β-受体阻滞剂在高血压治疗中的应用

β-受体阻滞剂是20世纪医学发展中的重要发现之一,尤其在高血压治疗方面有着极为重要的意义.作为高血压治疗的一线药物,β-受体阻滞剂在控制血压的同时,还能够长期改善高血压患者的预后.我国的高血压患者众多,治疗上要最大限度的降低患者长期心血管疾病的总体风险,多项相关研究的结果得出,从临床实际角度遵循个体化原则,积极、合理的应用β-受体阻滞剂治疗高血压,就可以对心血管疾病的恶性循环链起到重要的阻断作用.β-受体阻滞剂对高血压同时合并冠状动脉粥样硬化性心脏病(冠心病)、心肌梗死、心律失常、慢性心力衰竭和无症状左心室功能不全的患者具有不可取代的地位,明显地减少了心血管事件的发生率.     

硝苯地平联合倍他乐克治疗顽固性高血压临床观察

目的 观察钙离子拮抗剂硝苯地平缓释片联合倍他乐克治疗顽固性高血压的临床疗效.方法 选择我院顽固性高血压患者129例,随机分为两组,观察组76例,对照组53例,观察组患者给予硝苯地平缓释片10mg/次,2次/d,倍他乐克25mg/次,2次/d,对照组单用硝苯地平缓释片20mg/次,2次/d,均观察6周进行疗效评定.结果 两组患者降压疗效及症状改善情况间差异均有显著性意义（P＜0.05）.结论 硝苯地平缓释片与倍他乐克联合降压效果显著、平稳、安全,是顽固性高血压治疗的理想选择.     

β受体阻滞剂在高血压治疗中的研究进展

高血压是一种严重威胁人类健康的慢性疾病.β肾上素能受体阻滞剂,能降低心肌需氧量、心肌收缩力,抑制外周肾上腺能受体,降低心输出量和交感神经向外周发放冲动,能降低卧位和立位血压,临床上常作为一线抗高血压药.现就β受体阻滞剂在高血压治疗中的研究进展作一综述.     

卡维地洛治疗原发性高血压的长期疗效

目的 :评价卡维地洛对原发性高血压 ( EH)的长期疗效和安全性。方法 :卡维地洛治疗 4周显效或有效的 EH患者 61例 ,维持原剂量继续治疗至 2 4周末。结果 :观察的 61例中 ,47例( 77% )口服剂量为 10 mg bid,另 14例 ( 2 3% )第 3周起增至 2 0 mg bid。在延长治疗期 ,卡维地洛给药后能稳定降压 ,血压基本保持 4周末水平 ,与 4周末相比 ,显效率、有效率均无显著性差异 ,总有效率仍为 10 0 %。与治疗前相比 ,收缩压和舒张压分别下降 16.5 %和 17.6% ,由 ( 15 7.1± 14 .0 ) /( 10 1.4± 5 .5 ) mm Hg( 1mm Hg=0 .133k Pa)降至 ( 131.2± 10 .1) / ( 83.6± 5 .6) mm Hg。心率减慢 ,但仍在正常范围 ,4周后基本稳定。卡维地洛长期给药不良反应轻微 ,且在治疗过程中能自行缓解。对脂类代谢没有不良影响。结论 :卡维地洛长期治疗有稳定的降血压作用 ,是一种安全有效的新型抗高血压药物     

β受体阻滞剂和利尿剂治疗高血压的另一种说法

β阻滞剂已经用于治疗高血压 30年 ,从来没有该药单独治疗与安慰剂比较 ,及对老年人致死率和致残率影响的报道。最近荟萃分析证明 β阻滞剂虽然明显降压 ,但在预防冠心病上无效。对冠心病 ,心血管病死率 ,总病死率的ＯＲ ,分别为1.0 1,0 98,1.0 5。该荟萃分析共包括 10个临床研究 ,随机至少一年 ,共有 16 16 4老年人 ,2 / 3病人用利尿剂 ,1/ 3左右用 β阻滞剂单独治疗。终点指标上 ,利尿剂都比 β阻滞剂好 ,与对照组相较 ,利尿剂组脑血管意外 ,ＯＲ为 0 6 1,致死性中风ＯＲ0 6 7,冠心病ＯＲ为 0 74,心血管病死率ＯＲ为 0 75 ,总病死率…     

正确认识β受体阻滞剂在高血压治疗中的地位

β受体阻滞剂自20世纪60年代以来已广泛用于治疗高血压、冠心病、心力衰竭、心律失常、心肌病等。1978年世界卫生组织正式将β受体阻滞剂列为高血压治疗的一线药物,以后各国高血压防治指南均将β受体阻滞剂列为降压一线药物或主要药物。2005年,Lindholm在一项B受体阻,     

卡维地洛的降压及肾脏保护作用观察

目的观察卡维地洛的降压疗效及其对尿微量白蛋白（Alb）和β2-微球蛋白（β2-MG）排泄的影响。方法采用自身对照法观察50例轻、中度高血压患者，所有患者停用降压药物2周，然后口服卡维地洛，开始3d为6，25mg／次，2次／d，以后改为12．50mg／次，2次／d，如2周后血压仍≥140／90mmHg，则剂量倍增到25，00mg／次，2次／d，至24周结束。测定治疗前、后24hAlb和β2-MG的排泄。结果24周后显效19例，有效24例，无效7例，有效率为86％。50例患者治疗前、后SBP、DBP、Alb和β2-MG间差异有非常显著性意义（P〈0.01）。结论卡维地洛是治疗轻、中度高血压的一种安全有效的降压药物，同时能减少Alb和β2-MG的排泄，对肾脏具有保护作用，且不影响血脂及糖代谢。     

β肾上腺素能受体阻滞剂在心力衰竭中的应用进展

β肾上腺能受体阻滞剂（简称B阻滞剂）在心血管病临床的应用历史已达40余年,在治疗心绞痛、高血压及某些心律失常等方面效果肯定,已经成为临床的常用药物.但β阻滞剂在慢性心力衰竭中的作用和地位是在经历了一个艰难和漫长的历史才被认识和确定的,本文就其在心力衰竭（HF）中的临床应用进展作一综述.     

β-受体阻滞剂治疗慢性充血性心力衰竭的研究进展

本文对充血性心力衰竭 （CHF）患者应用 β-受体阻滞剂治疗的根据、最近的临床试验和剂量调节进行了评价     

Long-term treatment of hypertension with the calcium channel blocker diltiazem

A group of 48 patients with essential mild to moderate hypertension were treated with the calcium-channel blocker diltiazem (90-270 mg/day) for one year. Adequate blood pressure control was achieved in all patients. No tolerance developed during the one-year treatment period. The drug is almost free from side effects. Very few patients develop fluid retention, which can be controlled by adding a diuretic.     

β_1肾上腺素能受体Gly389Arg多态性与原发性高血压的关系

目的探讨汉族人群β1肾上腺素能受体Gly389Arg多态性与原发性高血压的关系。方法采用聚合酶链反应-限制性长度片段多态性技术分析原发性高血压患者和正常人群β1肾上腺素能受体Gly389Arg多态性。结果高血压组Arg/Arg,Arg/Gly,Gly/Gly基因型频率分别为59.06%、35.09%、5.85%,正常对照组分别为43.55%、45.97%、10.48%;两组间三种基因型频率分布有统计学差异(χ2=7.420,P<0.05);高血压组Arg等位基因频率为76.61%,Gly等位基因频率为23.39%,正常对照组分别为66.53%、33.47%,两组间等位基因频率分布存在统计学差异(χ2=7.299,P<0.05);高血压组Arg纯合子基因型频率和Arg等位基因频率均明显高于对照组。结论β1肾上腺素能受体Gly389Arg多态性可能与原发性高血压发病有关。     

选择性β1受体阻滞剂在慢性阻塞性肺疾病中的作用进展

慢性阻塞性肺疾病(COPD)患者是心血管疾病的高危人群,常有β受体阻滞剂的应用指征.但由于可能导致气道痉挛,多年来β受体阻滞剂被禁用于COPD合并心血管疾病的治疗.近年来发现,COPD患者使用选择性β1受体阻滞剂并未导致致死性支气管痉挛,还有降低病死率和急性加重次数、改善生活质量等作用.本文就选择性β1受体阻滞剂在COPD患者中的作用进展作一综述.     

β-肾上腺素受体激酶与心力衰竭治疗的研究进展

全球大约有2 300万人患有心力衰竭,对β-肾上腺素受体的反应性降低是心力衰竭的特征并由此导致心脏功能异常。通过转基因的办法抑制β-肾上腺素能受体激酶1(βARK1)进而改善衰竭心脏的收缩功能和对β-肾上腺素能神经兴奋的反应性,使得βARK1的抑制成为重要的治疗心力衰竭的手段。本文就βARK1研究的最新进展作一综述。     

Stress-induced hemodynamic and hemostatic changes in patients with systemic hypertension: Effect of verapamil

Stress-induced hemodynamic and hemostatic responses may acutely trigger atherosclerotic plaque disruption and thrombosis leading to myocardial infarction. This study was designed to evaluate the responses to three stressors and to determine if once-daily sustained release verapamil (Verelan®) modified these responses. We studied 13 patients with mild to moderate hypertension in a randomized, double-blind, placebo-controlled crossover trial. After 4 weeks of therapy, patients were evaluated following assumption of the upright posture, mental stress, and cold pressor test. During placebo, the stressors produced an increase in systolic pressure (144 ± 2 to 167 ± 3 mmHg, p < 0.001), heart rate (70 ± 2 to 77 ± 2 beats/ min, p< 0.001), and platelet aggregability to adenosine diphosphate (threshold concentration fell from 2.8 ± 0.4 to 1.9 ± 0.1 μM, p = 0.05)and epinephrine (3.4±0.9 to 1.6 ±0.6 μM, p < 0.001). Verapamil lowered systolic pressure at baseline (144 ± 2 to 134 ± 2 mmHg, p < 0.001), and after stress (167 ± 3 to 154 < 3 mmHg, p < 0.001), but did not alter the absolute increase with stress. During verapamil, platelet reactivity did not increase with stress, and the post-stress response to epinephrine was reduced (higher threshold concentration) compared with placebo (3.9 ± 1.3 vs. 1.5 ± 0.3 μM, p = 0.05). Verapamil also reduced the response to collagen (increased lag time) at baseline and after stress (111 ± 9 vs. 91 ± 3 s, p < 0.01). We conclude that verapamil blunted potentially harmful stress-induced hemodynamic and hemostatic changes. Further studies are required to determine whether these effects translate into a lower incidence of acute cardiovascular events.     

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高血压是心血管疾病的独立危险因素。单纯舒张期高血压(IDH),是指在标准状态下测量的收缩压<140 mmHg,同时舒张压≥90 mmHg。高血压分为三种亚型:单纯收缩期高血压(ISH)、单纯舒张期高血压(IDH)、收缩期合并舒张期高血压(SDH)。单纯舒张期高血压是一种发生率相对较低的高血压类型。然而近年来一些大型临床研究发现IDH与ISH、SDH一样已经成为心血管事件发生的独立危险因素。因此IDH越来越受到重视,了解掌握IDH的特点及治疗措施已经成为降压治疗及预防心血管疾病的重要组成部分。     

Medication compliance and clinical outcomes of fixed‐dose combinations vs free combinations of an angiotensin II receptor blocker and a calcium channel blocker in hypertension treatment

Using the National Health Insurance Research Database of Taiwan, the authors identified 1136 patients taking fixed‐dose combination and 4544 patients taking free combinations of an angiotensin II receptor blocker and a dihydropyridine calcium channel blocker from January 2009 to December 2012. At a mean follow‐up of 2.1 years, the fixed‐dose combination was associated with improved medication adherence and persistence and better survival free from major adverse cardiac events and hospitalization for heart failure compared with the free combination regimens.     

Risk factors of prehypertension and hypertension among workers at public elderly welfare facilities in Taiwan: A cross-sectional survey

The prevalence and factors that influence prehypertension and hypertension in workers at elderly welfare facilities remain unknown. This study investigated prehypertension and hypertension as well as the relevant factors affecting the development of these conditions in workers at elderly welfare facilities.A cross-sectional survey was conducted among 242 workers at 3 elderly welfare facilities in northern Taiwan. A structured questionnaire survey comprising demographic characteristics, job characteristics, burnout inventory, and health information was employed for data collection. Chi-Squared tests and multinomial logistic regression were adopted to analyze the correlation between research variables and blood pressures as well as relevant factors influencing prehypertension and hypertension.The results indicated that sex, age, education level, type of work shift, work-related burnout, and body mass index of the research participants were significantly correlated with prehypertension and hypertension. The results of multinominal logistic regression demonstrated that being male, being older, being a nonnurse assistant, being obese, working in shifts, and having moderate or severe work-related burnout were associated with higher risks of prehypertension and hypertension. The interaction between age and being a nonnurse assistant was statistically significant. Compared with nonnurse assistants, nurse assistants aged ≥55 years had a relatively low risk of prehypertension and hypertension.Age, job characteristics, work-related burnout, and obesity of workers in elderly welfare facilities were the major risk factors for prehypertension and hypertension.     

β1-AR持久兴奋通过CaMKIIδ-内质网应激凋亡通路导致心力衰竭的机制

目的研究β1-AR持久兴奋通过CaMKIIδ内质网应激（ERS）凋亡通路导致心力衰竭的机制。方法30只SD大鼠随机分成三组，正常对照组（Control）、异丙肾上腺组（Iso）和、异丙肾上腺＋美托洛尔组（Iso＋Meto），每组10只，所有动物均自由进食进水。（1）Iso组大鼠背部皮下注射Iso5mg／（kg·d），连续10d；Control组背部皮下注射相同体积的生理盐水；Iso＋Meto组大鼠背部皮下注射Iso5mg／（kg·d），连续10d，在背部皮下注射Iso前一天开始Meto 10mg／（kg·d）灌胃，连续4周；（2）所有大鼠饲养4周后，采用美国Millar公司P—V Loop导管经颈动脉插管至左心室，使用Pow—erlab生理记录系统测量血流动力学相关指标；统计各组大鼠心脏重量和心脏重量／体重比值；（3）TUNEL法和Caspase-3活性检测心肌细胞凋亡；（4）Western blot分析CaMKIIδERS相关基因（GRP78、CHOP和caspase-12）和凋亡相关基因Bcl-2／Bax的表达水平。结果30只SD大鼠实验过程精神状态好，进食进水正常。（1）与Control组比较，Iso组SD大鼠心脏重塑和血流动力学指标有显著性差异（P〈0．05）；而Iso＋Meto组心脏重塑和血流动力学指标与Iso组相比明显改善（P〈0．05）；（2）TUNEL法原位检测各组大鼠心肌细胞凋亡示与Control组比较，Iso组TUNEL阳性细胞数明显增高（P〈0．05）；而Iso＋Met组明显低于Iso组（P〈0．05）。心肌细胞Caspase-3活性和TUNEL凋亡阳性细胞核指数各组变化一致。Western blot检测心肌细胞凋亡相关基因bcl-2／Bax蛋白表达。与Control组相比，Iso组bcl-2蛋白表达明显降低和Bax蛋白表达明显增加（P〈0．05）；而Iso＋Met组与Iso组相比,bcl-2明显增高和Bax明显降低（P〈0．05）；（3）Western blot分析CaMKIIδp-CaMKIIδ白表达显示，与Control组比较，Iso组CAMKII活性和p-CaMKIIδ蛋白表达明显增加；而Iso＋Meto组与Iso组相比，CAMKII活性和p-     

The Association of ADRB1 and CYP2D6 Polymorphisms With Antihypertensive Effects and Analysis of Their Contribution to Hypertension Risk

Background

Genetic factors have a vital influence on the pathogenesis of hypertension. In this retrospective study, we aimed to evaluate the association of ADRB1 and CYP2D6 polymorphisms with antihypertensive effects and perform an analysis of their contribution to hypertension risk.