体重指数与不同亚型高血压的关系

目的探讨中国成年人体重指数(BMI)与不同亚型高血压患病率的关系。方法2000-2001年,对年龄35～74岁的中国成年人群中的代表性抽样样本进行横断面调查,分析了资料完整并且未服用降压药的14124名研究对象的数据。比较男性和女性不同BMI分组的各亚型高血压患病率、比数比(OR值)和归因危险。结果随着BMI水平的增加,男性和女性的收缩压和舒张压均值逐渐增高。男、女性在低体重组、正常体重组、超重组和肥胖组的各亚型高血压患病率和OR值基本上也呈升高趋势。男性超重和肥胖(BMI≥24kg/m2)时患单纯性收缩期高血压(ISH)、单纯性舒张期高血压(IDH)、收缩期和舒张期联合性高血压(SDH)的OR值分别为1.3、2.9和2.4,女性则各为1.6、2.4和2.3(P<0.05)。与非超重者相比,超重和肥胖男性中20%的ISH、65.4%的IDH和57.5%的SDH应归因于BMI≥24kg/m2,而女性相应有37.9%的ISH、59.0%的IDH和55.8%的SDH由超重和肥胖引起。结论体重指数与各亚型高血压的患病危险有显著正相关。减重和控制肥胖对于预防IDH和SDH的发生起重要作用。     

体重指数与不同亚型高血压的关系

目的探讨中国成年人体重指数(BMI)与不同亚型高血压患病率的关系.方法2000-2001年,对年龄35～74岁的中国成年人群中的代表性抽样样本进行横断面调查,分析了资料完整并且未服用降压药的14 124名研究对象的数据.比较男性和女性不同BMI分组的各亚型高血压患病率、比数比(OR值)和归因危险.结果随着BMI水平的增加,男性和女性的收缩压和舒张压均值逐渐增高.男、女性在低体重组、正常体重组、超重组和肥胖组的各亚型高血压患病率和OR值基本上也呈升高趋势.男性超重和肥胖(BMI≥24kg/m2)时患单纯性收缩期高血压(ISH)、单纯性舒张期高血压(IDH)、收缩期和舒张期联合性高血压(SDH)的OR值分别为1.3、2.9和2.4,女性则各为1.6、2.4和2.3(P＜0.05).与非超重者相比,超重和肥胖男性中20%的ISH、65.4%的IDH和57.5%的SDH应归因于BMI≥24 kg/m2,而女性相应有37.9%的ISH、59.0%的IDH和55.8%的SDH由超重和肥胖引起.结论体重指数与各亚型高血压的患病危险有显著正相关.减重和控制肥胖对于预防IDH和SDH的发生起重要作用.     

老年高血压患者脉压与血同型半胱氨酸及颈动脉粥样硬化相关性研究

目的探讨老年单纯收缩期高血压(ISH)患者脉压(PP)与血同型半胱氨酸(HCY)及颈动脉内膜厚度(IMT)之间相关性。方法对老年单纯收缩期高血压组(ISH组)31例患者,老年全期型高血压组(SDH组)29例患者,老年单纯舒张期高血压组(IDH组)28例患者及老年健康对照组32例患者,分别检测PP、血HCY及IMT。结果 ISH组、SDH组、IDH组3组PP及HCY水平均高于对照组,且ISH组较SDH及IDH组高,3组不同类型高血压IMT较对照组增高,脉压与血HCY及IMT呈正相关。结论 ISH患者PP升高与血HCY升高及IMT增厚相关,PP及血HCY升高可能是造成动脉粥样硬化的重要因素。     

原发性高血压患者高血压类型、脉压、脉压指数与早期肾损害的关系

目的 探讨原发性高血压患者不同高血压类型、脉压、脉压指数与早期肾损害的关系.方法 将原发性高血压患者182例作为高血压组,另选取体检健康者30例作为对照组.收集各组清晨首次清洁中段尿,测定尿微量白蛋白（mALB）、尿足细胞标志蛋白podocalyxin （PCX）,计算比较高血压组和对照组及不同类型高血压组[单纯收缩期高血压（ISH）组,单纯舒张期高血压（IDH）组,收缩期高血压合并舒张期高血压（SDH）组]、不同脉压组（≤50 mmHg组、51 ～60 mmHg组、＞60 mmHg组）、不同脉压指数组（＜0.4％组、0.4％ ～0.5％组、＞0.5％组）mALB、PCX阳性率.结果 高血压组mALB、PCX阳性率较对照组高（P＜0.05或＜0.01）;且高血压组PCX阳性率较mALB阳性率高（P＜0.01）.高血压类型中ISH组、SDH组mALB、PCX阳性率较IDH组高（P均＜0.01）;且ISH组、SDH组PCX阳性率较mALB阳性率高（P均＜0.01）.脉压＞60 mmHg组mALB、PCX阳性率较≤50 mmHg组高（P均＜0.01）,且各不同脉压组PCX阳性率较mALB阳性率高（P均＜0.05）.脉压指数0.4％ ～0.5％组、＞0.5％组mALB、PCX阳性率较＜0.4％组高（P＜0.05或＜0.01）;且不同脉压指数组PCX阳性率较mALB阳性率高（P＜0.01）.结论 原发性高血压患者ISH、SDH比IDH更易发生肾损害,脉压和脉压指数越大肾损害的发生率越高,所以联合检测尿中mALB、PCX有利于早期诊断高血压肾损害.     

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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。     

我国成人收缩期和舒张期高血压的分布

目的 了解收缩期和舒张期高血压在我国成人中的分布状况。方法 在第3次全国高血压抽样调查数据基础上，选用18岁及以上868131名成年人的资料进行分析。高血压的亚型分为3类，分别是单纯收缩期高血压（ISH）；单纯舒张期高血压（IDH）和收缩期舒张期高血压（SDH）。结果 在我国人群中，ISH、IDH和SDH的患病率分别为5．1％、2．8％和5．0％。55岁及以上的高血压患者占高血压总人数的53．2％。在高血压患者中．随着年龄的增长ISH的比例显著增高和IDH的比例显著降低，在≥55岁的高血压患者中ISH占52．7％。而〈、55岁的患者则以舒张期高血压为主（占75．2％），它们分别是IDH（占36．9％）和SDH（占38．3％）。结论 我周的中老年（≥55岁）患者占18岁及以上高血压患者总数的一半以上，在中老年患者中ISH是较为常见的高血压类型。     

糖尿病人群不同类型高血压发病率及影响因素的研究

目的 探讨糖尿病人群不同类型高血压的发病率及影响因素。方法 选择基线血压正常的糖尿病患者2367例,观察平均25.6月后进展为不同类型高血压的发病率及影响因素。 结果 进展为单纯收缩期高血压（ISH）、单纯舒张期高血压（IDH）及收缩期-舒张期双期高血压（SDH）的标化发病率（/1000人年）分别为80.2、89.2、130.8,男性为81.7、97.9、145.6,女性为66.8、55.6、80.3。影响糖尿病人群进展为ISH的危险因素是年龄、SBP及BMI （RR分别为2.409、2.757、1.807,P〈0.05）;进展为IDH的危险因素是男性、DBP、BMI、SUA（RR分别为2.064、1.771、1.569、1.463,P〈0.05）;进展为IDH的保护因素是年龄、糖尿病病程5年以上（RR分别为0.809、0.552,P〈0.05）;进展为SDH的危险因素是男性、SBP、BMI、TG、LDL-C（RR分别为1.882、2.720、1.549、1.284、1.410,P〈0.05）。 结论 糖尿病人群SDH的标化发病率最高,高血压各亚型发病影响因素不同,且有性别差异。     

我国成人收缩期和舒张期高血压的分布

目的了解收缩期和舒张期高血压在我国成人中的分布状况.方法在第3次全国高血压抽样调查数据基础上,选用18岁及以上868 131名成年人的资料进行分析.高血压的亚型分为3类,分别是单纯收缩期高血压(ISH);单纯舒张期高血压(IDH)和收缩期舒张期高血压(SDH).结果在我国人群中,ISH、IDH和SDH的患病率分别为5.1%、2.8%和5.0%.55岁及以上的高血压患者占高血压总人数的53.2%.在高血压患者中,随着年龄的增长ISH的比例显著增高和IDH的比例显著降低,在≥55岁的高血压患者中ISH占52.7%.而＜55岁的患者则以舒张期高血压为主(占75.2%),它们分别是IDH(占36.9%)和SDH(占38.3%).结论我国的中老年(≥55岁)患者占18岁及以上高血压患者总数的一半以上,在中老年患者中ISH是较为常见的高血压类型.     

老年高血压分型与健康老人血浆同型半胱氨酸、神经肽Y及血脂水平的比较研究

目的　探讨老年不同类型高血压患者与老年健康者之间的血浆同型半胱氨酸 (Hcy)、神经肽 Y(NPY)及血脂水平的差异。方法　对老年单纯收缩期高血压 (ISH) 36例、全期型高血压 (SDH) 31例、单纯舒张期高血压 (IDH) 34例及老年健康者 2 0例分别测取血浆 Hcy、NPY及血脂水平值 ,进行统计学处理分析其间的差异。结果　老年高血压患者血浆 Hcy及 NPY水平均高于老年健康组 (P<0 .0 1 ) ,且老年 ISH患者比老年 SDH和老年 IDH患者皆显著增高 (P<0 .0 1 )。但老年 SDH及 IDH两者血浆 NPY含量比较无差异 (P>0 .0 5) ,血脂代谢异常贯穿老年高血压发病的始终 ,但老年 ISH患者组 HDL- C较老年 SDH及 IDH患者明显降低 (P<0 .0 5,P<0 .0 1 ) ,而 ISH组 LDL- C较老年 IDH患者显著降低 (P<0 .0 5)。结论　控制患者血浆中 Hcy及 NPY浓度对预防老年高血压 ,尤其是 ISH的发生或发展可能有积极作用 ,调节脂代谢异常适用于各类型老年高血压的防治。     

维持性血液透析并发脑卒中的危险因素探讨

目的探讨维持性血液透析(MHD)并发脑卒中的相关危险因素。方法回顾性分析40例MHD并发脑卒中患者(卒中组)的临床资料,根据CT或者MRI分为缺血组(15例)与出血组(25例),50例同期单纯MHD患者(非卒中组)作为对照组。结果卒中组较非卒中组原发病为糖尿病肾病发生率、透前血压及平均动脉压、低密度脂蛋白(LDL)、超敏C-反应蛋白(hs-CRP)均偏高;从亚组分析看,缺血性卒中组尿酸(UA)较高,出血性卒中组血小板(PLT)较低(P0.05)。Logistic回归分析显示原发病为糖尿病、透前平均动脉压、超敏C-反应蛋白(hs-CRP)为血液透析发生脑卒中的危险因素;尿酸为血液透析发生缺血性卒中的危险因素;血小板为血液透析发生出血性卒中的保护性因素。结论 MHD患者发生脑卒中与糖尿病肾病、高血压、尿酸及血小板、hs-CRP水平相关。     

Prevalence of isolated systolic and isolated diastolic hypertension subtypes in China

BACKGROUND: Isolated systolic hypertension (ISH), more so than any other hypertension subtype, increases the risk for stroke and coronary heart disease. The prevalence of ISH versus other hypertension subtypes in the general Chinese adult population is not known. METHODS: The prevalence of isolated systolic and isolated diastolic hypertension (IDH) was examined in a representative national sample of 15,540 Chinese adults aged 35 to 74 years. Three seated blood pressure (BP) measurements taken after 5 min of rest were averaged and hypertension subtypes were defined among individuals not receiving antihypertensive therapy as follows: ISH as systolic BP >/=140 mm Hg and diastolic BP <90 mm Hg; IDH as systolic BP <140 mm Hg and diastolic BP >/=90 mm Hg; and combined systolic/diastolic hypertension (SDH) as a systolic BP >/=140 mm Hg and diastolic BP >/=90 mm Hg. RESULTS: Overall, 7.6% of the Chinese adult population had ISH, 7.4% had SDH, and 4.4% had IDH. The prevalence of ISH increased with age and was more common in older women than in older men. Stage 1 hypertension was much more prevalent than stage 2 hypertension among all hypertension subtypes. The prevalence of SDH, IDH, and ISH (women, only) were higher in northern China than southern. The prevalence of ISH and SDH (women, only) were higher among rural residents versus urban residents. CONCLUSIONS: These data document high rates of ISH in China. Given the risk of cardiovascular disease associated with ISH, our findings underscore the critical need for enhanced hypertension screening and treatment programs in China.     

Stroke risk in systolic and combined systolic and diastolic hypertension determined using ambulatory blood pressure. The Ohasama study

BACKGROUND: To investigate the risk of stroke in subjects with isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and combined systolic and diastolic hypertension (SDH) in a Japanese general population, we used 24-h ambulatory blood pressure (ABP) and casual-screening blood-pressure (CBP) readings. METHODS: Subtypes of hypertension were defined based on systolic blood pressure (SBP) >135 mm Hg or diastolic blood pressure (DBP) >80 mm Hg for 24-h ABP, and SBP >140 mm Hg or DBP >90 mm Hg for CBP. We obtained 24-h ABP and CBP data for 1271 (40% male) subjects aged > or =40 years (mean age, 61 years) without a history of symptomatic stroke; their stroke-free survival was then determined. The prognostic significance of each subtype of hypertension was determined by Cox proportional hazard analysis. RESULTS: There were 113 symptomatic strokes during follow-up (mean time, 11 years). Compared with normotension, among the hypertension subtypes determined by 24-h ABP, the adjusted relative hazards (RHs) of stroke were 2.24 for ISH (P = .002) and 2.39 for SDH (P = .0004). The association was less marked among subtypes determined by CBP (RH = 1.40 and P = .13 for ISH; RH = 2.07 and P = .017 for SDH). The IDH group was excluded from the Cox analysis because both the prevalence and the number of events were low in this group. CONCLUSIONS: Isolated systolic hypertension, as determined by 24-h ABP measurements, was associated with a high risk of stroke, similar to that found in SDH subjects; this suggests that the prognosis of hypertensive patients would be improved by focusing treatment on 24-h systolic ABP.     

The contribution of the systolic and diastolic components for the diagnosis of arterial hypertension under the 2017 ACC/AHA Guideline and metabolic heterogeneity among individuals with Stage 1 hypertension

Little is known about the impact of the 2017 ACC/AHA hypertension guideline on the distribution pattern of hypertension modalities (isolated systolic hypertension [ISH], isolated diastolic hypertension [IDH], and systolic‐diastolic hypertension [SDH]). This cross‐sectional study had the following objectives: to compare the prevalence of hypertension, ISH, IDH, and SDH, according to the definitions of the JNC 7 or the 2017 guideline; to determine the relative contribution of the systolic and the diastolic components for the diagnosis of hypertension; and to compare the metabolic profile of ISH, IDH, or SDH among new hypertensive individuals by the 2017 guideline. The authors retrospectively evaluated 33 594 patients (42 ± 10 years, 67% male) who underwent a routine health evaluation. Hypertensive patients not using antihypertensive medication were classified into ISH, IDH, or SDH using guideline‐defined thresholds. The prevalence of hypertension increased from 21.1% by the JNC 7 definition to 54.7% using the 2017 criteria (2.6‐fold increase). More profound increases were seen in the prevalence of IDH (8.7‐fold) and SDH (3.3‐fold), whereas the prevalence of ISH reduced from 1.1% (JNC 7) to 0.5% (2017 definition). Among patients with Stage 1 hypertension by the 2017 document, 85% had IDH and fewer metabolic abnormalities compared to those with SDH or ISH. The authors concluded that the 2017 guideline inflates the role of the diastolic component and diminishes the contribution of the systolic component for the diagnosis of hypertension. Individuals with Stage 1 hypertension by the 2017 guideline are metabolically heterogeneous and may have different long‐term prognoses.     

Alcohol intake and hypertension subtypes in Chinese men

OBJECTIVE: To examine the associations between alcohol intake and isolated systolic hypertension (ISH), systolic-diastolic hypertension (SDH), and isolated diastolic hypertension (IDH). DESIGN: Cross-sectional study of Chinese adults. METHODS: We analyzed data from 5317 Chinese males who were not on antihypertensive medications from a nationally representative sample of Chinese adults aged 35-74 years. ISH was defined as a mean systolic blood pressure (SBP) >/=140 mmHg and a mean diastolic blood pressure (DBP) < 90 mmHg, SDH as a SBP >/= 140 mmHg and DBP >/= 90 mmHg, and IDH as SBP < 140 mmHg and DBP >/= 90 mmHg. Alcohol intake was determined using an interviewer-administered questionnaire and participants were categorized either as non-drinkers (<12 drinks in the prior year) or by tertile of alcohol intake. RESULTS: The odds ratios of all three hypertension subtypes were higher at higher levels of alcohol intake, with those in the highest alcohol intake category (>/=30 drinks/week) 2.0 (95% confidence interval: 1.3, 3.0), 2.2 (1.6, 3.1), and 2.1 (1.4, 3.1) times more likely to have ISH, SDH, or IDH, respectively, than non-drinkers. The population attributable risk percentage due to heavy drinking (>/=30 drinks/week) was 13.9% for ISH, 13.4% for SDH, and 12.0% for IDH. Liquor drinking, specifically, was associated with a higher odds ratio of ISH, while SDH and IDH associations did not differ by type of alcoholic beverage. CONCLUSIONS: In Chinese males, higher intake of alcohol is associated with higher risk of ISH, SDH, and IDH. Efforts to reduce hypertension in China should include a strong focus on decreasing heavy alcohol consumption.     

Hypertension subtypes and risk of cardiovascular diseases in a Mongolian population,inner Mongolia,China

Background: There have been no reports about the effects of hypertension subtypes on the future cardiovascular events among Mongolian people, China. Methods and results: From June 2003 to July 2012, we conducted a prospective study to assess the association of hypertension subtypes with future risk of cardiovascular events including stroke and coronary heart disease among a Mongolian cohort of 2589 adults in China. According to the baseline blood pressure levels, the subjects were divided into those with normal blood pressure, prehypertension, isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and combined systolic and diastolic hypertension (SDH). Cox proportional hazards models were used to evaluate the association between blood pressure subtypes and risk of cardiovascular diseases. After adjustment for age and gender, hazard ratios (95% confidence intervals) of cardiovascular diseases were 1.75(0.92–3.33), 2.11(0.95–4.70), 2.14(1.01–4.56) and 5.31(2.86–9.77) for pre-hypertension, ISH, IDH and SDH, respectively, compared with normal blood pressure. Furthermore, after adding other cardiovascular risk factors to adjustment, hazard ratios(95% confidence intervals) of cardiovascular diseases were 1.74(0.92–3.31), 2.00(0.88–4.54), 2.20(1.02–4.74) and 4.92(2.62–9.26) for pre-hypertension, ISH, IDH and SDH, respectively, compared with the normal blood pressure group. Conclusions: IDH and SDH were significantly associated with the increased risk of cardiovascular diseases; this study suggests that carefully monitoring and actively treating the subjects with IDH should be an important strategy for CVD prevention among Mongolian population.     

Association of body mass index and alcohol intake with hypertension subtypes among HAN Chinese

Obesity and excessive drinking are major risk factors for development of hypertension. We aimed to explore association of body mass index (BMI) and alcohol intake with isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and combined systolic/diastolic hypertension (SDH) among Shandong Shengli Oil field workers. A total of 26,681 subjects were cross-sectionally analyzed. Statistical calculations included polytomous logistic regression and interaction analysis. After assigning normotensives as a reference, the odds of being ISH decreased by 4% for moderate drinkers, whereas that of being IDH and SDH increased significantly by 1.50 and 1.15 folds (P < 0.001). The odds for heavy drinkers of being ISH, IDH, and SDH increased by 1.38, 2.41, and 2.25 folds, respectively (P < 0.001). For BMI, the odds of being ISH, IDH, and SDH increased in a dose-response manner (P < 0.001). For patients with BMI of [23, 25), [25, 27), [27, 30) and ≥ 30 kg/m(2), the odds (95% confidence interval (CI)) of being SDH increased significantly by 2.28 (2.07-2.50), 3.22 (2.93-3.55), 5.44 (4.93-6.01), and 8.45 (7.31-9.77) folds, respectively. Interaction analysis indicated that BMI and alcohol intake were interactively associated with ISH (P ≤ 0.045) rather than IDH (P ≥ 0.161). Our results demonstrated that BMI and alcohol intake interactively influenced systolic hypertension, especially for overweight and obese patients.     

老年人高血压临床特征及其防治方法分析

目的探讨分析老年高血压患者的临床特征,并提出相应的防治方法。方法选取2011年5月到2014年5月来我院就诊的老年高血压患者128例作为研究对象,对其临床表现进行观察分析。结果 128例患者临床表现主要是头晕、头痛、心悸且伴有耳鸣等症状;其中61例患者为ISH,32例患者为IDH,而其余患者则为二者的合并症;高血压I期、II期、III期所占比例分别为12.5%、71.88%、15.62%%;高血压患者易导致多种并发症的发生,在128例患者中合并脑溢血、冠心病、脑梗塞的比例为11.72%、74.22%、26.56%,其中合并冠心病、脑溢血的患者男女之间并无明显差异(P0.05),而脑梗阻患者的男女发病率具有较大的差异。结论老年患者的主要临床特征为单纯性的收缩压增高,且具有较多的并发症和合并症。     

Uncontrolled Hypertension in Uganda: A Comparative Cross‐Sectional Study

In a community survey, 4432 persons aged 15 years and older in two districts in Uganda were studied. Blood pressure was measured and predictors for subtypes of uncontrolled hypertension (HTN) were assessed using bivariate and multivariate logistic regression modeling. Prevalence of uncontrolled HTN was 20.2% and the subgroups of isolated systolic HTN (ISH), isolated diastolic HTN (IDH), and systolic‐diastolic HTN (SDH) were 7.2%, 4.2%, and 8.8%, respectively. No difference was observed between the sexes. For all HTN subtypes, middle (35–49 years) and older age (50+) groups had a higher prevalence compared with younger subjects (15–34 years) (all P<.001). IDH prevalence in older age was not higher compared with younger age (P=.417). After multivariate analysis, middle age predicted all subtypes of HTN and old age predicted ISH and SDH. Alcohol consumption predicted IDH and SDH. Uncontrolled HTN in this population increases in the order IDH, ISH, and SDH, with more than 1 in 5 having uncontrolled HTN.