老年高血压的动态血压监测

对60例老年高血压病患者(Ⅰ期24例,Ⅱ期21例、Ⅲ期15例)、30例健康老年人、30例健康中青年分别进行动态血压监测和比较。结果老年对照组动态血压监测各参数值均明显高于中青年对照组;高血压Ⅰ、Ⅱ、Ⅲ期各组与老年对照组比较各参数值也明显增高。如以老年对照组各项参数的(?)±2s为正常高限,则高血压Ⅰ、Ⅱ、Ⅲ期各组分别有9、13、15项数值超过正常。其中以24小时平均收缩压和舒张压日间平均收缩压和舒张压、夜间平均收缩压和舒张压及血压负荷值等为诊断动态高血压的重要指标。     

Ambulatory Blood Pressure and Endothelial Dysfunction in Hematopoietic Cell Transplantation Recipients

Hematopoietic cell transplantation (HCT) is a common treatment for many disorders. Albuminuria post-HCT, which may represent endothelial injury or inflammation from graft- versus-host disease, increases the risk of chronic kidney disease and nonrelapse mortality at 1 year. HCT recipients also have abnormal blood pressure (BP) and increased rates of cardiovascular complications. We sought to determine the relationships among albuminuria, endothelial dysfunction, and BP in HCT recipients. Patients age ?≥12 years who underwent their first allogeneic HCT between 2012 and 2015 and survived through day 80 post-HCT were eligible. Peripheral endothelial function was assessed using the EndoPAT2000 device at day 80 along with 24-hour ambulatory BP monitoring (ABPM). Clinical and laboratory data were collected along with a urine sample for calculation of the albumin-to-creatinine ratio. Both logistic and linear regression analyses were used to identify associations between EndoPAT score and clinical variables. Sixty patients (median age, 48 years; range, 14 to 69 years) completed the study. The median EndoPAT score was 2.05 (range, 1.02 to 4.45), and 17 patients (28%) had abnormal endothelial function. Forty-two patients (72%) had ambulatory hypertension (HTN), and 38 (63%) had blunted nocturnal dipping. HTN on ABPM (P?=?.045) and blunted nocturnal dipping (P?=?.04) were associated with a lower EndoPAT score. Albuminuria was not associated with EndoPAT score. There was a lack of agreement between our clinical definition of HTN (office BP and/or use of medications) and ABPM results (P?=?.04). We did not find an association between lower EndoPAT scores and albuminuria, but did find an association between an abnormal nocturnal dip and HTN diagnosed by ABPM. This suggests that albuminuria may reflect local endothelial injury and inflammation rather than a systemic process. Office BP readings do not accurately reflect true BP, suggesting that 24-hour ABPM studies are needed to diagnose and treat HTN appropriately.     

Evaluation of a New Ambulatory Blood Pressure Monitor (Accutracker 102): Laboratory Comparisons With Direct Arterial Pressure, Stethoscopic Auscultatory Pressure, and Readings From a Similar Monitor (Spacelabs Model 5200)

Systolic (SBP) and diastolic (DBP) blood pressure levels generated by a new noninvasive ambulatory monitor, the Accutracker 102, were compared in the laboratory with intra-arterial pressure levels in 12 normotensive men, and with stethoscopic auscultatory determinations in 27 normotensive and hypertensive men and women over a wide range of within-subject pressure variations. In 11 subjects, its performance was also compared with another ambulatory monitor, the Spacelabs Model 5200. Highly positive correlations with both the intra-arterial (median r=+.90 for SBP, +.92 for DBP) and the stethoscopic standards (median r=+.93 for SBP, +.88 for DBP) were obtained using Accutracker's automatic readings (digital readout), while slightly higher correlations were obtained with hand-scoring of recorded data. The Spacelabs BP monitor also yielded readings that were highly correlated with stethoscopic readings (median r=+.83 for SBP, +.77 for DBP), although in 3 of the 11 subjects the Accutracker correlations were substantially higher than the Spacelabs correlations. Despite their generally good tracking of changes in pressure, both ambulatory monitors yielded absolute values in many subjects that differed by 5 mmHg or more from stethoscopic levels. The Accutracker's SBP levels were consistently too high and its DBP levels were occasionally too low, while Spacelabs' SBP and DBP values were too high and too low with equal frequency. However, mean deviation scores for each patient calculated from 5 concurrent ambulatory monitor and stethoscopic readings were shown to yield relatively stable correction factors for use when comparison with clinical standards is desired.     

高血压病患者动态血压变异性与微循环变化的关系

目的 :探讨高血压病 (EH)患者的动态血压变异性 (ABPV)、甲襞微循环变化特点及二者的关系。方法 :以 3 0例年龄相当、血压正常的健康者作对照组观察了 67例EH患者的动态血压变异性(ABPV)、甲襞微循环变化。结果 :发现高血压病组微循环的管袢形态、血流流态、袢周状态积分值及总积分值明显高于正常对照组。相关分析结果显示 :正常对照组甲襞微循环总积分值仅与年龄呈弱相关 (r=0 .3 75 ,P <0 .0 5 ) ,与偶测血压 (CBP)、动态血压的各参数平均值 (ABP)、ABPV无显著性相关。高血压病组总积分值主要与CBP、ABP呈显著正相关 ,与 2 4h、夜间的ABPVs、ABPVd呈显著负相关 ,其中与 2 4hABPs关系最为显著 (r =0 .60 4,P <0 .0 1)。结论 :高血压病昼夜血压水平与血压的变异性 ,对微循环恶化改变的发生发展起重要的作用。     

吸烟对动态血压及动脉硬化指数影响的相关性分析

目的 分析吸烟对动态血压及动脉硬化指数影响的相关性。方法 选取四会万隆医院心内科2018年1月~12月收治的120例高血压患者设为观察组,另选同期120例健康体检者为对照组,分别比较观察组与对照组、观察组内吸烟患者与不吸烟患者动态血压（24h平均收缩压、24h平均舒张压）、动脉硬化指数,并使用Pearson相关性分析法对其相关性进行检验。结果 观察组24h平均收缩压（134.65±2.10）mmHg、24h平均舒张压（86.20±2.45）mmHg、动脉硬化指数（0.67±0.05）,分别高于对照组的（117.45±2.35）mmHg、（75.25±2.70）mmHg、（0.52±0.03）,差异有统计学意义（P＜0.05）;观察组吸烟患者24h平均收缩压（137.21±2.40）mmHg、24h平均舒张压（90.20±2.35）mmHg、动脉硬化指数（0.75±0.05）,高于不吸烟患者的（132.48±2.32）mmHg、（82.49±2.41）mmHg、（0.61±0.08）,差异有统计学意义（P＜0.05）;Pearson相关性分析结果提示,吸烟与动态血压及动脉硬化指数呈正相关性（r=0.68、0.85,P＜0.05）。结论 吸烟与动态血压及动脉性硬化指数之间存在着密切的关联性,戒烟有助于遏制高血压及动脉粥样硬化的进一步恶化。     

2型糖尿病并脑梗死动态血压变化及其影响因素研究

目的　探讨 2型糖尿病 (2 -DM)患者并初发脑梗死 (CI)动态压血改变的特点及其意义 .方法　配对方法观察 41例 2 -DM并初发CI与 41例一般CI患者的 2 4小时动态血压 (ABP)改变情况 .结果　 2 -DM并初发CI患者的 2 4小时收缩压负荷、白天和夜间收缩压较一般CI患者高 (p <0 .0 5 ) ,白天和夜间舒张压、2 4小时舒张压负荷两者无显著性差异 (p >0 .0 5 ) .结论　 2 -DM初发CI后 2 4小时收缩压负荷及夜间血压增高 ,可能是2 -DM患者CI再发率高的原因之一 .     

原发性高血压合并微量白蛋白尿患者动态血压观察

目的了解原发性高血压患者微量白蛋白尿(micro-albuminuria,MAU)与动态血压的特征性改变,包括血压变异指数(ABPVs、ABPVd)、血压负荷(BPload)及血压昼夜节律的相关性。方法确诊的141例原发性高血压患者进行24h动态血压和24h尿微量白蛋白检查,分为微量白蛋白尿(MAU)组及尿微量白蛋白正常组(NAU)。结果MAU组血压变异指数及血压负荷较NAU组增大(P<0.05),合并MAU的患者血压昼夜节律不明显。结论微量白蛋白尿的发生与血压变异指数、血压负荷和血压昼夜节律密切相关,有无微量白蛋白尿可一定程度上反映血压控制状况。     

Acute and Chronic Effects of Aerobic and Resistance Exercise on Ambulatory Blood Pressure

Hypertension is a ubiquitous and serious disease. Regular exercise has been recommended as a strategy for the prevention and treatment of hypertension because of its effects in reducing clinical blood pressure; however, ambulatory blood pressure is a better predictor of target-organ damage than clinical blood pressure, and therefore studying the effects of exercise on ambulatory blood pressure is important as well. Moreover, different kinds of exercise might produce distinct effects that might differ between normotensive and hypertensive subjects.The aim of this study was to review the current literature on the acute and chronic effects of aerobic and resistance exercise on ambulatory blood pressure in normotensive and hypertensive subjects. It has been conclusively shown that a single episode of aerobic exercise reduces ambulatory blood pressure in hypertensive patients. Similarly, regular aerobic training also decreases ambulatory blood pressure in hypertensive individuals. In contrast, data on the effects of resistance exercise is both scarce and controversial. Nevertheless, studies suggest that resistance exercise might acutely decrease ambulatory blood pressure after exercise, and that this effect seems to be greater after low-intensity exercise and in patients receiving anti-hypertensive drugs. On the other hand, only two studies investigating resistance training in hypertensive patients have been conducted, and neither has demonstrated any hypotensive effect. Thus, based on current knowledge, aerobic training should be recommended to decrease ambulatory blood pressure in hypertensive individuals, while resistance exercise could be prescribed as a complementary strategy.     

The Cultural Gradient: Culture Moderates the Relationship between Socioeconomic Status (SES) and Ambulatory Blood Pressure

A social gradient has been consistently demonstrated in Western countries with higher socioeconomic status (SES) related to lower blood pressure (BP). In non-Western countries, however, the social gradient is not always evident, with some countries appearing to show a reversed social gradient. It was hypothesized that culture moderates the social gradient, with the relationship between SES and BP differing as a function of culture. To investigate the idea of a “cultural gradient” a sample of Hispanic immigrants and Whites was studied. A total of 79 participants (30 Hispanic immigrant, 49 White) wore ambulatory blood pressure monitors for 24 h. The Hispanic immigrants also completed the Acculturation Rating Scale for Mexican Americans- II. Hispanic immigrants had lower SES and lower BP compared to Whites. A cultural gradient moderating the social gradient was evident with Hispanic immigrants displaying a positive relationship between SES and BP and Whites displaying a negative relationship. Among Hispanic immigrants, increased acculturation to Western culture decreased the positive relationship between SES and BP. Just as there is a social gradient with increasing socioeconomic status related to better cardiovascular health, there appears to be a cultural gradient with increasing acculturation to Western society related to worse cardiovascular health.     

Predicting Home and Work Blood Pressure Measurements from Resting Baselines and Laboratory Reactivity in Black and White Americans

The relationship between blood pressure in the laboratory (both at rest and in response to laboratory tasks) and ambulatory blood pressure at home and at work was evaluated. One hundred nineteen normotensive and unmedicated mild-moderate hypertensive black and white females and males participated in laboratory blood pressure monitoring at rest and during four challenging tasks (structured interview, video game, bicycle exercise, and cold pressor test) as well as ambulatory blood pressure monitoring while at home and at work. Baseline blood pressure taken while subjects were at rest was the strongest predictor of ambulatory systolic blood pressure (r = .64) and diastolic blood pressure (r = .77) at work. Among reactivity tasks the strongest predictors of ambulatory blood pressure in the total population were the structured interview and the video game (both psychological tasks) followed by the cold pressor test. Racial comparisons, however, determined that the cold pressor test predicted diastolic blood pressure significantly better for blacks (r = .73) than for whites (r = .40), suggesting a possible difference in blood pressure regulation.     

Ambulatory Blood Pressure and Marital Distress in Employed Women

Abstract

In this investigation, the relationship between marital distress and blood pressure during daily life in a sample of married employed women was examined. It was hypothesized that greater marital distress would be associated with elevated blood pressure in the home environment, but not in the workplace. Participants were 50 married employed women, aged 25 to 45 years. Participants underwent ambulatory blood pressure monitoring on a typical workday. The women with higher levels of marital distress exhibited greater negative emotions and higher levels of blood pressure at home. These results suggest that the physiological concomitants of stress and emotional upset associated with marital distress are manifest in elevated blood pressure that is most pronounced in the home environment.     

Trait Anger, Anger Expression, and Ambulatory Blood Pressure: A Meta-Analytic Review

A meta-analysis of 15 studies was conducted to investigate the relationship between trait anger and ambulatory blood pressure. Overall, the experience of anger was significantly and positively associated with systolic blood pressure (r ₊ = 0.049), but not reliably associated with diastolic blood pressure (r ₊ = 0.028). After removing an outlier, the expression of anger was found to have a reliable inverse relationship with diastolic blood pressure (r ₊ = –0.072). No reliable relationship between expression of anger and systolic blood pressure (r ₊ = –0.041) was found. These results continue to support the modest role of self-reported trait anger and anger expression in blood pressure levels. Several suggestions for future research are discussed, including increasing the focus on the complexity and synergism of these effects.     

Blood pressure measurements taken by patients are similar to home and ambulatory blood pressure measurements

OBJECTIVE: To compare blood pressure measurements taken at home by physicians, nurses, and patients with office blood pressure measurement , ambulatory blood pressure monitoring and home blood pressure measurement. METHODS: A total of 44 patients seen by a home care program were studied. Protocol 1 a) blood pressure was measured by the patient, a physician and a nurse during a regular home visit (Home1); b) home blood pressure measurement was measured for 4 days (HBPM1); c) office blood pressure measurement was measured by a physician, a nurse, and the patient; and by 24-hour ambulatory blood pressure monitoring. Protocol 2 blood pressure was measured by the patient, a physician, and a nurse during a special home visit in the presence of a physician and a nurse only (Home2); and b) home blood pressure measurement was taken for the second time (HBPM2). Echocardiography, guided by a two-dimensional echocardiograph, was performed. RESULTS: Protocol 1: a) office blood pressure measurement and Home1 were significantly higher than ambulatory blood pressure monitoring, except for systolic and diastolic office blood pressure measurement taken by the patient or a family member, systolic blood pressure taken by a nurse, and diastolic blood pressure taken by a physician. b) ambulatory blood pressure monitoring and HBPM1 were similar. Protocol 2: a) HBPM2 and Home2 were similar. b) Home2 was significantly lower than Home1, except for diastolic blood pressure taken by a nurse or the patient. There were significant relationships between: a) diastolic blood pressure measured by the patient and the thickness of the interventricular septum, posterior wall, and left ventricular mass; and b) ambulatory and HBPM2 diastolic and systolic blood pressure taken by a physician (home2) and left ventricular mass. Therefore, the data indicate that home blood pressure measurement and ambulatory blood pressure monitoring had good prognostic values relative to "office measurement." CONCLUSION: This study showed that the measurement most similar to home blood pressure measurement and ambulatory blood pressure monitoring was blood pressure measured by the patient, and that home blood pressure measurement and ambulatory blood pressure monitoring had good prognostic value relative to "office measurements".     

Baroreceptor Stimulation Alters Pain Sensation Depending on Tonic Blood Pressure

It has been hypothesized that activation of the baroreceptor reflex arc, by its central nervous inhibitory effects, is involved in an operant learning mechanism of blood pressure elevation. The present study investigated the effects of mechanical stimulation of the baroreceptors in the carotid sinus on pain threshold and electrical brain activity in two groups of humans with different tonic blood pressure levels. In normotensives, baroreceptor stimulation lowered pain threshold as compared to a control condition, while borderline hypertensives tolerated more intense electric stimulation when baroreceptors were activated. A marked reduction of the contingent negative variation in anticipation of the aversive stimulation accompanied baroreceptor stimulation, probably a consequence of baroreceptor afferent impulses exerted via brainstem centers to cerebral cortex. The distribution of the potential change across the scalp depended on the tonic blood pressure, indicating differences in brain functioning between normotensives and borderline hypertensives. The present results suggest that the hypothesis of an operantly-conditioned blood pressure elevation under stress may be valid only in subjects with a predisposition for essential hypertension.     

Association between Central Obesity and Circadian Parameters of Blood Pressure from the Korean Ambulatory Blood Pressure Monitoring Registry: Kor-ABP Registry

Central obesity has been reported as a risk for atherosclerosis and metabolic syndrome. The influence of central obesity on diurnal blood pressure (BP) has not been established. In this study, we investigated the influence of central obesity on the circadian parameters of BP by 24 hr ambulatory BP monitoring. Total 1,290 subjects were enrolled from the Korean Ambulatory BP registry. Central obesity was defined as having a waist circumference≥90 cm in males and ≥85 cm in females. The central-obese group had higher daytime systolic BP (SBP), nighttime SBP and diastolic BP (DBP) than the non-obese group (all, P<0.001). There were no differences in nocturnal dipping (ND) patterns between the groups. Female participants showed a higher BP mean difference (MD) than male participants with concerns of central obesity (daytime SBP MD 5.28 vs 4.27, nighttime SBP MD 6.48 vs 2.72) and wider pulse pressure (PP). Central obesity within the elderly (≥65 yr) also showed a higher BP MD than within the younger group (daytime SBP MD 8.23 vs 3.87, daytime DBP 4.10 vs 1.59). In conclusion, central obesity has no influence on nocturnal dipping patterns. However, higher SBP and wider PP are associated with central obesity, which is accentuated in women.     

电磁辐射对清醒大鼠动脉收缩压的影响及其机制研究

目的:观察电磁辐射(EMR)对大鼠整体血压的影响并初步探讨其机理。方法:用无创性的尾套式大鼠动脉血压测量仪观察一定场强和脉冲次数的EMR照后不同时间内清醒大鼠动脉收缩压的变化规律,并观察血液中前列环素(PGI2)、血栓烷素(TXA2)、内皮素(ET),心钠素(ANP)、一氧化氮浓度及一氧化氮合酶活性的变化。结果:照射后的大鼠的动脉血压先升高,维持至第2 h,开始下降,在第12 h下降至最低点,而后开始缓慢回升,在到第24 h,逐渐恢复接近正常水平。在收缩压变动的最显著的第12 h,血浆前列腺环素和心钠素的浓度明显降低,内皮素含量升高,血栓素在照射后没有显著改变,NOS活性升高,NO含量略有升高,但无显著差异。结论:EMR照射后,大鼠血压呈规律性改变,内皮素、心钠素、前列环素参与了辐射引起的血压波动,NO/NOS系统在其中的作用尚不能肯定。     

Cuff Pressure Oscillations in the Measurement of Relative Blood Pressure

The continuous relative blood pressure measure obtained with a partially-inflated arm blood-pressure cuff operates under the same principle as the oscillometric method of blood pressure determination. In psychophysiological studies the rise in blood pressure seen, for example, in response to an emotion-evoking question, produces a rise in cuff pressure, along with any of three pulse-amplitude changes: a decrease, no change, or an increase. These seemingly paradoxical responses which accompany an increase in blood pressure may be explained by considering the relationship of cuff pressure to the cuff pressure for maximum oscillations. Experiments were conducted in which cuff pressure and its oscillations were recorded. Indications of an increase in blood pressure, and the pulse-amplitude changes resulting there from, were obtained at different cuff pressures in the same subject. The results confirm the hypothesis that with cuff pressure below the point of maximum oscillation, an increase in blood pressure results in a decrease in pulse amplitude. With a cuff pressure just above the point of maximum oscillations, an increase in blood pressure results in an increase in pulse amplitude.     

高血压病患者血脂、血糖与血压关系的研究

目的:探讨高血压病患者血脂、血糖与血压的相关性。方法:测定482例高血压病患者和100例健康人Cho-C、TG、LDL-C、HDL-C、apoA、apoB、血糖(BS)以及血压(SBP、DBP),并进行统计学分析。结果:高血压组Cho-C、TG、LDL-C、BS明显升高(P<0.05~0.01);Cho-C与BS呈明显正相关(P<0.05);TG与BS、SBP、DBP呈明显正相关(P<0.05~0.01);BS与SBP呈明显正相关(P<0.05)。结论:高血压病患者存在脂代谢及糖代谢异常。TG与血糖水平及血压均呈正相关。     

不同周龄自发性高血压大鼠动态血压变化及阻力血管形态学研究

目的: 观察不同周龄自发性高血压大鼠(SHR)动态血压变化及阻力血管形态。方法: 分别选用16周及40周龄的SHR模型,使用遥感监测技术观察清醒、无拘束SHR的动态血压变化,分析不同周龄SHR的血压昼夜变化及变异度,比较不同周龄SHR阻力血管的形态学变化。结果: 40周SHR较16周SHR 24 h血压均值高,但无显著差异;16周SHR夜间血压下降率较40周明显升高(P<0.05);40周SHR 血压变异系数较16周SHR明显增大。肠系膜动脉(阻力血管)中膜面积/管腔面积比值随着周龄的增加而增加,5周、16周与40周相比有显著差异(P<0.05)。结论: 40周SHR动态观察24 h血压变异度较16周SHR大,且随着周龄的增加,阻力血管(肠系膜动脉)的中膜面积/管腔面积增加。