血压、血脂、血糖及肾功能不同水平对老年高血压心血管事件的影响

目的 探讨血压、血脂、血糖及肾功能不同水平对老年高血压心血管事件的影响.方法 选取老年高血压患者448例,以血压(收缩压SBP 140 mm Hg,舒张压DBP 80 mm Hg,脉压PP 60 mm Hg)、血脂(总胆固醇TC 5构.72 mmol/L)、血糖(空腹血糖FPG 7.0 mmol/L)及肾功能(估算肾小球滤过率eGFR 60 ml·min-1·1.73-2)为界值分为低、高水平组.结果 2年随访期间统计冠心病事件52.90%(237/448),脑卒中事件24.11%(108/448),心血管死亡6.70%(30/448).高SBP、DBP、PP、TC、FPG组患者冠心病事件、脑卒中事件与心血管死亡发生率明显高于低SBP、DBP、PP、TC、FPG组(P<0.05),低eGFR组上述指标明显高于高eGFR组(P<0.05).结论 血压、血脂、血糖及肾功能不同水平与老年高血压心血管事件的发生具有紧密关系,控制上述指标于正常范围在改善疾病预后状况中具有重要的意义.     

血压参数脉压对院内心血管病死率的相关分析

目的 :研究血压参数脉压对心血管病死率的相关作用。方法 :住院患者 14 4例入选 ,其中因心血管病死亡 2 4例 (病死组 ) ,选择连续病例 12 0例 (对照组 ) ,使用双变量相关分析判断年龄、糖尿病、收缩压、舒张压、平均动脉压和脉压与心血管病死率的相关性。结果 :两组间方差分析 :年龄、脉压差异有显著性 (P<0 .0 5 ) ,提示脉压增高可能是死亡的危险因素。其余参数差异没有显著性 (P>0 .0 5 )。相关分析结果表明死亡与年龄、脉压显著相关 ,而脉压有随着年龄增大而增大的相关趋势。结论 :与其他血压测值比较 ,脉压与心血管病死率呈明显相关性 ,更好地预测心血管病的死亡     

Endogenous migration modulators as parent compounds for the development of novel cardiovascular and anti-inflammatory drugs

Development of novel cell migration modulators for anti-inflammatory and cardiovascular therapy is a complex task since any modulator will necessarily interfere with a balanced system of physiological regulators directing proper positioning of diverse immune cell types within the body. Whereas this shall serve efficient pathogen elimination, lack of proper control over these processes may result in counterproductive chronic inflammation and progressive tissue injury instead of healing. Prediction of the therapeutic potential or side effects of any migration modulator is not possible based on theoretical considerations alone but needs to be experimentally evaluated in preclinical disease models and by clinical studies. Here, we briefly summarize basic mechanism of cell migration, and groups of synthetic drugs currently in use for migration modulation. We then discuss one fundamental problem encountered with single-target approaches that arises from the complexity of any inflammation, with multiple interacting and often redundant factors being involved. This issue is likely to arise for any class of therapeutic agent (small molecules, peptides, antibodies, regulatory RNAs) addressing a single gene or protein. Against this background of studies on synthetic migration modulators addressing single targets, we then discuss the potential of endogenous proteins as therapeutic migration modulators, or as parent compounds for the development of mimetic drugs. Regulatory proteins of this type commonly address multiple receptors and signalling pathways and act upon the immune response in a phase-specific manner. Based on recent evidence, we suggest investigation of such endogenous migration modulators as novel starting points for anti-inflammatory and cardiovascular drug development.     

2000-2006年他汀类药物对糖尿病肾病尿蛋白影响的国内文献Meta分析

目的:评价他汀类药物对糖尿病肾病尿蛋白的影响。方法:对国内他汀类药物影响糖尿病肾病尿蛋白的对照研究进行全面调查,对15项随机对照试验(包括1 364例患者)进行Meta分析。结果:采用随机效应模型对24 h尿蛋白进行比较:2χ=22.31,加权均数差(WMD)=-0.68(-1.15,-0.21)。采用随机效应模型对早期糖尿病肾病24 h尿白蛋白进行比较:χ2=925.73,WMD=-42.94(-85.19,-0.50)。采用随机效应模型对临床期糖尿病肾病24 h尿白蛋白进行比较:χ2=63.77,WMD=-566.72(-1 597.57,-464.12);报道的不良反应比较轻微。结论:他汀类药物可以降低糖尿病肾病的病理性尿蛋白,对尿白蛋白的作用不明显,但是否对终末期肾病有效,还取决于能在多大程度上改善尿蛋白的排泄,仍然需要大量的大规模多中心随机临床对照试验来加以证明。     

Treating cardiovascular complications of radiotherapy: a role for new pharmacotherapies

Introduction: Available data indicate that survivors of breast cancer and Hodgkin lymphoma who received mediastinal radiotherapy are at increased risk of developing radiation-induced cardiovascular diseases (RICVD) one or two decades after treatment. Although the risk with modern radiation treatment is likely to be lower in these patient groups, cardiotoxicity is still observed in a subset of patients. In addition, radiation-associated cardiovascular complications can, in the future, extend to other groups of cancer patients who are treated for tumors that are localized near the heart.

Areas covered: The authors briefly describe the most commonly observed types of RICVD. They then present an overview of preclinical animal and cellular models that have been used to investigate the mechanisms underlying RICVD pathophysiology. The beneficial effects of available drugs, and potential targets for new molecules are also reported.

Expert opinion: There is a need to develop cardio-oncological programs and pharmacotherapies specifically targeting RICVD. Beyond statins, ACE inhibitors, anti-inflammatory and antioxidant agents, preclinical studies indicate that TGFβ receptor I inhibitors, Sestrin2 inducers, recombinant neuregulin-1 and miR-21 inhibitors might represent novel promising strategies. In order to properly determine the optimal therapeutic index for these molecules, in vivo models combining cancer and RICVD should be envisioned.     

Differences in preventing new‐onset cardiovascular events with statin therapy in seniors aged 75 years and over: A cohort study in the South Korean National Health Insurance Database

The aim of this cohort study was to compare the effectiveness of statin regimens for primary prevention among seniors aged ≥ 75 years. Seniors aged 75‐100 years for whom statin therapies for primary prevention were newly initiated between 1 January 2009 and 31 December 2011, and who continued the same statin regimen during the first year after the index date were identified using the claims data from the South Korean National Health Insurance Database. A propensity score matching and multivariable Cox proportional hazards model were developed to evaluate adjusted ischaemic cardiovascular‐cerebrovascular event (CCE) risk and all‐cause mortality risk for all patients, as well as for subgroups. A total of 5629 older patients aged 75‐100 years were included in the study population. Compared to moderate‐intensity statin therapy, low‐intensity statin therapy was significantly associated with increased risk of ischaemic CCEs, while high‐intensity statin therapy was associated with reduced risk of ischaemic CCEs; however, compared to moderate‐intensity statin therapy, both low‐intensity and high‐intensity statin therapies were associated with increased risk of all‐cause mortality. For the 4689 older patients who regularly received moderate‐intensity statin therapy including 10 mg atorvastatin, 20 mg atorvastatin, 10 mg rosuvastatin or 20 mg simvastatin for primary prevention, multivariable regression adjusting for potential covariates revealed no significant difference in ischaemic CCEs or all‐cause mortality between the moderate‐intensity statin users and 10 mg atorvastatin users both before and after propensity scoring matching. No significant heterogeneity was detected in the patient subgroups. The results of this study based on real‐world data can supply evidence‐based reasons for choice of statin regimen for the primary prevention of CCEs in older people aged ≥ 75 years.     

Neurotransmitters in central cardiovascular regulation: glutamate and GABA

1. The role of the amino acids L-glutamate and GABA as neurotransmitters in central pathways regulating cardiovascular function is briefly summarized.     

Understanding the morning rise in blood pressure

1. The morning period has been recognized as the highest risk period of the day for cardiovascular events, particularly stroke and is also associated with a rapid surge in blood pressure. 2. Evidence now exists to show that the morning surge in blood pressure is an independent risk factor in some elderly hypertensive subjects. 3. However, methods to assess the contribution of the morning blood pressure surge from ambulatory recordings or home recordings, using clock times or times of waking, do not take into consideration the individual patterns of blood pressure change which can range from a rapid rise prior to or following waking to a slow increase over several hours. 4. In the present review we describe a novel method for determining the individual changes using a double logistic equation fitted to the individual pattern of blood pressure change. 5. Methods are presented to determine the rate of rise function over the morning period as well as predicting the change over a fixed time window which may be useful in refining the contribution of the blood pressure surge to cardiovascular risk. 6. Hypertensive people have an exaggerated rise in morning blood pressure as well as a greater rate of rise. 7. Antihypertensive drugs and dosing regimes are being developed which may be useful adjuncts to standard therapy for preventing morning hypertension and hopefully also reducing cardiovascular damage or events.     

嘉定区华亭社区2012年心脑血管疾病监测结果分析

目的 ：了解嘉定区华亭镇2012年社区人群中心脑血管病发病现状及变化趋势,探索降低社区人群心脑血管病发病的措施。方法：利用防治条线汇总资料进行统计分析。结果：华亭镇2012年心脑血管病发病率为247.95/10万,死亡率为292.66/10万。缺血性脑卒中发病率最高,男性高于女性,随年龄增长呈递增趋势,60岁以上发病人数占总发病人数的88.52%。结论 ：心脑血管疾病已经成为严重危害华亭镇社区居民的慢性病之一,加强60岁以上人群心脑血管病防治已刻不容缓。     

Cigarette smoking lowers blood pressure in adolescents: the Irbid-TRY

Objective: Tobacco consumption adversely affects cardiovascular (CV) disease (CVD) and risk profile, including hypertension. The long-term effect of cigarette smoking on blood pressure (BP) in adolescents is still, however, equivocal. Thus, the current study examined the CV indices in male adolescent cigarette smokers versus nonsmokers.

Method: Resting heart rate, systolic BP (SBP) and diastolic BP (DBP), mean arterial pressure (MAP), pulse pressure (PP) and rate pressure products (RPP) were examined using automatic oscillatory method, while smoking status was determined with Youth Risk Behavior Survey.

Results: After controlling for cofactors, the ANCOVA showed that CV measures in the male adolescent smokers were lower (p?<?0.05) than nonsmokers. Additionally, regression showed that smoking status explained 20.6% of SBP, 5.0% of DBP, 13.4% of MAP, 7.5% of PP and 13.4% of RPP.

Conclusion: The results suggest that cigarette smoking lowers CV measures in adolescents. However, more studies are needed to describe the mechanism(s) for lowering CV measures and explain the relationship of adolescent smoking with adulthood CVDs.     

普罗帕酮致严重心血管不良反应8例

本文报道普罗帕酮(propafenone)致严重心血管不良反应8例。静脉注射普罗帕酮7例中,显著血压下降者6例;窦房结功能抑制3例;急性左心衰竭2例;心房扑动患者静脉给药后,心房扑动变为1:1传导,心室率显著加快1例;另1例心房扑动患者,口服普罗帕酮600mg/d,9d后发生完全性房室传导阻滞,呈缓慢室性自搏性心律伴显著血压下降。作者推荐先用最低有效量,逐渐加量,特别对左室功能受损,窦房结功能不全和有传导障碍者,尤须谨慎。     

Antihypertensive efficacy of pinacidil — Automatic ambulatory blood pressure monitoring

Summary Forty-three patients with mild essential hypertension were randomized into two double-blind studies: pinacidil vs. placebo or pinacidil vs. hydralazine. Pinacidil (62±18 mg/day) decreased office systolic and diastolic blood pressures from 145 to 137 mm Hg and from 98 to 89 mm Hg, respectively, after 6 weeks of therapy. Similarly, hydralazine (128±28 mg/day) reduced supine systolic blood pressure from 140 to 134 mm Hg and supine diastolic blood pressure from 93 mm Hg to 84 mm Hg. Significant tachycardia was not noted with either drug. Ambulatory blood pressure was monitored for 24 h during the placebo-washout and efficacy phases with both pinacidil and hydralazine. Mean 24-h blood pressure was 128 systolic and 81 diastolic with pinacidil and 121 systolic and 76 diastolic with hydralazine. Reduction in awake hypertensive diastolic blood pressure was significant for both pinacidil and hydralazine. Normal sleep diastolic blood pressure was not reduced by pinacidil but was reduced by hydralazine. Side-effects with both drugs included edema, headache, and palpitations. These data demonstrate that pinacidil is as effective an antihypertensive agent as hydralazine.     

饱和脂肪酸与心血管疾病关系的研究进展

摘要： 关于饱和脂肪酸 （SFA） 对心血管疾病的作用现在观点不一, 食物种类来源、 SFA碳链的奇偶和链长是很大的影响因素。本文回顾了饱和脂肪酸对心血管疾病危险因素的影响, 除了中链饱和脂肪酸 （MCSFA）, 其余类型的 SFA可使血压升高, SFA对血管功能中度有害, 随着摄入时间的延长, 乳制品导致血脂异常的风险将增大, 纯棕榈油和椰子油对降低血脂有帮助, 摄入SFA碳链的奇偶和长度不同的SFA, 罹患2型糖尿病的风险不同; 同时总结了SFA 对心血管疾病 （CVD） 患病风险的影响, 总体SFA的摄入会增加CVD的风险, 但不同食物有不同的影响, 富含SFA的椰子油会导致心肌纤维化, 乳制品尤其是奶酪的摄入可降低CVD的发病风险, 红肉对心血管健康中度有害。     

昼夜节律与心血管意外的药物治疗对策

198 5年以来许多回顾性和前瞻性的研究表明 ,心血管意外的发生率存在着明显的昼夜节律变化 ,表现为早晨觉醒后数小时的高发生率和夜间的低发生率。也有一些研究显示午后还有一个次高发时段。这种节律性可能与人的昼夜生理节律变化及起床后的体力活动有关。由于传统的药物治疗方法可能在次日早晨醒起后不再发挥有效的保护作用 ,所以制定合理的给药方案有重要意义     

739例心血管类药物不良反应分析

目的:调查心血管类药物ADR的临床特点及产生原因。方法:从1998年～2001年4月公开发行的国内70余种医药学期刊中收集到心血管类药物不良反应个案776例,其中符合药物不良反应判定标准的739例,按照不良反应类别进行归纳、统计和分析。结果:心血管类药物的不良反应共涉及人体7个系统,其中呼吸系统所占的比例最大(29.8%);涉及相关药物六大类,以ACEI类药物较为常见(230例);重度不良反应46例,死亡15例,死亡占2.03％;51岁以上年龄组的不良反应(78.9％)高于其 他年龄组;口服给药(65.5％)较其他给药途径发生的比例高。结论:心血管类药物ADR的发生与药物的药理作用、给药途径、合并用药及患者的年龄、个体差异、饮食习惯等有关。