生物钟节律紊乱与高血压

生物钟蛋白参与许多重要生理过程的调节, 包括血压。核心生物钟基因的缺失或突变可造成血压水平升高以及血压节律紊乱, 加重血管功能损伤, 最终导致缺血性卒中的发生和发展以及转归不良。文章对生物钟节律的分子机制、生物钟基因与血压调控机制之间的联系、昼夜节律紊乱在高血压发生发展中的作用机制以及血压节律紊乱与卒中之间的关系进行了综述。     

血红素氧化酶系统: 高血压治疗的新靶点

本文介绍了血红素氧化酶系统在高血压中的调节作用,从针对自发高血压大鼠模型的研究和血管紧张素Ⅱ依赖的高血压/肾血管性高血压的研究两个角度分析了血红素氧化酶系统调节血压的机制,认为血红素氧化酶系统可以通过抗氧化、抗炎、抗凋亡、改善内皮功能以及舒张血管等方面降低血压。此外,还介绍了脂联素与血红素氧化酶系统的关系及其在调节血压中的作用,提出针对HO-1-脂联素轴的策略可能是一种有前景的控制高血压的治疗方法。     

国外动态

高血压患者血压变异性(blood pressure variability,BPV)增加是心血管事件的一个独立危险因素。动脉压力感受器反射是血压的一个有力调节因素,可以通过交感神经负反馈调节机制降低BPV。常规压力反射激活疗法(conventional baroreceptor activation therapy,cBAT)是通过恒定刺激参数电刺激颈动脉压力感受器,cBAT降低血压不伴有压力反馈机制。研究人员假设,伴有压力反馈系统的精确压力反射激活疗法(smart baroreceptor activation therapy,sBAT)可降低BPV及血压。研究人员研发的sBAT是以与即刻血压和预设参考血压差异成比例的频率电刺激压力感受器,并与cBAT进行比较。     

巨噬细胞免疫效应与溃疡性结肠炎的研究进展

巨噬细胞在机体免疫反应的调节中起重要作用,不同组织微环境能影响其表型和功能,以调控不同免疫效应。研究发现巨噬细胞功能异常与溃疡性结肠炎(UC)的发生、发展间存在高度相关性,靶向调节巨噬细胞的免疫活性能有效改善UC患者的临床症状和肠道组织学病变。通过改善微环境以调节巨噬细胞的活化、迁移可能是艾灸治疗UC的起效机制之一。本文就巨噬细胞免疫效应与UC的研究进展作一综述。     

肾素血管紧张素系统中原发性高血压候选基因的研究进展

原发性高血压(EH)是体循环动脉压增高为特征的临床综合征。流行病学调查显示20%～40%的高血压患者有家族史遗传基础,是一种多基因遗传病。由于人体血压受多种生理机制的调节,而每种机制又受多种基因调控,因而多种基因的多态性均会导致个体对 EH 的易感性或抵抗性。肾素血管紧张素系统(RAS)在调节血压、血流和内环境的稳定起着重要的作用,近年来研究发现,RAS 与 EH 的关系较为密切。     

DNA甲基化在高血压病中的研究进展

高血压病是由多个基因和环境因素共同作用的疾病,是全球最大的公共卫生健康问题之一。DNA甲基化是最早发现的表观遗传调控机制,在高血压的发生和发展中起着重要作用。与血压调节相关的基因启动子区域发生甲基化或去甲基化会影响相关酶和受体的表达,从而引起血压升高。深入探讨DNA甲基化在高血压病中的分子机制将为高血压的发病机制寻找新的科学依据。本文主要就DNA甲基化在高血压病发展中的表观遗传学机制进行综述。     

瞬时受体电位香草酸亚型1对血压的调控和靶器官的保护作用

高血压是心血管疾病的重要危险因素之一,但目前导致高血压的具体机制尚未完全阐明。近年来越来越多的研究发现感觉神经对血压具有调控作用,而该作用需依赖表达于感觉神经的瞬时受体电位香草酸亚型1。现主要研究瞬时受体电位香草酸亚型1对血压的调控及其对靶器官的保护作用。     

肾素血管紧张素系统中原发性高血压候选基因的研究进展

原发性高血压(EH)是体循环动脉压增高为特征的临床综合征.流行病学调查显示20%～40%的高血压患者有家族史遗传基础,是一种多基因遗传病.由于人体血压受多种生理机制的调节,而每种机制又受多种基因调控,因而多种基因的多态性均会导致个体对EH的易感性或抵抗性.肾素血管紧张素系统(RAS)在调节血压、血流和内环境的稳定起着重要的作用,近年来研究发现,RAS与EH的关系较为密切.     

辣椒素受体在血压调节中的研究进展

综述辣椒素受体(TRPV1)介导血压调节的潜在机制及最新研究进展。高血压是导致心肌缺血、心肌梗死、中风、心功能衰竭等不良心血管事件的主要危险因素,大量证据表明支配心血管系统的交感神经和感觉神经在调节水钠稳态、血压方面起着关键作用,目前交感神经系统的作用机制相对明确,但感觉神经对血压调节的影响仍有诸多未知,越来越多的研究揭示TRPV1在调节心血管功能方面发挥重要作用,TRPV1信号通路损伤可能是高血压、心力衰竭、动脉粥样硬化、心肌缺血、中风等疾病的发病机制之一。鉴于高血压及其相关疾病的广泛流行,TRPV1有希望成为心血管疾病治疗的靶点。     

摆动类手法作用于循环系统的机制

<正>循环系统在人体分布范围较广、作用颇多,因此循环系统疾病也表现出了疾病种类多样化、疾病病因复杂化、临床疗法多元化的特点。摆动类手法是推拿手法中的一大类别,以法类手法、一指禅类手法、揉法类手法为主[1]。通过辨证施治应用特定的摆动类推拿手法可有效调节心脏功能、调节血压、改善微循环及血液流变学特性、调节淋巴循环,以起到通过摆动类手法治疗或辅助治疗循环系统疾病的作用。本文对摆动类手法对循环系统的作用机制进行综述。     

综合康复治疗老年高血压病的疗效观察

目的:探讨综合康复治疗对老年高血压病的临床疗效。方法:68例老年高血压病患者,随机分为两组。观察组(34例)在常规药物治疗的基础上给予综合康复治疗,对照组(34例)给予常规药物治疗,3个月后进行24小时动态血压检查。结果:综合康复组降压疗效明显优于对照组(P<0.05)。结论:综合康复对老年高血压病具有较好的疗效。     

Efficacy and safety of community-based moxibustion for primary hypertension: A randomized controlled trial with patient preference arms

Moxibustion has been shown to have a potential antihypertensive effect, but its applicability for the primary care of hypertension is unclear. The authors conducted a multicenter randomized controlled trial (RCT) with patient preference arms to investigate the effect, safety, cost-effectiveness, and compliance of moxibustion in community patients with hypertension. Patients with primary hypertension were enrolled from seven communities randomly or nonrandomly assigned to receive self-administered moxibustion + the original hypertensive regimen or the original hypertensive regimen alone for 6 months. The authors mainly evaluated the effects of moxibustion on hypertensive outcomes and adverse events. As a result, a total of 160 and 240 patients were recruited into the randomized and nonrandomized arms, respectively, with 87.5% completing the follow-up. At month 6, there was a significantly greater reduction in systolic blood pressure (SBP) (difference: −10.57 mmHg), a higher proportion of responders (82.2% vs. 53.7%; odds ratio 4.00), and better improvements in hypertensive symptoms and quality of life (QoL) in the moxibustion group than in the control group in the randomized population, but there was no significant between-group difference in diastolic blood pressure (DBP). The nonrandomized findings showed the same effect direction for all outcomes, except for DBP. All moxibustion-related adverse events were mild. In conclusion, moxibustion can reduce SBP and improve hypertensive symptoms and QoL in community patients with hypertension, with good safety and low cost, although its effect on DBP remains uncertain. The findings suggest that moxibustion may be an appropriate technique for community primary care of hypertension.     

民航飞行人员同型半胱氨酸与高血压病的关系及其与血脂的相关性

目的 分析同型半胱氨酸（homocysteine，Hcy）与原发性高血压（高血压病）的关系及其Hcy与血脂的相关性。 方法 28例健康体检者为对照组，38例高血压病患者为高血压病组，高血压病组又分为调脂组20例和未调脂组18例。分别测定各组受试对象血浆Hcy及血脂指标。 结果 与对照组比较，高血压组Hcy水平显著升高（P<0.01）；与未调脂组比较，调脂组总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白B(ApoB)显著降低（P <0.01），但Hcy水平下降不显著；Pearson相关性分析显示:调脂组Hcy与三项血脂指标TC、LDL-C、ApoB均无相关性。 结论 高Hcy血症（HHcy）是民航飞行员高血压患者的危险因素；Hcy与TC、LDL-C水平无相关性，调脂治疗并不能够改善血浆Hcy水平。     

Use of gene markers to guide antihypertensive therapy

Sequencing of the human genome has elevated the potential for genetic information to aid in the prevention, diagnosis, and treatment of common chronic diseases. One beneficial application of genetic information is the identification of variants that influence response to pharmaceutical agents used to lower blood pressure and prevent target organ complications of hypertension. Knowledge of genetic variants that influence blood pressure response to antihypertensive drugs may allow more individualized tailoring of antihypertensive drug therapy, and provide greater insight into the molecular mechanisms regulating blood pressure levels and causing hypertension.     

Baroreflex device therapy in the treatment of hypertension

Despite therapy with multiple optimally dosed medications, hypertension remains poorly controlled in a sizeable number of people worldwide. This has spurred interest in exploring other pharmacologic and nonpharmacologic options for treatment. The carotid baroreceptors are important in regulating blood pressure in chronic hypertension by centrally mediated sympathoinhibitory effects and other effects. This has led to renewed interest in treating hypertension by electrically stimulating the carotid baroreceptors. Although this concept was first studied several decades ago, modern technology and better understanding of physiology have finally allowed the development of a feasible treatment option. Ongoing trials are finding significant and sustained reductions in blood pressure, a good safety profile, and tolerable side-effects. These promising results indicate that this modality has the potential to become a useful tool in future treatment of hypertension.     

原发性高血压及其继发肾脏损害机理的研究进展

以氧化应激(oxidative stress,OS)为核心的氧化自由基理论是目前生物医学界研究的热点。临床和动物实验均证明OS与原发性高血压呈密切的正相关。肾脏对慢性血压的调控及原发性高血压的发生起主导作用。盐敏感高血压具有显著的肾损害易感性,以盐敏感高血压动物模型对肾脏OS、肾脏损害及高血压之间关系的研究提示:肾脏OS参与了高血压继发性肾损害的发生及高血压的恶化过程。该发现突破了长期以来对此类疾病机理的传统认识,为将来可能的新的治疗措施提供了依据。     

Moxibustion therapy for treating psoriasis vulgaris: A protocol for systematic review and meta-analysis

Background:Psoriasis vulgaris (PV) is an immune-mediated skin disease, which has seriously affected the quality of life of patients. At present, moxibustion therapy has been widely used in the treatment of PV. The purpose of this study is to provide high-quality evidence-based medicine to evaluate the effectiveness and safety of moxibustion for PV.Methods:We will search the following Electronic databases from their inceptions to February 2021 without any language limitation: PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, WangFang Database, Chinese Science Journal Database, Chinese Biomedical Literature Database. What''s more, the grey literature and the references of all included literature will also be retrieved manually. Any clinical randomized controlled trials (RCTs) related to moxibustion therapy for PV will be taken into. In order to complete data synthesis and assess the risk of bias, we will use the RevMan V.5.3 software.Results:This systematic review will provide an assessment of the current state of moxibustion for PV, aiming to assess the efficacy and safety of moxibustion for patients with PV.Conclusion:This systematic review will establish convincing evidence to prove the effectiveness and safety of moxibustion for PV.INPLASY registration number:INPLASY202120008.     

Hazards in treatment of systolic hypertension

Eight patients with arteriosclerotic systolic hypertension whose blood pressure had been nonresponsive to conventional antihypertensive therapy, were given minoxidil in daily doses of 4 to 15 mg. Within 2 to 5 days the blood pressure of seven patients was brought to more “normal” levels. After 10 to 20 days of treatment, a significant weight increase was observed with a concomitant rise of blood pressure, which could be overcome by more vigorous diuretic therapy. However, six of the seven blood pressure responders and the one nonresponder complained of severe adverse effects curtailing futher use of the drug. It is concluded that despite the effectiveness of arteriolar vasodilation in the reduction of elevated systolic blood pressure, such lowering may be deleterious in patients with atherosclerotic involvement of vital organs.     

Therapierefrakt?re Hypertonie

Sympathetic overexpression can be found in a majority of hypertensive patients. Resistant arterial hypertension requires a targeted diagnostic procedure in order to exclude secondary causes of hypertension which can be treated specifically with established therapies. If secondary reasons are not identified, the antihypertensive medication is already optimal and lifestyle changes have been realized, but still the goal of antihypertensive therapy cannot be achieved, alternative invasive therapy strategies such as renal sympathetic denervation and baroreflex activation have been developed to achieve blood pressure control. These therapies are restricted to specialized centers which treat well-defined patients with therapy-resistant hypertension. Little long-term data concerning safety and efficacy are available for the two strategies. However, they should preferably be used as an ultima-ratio and add-on pathway to conservative procedures when established medication fails to achieve blood pressure control. To date, the effectiveness of the interventional antihypertensive therapies has only been shown on patients with systolic blood pressure over 160?mmHg and a mean oral medication of five drugs.