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盐敏感性高血压是基因机制、离子转运机制、内皮功能障碍机制、肾脏机制、交感神经系统和中枢神经系统机制、肾素-血管紧张素-醛固酮机制、内分泌机制、胰岛素抵抗机制等等共同作用的结果。除了限盐治疗以外,其他针对盐敏感性高血压的降压措施包括补充钾离子和钙离子,降压药治疗,免疫疗法,基因疗法等等。降压药物包括利尿剂、钙离子拮抗剂、血管紧张素转化酶抑制剂、血管紧张素受体拮抗剂都是治疗盐敏感性高血压的适用药物,改变我国高盐饮食习惯是盐敏感性高血压一级预防的关键性措施。     

脉搏波传导速度在假性高血压诊断中的应用

目的采用踝臂脉搏波传导速度评价动脉硬化,为假性高血压诊断提供参考。方法冠状动脉造影患者30例,造影结束后同步测量肱动脉内直接血压及间接血压各3次,计算直接血压与间接血压收缩压差值和直接血压与间接血压舒张压差值;并应用动脉硬化检测仪测定双侧踝臂脉搏波传导速度,并获得年龄、疾病、体质指数、血脂参数。根据收缩压差值或舒张压差值是否大于10 mmHg分为假性高血压组和非假性高血压组,对各项变量进行统计学分析。结果两组间的年龄、性别比例、体质指数、吸烟史比例、冠心病比例、糖尿病比例、高脂血症比例、血脂水平相近,差异无统计学意义(P>0.05);脉压(P=0.001)、无创收缩压(P=0.018)、无创血压与直接血压差值差异均有统计学(P<0.05);假性高血压组患者脉搏波传导速度与非假性高血压组患者比较差异具有统计学意义(P=0.029)。根据统计学操作者工作特征曲线得出踝臂脉搏波传导速度>1896.0 cm/s时,预测假性高血压具有最高的敏感度(80.0%)和特异度(73.3%)。Pearson相关分析得出两者的Pearson相关系数为0.431,具有中等相关性。结论根据踝臂脉搏波传导速度的异常可对假性高血压的诊断有...     

顽固性高血压的降压药物治疗

顽固性高血压临床上并不少见,降压药物使用不当是主要原因之一。在排除假性顽固性高血压、纠正干扰降压药物效果的因素和治疗继发性高血压之后,大多数患者需要个体化地修正降压药物治疗方案,包括正确使用利尿剂、调整降压药物组合、在五大类降压药物(利尿剂、β受体阻滞剂、血管紧张素转换酶抑制剂、血管紧张素受体拮抗剂和钙拮抗剂)的基础上加用其他降压药物、逐一上调药物的剂量。最佳化地使用降压药物能使大多数顽固性高血压患者的血压得到有效控制。     

难治性高血压的诊疗进展

难治性高血压是一种特殊类型的高血压,危害较大。合理的诊断和治疗对有效控制患者血压、预防心脑血管事件发生有重要的意义。正确的诊断需要明确或排除包括依从性差、继发性高血压等多种影响血压控制的因素。有效的降压治疗一方面需要强调生活方式的改善,另一方面要在肾素-血管紧张素系统抑制剂(RASI)、钙离子通道阻滞剂(CCB)和利尿剂治疗的基础上,根据血浆肾素水平调整药物剂量,并加用醛固酮拮抗剂等其他降压药物。     

氯沙坦与氨氯地平对原发性高血压病早期肾损害的作用比较

高血压性肾损害是高血压病损伤靶器官的表现之一 ,肾脏受损后加剧高血压 ,形成恶性循环。近年来既有降压作用又有抗肾损害的血管紧张素Ⅱ (ＡＴⅡ )受体拮抗剂受到重视。本组资料通过测定高血压病患者尿 β2 微球蛋白 (β2 ＭＧ)来评价ＡＴⅡ拮抗剂对高血压病患者的降压及对肾脏的保护作用。对象与方法1.对象 :根据ＷＨＯ/ＩＳＨ 1999年高血压病诊断标准确诊的Ⅰ～Ⅱ级高血压病患者 64例 ,入院后停用降压药并服安慰剂 1周 ,静息坐位血压 >14 0 / 90ｍｍＨｇ ,晨尿 β2 ＭＧ >0 .15ｍｇ/Ｌ ,经临床及实验室检查排除继发性高血压 ,无糖尿病…     

氨氯地平对高血压病患者颈动脉内膜-中膜厚度及血清C反应蛋白含量的影响

氨氯地平是长效二氢吡啶类钙拮抗剂，具有高度选择性，直接作用于周围血管，用于治疗高血压，具有服用方便、血压稳定下降的优点。与高血压相关的血管改变不仅需要积极降压，同时需要逆转其结构异常，从而有效减轻早期血管改变和控制心血管疾病的发生率和死亡率。我们观察高血压病人使用氨氯地平后颈动脉内膜-中膜厚度（IMT）和C反应蛋白（CRP）的变化，进一步探讨氨氯地平的降压效果及对高血压患者血管改变的影响。     

假性高血压研究进展

国内外关于假性高血压(pseudohypertension,PT)的报道不多,PT是指用普通的袖带测压法所测得的血压值高于经动脉穿刺而直接测得的血压值,它是血压升高的一种假象,若不能正确认识,会给临床治疗带来严重的后果.本文就近年来国内外研究报道的关于假性高血压流行病学、发生机制、诊断及治疗方面的进展加以综述.     

老年高血压患者的血压控制现状及影响因素分析

目的分析老年高血压患者的血压控制现状及影响因素,指导老年高血压患者的综合防治。方法回顾性分析老年高血压患者2593例,依据血压控制情况分为血压控制正常组(853例)和高血压组(1740例)。所有患者均进行了超声心动图检查,测定左心室二尖瓣舒张早期血流峰值(E)和舒张晚期血流峰值(A)比值(E/A)及LVEF等指标。结果2 593例老年高血压患者服药率和血压控制率分别为94.4%、32.9%。6种常用的降压药物中应用较多的是利尿剂、钙离子拮抗剂、血管紧张素Ⅱ受体拮抗剂和血管紧张素转换酶抑制剂。1988例(76.7%)合并有吸烟史、血脂异常、高血压家族史、肥胖等危险因素。超声心动图检查心脏收缩功能异常率17.2%、E/A比值异常率27.6%。单因素及多因素logistic回归分析,血压控制正常组和高血压组动脉粥样硬化、冠心病、体重指数、TC、HDL-C和左心室后壁等6项指标差异有统计学意义。结论老年高血压患者血压的控制并未有随着服药数量的增加而改善。应该对合并的危险因素及临床情况、生化指标及心脏的结构和功能异常等进行综合防治。     

东莞市社区高血压规范化诊疗现状与对策

目的探讨社区原发性高血压(高血压)规范化诊疗的现状和对策。方法回顾性抽取2017年6月至2017年8月东莞市33家社区卫生服务机构全科医生高血压患者病历32 596份,评价高血压患者的血压测量和记录、规范诊断、危险因素药物干预及并发症诊断、降压药物使用及综合干预等情况,并评价社区卫生服务中心的硬件配置和医务人员的职称、专业等情况。结果高血压患者的血压尾数为"0"约41.4%、多次复诊出现相同血压值约10.1%;高血压诊断的分级、分层约为2.9%、1.4%;脑卒中、高血压性心脏病、高血压肾病等并发症诊断率分别为2.1%、1.0%、0.8%,高脂血症、高尿酸血症、高同型半胱氨酸血症规范治疗率分别为9.24%、2.66%、0.03%。钙拮抗剂(CCB)、血管紧张素Ⅱ受体拮抗剂(ARB)、血管紧张素转换酶抑制剂(ACEI)、β受体阻断药使用率分别为67.3%、67.2%、4.8%、12.1%。社区医务人员高级、中级、初级职称分别为4.0%、29.5%、66.5%。硬件配置方面,能利用超声心动图或血管彩色超声进行高血压靶器官筛查的仅为1.9%。结论社区在高血压的测量与记录、规范诊断、危险因素药物干预、降压药物应用及并发症的筛查等方面还存在不足。同时,高级医疗人才和必需检查设备缺乏。     

肾脏对血压调节作用的研究进展

人体的动脉血压是由心搏出血量和总的周围血管阻力所决定的,肾脏分泌的升压与降压物质及肾脏的排钠排水等正常功能,均直接或间接的影响心排出量和外周血管阻力,对血压的调节起着重要的作用.高血压患者中由肾脏病引起者约占10%,继发性高血压患者中因肾脏病引起者占首位[1],小儿继发性高血压的发病率占小儿高血压的65~80%[2].表明肾脏与高血压之间有着密切的关系.     

Effects of normal blood pressure, prehypertension, and hypertension on autonomic nervous system function

Background

Autonomic nervous system plays an important role in blood pressure (BP) regulation, and large proportion of patients with hypertension have increased sympathetic and decreased parasympathetic activity. Heart rate recovery (HRR) is a simple non-invasive measurement for investigating autonomic nervous system influence on the cardiovascular system; however, this methodology has not been used to evaluate autonomic nervous system in subjects with prehypertension (PHT). Accordingly, the present study was designed to evaluate HRR in subjects with PHT.

Methods and results

We measured HRR of 91 subjects with PHT, 44 patients with hypertension, and 53 normotensive healthy volunteers. HRR was significantly lower in the HT and PHT groups as compared to the control group (24.4 ± 5.7, 26.0 ± 8.4, 30.0 ± 8.7; hypertension, PHT, and control groups, respectively), but it did not significantly differ between HT and PHT groups. HRR was significantly and inversely correlated with age, systolic and diastolic BP, fasting and postprandial glucose level, waist circumference, total cholesterol, LDL cholesterol and non-HDL cholesterol, whereas exercise duration and METs were positively correlated with HRR. In multivariable analysis, we found that systolic BP, postprandial glucose level and exercise duration were independent predictors of lower HRR.

Conclusions

HRR, a non-invasive measurement analyzing the dysfunction in autonomic nervous system, was reduced in subjects with PHT as compared to normotensives, and the subjects with PHT had HRR as lower as patients with HT did. Our findings are supportive for the hypothesis that autonomic dysregulation is present in an early stage of essential hypertension.     

Clinical applicability for the assessment of the valvular mitral stenosis severity with Doppler echocardiography and the proximal isovelocity surface area (PISA) method

Evaluation of the severity of valvular mitral stenosis and measurements of the effective rheumatic mitral valve area by noninvasive echocardiography has been well accepted. The area is measured by the two-dimensional planimetry (PLM) method and the Doppler pressure half-time (PHT) method. Recently, the proximal isovelocity surface area (PISA) by color Doppler technique has been used as a quantitative measurement for valvular heart disease. However, this method needs more validation. The aim of this study was therefore to investigate the clinical applicability of the PISA method in the measurements of effective mitral valve area in patients with rheumatic valvular heart disease. Forty-seven patients aged from 23 to 71 years, with a mean age of 53 +/- 13 (25 male and 22 female, 15 with sinus rhythm, mean heart rate of 83 +/- 14 beats per minute, with rheumatic valvular mitral stenosis without hemodynamically significant mitral regurgitation) were included in the study. Effective mitral valve area (MVA) derived by the PISA method was calculated as follows: 2 x Pi x (proximal aliasing color zone radius)2x aliasing velocity/peak velocity across mitral orifice. Effective mitral valve areas measured by three different methods (PLM, PHT, and PISA) were compared and correlated with those calculated by the "gold standard" invasive Gorlin's formula. The MVA derived from PHT, PLM, PISA and Gorlin's formula were 1.00 +/- 0.31cm2, 0.99 +/- 0.30 cm2, 0.95 +/- 0.30 cm2 and 0.91 +/- 0.29 cm2, respectively. The correlation coefficients (r value) between PHT, PLM, PISA, and Gorlin's formula, respectively, were 0.66 (P = 0.032, SEE = 0.64), 0.67 (P = 0.25, SEE = 0.72) and 0.80 (P = 0.002, SEE = 0.53). In conclusion, the PISA method is useful clinically in the measurement of effective mitral valve area in patients with rheumatic mitral valve stenosis. The technique is relatively simple, highly feasible and accurate when compared with the PHT, PLM, and Gorlin's formula. Therefore, this method could be a promising supplement to methods already in use.     

A simple noninvasive measurement of stenotic mitral valve area: an alternative approach using M-mode and Doppler echocardiography.

Doppler echocardiography is a widely used noninvasive technique to examine the mitral valve area (MVA) by obtaining mitral pressure half-time (PHT) and to assess the severity of the stenosis. However, several hemodynamic factors influence the PHT and may render the PHT data inaccurate in any measurement of MVA under certain conditions. Using a simple echo-Doppler (E-D) method, we assessed the MVA in a physiological equation. The mitral flow volume (MFV) is represented by MVA x transmitral mean flow velocity (mV) x diastolic filling time (DFT). Thus, the formula can be restated as MVA (cm2) = MFV (cm3)/mV (cm/sec) x DFT (sec). We measured MFV by M-mode, and mV and DFT by continuous wave Doppler echocardiography. This formula was tested in 43 patients with isolated mitral stenosis. MVA was obtained by the PHT and E-D methods, and the data obtained were validated against the results of cardiac catheterization. The results obtained using the E-D method showed much better correlation (r = 0.82) with those of catheterization than those with the PHT method (r = 0.52). The inter- and intraobserver variabilities were checked. The results obtained with the E-D method were found to be reproducible. To further validate the accuracy of the E-D method, MVA was measured by both methods at different R-R intervals after exercise and the results were compared. The MVA obtained by the PHT method showed marked variations; whereas, that obtained by the E-D method remained nearly constant. Similarly, in a patient with atrial fibrillation, the MVA assessed by the PHT method varied from beat to beat; whereas, the fluctuations in MVA were minimal using the E-D method. We concluded that the E-D method can be reliable and clinically easily applicable for the accurate assessment of MVA.     

Pulmonary hypertension in systemic lupus erythematosus: clinical association and survival in 18 patients.

OBJECTIVE: To examine the clinical and serologic features in patients with systemic lupus erythematosus (SLE) with pulmonary hypertension (PHT). METHODS: Case records were reviewed for 419 Chinese patients with SLE from a single center in Hong Kong between January 1985 and June 1997. Patients with PHT were compared with SLE controls. The diagnosis of PHT was made when the pulmonary artery systolic pressure (PASP), measured by 2 dimensional echocardiogram and Doppler studies at rest, was >30 mm Hg, or at postmortem. Clinical features, serologic profile, and outcome of those with PHT were compared with those without PHT. Thirteen patients had repeat echocardiogram to determine subsequent PASP. RESULTS: Eighteen of 419 patients, all female, were identified as having PHT. The clinical and serologic features of patients with SLE with PHT were similar to those without PHT except for serositis and Raynaud's phenomenon, which occurred more frequently in patients with PHT (p = 0.01, p = 0.03, respectively). The age at diagnosis of PHT was 30.5+/-10.2 (mean +/- SD) years. The duration of followup from time of diagnosis of PHT was 23.6+/-20.1 months. PASP was 52+/-23.4 mm Hg. There were 4 deaths. Survival of PHT patients as a group was 40.2+/-5.18 (95% CI 30.1-50.4) months. Repeat echocardiogram in 13 patients revealed a mean reduction in PASP of 21.3% over a median interval of 43 (range 4-52) months. CONCLUSION: Raynaud's phenomenon is associated in patients with SLE with PHT. The prognosis of these patients is variable, with the majority of patients having mild to moderate disease showing little change over 2 years. Nearly a quarter died and a few improved markedly.     

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血压测量是高血压诊断、评估、治疗和科学研究的重要方法,规范化操作是准确测量血压的关键。目前血压测量的方法为:诊室血压测量(OBPM)、动态血压测量(ABPM)、家庭血压测量(HBPM)。文章比较了3种测量方法的应用要点和注意事项,要根据临床情况选用适合的血压测量方法。推荐使用经国际标准认证的上臂式电子血压计进行家庭血压测量,有助于提高患者的依从性和血压控制率。有条件的地区可推广应用动态血压测量,有助于了解24 h血压及其节律。     

Underlying aetiology of pulmonary hypertension in 191 patients: a single centre experience

Background and objective: The aim of this study was to describe the prevalence and annual incidence, as well as the aetiology of pulmonary hypertension (PHT) in a PHT clinic, so as to assist in future assessments of the economic burden of PHT. Methods: The medical records for all new cases of PHT, defined as systolic pulmonary artery pressure >45 mm Hg as measured by Doppler echocardiography, or as mean pulmonary artery pressure >25 mm Hg measured at cardiac catheterization, between January 1998 and December 2005, were reviewed. The aetiology of the PHT was recorded and separate mean annual incidences were calculated. Results: The study population included 191 patients ranging in age from 16 to 90 years. Respiratory disorders were the leading aetiology for PHT, accounting for 31% of cases, followed by collagen vascular diseases (19%), idiopathic (12%), haemodialysis (13%), chronic thromboembolism (8%), haematological diseases (7%), liver cirrhosis (6%) and hypoventilation syndrome (4%). The mean annual incidence of PHT was 15.9 new cases per million citizens per year, with a mean annual incidence due to respiratory disease of 4.82 (COPD, 3.83), collagen vascular disease 3.08, haemodialysis 2.08, idiopathic 1.92, chronic thromboembolism 1.33, haematological disease 1.17, liver disease 0.92 and hypoventilation syndrome 0.58. The mean annual incidence of PAH and chronic thromboembolic PHT that fitted the guidelines for therapy was 8.58 cases per year per million citizens. Conclusion: The current data may help in estimating the economic burden of PHT.     

The value of blood pressure self-measurement by patients with hypertension

Blood pressure (BP) self-measurement (SM) is a promising method of investigation of patients with hypertension capable to provide information unobtainable neither with traditional office measurements nor with 24-hour BP monitoring. Advantages of BPSM are as follows: accessibility, low effect of anxiety on results of BP measurement; possibility of long-term monitoring of BP. Conditions which should be satisfied in order to realize these advantages include availability of individually selected measurement device, correct fulfillment of measurements, sufficient frequency of measurements, exact reporting of results to a physician. Besides inherent possibility of incorrect measurements BPSM has some other limitations - tendency to underestimation of real BP level and relatively low sensitivity in diagnosis of hypertension. At present BPSM can be used both for diagnosis of hypertension and for assessment of efficacy of antihypertensive therapy. Comparative value of BPSM and 24-hour blood pressure monitoring for clinical pharmacology deserves special investigation. In some difficult cases ('white coat hypertension', 'pseudoresistance to therapy') BPSM should apparently precede 24-hour BP monitoring.     

Predictors of isolated pulmonary hypertension in patients with systemic sclerosis and limited cutaneous involvement

OBJECTIVE: To determine whether there are factors, such as the diffusing capacity for carbon monoxide (DLCO) or pulmonary artery pressure (PAP) on echocardiogram, that can predict the development of pulmonary hypertension (PHT) in patients with limited scleroderma. METHODS: Using the large Pittsburgh Scleroderma Databank, 106 patients who had the diagnosis of PHT after January 1, 1982, were matched with 106 controls by scleroderma subtype, age, sex, race, disease duration, and the mean time to the diagnosis of PHT after the initial Pittsburgh visit. Autoantibodies, vascular features, use of calcium channel blockers, extent of pulmonary function, and echocardiogram findings were determined at any time prior to the diagnosis of PHT (or prior to the matched time in controls). RESULTS: Patients with PHT had a mean DLCO of 52% of predicted at an average of 4.5 years prior to the diagnosis of PHT. This was markedly decreased compared with the values in controls, whose mean DLCO was 81% of predicted (P < 0.0001). The estimated mean PAP on echocardiogram was only slightly higher in the PHT patients compared with controls (34 mm Hg versus 29 mm Hg; P not significant). Nineteen PHT patients had 4 serial measurements of the DLCO during the 15 years prior to the diagnosis of PHT. The initial mean DLCO was 80% of predicted, which decreased in a linear manner to a mean of 35% of predicted at the time of diagnosis of PHT, whereas the value in controls remained at approximately 80% of predicted (P < 0.0001). PHT patients had more severe Raynaud's phenomenon and more severe digital tip ulcers, but they used calcium channel blockers significantly less frequently (37% versus 61% of controls; P < 0.01). The predominance of nucleolar autoantibodies and the absence of anti-Scl 70 antibody were associated with PHT. CONCLUSION: A decreasing DLCO is an excellent predictor of the subsequent development of isolated PHT in limited scleroderma. The DLCO may be significantly decreased for many years prior to the diagnosis of PHT. The presence of autoantibodies and the PAP may also be helpful predictors. The long-term use of calcium channel blockers may be protective, but newer agents that are more effective in treating PHT may also be helpful in altering the natural history of this serious complication in limited scleroderma.     

Comparative study on auscultatory and oscillometric methods of ambulatory blood pressure measurements in adult patients

BACKGROUND: Ambulatory blood pressure (BP) monitors measure BP by oscillometric (Osc) or auscultatory (Aus) methods. In this study, we aimed to compare the values obtained by BP measurement methods in the ambulatory blood pressure monitoring (ABPM) device that can take measurements using both the methods, factors influencing these values, and their relevancy in obtaining valid measurement percentages. METHODS: The study was conducted on 212 patients. BP values of these patients were measured with the Nissei DS-250 (Nihon Seimitsu Sokki Co. Ltd, Gunma, Japan) monitor capable of recording BP simultaneously by the Aus and the Osc methods. The cases, for which no records were obtained by any one of the two methods, were considered to have missing records. The impacts of age, sex, body mass index, and arm circumference on the valid BP measurement values were examined. RESULTS: The valid measurement percentage without any missing records obtained by the Osc method was 87.3 and 16% by the Aus method. The body mass index, age, and arm circumference did not affect this percentage. The 24-h BP measurement values were higher by the Osc method. The differences between both methods in systolic blood pressure and diastolic blood pressure were 3.8+/-4.6 and 2.3+/-2.7 mmHg, respectively. Although the Aus method yielded higher standard deviation values than the Osc method for systolic blood pressure, standard deviation values obtained by the Osc method were higher than those obtained by the Aus method for diastolic blood pressure. CONCLUSION: The percentage of obtaining valid measurements by the Osc method used in the Nissei DS-250 model ABPM device examined in this study is higher when compared with the Aus method. Therefore, while examining ABPM results, the Osc method may be preferable over the Aus method.