波依定治疗老年单纯收缩期高血压的疗效观察

目的：观察波依定对老年单纯收缩期高血压的疗效。方法：42例老年单纯收缩期高血压患者波依定5－10mg,每天早晨口服1次,疗程3个月,治疗前后对患者的动态血压,血糖、血脂和血尿酸进行监测,并进行统计分析,结果：波依定治疗后24小时平均收缩压、日间及平均收缩压均明显下降（P＜0．05）;24小时平均舒张压、日间及夜间舒张压亦有所下降（P＜0．05）24小时平均心率、血糖、血脂、血尿酸未见明显改变。结论：波依定治疗老年单纯收缩期高血压是有效而安全的。     

硝苯地平缓释片联合吲达帕胺治疗老年单纯收缩期高血压疗效观察

目的 研究硝苯地平缓释片联合吲达帕胺治疗老年单纯收缩期高血压的效果.方法 以160例老年ISH志者随机分为硝苯地平缓释片联合吲达帕胺治疗组和硝苯地平缓释片对照组,记录用药前、后4周血压.结果 治疗组总有效率97.5%,高于对照组的80%(P<0.01).结论 硝苯地平缓释片与吲述帕胺联合治疗老年单纯收缩期高血压效果好.     

老年单纯收缩期高血压对颈动脉和左室重构的影响

目的:比较老年单纯收缩期高血压(ISH)及老年混合性高血压对颈动脉和左室重构的影响程度,从而探讨老年单纯收缩期高血压对心、脑靶器官损害的影响。方法:选取77例门诊及住院的初诊、血压水平在1~2级之间的老年高血压患者(年龄≥60岁),按血压类型不同分为单纯收缩期高血压(ISH)组40例、收缩压和舒张压均升高的混合性高血压组37例;另外选取30例同期的血压正常的老年健康检查者为对照组。对各组病人行颈动脉和心脏彩色多普勒超声检查,测量颈动脉内-中膜厚度(IMT),斑块厚度,根据crous法计算斑块积分(PS);测量左室舒张末期内径(LVD),室间隔厚度(IVST),左室后壁厚度(PWT),计算左室实际质量和左室质量预测值,得出左室质量比值(%PLM);对全部入选病人行血压、血糖、血脂、肝肾功能、身高、体重检测,计算体重指数(BMI)和脉压(PP)。结果:①ISH组与混合组之间颈动脉斑块积分(PS),颈动脉内-中膜厚度(IMT),颈动脉斑块发生率左室质量比值(%PLM)有显著性差异(P<0.01);②两变量间相关分析时老年高血压患者SBP、PP、DBP、年龄均与PS、IMT、%PLM呈正相关,而对SBP、DBP、PP与年龄的多元逐步回归显示:以IMT为因变量,SBP、DBP、PP及年龄为自变量时,SBP和年龄被有效选入回归方程,DBP、脉压未被引入方程。以PS为因变量,SBP、DBP、PP及年龄为自变量时,SBP被选入回归方程,DBP、PP、年龄未引入方程;以%PLM为因变量,SBP、DBP、PP及年龄为自变量时,SBP被有效选入回归方程,DBP、PP、年龄未引入方程。③PS、IMT与%PLM有相关性(相关系数分别为0.368,0.286,P<0.01)。结论:老年单纯收缩期高血压比混合性高血压对靶器官损害的程度更严重;在老年高血压中SBP是最重要的心血管并发症的危险因素,年龄因素也与动脉粥样硬化有重要的关系;老年高血压血管重构与左室重构有相关性,血管重构可能参与和加重左室重构的发生。     

长期尼群地平治疗对老年收缩期高血压患者明尼苏达编码的影响

采用心电图明尼苏达编码对经尼群地平及安慰剂双盲对照治疗长达4年的老年收缩期高血压患者的心电图进行分析比较,结果发现治疗后反映ST—T变化的4—X及5—X项尼群地平组较安慰剂组编码率显著减少(P<0.05或P<0.01);而组内治疗前后比较,尼群地平组4—3和5—3项编码率明显减少、安慰剂组4—1和4—2项编码率显著增加(P<0.05或P<0.01);尼群地平治疗组的编码较安慰剂组明显改善(P<0.005),提示尼群地平更适于合并心肌缺血的老年收缩期高血压的治疗。     

补肾和脉方加减对中老年单纯收缩期高血压病患者管壁僵硬度的影响

目的:探讨中老年单纯收缩期高血压患者应用补肾和脉方加减治疗疗效以及对患者管壁僵硬度的影响。方法:按照随机表法将收治的126例中老年单纯收缩期高血压患者分为对照组63例与观察组63例。对照组采用常规西药治疗,观察组在对照组基础上结合补肾和脉方甲减治疗。两组疗程均为4周。比较两组治疗前后收缩压和舒张压变化、心电图ST段水平变化和脉搏传导速度变化及治疗疗效。结果:两组治疗后收缩压较治疗前降低(观察组:t=16.165,对照组:t=13.537,P<0.05);两组治疗后收缩压较治疗前无明显变化(观察组:t=1.857,对照组:t=0.483,P>0.05);观察组治疗后收缩压低于对照组(t=16.165,P<0.05)。两组治疗后心电图ST段水平较治疗前降低(观察组:t=22.145,对照组:t=11.007,P<0.05);观察组治疗后心电图ST段水平低于对照组(t=8.130,P<0.05)。两组治疗后脉搏传导速度较治疗前降低(观察组:t=8.694,对照组:t=3.944,P<0.05);观察组治疗后脉搏传导速度低于对照组(t=5.326,P<0.05)。观察组总有效率(93.65%)高于对照组(76.19%)(P<0.05)。结论:中老年单纯收缩期高血压患者应用补肾和脉方加减治疗疗效明显,且可使患者管壁僵硬度得以改善。     

苏州市区老年人收缩期高血压及其有关社会因素的调查

苏州市区1577名老年人中,高血压者567名,其中收缩期高血压者283名,占高血压的49.91%。经多元回归法分析,得出其年龄因素贡献最大。     

粤港地区老年单纯收缩期高血压中医证侯流行病学调查分析

目的 探讨粤港地区老年单纯收缩期高血压(EISH)中医证型构成及其相关影响因素.方法 以60岁以上老年单纯收缩期高血压患者为调查对象,填写"高血压中医证候调查表"收集数据,应用Epidata 2.1软件建立数据库,运用SPSS13.0软件对数据进行统计分析,基本情况应用描述性统计,利用x2检验分析其中医证型构成与性别、年龄、病史、家族史、吸烟和饮酒史、生活习性、体重指数、合并心脑血管疾病、合并代谢疾病等因素的相关性.结果 共调查EISH患者302例,其中阴虚阳亢证91例(30.1%)、阴阳两虚证51例(16.9%)、肝肾阴虚证49例(16.2%)、肝阳上亢证37例(12.3%)、痰湿壅盛证37例(12.3%).EISH中医证型构成在不同年龄、性别、血压分级、病程、生活习惯中分布差异具有显著性(P均<0.05).结论 EISH中医主要证型依次为阴虚阳亢证、阴阳两虚证、肝肾阴虚证、肝阳上亢证、痰湿壅盛证.年龄、性别、血压分级、病程、生活方式是EISH中医证型分布的影响因素.     

氟伐他汀对纯收缩期高血压血管内皮功能和血压的影响

目的 :探讨氟伐他汀对血脂正常的纯收缩期高血压血管内皮功能和血压的作用。方法 :应用随机、交叉设计的方法 ,纯收缩期高血压 I级 2 6例接受 3个月氟伐他汀 (2 0 mg/d)治疗和 3个月安慰剂。采用高分辨率的超声检测肱动脉内皮依赖性舒张功能。结果 :与安慰剂相比 ,氟伐他汀能明显提高肱动脉内皮依赖性舒张功能 (氟伐他汀 vs安慰剂 :6 .32± 0 .71vs2 .96± 0 .32 ,P<0 .0 5 )。氟伐他汀亦能明显降低肱动脉收缩压 (14 8± 2 mm Hg vs15 4± 3mm Hg,P<0 .0 5 )及肱动脉舒张压 (78± 2 mm Hg vs81± 3mm Hg,P<0 .0 5 )。结论 :降脂治疗能改善血脂正常的纯收缩期高血压患者的血管内皮功能。     

规范化社区高血压健康指导对老年高血压的控制作用

目的：探讨规范化社区高血压健康指导对老年高血压的控制作用。方法2012年2月—2013年2月期间,选择82例老年高血压患者,随机均分为两组,即对照组予以常规健康指导,而实验组则予以规范化社区高血压健康指导,比较两组血压的控制效果。结果实验组患者指导后收缩压（96.68±10.88）mmHg、舒张压（81.81±5.59）mmHg,对照组患者指导后收缩压（138.57±8.78）mmHg、舒张压（88.92±5.25）mmHg,二者相比明显实验组血压控制效果更为理想,差异有统计学意义（P＜0.01）。并且实验组满意率（95.12%）明显高于对照组（68.29%）,差异有统计学意义（P＜0.01）。结论规范化社区高血压健康指导对老年高血压的控制效果极佳,值得推广。     

左旋氨氯地平与培哚普利治疗老年纯收缩期高血压合并糖尿病的临床分析

目的探索老年纯收缩期高血压（EISH）合并糖尿病治疗选择的相关因素，为临床治疗提供依据。方法采用随机单盲平行对照的方法分析两院2004年11月-2007年10月门诊及住院治疗的124例老年纯收缩期高血压合并2型糖尿病患者的临床资料，并进行统计学分析。结果124例所选病例中，左旋氨氯地平组62例，培哚普利组62例，两组治疗共24wk。两组降压效果比较，左旋氨氯地平组显效40例（64．5％），有效17例（27．4％），无效5例（8．1％），总有效率为91．9％。培哚普利组显效36例（58．1％），有效18例（29％），无效8例（12．9％），总有效率为87．1％。两组间总有效率比较，经Ridit检验，R左旋氨氯地平=0．53，R培哚普利=0．49，差别无显著性（P〉0．05）；两组治疗前后左室肥厚（LVH），血尿酸（UA）、血肌酐（Scr）、血糖（BS）和尿白蛋白排泄量之间差异均有统计学意义，其对治疗结果有影响。结论左旋氨氯地平和培哚普利均能明显地降低老年纯收缩期高血压合并糖尿病患者的收缩压（SBP）。且能逆转LVH及降低UA、Scr、BS和尿白蛋白排泄量，尤以后者为优。     

Hypertension control and the risk of myocardial infarction and stroke: a population-based study

A population-based case-control study was performed to determine the importance of the presence of hypertension and the control of blood pressure level during treatment for hypertension on the occurrence of acute myocardial infarction (AMI) and stroke in persons aged 35-69 years in the Hunter Region community. Patients with a first episode of AMI or stroke were identified from community-based heart attack and stroke registers and compared with control subjects obtained from a random population sample from the same community. Twenty per cent of control subjects were currently receiving treatment for hypertension compared with 37% of patients with myocardial infarction (odds ratio adjusted for age, sex and several other possible confounding variables, 2.6; 95% confidence interval (CI), 1.9-3.4) and 51% of patients with stroke (adjusted odds ratio, 3.5; 95% CI, 2.3-54). Among those who had ever been told they had hypertension, 71%, 73% and 59% of patients with AMI, patients with stroke and control subjects, respectively, were receiving treatment at the time of the AMI or the stroke or at the time of the survey (control subjects). For those receiving treatment for hypertension, blood pressure levels were obtained from the records of their general practitioner. Despite similar pretreatment levels the last recorded blood pressure level (either before the survey of the development of AMI or stroke) was higher among those who developed AMI or stroke than those in the control group. Those with a treated diastolic blood pressure of less than 80 mmHg appeared to be at a higher risk of both AMI and stroke than those with a treated diastolic blood pressure level of 80-89 mmHg, but the difference was not statistically significant. Randomised controlled trials do not show a reduction in rates of AMI in response to a reduction of blood pressure. Nevertheless our findings suggest that the presence of hypertension and poor control of blood pressure levels despite treatment may be important aetiologically both for AMI and stroke occurrence.     

Effect of traditional and integrative regimens on quality of life and early renal impairment in elderly patients with isolated systolic hypertension

Objective：To observe the effect of Chinese medical regimen and integrative medical regimen on quality of life and early renal impairment in elderly patients with isolated systolic hypertension（EISH）.Methods： A multi-center,randomized,double-blinded controlled trail was adopted.A total of 270 cases of EISH were randomly divided into 3 groups：Chinese medicine group（CM）,combination group and Western medicine group （WM）.The course of treatment was 4 weeks.The clinical blood pressure,integral of quality of life（SF-36 scale）, immunoglubin G（IgG）,microalbumin（mALB）,β_2-microglobulin（β_2-MG）,transferrin（TRF）and N-acetyl-β＇- D-glucosa-minidase（NAG）in urine were determined before and after the treatment.Results：After treatment, systolic blood pressure depressed significantly in each group（P〈0.05）,and the combination group was superior to CM or WM group in depressing SBP（P〈0.05）; in each group,integral of quality of life improved in different degree,and combination group was superior to WM group in all 8 dimensions（P〈0.05）.The level of mALB andβ_2-MG in urine decreased in all groups（P〈0.05）,and the combination group was superior to CM group or WM group in decreasing mALB（P〈0.05）.Conclusions：Chinese medical regimen has affirmative effect in treating EISH patients,and could lower the systolic blood pressure,improve quality of life and early renal impairment of the patients,and integrative medical regimen has superiority on account of cooperation,and deserves further study.     

拉西地平与小剂量双氢克尿噻联用治疗老年单纯收缩期高血压疗效观察

目的 观察拉西地平与小剂量双氢克尿噻联用治疗老年单纯收缩期高血压疗效及不良反应.方法 入选126例年龄≥60岁单纯收缩期高血压病患者随机分为三组.A组拉西地平4mg/d,双氢克尿噻12.5mg/d联用;B组拉西地平4mg/d;C组双氢克尿噻25mg/d;各组疗程均为4周.结果 A组显效34例(81%),有效6例(14%),无效2例(5%),总有效率95%;B组显效21例(50%),有效10例(24%),无效11例(26%),总有效率74%;C组显效13例(31%),有效13例(31%),无效16例(38%),总有效率67%.结论 拉西地平与小剂量双氢克尿噻联用治疗老年单纯收缩期高血压疗效显著,不良反应少.     

拉西地平与小剂量双氢克尿噻联用治疗老年单纯收缩期高血压疗效观察

目的 观察拉西地平与小剂量双氢克尿噻联用治疗老年单纯收缩期高血压疗效及不良反应.方法 入选126例年龄≥60岁单纯收缩期高血压病患者随机分为三组.A组拉西地平4mg/d,双氢克尿噻12.5mg/d联用;B组拉西地平4mg/d;C组双氢克尿噻25mg/d;各组疗程均为4周.结果 A组显效34例(81%),有效6例(14%),无效2例(5%),总有效率95%;B组显效21例(50%),有效10例(24%),无效11例(26%),总有效率74%;C组显效13例(31%),有效13例(31%),无效16例(38%),总有效率67%.结论 拉西地平与小剂量双氢克尿噻联用治疗老年单纯收缩期高血压疗效显著,不良反应少.     

非洛地平并阿托伐他汀治疗单纯收缩期高血压的临床研究

目的：探讨非洛地平并阿托伐他汀治疗单纯收缩期高血压的临床疗效。方法方便选取2014年2月-2015年2月于该院住院的72例单纯收缩期高血压患者抽签随机分为两组。对照组(36例)给予非洛地平缓释片口服,观察组(36例)及在对照组的基础上加用阿托伐他汀钙片口服。比较两组患者治疗前后的收缩压、脉压、高敏C反应蛋白的改善情况来评估两组患者药物治疗的临床疗效。结果治疗后观察组患者一氧化氮(78.56±8.43)μmol/L较治疗前及对照组治疗后(52.34±8.25)μmol/L显著较高(P<0.05),收缩压[(131.25±8.46)mmHg、脉压(56.82±5.46)mmHg、高敏C反应蛋白(7.48±2.16)mg/L较对治疗前及对照组治疗后(145.28±8.09)mmHg、(67.48±6.13)mmHg、(12.15±2.11)mg/L]显著较低,差异有统计学意义(P<0.05)。结论对于治疗单纯收缩期高血压患者,非洛地平并阿托伐他汀治疗比单独用药能更好地降低患者的收缩期血压和脉压,降低患者的血管炎性水平,提高临床疗效。     

Effects of losartan on cardiovascular morbidity and mortality in patients with isolated systolic hypertension and left ventricular hypertrophy: a Losartan Intervention for Endpoint Reduction (LIFE) substudy

Context  Drug intervention in placebo-controlled trials has been beneficial in isolated systolic hypertension. Objective  To test the hypothesis that losartan improves outcome better than atenolol in patients with isolated systolic hypertension and electrocardiographically documented left ventricular hypertrophy (ECG-LVH). Design  Double-blind, randomized, parallel-group study conducted in 1995-2001. Setting and Participants  A total of 1326 men and women aged 55 through 80 years (mean, 70 years) with systolic blood pressure of 160 to 200 mm Hg and diastolic blood pressure of less than 90 mm Hg (mean, 174/83 mm Hg) and ECG-LVH, recruited from 945 outpatient settings in the Nordic countries, the United Kingdom, and the United States. Interventions  Patients were randomly assigned to receive once-daily losartan (n = 660) or atenolol (n = 666) with hydrochlorothiazide as the second agent in both arms, for a mean of 4.7 years. Main Outcome Measure  Composite end point of cardiovascular death, stroke, or myocardial infarction. Results  Blood pressure was reduced by 28/9 and 28/9 mm Hg in the losartan and atenolol arms. The main outcome was reduced by 25% with losartan compared with atenolol, 25.1 vs 35.4 events per 1000 patient-years (relative risk [RR], 0.75; 95% confidence interval [CI], 0.56-1.01; P = .06, adjusted for risk and degree of ECG-LVH; unadjusted RR, 0.71; 95% CI, 0.53-0.95; P = .02). Patients receiving losartan had reductions in the following without a difference in the incidence of myocardial infarction: cardiovascular mortality (8.7 vs 16.9 events per 1000 patient-years; RR, 0.54; 95% CI, 0.34-0.87; P = .01), nonfatal and fatal stroke (10.6 vs 18.9 events per 1000 patient-years; RR, 0.60; 95% CI, 0.38-0.92; P = .02), new-onset diabetes (12.6 vs 20.1 events per 1000 patient-years; RR, 0.62; 95% CI, 0.40-0.97; P = .04), and total mortality (21.2 vs 30.2 events per 1000 patient-years; RR, 0.72; 95% CI, 0.53-1.00; P = .046). Losartan decreased ECG-LVH more than atenolol (P<.001) and was better tolerated. Conclusion  These data suggest that losartan is superior to atenolol for treatment of patients with isolated systolic hypertension and ECG-LVH.