北京市城乡老年人抗高血压药物7年变化趋势

目的: 了解北京市城乡老年人抗高血压药物使用7年变化情况。 方法: 采用分层、随机、整群等距的抽样原则,于2000、2004和2007年3次选取北京地区≥60岁的2 832、1 828和2 277例老年人进行血压测量及相关资料的收集,应用χ2检验对不同性别、年龄、居住地区与高血压用药7年变化趋势进行单因素分析。结果: 钙通道阻滞剂（CCB）、血管紧张素转换酶抑制剂（ACEI）、利尿剂和β-受体阻滞剂的使用逐年增多,而降压片的使用明显减少。结论: 老年高血压病的治疗已不仅仅局限于降压,还要考虑防治并发症,提高高血压病患者的生命质量。     

A 5-year prospective,observational study of the withdrawal of antihypertensive treatment in elderly people

Abstract. Objectives . To observe blood pressure, cardiovascular events, and total mortality after withdrawing antihypertensive treatment for elderly patients. Design . Multicentre observational study. Setting . Sweden. A 5-year follow-up of 333 elderly hypertensive patients, aged 70–84 years (mean age 75.2 ± sd 3.8 years, 68% females). In all, 74 out of the 333 patients (22%) died during the study period. Method . After withdrawal of the antihypertensive therapy, all patients started in the untreated state and during the 5-year follow-up they could then either remain in the untreated state, or be reverted to blood-pressure-lowering drug treatment because of hypertension or other diseases, e.g. angina pectoris, oedema, congestive heart failure, etc. Results . The probability of remaining without treatment for 5 years was estimated to be 20%. During the state of no treatment the patients had a lower total mortality risk than that of the general Swedish population, matched for age and sex. They also had a lower risk of cardiovascular events than those in the treated states. Markers indicating a successful withdrawal were monotherapy in low doses and relatively low blood pressure before withdrawal. Conclusion . These results suggest that with frequent check-ups, withdrawal of antihypertensive therapy in the elderly can be tried without increased risk of cardiovascular events.     

The relationship between casual and ambulatory blood pressure in essential hypertension: the influence of work, duration of hypertension and antihypertensive treatment

Casual blood pressure (BP) and ambulatory BP (mean 24-h BP) were determined in 23 untreated patients with essential hypertension and in 11 normotensive healthy control subjects. Mean 24-h BP was significantly lower than casual BP in patients with essential hypertension, but not in control subjects. This was demonstrated in the patients who did not work during the ambulatory BP monitoring and in the patients with newly recognized hypertension, whereas no differences were revealed either in the patients who went to work or had a known duration of hypertension longer than 6 months. The size of the difference between casual BP and mean 24-h BP was unaffected by antihypertensive therapy with metoprolol and also individually reproducible. An accordance between casual and ambulatory BP measurements in evaluation of the efficacy of antihypertensive treatment was found in 75% of the patients. Casual BP and mean 24-h BP were weakly correlated both before and during antihypertensive treatment. It is concluded that the higher casual BP than ambulatory BP in essential hypertension may be a specific characteristic of the disease. Both work and known duration of hypertension longer than 6 months eliminate the difference between casual ambulatory BP in essential hypertension. Ambulatory BP monitoring seems to be superior to casual BP measurements in the evaluation of antihypertensive treatment.     

高龄男性原发性高血压患者降压药物应用现状

目的探讨高龄男性原发性高血压患者的降压药物治疗现状,为临床治疗提供参考。方法对106例75岁以上男性原发性高血压患者出院时降压药物应用方案进行登记并行χ2检验。结果应用最多的是长效钙离子拮抗剂(CCB,77.35%)、其次是β受体阻滞剂(46.23%)、血管紧张素转换酶抑制剂(40.57%)、血管紧张素Ⅱ受体拮抗剂(28.30%)、利尿剂(26.42%)和α受体阻滞剂(0.94%),长效CCB明显高于其他种类降压药物,有78.31%的患者需要两种以上降压药物的联合治疗,平均服降压药物种类(2.19±0.86)种例。结论高龄男性原发性高血压患者适用于以长效CCB为基础的小剂量联合降压治疗方案,而利尿剂不是其一线药物。     

Association between blood pressure reduction with antihypertensive treatment and sleep apnea activity

This study investigated whether a drug therapy–induced reduction in nocturnal blood pressure (BP) was associated with decreased sleep apnea activity. Two polysomnographies from 54 hospitalized male hypertensive, obstructive sleep apnea patients were analyzed in a double-blind, randomized, parallel-group trial of the angiotensin-converting enzyme inhibitor cilazapril (C), 2.5 mg once daily, or placebo (P). Blood pressure was measured by means of an intra-arterial catheter. Compared with P, C lowered mean arterial BP during non-rapid eye movement (NREM) (−8.3 ± 10.7 mm Hg, P = .05) and REM sleep (−8.6 ± 10.1 mm Hg, P = .02). Respiratory disturbance index (−8.6 ± 3.2 events/h of sleep (n/h), P = .01) and apnea index (AI) (−6.6 ± 3.0 n/h, P = .04) during NREM sleep were lowered by C and, to a lesser extent, by P (−5.9 ± 3.2 n/h, P = .07 and −5.0 ± 3.6 n/h, P = .18, respectively). The effect on AI and hypopnea index (HI) during REM sleep was not significant for C (−5.9 ± 3.4 and 0.1 ± 2.0, NS, respectively) and P (−2.6 ± 3.9 and 1.6 ± 2.0, NS, respectively). There was a significant linear correlation between the change in REM systolic BP and the change in REM AI (r = 0.28, P = .04); the mean BP change correlated negatively with the change in HI (−0.28, P = .04). During NREM sleep there was no significant correlation between changes in BP and the treatment effects on sleep apnea activity. Blood pressure reduction after short-term antihypertensive treatment did not affect sleep disordered breathing during NREM sleep. Reduced BP was associated with a weak reduction of AI and a slight increase of HI during REM sleep. It appears that elevated BP contributes only marginally to sleep apnea severity in hypertensive patients with obstructive sleep apnea.     

老年高血压患者降压治疗后舒张压对心脑血管事件的影响

目的探讨老年高血压患者降压治疗后,舒张压水平与心脑血管事件的关系,并了解是否存在关于舒张压的"J"型曲线。方法采用回顾性研究方法将1010例老年高血压患者按降压治疗后舒张压水平分为6组:1组舒张压<65 mm Hg(1 mm Hg=0.1 33 kPa)68例,2组舒张压65～69 mm Hg 154例,3组舒张压70～74 mm Hg 334例,4组舒张压75～79 mm Hg 235例,5组舒张压80～84 mm Hg 148例,6组舒张压85～89 mm Hg 71例;应用Cox比例风险模型分析不同舒张压水平对心脑血管事件的影响。结果 2组心脑血管事件发病率最低,在校正传统危险因素后,与2组比较,4组、5组和6组心脑血管事件发生相对风险分别增加了68%、184%及203%(P<0.05,P<0.01),1组心脑血管事件发生相对风险虽有增加趋势,但差异无统计学意义(P>0.05)。结论老年高血压患者心脑血管事件随降压治疗后舒张压降低有减少趋势,舒张压降至65～69 mm Hg亦能获益。     

糖尿病对老年高血压患者动态血压及血压变异性的影响

目的探讨老年2型糖尿病患者中糖尿病对原发性高血压（高血压）患者的动态血压（ambulatory bloodpressure,ABP）及血压变异性（blood pressure variability,BPV）的影响。方法选取40例单纯高血压及42例65岁以上合并2型糖尿病的高血压患者,行24 h ABP监测,对2组患者的ABP及BPV进行对比分析。结果合并2型糖尿病的高血压患者日间平均收缩压（dmSBP）及夜间平均收缩压（nmSBP）高于单纯高血压患者,差异有统计学意义（P〈0.05或0.01）;合并2型糖尿病的高血压患者日间脉压（dmPP）、夜间脉压（nmPP）及24 h平均脉压差（24 h-mPP）均大于单纯高血压患者,差异有统计学意义（P〈0.05或0.01）;BPV方面,合并2型糖尿病的高血压患者日间收缩压标准差（dSBPSD）及日间收缩压标准差变异系数（dSBPCV）、夜间收缩压标准差（nSBPSD）及夜间收缩压标准差变异系数（nSBPCV）、24 h收缩压标准差（24 h-SBPSD）均显著高于单纯高血压患者,差异有统计学意义（P〈0.05或0.01）。结论年龄、高血压是老年2型糖尿病患者大血管病变的独立危险因素,2型糖尿病合并高血压时,ABP及BPV增大,心血管系统的结构与功能异常。改善糖代谢状况将有助于形成良好的代谢记忆,从而改善血流动力学,减少心血管并发症。     

Antihypertensive efficacy and tolerability of different drug regimens in isolated systolic hypertension in the elderly

The pharmacological treatment, mainly based on diuretics, ofisolated systolic hypertension (ISH) has recently been shownto reduce the risk of stroke and coronary heart disease in theelderly. The purpose of this study was to compare the antithypertensiveeffect and tolerability of different drug regimens in elderlysubjects with ISH (systolic blood pressure—SBP —160mmHg and diastolic blood pressure — DBP — <90mmHg). A multicentre, randomized, controlled open trial wasplanned in the general practice setting. Four widely used treatmentschedules were tested: hydrochlorothiazide 25 mg plus amiloride2·5 mg (H+Am), nifedipine slow release 20 mg (N), atenolol50 mg (At) and atenolol 25mg plus chlorthalidone 6·25mg (At+C). After a baseline evaluation, 308 patients (76·3% female,mean age 75·3 ± 7·1 years) were randomizedand followed up for 6 months. After 3 months the drug dosagewas doubled if the systolic blood pressure goal (SBP<160mmHg and SBP reduction of at least 20 mmHg) had not been reachedNinety-four subjects (30·5%) presented contraindicationsto ß-blockers. At the 3rd- and 6th-month visits alltreatment groups, except At, showed a significant reductionin SBP compared to the control group; DBP showed no significantreduction in any group at any time. At the end of the follow-upthe percentage of hypertensives who had reached the BP goalwas 14·6% in the control group, 52·9% in H+Am,54·8% in N, 28·6% in At and 52·2% in At+C.Over two-thirds of the patients on H+Am or N, and about 50%of those on At or At+ C at 6 months were taking the medicationat low dose. The rate of therapy discontinuation due to side effects duringfollow-up was significantly different among the drug regimenstested: 1·9% in the H+Am group compared to 12·5%,19·2% and 14·8% respectively in N, At and At+Cgroups (P<0·05 for H+Am vs At). The proportion ofsubjects who spontaneously reported, mild adverse effects after3 and 6 months of therapy was not signficantly different inthe study groups, even if an excess was observed in the N groupat 3 months. In conclusion, these data suggest that. diuretics are a firstchoice in the treatment of ISH, because of their hypotensiveefficacy and acceptability; nifedipine, if well tolerated, isan effective alternative to diuretics; a high proportion ofelderly patient with ISH present contraindications to ß-blockers,and atenolol has a poor antihypertensive effect.     

长时间立、坐、卧三体位对老年高血压患者血压值影响的观察

目的研究不同体位对老年高血压患者血压值的影响,并探讨可能的影响因素。方法连续选取在高血压科住院的60岁以上高血压患者为试验组,并以同期住院的45～60岁之间的高血压患者作为中年对照组,45岁以下的高血压患者为青年对照组,每组入选22例。试验日所有受试者停服降压药物并且避免吸烟、饮酒及饮用咖啡等影响准确测量血压的干扰因素。试验时每位患者依次采取立、坐、卧三体位,每种体位均保持2h,在保持同一体位的2h末使用台式汞柱血压计测量血压。结果试验组的收缩压随体位改变有显著性变化（P=0.026）：卧位、坐位、立位依次减低.分别为（140±16）,（134±14）,（130±17）mmHg。但舒张压随体位改变无显著性变化（P=0.082）。中年对照组和青年对照组的收缩压及舒张压随体位改变均无显著性变化（P〉0.05）。通过多元回归分析发现,胆固醇与老年高血压患者体位收缩压差值有关。结论立、坐、卧三体位对老年高血压患者的收缩压有显著影响。胆固醇是老年患者体位收缩压差值的独立影响因素。     

老年男性原发性高血压患者收缩压水平降低对心脑血管事件的影响

目的探讨老年男性原发性高血压患者降压治疗后,收缩压(SBP)水平与心脑血管事件发生的关系。方法采用回顾性研究方法 ,将836例老年男性原发性高血压患者,按降压治疗后SBP水平分为7组:1组29例,SBP110 mm Hg(1 mm Hg=0.133 kPa);2组71例,SBP 110～11 9 mm Hg;3组224例,SBP 120～1 29 mm Hg,4组290例,SBP 1 30～1 39 mm Hg,5组150例,SBP 140～149 mm Hg,6组45例,SBP 150～1 59 mm Hg,7组27例,SBP≥1 60 mm Hg;应用COX比例风险模型分析不同SBP水平对心脑血管事件的影响。结果与4组比较,6组和7组心脑血管事件发生相对风险分别增加了123%和251%(P0.01);在校正传统危险因素后,与4组比较,1组、6组和7组心脑血管终点事件发生相对风险分别增加了118%、75%和148%(P0.05),心脑血管事件发生与SBP水平呈"J型曲线"现象。结论老年原发性高血压患者SBP水平过高或过低,均显著增加心脑血管事件,SBP在130～139 mm Hg是老年男性高血压患者合适的目标血压范围。     

北京城乡老年人高血压现状调查

目的了解北京城乡老年人高血压的现状。方法采用分层整群随机抽样方法,选取北京地区年龄≥60岁的老年人2277例进行血压测量及相关资料的收集。结果 2277例老年人中,高血压患者1275例,北京地区老年人高血压患病率为56.0%,知晓率为57.7%,治疗率为56.2%,治疗后控制率为36.4%。结论高血压患病率高,但知晓率、治疗率和控制率较低,必须积极采取有效的措施以降低高血压的患病率,提高知晓率、治疗率和控制率。     

血脂康对老年单纯收缩期高血压患者脉压及平滑指数的影响

目的观察血脂康对老年单纯收缩期高血压患者脉压及平滑指数的影响。方法选择老年单纯收缩期高血压患者77例,随机分为治疗组38例和对照组39例。对照组采用常规降压药物治疗,治疗组在对照组基础上,加服血脂康0.6g,2次/d。2组随访观察6个月。结果 2组患者治疗6个月后,24h收缩压较治疗前均下降,治疗组24h收缩压和脉压差较对照组明显降低(P<0.05,P<0.01),平滑指数较对照组明显升高(P<0.01)。结论降压协同血脂康治疗,能缩小老年单纯收缩期高血压患者的脉压差,明显提高降压药物的平滑指数。     

The association between hypertension treatment,control, and functional status

The authors examined the relationship between hypertension treatment, control, and functional status among 356 “uncomplicated” hypertensive patients receiving care in 16 teaching hospital group ractices. Antihypertensive drug therapy and blood pressure control were determined from a medical record review. Functional status (health perceptions, mental health, role, and physical functioning) was assessed with a questionnaire. After adjustment for potential confounders, hypertensive patients without drug therapy were less likely to have impairment in mental health functioning, compared with patients receiving one or more than one antihypertensive medication (9% versus 25% and 20%, respectively, p<0.05). However, uncontrolled hypertensive patients were more likely to have role limitations than patients controlled only at the end or throughout the record review period (51% versus 39% and 36%, respectively, p<0.05). Patients controlled throughout the review period had the least impairment for each measure of functional status. These preliminary findings suggest that pharmacologic therapy may have a negative influence on the mental health of “uncomplicated” hypertensive patients, but that the dual goals of blood pressure control and positive functional status are not incompatible. Presented in part at the American Federation for Clinical Research Annual Meeting, May 1986. Supported by a grant from the Robert Wood Johnson Foundation. The conclusions are those of the authors and do not necessarily reflect the opinion of the Robert Wood Johnson Foundation or the Rand Corporation. Dr. Siscovick was a Teaching and Research Scholar of the American College of Physicians and an NHLBI Preventive Cardiology Academic Awardee.     

Blood Pressure Control in Patients with Hypertension: a Community-Based Study

The objective of own study was to investigate the quality of hypertension management in a rural Chinese population. A prospective cross-sectional study was conducted in 922 hypertensive patients in a regional community in southern China. The average systolic (SBP) and diastolic blood pressure (DBP) was 167.8 ± 22.5 mmHg and 94.3 ± 14.2 mmHg respectively. A total of 823 patients (89.3%) patients had a SBP of greater than or equal to 140 mmHg, and 596 (64.6%) had a DBP of greater than or equal to 90 mmHg. Fully 568 patients (69.7%) were treated with one or two antihypertensive drugs, mostly with calcium channel blockers. In patients treated with antihypertensive drugs, the average SBP and DBP were 170.3 ± 23.1 mmHg and 96.2 ± 14.8 mmHg, respectively. Blood pressure was poorly controlled in these hypertensive patients. Further studies are required to identify the barriers to the effective management of uncontrolled hypertension in a rural setting.     

Trend of office and home blood pressure control in treated hypertensive patients: changes in antihypertensive medication and salt intake

Blood pressure (BP) control in hypertensives has improved in recent years; however, it remains insufficient. We investigated the trend of BP control status in hypertensive patients with antihypertensive medication and salt intake. Two hundred and eight treated hypertensive patients were prospectively followed between 2007 and 2012. During this period, average clinic BP significantly decreased from 137?±?12/80?±?9 to 133?±?11/76?±?8?mmHg, and the achievement rate of BP control defined as <140/90?mmHg increased from 58% to 71% (p?p?p?相似文献