑血管并发症和全因死亡是CKD患者一体化治疗的重要措施。     

血液透析患者血压控制的目标值及其措施

高血压既可以是慢性肾脏病（CKD）的病因，也是其常见的并发症。高血压作为并发症可在CKD的早期出现，并且与肾脏病预后不良相关。在美国第三次全国健康和营养检测对15，600例参加的调查表明，随着肾小球滤过率（GFR）的下降，高血压的发生率也随之增高。在GFR小于60mL／min／1．73m2（CKD3～5期）的人当中大约50％～75％患有高血压。如果用JNC7的标准[SBP≥140mmHg（1mmHg=0．133kpa）或DBP≥90mmHg]，在一个2535例血液透析患的研究中，仅14％的患血压正常，同时在高血压的患中，也仅有30％的患血压得到控制。[第一段]     

维持性血液透析合并高血压治疗状况的多中心调查

目的 调查分析维持性血液透析（MHD）患者高血压治疗现状及相关危险因素。方法 对南京市5所三级甲等医院电97例MHD合并高血压患者的有关临床资料进行调查，用多因素Logistic回归分析该组人群人口学资料、透析时间、透析剂量、降压药物应用情况以及各种实验室参数与透析前、透析后高血压的关系。结果 ①297例MHD患者中，221例（74．4％）血压控制不理想[透析前和（或）透析后血压≥140／90mmHg（1mmHg=0．133kpa）]，242例患者服用降压药物，其中91例（37．6％）用单药降压，151例（62．4％）患者联合降压；所有降压药物中CCBs应用最为广泛（85．1％），其次为β-受体阻滞剂、ACEIS、ARBs（分别为44．6％、20．7％、16．5％），所有患者平均用药数量为1．54种；②MHD患者主要以单纯收缩压（收缩压≥140mmHg，舒张压〈90mmHg）升高为主，透析前、透析后所占比例分别为63．9％、72．0％。单纯舒张压升高（收缩压〈140mmHg，舒张压≥90mmHg）的患者较少（透析前、透析后仅为2．1％、6．9％）；③应用降压药物数量与血红蛋白浓度（r=-0．250，P=0．001）存在负相关关系。④多因素Logistic回归分析表明透析不充分（Kt/v〈1．4）（OR=5．308，95％CI1．60817．560）、血红蛋白浓度（OR=O．956，95％C10．914～0．999）是透析前血压未得到控制的主要危险因素；中重度贫血（OR=2．493，95％CI 1．085～5．728）是透析后血压未得到控制的主要危险因素。结论 MHD患者高血压控制不达标仍较突出，以收缩压升高为主，提高透析充分性、纠正贫血可能有助于透析患者血压控制。     

Management of hypertension for prevention from cardiovascular events

Hypertension is the one of the strongest predictors of cardiovascular events. The objectives of treatment are to control hypertension and prevent the occurrence of cardiovascular diseases due to sustained high blood pressure, thereby reducing morbidity and mortality. Treatment is necessary for all patients with hypertension (blood pressure > or =140/ 90 mmHg) and for those with a blood pressure of 130/80 mmHg if they have diabetes, chronic kidney disease (CKD) or myocardial infarction. The recommended target for blood pressure control is < 130/85 mmHg in young and middle-aged people. It should be < 130/80 mmHg in those with diabetes mellitus, CKD or myocardial infarction and < 140/ 90 mmHg in elderly people and patients with cerebrovascular diseases. Moreover, these hypertensive patients should be strictly controlled their blood pressure by adequate antihypertensive agents.     

Aliskiren for the treatment of essential hypertension under real-life practice conditions: design and baseline data of the prospective 3A registry

Background: The renin–angiotensin system (RAS) is a key target for blood pressure control and for cardiovascular and renal protection. Aliskiren is the first‐in‐class direct oral inhibitor of renin that controls the rate‐limiting step in the RAS cascade. So far little is known about the use and efficacy of aliskiren in the treatment of essential hypertension under clinical practice conditions. Methods: The 3A registry was an open, prospective cohort study (observational registry) of 14,988 patients in 899 offices throughout Germany. Consecutive patients were eligible for inclusion if their physician had decided to modify their antihypertensive therapy. This included treatment with aliskiren or an angiotensin converting enzyme inhibitor (ACE‐I)/angiotensin receptor blocker (ARB) or agents not blocking the RAS, alone or on top of an existing drug regimen. Results: Mean age of patients was 65 years, their mean body mass index was 28.2 kg/m² 53.5% were men, 36% working, 90% in statutory health insurance and 26% in any disease management programme. Patients in the aliskiren and the RAS groups compared with the non‐RAS group were older, more often men, had a longer history of hypertension, and had a higher prevalence of comorbidities (diabetes, chronic heart failure, ischaemic heart disease, renal disease). Mean systolic, but not diastolic blood pressure was substantially higher in the aliskiren group (158/91 mmHg vs. 154/89 mmHg in ACE‐I/ARB vs. 152/89 mmHg in non‐RAS). Mean number of antihypertensive drugs was higher in the aliskiren group compared with the other groups (3.0 drugs vs. 2.5 in ACE‐I/ARB vs. 1.6 in non‐RAS; p < 0.0001). Conclusions: In this large cohort of outpatients with hypertension, aliskiren was used mainly in patients with more severe stages of hypertension and those with concomitant diseases such as diabetes mellitus and impaired renal function. The 3A registry will provide important information about the use and efficacy of aliskiren in a real‐life setting.     

Management of hypertension in patients developing end-stage renal failure

The benefits of treating hypertension include preventing or delaying the progression of chronic renal failure, and reducing the cardiovascular complications of patients with renal disease. We examined how well hypertension had been managed in all 145 patients from a single health district who started dialysis during a 3-year period. Data relating to management of hypertension, including all blood pressure readings, were obtained from their general practice and hospital case notes. The anonymized data were reviewed by two independent assessors against a set of standards based on the British Hypertension Society guidelines. There was close agreement between the assessors. Complete records were obtained in 98.5% of cases. Of the 145 patients, 107 (76.4%) were hypertensive before developing end-stage renal failure. There were departures from standards in all categories of care: 24.3% in detection/diagnosis, 29% in investigation, 22.4% in referring to a nephrologist, and 17% in follow-up. The British Hypertension Society recommended standard for diastolic blood pressure of 90 mmHg was achieved in only 45%. In 32%, the assessors independently concluded that poor blood pressure control might have affected adversely the progression of renal failure. New methods of dealing with these problems are required and possible approaches are discussed.     

肾活检所致出血的相关因素分析

[目的]探讨超声引导下肾活检所致出血并发症的相关因素,对出血原因进行分析,以减少并发症的发生.[方法]在超声引导下以美国Bard 16G自动活检装置对520例肾脏病患者行肾穿刺活检,从肾实质厚度、肾穿刺次数、肾穿时血压水平、肾脏病理改变几方面进行分析.[结果]在520例肾穿活检中,肾实质厚度在0.80~1.5 cm、肾...     

Controlling hypertension in patients with diabetes

Hypertension and diabetes mellitus are common diseases in the United States. Patients with diabetes have a much higher rate of hypertension than would be expected in the general population. Regardless of the antihypertensive agent used, a reduction in blood pressure helps to prevent diabetic complications. Barring contraindications, angiotensin-converting enzyme inhibitors are considered first-line therapy in patients with diabetes and hypertension because of their well-established renal protective effects. Calcium channel blockers, low-dose diuretics, beta blockers, and alpha blockers have also been studied in this group. Most diabetic patients with hypertension require combination therapy to achieve optimal blood pressure goals.     

Prevalence of hypertension and associated risk factors in people with long-term spinal cord injury living in the Netherlands

Purpose: To describe the prevalence of hypertension and associated risk factors in people with long-term spinal cord injury (SCI) and to compare the prevalence of high blood pressure and/or the use of antihypertensive drugs with the prevalence in the Dutch general population.

Method: Multicentre cross-sectional study (N?=?282). Hypertension was defined as a systolic blood pressure (SBP) of ≥140?mmHg and/or a diastolic blood pressure (DBP) of ≥90?mmHg after?≥2 blood pressure measurements during?≥2 doctor visits. High blood pressure was defined as a single measurement of a SBP of ≥140?mmHg and/or a DBP of ≥90?mmHg.

Results: The prevalence of hypertension was 21.5%. Significant predictors were: lesion level below C8 (T1–T6: OR =6.4, T7–L5: OR =10.1), history of hypercholesterolemia (OR =4.8), longer time since injury (OR =1.1), higher age (OR =1.1). The prevalence of high blood pressure and/or the use of antihypertensive drugs was higher in men (T1–T6 lesion: 48%; T7–L5 lesion: 57%) and women (T1–T6 lesion: 48%; T7–L5 lesion: 25%) with a SCI below C8 compared to Dutch able-bodied men (31%) and women (18%).

Conclusion: High blood pressure is common in people with SCI. Screening for hypertension during annual checkups is recommended, especially in those with a SCI below C8.

• Implications for Rehabilitation

• High blood pressure is common in people with long-term SCI living in the Netherlands and its prevalence is higher in both men and women with a spinal cord lesion level below C8 compared with the age-matched Dutch general population.

• It is recommended to screen for hypertension during annual checkups in people with SCI, especially in those with a higher risk of developing hypertension, e.g. those with a spinal cord lesion level below C8 and an age of ≥45 years or a time since injury of ≥20 years.

• When a high blood pressure is measured in people with SCI, they should receive a further assessment of the blood pressure according to the available guidelines for the general population, including ambulatory 24?h-blood pressure monitoring.

     

甘油三酯/胱抑素C比值联合3项指标对糖尿病肾病的诊断价值

目的:探讨甘油三酯/胱抑素C（TG/Cys-C）比值联合糖尿病视网膜病变、糖尿病病程、收缩压3项指标对糖尿病肾病（DKD）的诊断及鉴别诊断价值。方法:回顾性分析2013年1月至2021年2月徐州市4家三甲医院肾脏病科已行肾活检的2型糖尿病合并肾损伤患者的临床资料。根据肾脏病理分型分为DKD组（51例）和非糖尿病肾病（N...     

肾活检术患者使用镇静药物的临床观察及护理

目的观察肾活检术前镇静药物对缓解患者疼痛感及紧张程度、预防术中高血压、改善术后睡眠状况的效果。方法2005年6月至8月,将符合肾活检指征的102例肾脏病患者随机分成两组,治疗组（n=52）在肾活检术前晚使用“艾司唑仑”及术前15min使用“咪达唑仑”,对照组（n=50）术前不使用任何镇静药物;分别观察两组患者术前、术中和术后的心理评分,术中血压、疼痛感、紧张程度及术中配合情况,术后睡眠及发生出血并发症等情况。结果治疗组患者术前心理评分高于对照组（P〈0．05）,术中血压升高比例、高度紧张比例、重度疼痛感患者比例均低于对照组（P〈0．05）,术中配合程度及术后入睡休息情况也明显优于对照组（P〈0．01）;两组患者发生术后出血并发症的情况无明显差异。结论对拟施肾活检术的患者在术前晚使用“艾司唑仑”及术前15min使用“咪达唑仑”能降低患者术中紧张度及疼痛感,改善术中配合情况及术后入睡休息情况。     

Hypotensive effect of nephrectomy in malignant renal hypertension and the function of the remaining kidney at late follow-up

The long-term results of nephrectomy were evaluated in 27 patients with malignant renal hypertension. The hypotensive effect of nephrectomy, function of the remaining kidney, central hemodynamics, and peripheral blood renin were investigated. It was found that hypertension remitted in subjects with an unaffected remaining kidney which completely compensated for the function of the removed kidney and maintained blood pressure within normal. Nephrectomy performed during malignant arterial hypertension that developed because of unilateral pyelonephritis and unilateral stenosing of the renal artery with a sufficient total renal function before surgery led to a prolonged remission of arterial hypertension and reverse development of the symptoms of its malignancy. Hypertension did not remit during chronic pyelonephritis of a single kidney. Renal function was substantially decreased as compared with the control group.     

Orthostatic hypertension in patients with type 2 diabetes

OBJECTIVE: The prevalence and clinical importance of orthostatic hypertension (OHT) in diabetic patients has not been elucidated, in contrast to orthostatic hypotension, which is occasionally found in diabetic patients with autonomic neuropathy. RESEARCH DESIGN AND METHODS: The prevalence and severity of orthostatic hypertension was investigated in 277 Japanese male patients with type 2 diabetes, including 90 hypertensive patients and 128 nondiabetic age-matched male subjects. Patients treated with antihypertensive drugs were excluded from the study. OHT was defined as an increase in diastolic blood pressure (DBP) from <90 to >or=90 mmHg and/or an increase in systolic blood pressure (SBP) from <140 to >or=140 mmHg after standing from supine position. Clinical profiles and several serum biochemical parameters were determined in addition to chest X-rays and electrocardiograms. RESULTS: The prevalence of OHT in normotensive and hypertensive diabetic patients was significantly higher than in control subjects (12.8 vs. 1.8%, P < 0.01, for normotensive patients; 12.6 vs. 11.1%, not significant, for hypertensive patients). Orthostasis induced a mean increase of 6.8 +/- 11.4 mmHg in SBP and 9.1 +/- 5.2 mmHg in DBP in diabetic patients with OHT compared with those without OHT (-1.0 +/- 9.0 and 3.8 +/- 6.6 mmHg, respectively). Vibration sensation in the lower limb was reduced in diabetic patients with OHT, but the percent coefficient of variation of RR interval, cardio-to-thoracic ratio on chest X-ray, and serum triglyceride levels were higher in these patients compared with normotensive diabetic patients without OHT. CONCLUSIONS: Orthostatic hypertension is a novel complication in normotensive diabetic patients and may associate with early stage neuropathy and development of sustained hypertension.