北京社区自然抽样人群冠状动脉钙化的多排螺旋CT初步研究

目的 探讨住院2型糖尿病(T2DM)患者血压控制的影响因素。方法 169例合并高血压的T2DM患者给予降压等综合治疗,以出院时血压130/80mmHg为界限分为达标组(n=97)及未达标组(n=72),比较两组入院时临床及实验室指标,并通过回归分析观察各种因素对出院时平均动脉压(MAP)水平的影响。结果 全组T2DM入院时收缩压(SBP)为143±15 mmHg,舒张压(DBP)为 78±8 mmHg,控制达标率仅17.8%;出院时血压达标率57.4%,降压药物种类平均增加0.8种。未达标组患者入院时SBP(151±15 vs. 137±12 mmHg, P=0.000)、DBP(80±9 vs. 77±7 mmHg, P=0.000)均高于达标组,且总胆固醇(TC)及24h尿白蛋白排泄率(UAE)显著升高。回归分析显示MAP与入院时SBP、DBP、TC及高血压病程显著正相关,与年龄负相关;MAP与UAE显著正相关(r=0.303, P=0.000)。合并糖尿病肾病(DN)患者随UAE增多而SBP显著升高,大量蛋白尿者需要多种降压药物联合且血压难以控制。结论 T2DM患者门诊血压控制达标率低;住院T2DM患者血压控制受入院时血压水平、高血压病程、高胆固醇血症、高UAE等因素影响;UAE增加可能是合并DN患者血压难以控制的直接原因。     

遵义地区住院老年2型糖尿病患者的血压控制情况及影响因素

目的探讨遵义地区住院老年2型糖尿病(T2DM)患者的血压控制情况及影响因素。方法选择2010年6月至2014年6月该院内分泌科收治入院的94例老年T2DM伴高血压患者予以降压等综合治疗,根据患者出院时血压状况。分为血压达标组及血压未达标组,比较两组患者的临床资料及实验室检查指标,并将单因素分析结果纳入多因素Logistic回归模型中予以分析。结果 94例患者出院时收缩压(SBP)、舒张压(DBP)均低于入院时,血压达标患者比例高于入院时,降压药物使用数量低于入院时(P<0.05)。多因素分析结果发现,影响住院老年T2DM患者的血压控制情况的因素有高血压病程、入院时SBP、入院时DBP、糖化血红蛋白(Hb A1c)、总胆固醇(TC)、及24 h尿蛋白定量。高血压病程越长、入院时血压越高、Hb A1c、TC水平及24 h尿蛋白定量越高的老年T2DM患者其血压控制情况越不良。结论 T2DM患者入院时血压达标率较低,住院治疗明显改善血压水平;住院T2DM伴高血压患者血压控制情况与高血压病程、入院时血压水平、Hb A1c、TC水平及24 h尿蛋白定量等因素密切相关。     

住院2型糖尿病患者血压控制的影响因素

目的探讨住院2型糖尿病(type2diabetes mellitus,T2DM)患者血压控制的影响因素。方法 169例合并原发性高血压(高血压)的T2DM患者给予降压等综合治疗,以出院时血压130/80mm Hg(1mm Hg=0.133kPa)为界限分为达标组(n=97)及未达标组(n=72),比较两组入院时临床及实验室指标,并通过回归分析观察各种因素对出院时平均动脉压水平的影响。结果全组T2DM入院时收缩压为(143±15)mm Hg,舒张压为(78±8)mm Hg,控制达标率仅17.8%;出院时血压达标率57.4%,降压药物种类平均增加1种。未达标组患者入院时收缩压[(151±15)mm Hg vs.(137±12)mm Hg,P0.05)、舒张压[(80±9)mm Hg vs.(77±7)mm Hg,P0.05]均高于达标组,且血清总胆固醇浓度及24h尿白蛋白排泄率显著升高。回归分析显示,平均动脉压与入院时收缩压、舒张压、血清总胆固醇及高血压病程显著正相关,与年龄负相关;平均动脉压与尿白蛋白排泄率显著正相关(r=0.303,P0.01)。合并糖尿病肾病患者随尿白蛋白排泄率增多而收缩压显著升高,大量蛋白尿者需要多种降压药物联合治疗且血压难以控制。结论 T2DM患者门诊血压控制达标率低;住院T2DM患者血压控制受入院时血压水平、高血压病程、高胆固醇血症、高尿白蛋白排泄率等因素影响;尿白蛋白排泄率增加可能是合并糖尿病肾病患者血压难以控制的直接原因。     

左旋氨氯地平与硝苯地平缓释片治疗原发性高血压的对比研究

目的 评价苯磺酸左旋氨氯地平(施慧迭)对原发性高血压的降压疗效及不良反应,并与硝苯地平缓释片(伲福达)对比研究.方法 采用随机分组平行对照方法 ,将84例原发性高血压1、2级患者分成:A组(42例),口服施慧达2.5～5mg,1次/d和B组(42例),口服伲福达10～20mg,2次/d.疗程4周.每周3次测白天坐位血压、观察不良反应,治疗4周后对血压达标的患者进行24h动态血压监测评估夜间血压控制情况.结果 4周末,SBP与DBP下降差值:A组为(15±9)mmHg和(8±6)mmHg;B组为(12±6)和(5±5)mmHg.每组治疗前后比较差异非常显著(P<0.01),组间比较有显著差异(P<0.05).24h动态血压监测夜间平均SBP和DBP值:A组为(120.15±11.22)mmHg和(78.52±8.23)mmHg,B组为(125±12.32)mmHg和(81.32±9.56)mmHg.治疗后2、3及4周时有效率A组优于B组,比较有统计学意义(P<0.05).治疗4周后夜间血压控制A组优于B组,比较有统计学意义(P<0.05).两组惠者均无因不良反应退出研究.结论 施慧达对原发性高血压的降压疗效优于伲福达.     

急性脑卒中：降压或不降压？

急性脑卒中时的降压问题是个临床上很棘手的问题，应当视卒中的性质、血压升高的程度等具体情况而决定是否降压和降压的速度和幅度。高血压脑出血病人血压极度升高时，即当SBP≥200mmHg，和／或DBP≥120mmHg，和／或MAP≥125mmHg时(MAP=SBP 2DBP／3)，     

艾司洛尔复合硝酸甘油控制性降压在高血压病人手术中的应用

目的探讨艾司洛尔复合硝酸甘油在高血压病人术中控制性降压的临床效果。方法40例术前诊断为高血压病的择期手术的病人,随机分成两组,每组20例。对照组:术中应用硝酸甘油降压;艾司洛尔复合硝酸甘油组(实验组):术中应用艾司洛尔复合硝酸甘油降压。于血压稳定后降压前即刻(T1)、降压30min(T2)、60min(T3)、停止降压后15min(T4)4个时间记录血压(SBP、DBP、MAP)、心率(HR)、脉搏血氧饱和度(SpO2)、PETCO2的变化及晶胶体输入量、尿量、输血量和出血量。同时记录两组病人开始降压时间,停药后血压回升时间。结果两组病人开始降压时间分别为(2.8±1.3)min和(5.6±2.0)min,实验组短于对照组(P<0.05)。停药后实验组血压回升时间较对照组明显延长(P<0.05)。实验组在降压后30、60min时HR,SBP和DBP明显低于对照组(P<0.05)。结论艾司洛尔复合硝酸甘油实施控制性降压用于高血压病人手术中降压,如果术前能很好地稳定病人的血压,降压时根据MAP情况,适量用药,短时间降压还是比较安全、平稳的。     

艾司洛尔复合硝酸甘油控制性降压在高血压病人手术中的应用

目的 探讨艾司洛尔复合硝酸甘油在高血压病人术中控制性降压的临床效果.方法 40例术前诊断为高血压病的择期手术的病人,随机分成两组,每组20例.对照组:术中应用硝酸甘油降压;艾司洛尔复合硝酸甘油组(实验组):术中应用艾司洛尔复合硝酸甘油降压.于血压稳定后降压前即刻(T1),降压30 min(T2)、60 min(T3)、停止降压后15 min(T4)4个时间记录血压(SBP、DBP、MAP)、心率(HR)、脉搏血氧饱和度(SpO2)、PETCO2的变化及晶胶体输入量、尿量、输血量和出血量.同时记录两组病人开始降压时间,停药后血压回升时间.结果 两组病人开始降压时间分别为(2.8±1.3)min和(5.6±2.0)min,实验组短于对照组(P＜0.05).停药后实验组血压回升时间较对照组明显延长(P＜0.05).实验组在降压后30、60 min时HR,SBP和DBP明显低于对照组(P＜0.05).结论 艾司洛尔复合硝酸甘油实施控制性降压用于高血压病人手术中降压,如果术前能很好地稳定病人的血压,降压时根据MAP情况,适量用药,短时间降压还是比较安全、平稳的.     

老年高血压住院病人的临床特点及血压治疗情况

目的探讨老年高血压住院病人的临床特点及血压治疗情况。方法回顾性分析2013年7月—2015年1月山西大医院心内科住院的老年高血压病人资料,根据年龄分为高龄老年组和低龄老年组,分析两组高血压病人的一般情况、入出院的血压水平、降压药物的服用情况及临床事件发生率;按入院时的收缩压水平将两组病人分为A组(≥150 mm Hg)、B组(150 mm Hg)。分析各组高血压病人入院、出院的血压水平及降压药物的服用情况。结果与低龄老年组的基线资料比较,高龄老年组高血压病史较长,体重指数、血红蛋白较低,更多病人合并脑血管病、外周动脉疾病、肾功能不全及房颤/房扑。高龄老年组和低龄老年组入院时收缩压(SBP)分别为(140.38±19.51)mm Hg、(139.22±17.71)mm Hg,舒张压(DBP)分别为(74.36±10.15)mm Hg、(76.40±11.13)mm Hg,出院时SBP分别为(129.79±14.31)mm Hg、(128.55±10.79)mm Hg,DBP分别为(72.27±8.16)mm Hg、(72.86±7.76)mm Hg,两组比较收缩压及舒张压水平差异无统计学意义(P0.05),两组使用降压药物的种类相近,高龄老年组和低龄老年组分别为2.14±1.06、2.13±1.03(P0.05),两组住院期间的临床事件比较无统计学意义(P0.05)。高龄老年组和低龄老年组入院时SBP≥150 mm Hg的病人分别占34.97%、31.01%,住院期间SBP、DBP变化幅度较入院时明显(P0.01),高龄老年组和低龄老年组比较差异无统计学意义(P0.05)。出院时SBP≥150 mm Hg的病人高龄老年组、低龄老年组分别占13.19%、3.58%,较低血压水平SBP1 3 0 mm Hg,高龄老年组和低龄老年组分别占4 1.2 1%和4 5.5 8%,DBP≤6 0 mm Hg,高龄老年组和低龄老年组分别占1 3.1 9%、11.73%,两组比较差异无统计学意义(P0.05)。结论临床工作中对高龄老年高血压的治疗比较积极,降压达标率高,但在治疗中未根据年龄及一般状况进行细化区分,应引起重视。     

比索洛尔／氢氯噻嗪复方片对血压晨峰的影响

目的 采用动态血压监测(ABPM)观察比索洛尔/氢氯噻嗪复方片对轻、中度原发性高血压患者服药后18～24 h血压和血压晨峰(MBPS)程度的影响.方法 选择90例轻、中度高血压患者[收缩压(SBP)<180mmHg,舒张压(DBP)95～109 mmHg],口服比索洛尔/氢氯噻嗪复方片2.5 rag/6.25 mg,4周后血压不达标者用比索洛尔/氢氯噻嗪复方片5.0 mg/6.25 mg继续治疗4周,应用ABPM评价治疗前后服血压和血压晨峰程度的变化.以起床后2 h内SBP增加≥23 mmHg,DBP>15 mmHg为晨峰阳性(MBPS)( )组,低于以上值为MBPS(一)组.结果 1)入选84例患者,比索洛尔/氢氯噻嗪复方片(2.5 mg/6.25 mg)治疗4周末,24 h SBP/DBP降低(10.8±1.7)/(8.6±0.8)mmHg,服药后18～24 h SBP/DBP降低(10.1±1.5)/(7.6±1.O)mmHg,治疗前后比较,差异有非常显著意义(P均d0.01).MBPS( )和(一)患者的服药后18～24 h SBP/DBP分别降低(11.1±2.5)/(8.9±1.8)mmHg(n=26)和(9.9±1.5)/(8.0±2.O)mmHg(n=58)(组间比较,P<0.05).MBPS( )患者的晨峰程度降低(14.1±2.7)/(10.5±2.5)mmHg(P<0.05),而MBPS(一)患者的晨峰程度未见明显降低,两组间有显著性差异(P相似文献   

老年糖尿病肾病患者血清游离脂肪酸变化及其与胰岛素抵抗的相关性

根据24 h尿白蛋白排泄率(24 h UAE),将94例老年2型糖尿病(T2DM)患者分为单纯糖尿病(DM组)54例和糖尿病肾病(DN组)40例,观察各组血压、血脂、血糖、体质量指数(BMI)、腰臀比(WHR)、IL-6、TNF-α、血清游离脂肪酸(FFA)、胰岛素敏感指数(ISI).结果 与DM组比较,DN组收缩压(SBP)、胆固醇、WHR、IL-6、TNF-α、FFA明显升高,ISI明显降低(P均<0.05).多元逐步回归分析显示,SBP、WHR、FFA是老年DN发生的主要危险因素(P<0.01,<0.05),ISI与DN发生呈显著负相关(P<0.01).提示老年DN患者存在明显胰岛索抵抗,高血压、血清FFA及向心性肥胖是其重要影响因素.     

氯沙坦对高血压病人24小时血压的影响

目的观察氯沙坦对高血压病人24小时血压的影响,探讨其临床意义。 方法20例Ⅰ-Ⅱ级高血压病人,入院后停药2周,服氯沙坦50mg,qd,疗程12周,1个月后血压若未降至140/90mmHg以下,可加大剂量到100mg,qd,治疗前后复查24小时动态血压。以二次给药间距终末时血压下降数除以给药间距中最大血压下降数值作为药物降压的谷/峰比(T∶P),以夜间血压均值与白昼血压均值比较时下降10%或大于10mmHg者为夜间血压下降或"杓型者",反之为夜间血压不下降者或"非杓型者"。 结果　发现(1)氯沙坦能明显降低高血压病人的24小时平均血压(mmHg)(SBP134±14比113±8,DBP89±12比71±5,P<0.01);有效率为85.0%.(2)氯沙坦降压的SBP和DBPTP比率分别为78.6%(48%～93.9%)和76.2%(46.4%～89.6%).SBP,DBP和MBP的平滑曲线指数分别是1.23±0.32,1.36±0.41和1.32±0.38.(3)对夜间血压高于正常值(120/80mmHg)的高血压患者,氯沙坦明显降低夜间血压(mmHg)(SBP142.6±8.8降至116.3±11.4,DBP89.2±9.6降至74.3±6.8,P<0.01),对夜间血压已属正常者,氯沙坦无进一步降压作用(SBP120.3±3.7比116.3±6.8;DBP78.2±6.1比74.3±7.2,P>0.05).(3)24小时SBP,DBP下降幅度与治疗前SBP,DBP明显相关,r分别为0.803和0.797,P<0.01. 结论　氯沙坦是一种安全有效的降压药,其主要优点是24小时平稳降压,谷峰比满意,夜间无过度降压的危险,晨间血压上升受到明显抑制,基础血压越高,降压效果越好。     

新诊断2型糖尿病患者脉压与颈动脉内膜-中层厚度的关系

目的对新诊断2型糖尿病患者血压及脉压水平与颈动脉内膜-中层厚度(IMT)的关系进行分析,以期为2型糖尿病患者预防早期心脑血管疾病提供临床依据。方法对中国糖尿病并发症防治研究——CDCPSⅠ期及Ⅱ期研究中1567例新诊断2型糖尿病患者(年龄30～70岁,其中女性698例,40.9%)行B超检查测量颈动脉IMT,并通过对血压的测量,分析血压及不同脉压(PP)对颈动脉IMT的影响,同时分析内膜增厚组(IMT≥0.8 mm)与内膜正常组(IMT<0.8 mm)血压和PP水平有无差异结果(1)合并高血压组与不合并高血压组比较,颈动脉IMT显著增厚[高血压组(0.76±0.15)mm,非高血压组(0.74±0.14)mm,差异有统计学意义(P=0.0006)]。(2)直线相关分析发现,颈动脉IMT与年龄(r=0.19548)、BMI(r=0.07252)、LDL(r=0.06523)、SBP(r=0.11173)、DBP(r=0.05962)、PP(r=0.10592)显著正相关(均为P<0.05)。(3)以PP 50mm Hg为界限将患者分为两组,脉压≥50mm Hg组颈动脉IMT(0.77±0.14)mm较脉压<50mm Hg组(0.74±0.15)mm显著增厚(P=0.0006);即使在非高血压患者,脉压≥50mm Hg组的颈动脉IMT(0.75±0.14)mm较脉压<50 mm Hg组(0.73±0.14)mm也有增厚(P=0.046);在<60岁的患者脉压≥50 mm Hg组的颈动脉IMT(0.75±0.15)mm较脉压<50 mm Hg组(0.73±0.14)mm也有显著增厚(P=0.008)(4)颈动脉IMT≥0.8 mm组SBP、PP均较IMT<0.8 mm组显著升高(P值分别为0.001和0.002),而两组间DBPIMT增厚组(78 2±9.8)mm Hg,正常组(79.1±10.0)mm Hg]差异无统计学意义(P=0.075)。结论在新诊断的2型糖尿病患者,PP与颈动脉IMT的正相关性与SBP相近,而强于DBP。对于PP≥50mm Hg的患者要尽早行颈动脉超声检查测量颈动脉IMT以早期发现可能存在的亚临床动脉粥样硬化性疾病,尽早进行干预治疗。     

Intervention at lower blood pressure levels to achieve target goals in type 2 diabetes: PRADID (PResión Arterial en DIabéticos tipo Dos) study

BACKGROUND: Arterial hypertension greatly increases the risk of cardiovascular disease, renal insufficiency, and retinopathy in patients with type 2 diabetes. Epidemiological studies all document a reduced risk for the aforementioned consequences at a blood pressure (BP) lower than 130/80 mmHg. For this reason, lower target BPs are recommended by recent guidelines committees. A lower threshold BP for treatment, also proposed in guidelines, could facilitate the attainment of the recommended target BP. However, little data exist on the efficacy and safety of starting pharmacological therapy in type 2 diabetic patients exhibiting high-normal BP (HNBP) or the first stage of isolated systolic hypertension previously considered as borderline isolated systolic hypertension (BISH). OBJECTIVE: To determine the antihypertensive efficacy and safety of the fixed-dose combination of the non-dihydropiridine calcium channel blocker (CCB) and ACE inhibitor verapamil SR/trandolapril 180/2 mg (V + T), versus trandolapril 2 mg (T), versus placebo (P) in previously untreated type 2 diabetic patients diagnosed as having HNBP or BISH. METHODS: Multicentric, double-blind, placebo-controlled study with a 16-week follow-up in three groups totalling 438 participants. The primary end-point was to attain the recommended guideline goal of a systolic BP (SBP) value lower than 130 mmHg in all patients and a diastolic BP (DBP) value lower than 85 mmHg in HNBP. Participants were randomized (2:2:1) to verapamil V + T, T, or P. Doses were doubled at week 8 if BP was not controlled. RESULTS: Both active groups were more effective than placebo to decrease SBP and DBP. The mean difference in SBP from placebo was 7.1 mmHg (3.3-10.9, 95% confidence interval (CI); P < 0.001) for T and 7.8 mmHg (3.9-11.6, 95% CI; P < 0.001) for V + T, with no statistical difference between both active groups. Combined treatment (V + T) decreased DBP by 4.6 mmHg (2.3-6.9, 95% CI; P < 0.001) more than placebo and 2.1 mmHg (0.3-4.0, 95% CI; P = 0.021) more than T. At the end of the study, 36.5% in the T group, 37.8% in the V + T group, and 14.9% (P = 0.009, P versus V + T and T) had attained the primary end-point. No significant difference was found between T and V + T with regard to the percentage of good control for SBP, but the control rate on the DBP (DBP < 85 mmHg) was significantly higher in the V + T group (88.8%), when compared with T (79.1%) or P (63.5%) (P = 0.002). Withdrawal rates due to adverse effects did not differ among trandolapril alone (9.4%), the combination (11.7%) and placebo (8.1%). CONCLUSION: Antihypertensive treatment is more effective than placebo for controlling SBP and DBP in previously untreated participants with type 2 diabetes exhibiting low threshold BP values. Combination therapy with verapamil SR/trandolapril was more effective than trandolapril alone for controlling DBP.     

Isolated uncontrolled hypertension at home and in the office among treated hypertensive patients from the J-HOME study

OBJECTIVES: To evaluate the current status of blood pressure (BP) control as measured at home and in the office, as well as to clarify and compare the prevalence and characteristics of isolated uncontrolled hypertension as measured at home (home hypertension) and in the office (office hypertension). DESIGN: A cross-sectional study. SETTING: Primary care offices in Japan. PARTICIPANTS: A sample of 3400 patients with essential hypertension (mean age, 66 years; males, 45%) receiving antihypertensive treatment. RESULTS: Overall, the mean home systolic BP (SBP)/diastolic BP (DBP) was 140/82 mmHg, and the mean office SBP/DBP was 143/81 mmHg. Of the 3400 subjects, 19% had controlled hypertension (home SBP/DBP < 135/85 mmHg and office SBP/DBP < 140/90 mmHg), 23% had isolated uncontrolled home hypertension (home SBP/DBP >/= 135/85 mmHg and office SBP/DBP < 140/90 mmHg), 15% had isolated uncontrolled office hypertension (home SBP/DBP < 135/85 mmHg and office SBP/DBP < 140/90 mmHg), and 43% had uncontrolled hypertension (home SBP/DBP >/= 135/85 mmHg and office SBP/DBP >/= 140/90 mmHg). Compared to controlled hypertension, factors associated with isolated uncontrolled home hypertension included obesity, relatively higher office SBP, habitual drinking, and the use of two or more prescribed antihypertensive drugs. Compared to uncontrolled hypertension, factors associated with isolated uncontrolled office hypertension included female gender, lower body mass index, and relatively lower office SBP. CONCLUSIONS: The use of all four, three of four, or all three predictive factors might be useful for the clinician to suspect isolated uncontrolled home or office hypertension.     

Effects of hypertension and type 2 diabetes mellitus on the risk of total cardiovascular events in Japanese patients with hypercholesterolemia: implications from the Japan Lipid Intervention Trial (J-LIT).

Hyperlipidemia, hypertension, and diabetes mellitus (DM) are well-established risk factors for cardiovascular disease. We analyzed the cardiovascular events in hyperlipidemic patients with or without DM who were administered open-labeled simvastatin in groups stratified by blood pressure level using data from the Japan Lipid Intervention Trial (J-LIT). Hyperlipidemic patients with DM (n=6,288) had significantly more cardiovascular events than those without DM (n=33,933). The incidence rates of total cardiovascular events in the Non-DM and DM groups were 15.40 and 25.76 per 1,000 patients for the 6-year period, respectively. The relative risk of total cardiovascular events in the DM vs. the Non-DM group was 1.68, and the relative risk was significantly higher in the DM than in the Non-DM group. The relative risks of total cardiovascular events were significantly higher in DM and Non-DM patients whose systolic blood pressure (SBP) was greater than or equal to 130 mmHg compared to that of Non-DM patients whose SBP was less than 130 mmHg, and in DM and Non-DM patients whose diastolic blood pressure (DBP) was greater than or equal to 80 mmHg compared to that of Non-DM patients whose DBP was less than 80 mmHg. In all groups stratified by SBP and DBP, relative risks of total cardiovascular events were higher in DM patients than in Non-DM patients. For patients with hypercholesterolemia and DM, blood pressure should be strictly controlled in order to prevent both coronary events and stroke. These results are in good agreement with the JNC 7 and the ESH/ESC guidelines for DM patients, which recommended that the SBP and DBP be less than 130 and 80 mmHg, respectively.     

不同时间服用苯那普利对非勺型高血压的降压效果

目的：观察不同时间给药对非勺型高血压患者血压昼夜节律的影响。方法：选择80例经24h动态血压监测（ABPM）,属非勺型的轻中度原发性高血压患者,随机均分为对照组、治疗组,对照组上午7时服用苯那普利10mg,治疗组上午7时和晚上7时各服用苯那普利5mg。给药6周后复测ABPM。比较两组血压昼夜节律的变化。结果：两组治疗后24h,白昼、夜间平均收缩压、舒张压,均显著下降（P〈0．01）,且治疗组的夜间平均收缩压[（121．3±4．9）mmHg]、舒张压[（77．6±8．0）mmHg],白昼、夜间血压负荷[（12．7±9．6）％,（8．5±6．7）％]较对照组显著下降（P〈0．05）。对照组和治疗组血压昼夜节律改变有效率分别为SBP48．65％和77．78％;DBP45．95％和72．22％,有显著性差异（P〈0．01）。结论：对于非勺型高血压,苯那普利分为早晚两次服用,可以更好改变血压昼夜节律,从而达到保护靶器官的目的。     

Effects of blood pressure levels on case fatality after acute stroke

OBJECTIVE: We evaluated the relationship between admission blood pressure (BP) and early prognosis in patients with acute stroke in a single cohort. DESIGN: The subjects comprised 1004 cases of brain infarction and 1097 cases of brain hemorrhage, who were admitted to hospitals on the day of stroke onset. Death within 30 days after onset was evaluated in relation to admission BP levels. RESULTS: In brain infarction, a U-shaped relationship was found between BP levels and mortality rate, with a nadir at systolic blood pressure (SBP) of 150-169 mmHg and at diastolic blood pressure (DBP) of 100-110 mmHg. After adjustments for age and sex, the highest relative risks (RR) was observed in the lowest BP levels compared with nadir groups, and were 2.69 [95% confidence interval (CI), 1.43-5.07] in SBP and 3.49 (95% CI, 1.58-7.74) in DBP. In subjects with previous hypertension, the relationship between prognosis and SBP level shifted significantly toward higher pressure by about 10 mmHg compared with those without previous hypertension. In subjects with brain hemorrhage, the relationship between BP levels and mortality rate showed a J-shape in SBP and a U-shape in DBP. Highest BP levels had the poorest prognoses (>/= 230 mmHg in SBP, RR = 4.13, 95% CI = 2.45-6.94; >/= 120 mmHg in DBP, RR = 1.83, 95% CI = 1.11-3.04). CONCLUSION: Lower and higher BP after brain infarction and higher BP after brain hemorrhage were predictors for poor early prognosis. In subjects with brain infarction, patients with previous hypertension had better outcomes at higher admission BP level than did normotensive patients.     

原发性高血压患者血压变异性与左心室质量指数的相关性分析

目的探讨原发性高血压患者血压变异性(blood pressure variability,BPV)与左心室质量指数(left ventricular mass index,LVMI)的相关性。方法选择我院住院的原发性高血压患者95例,根据心电图、彩色超声心动图检查确定是否伴有左心室肥厚(left ventricular hypertrophy,LVH)分为LVH组42例及无LVH组53例,另选择血压正常且无LVH的健康体检者40例为对照组,收集3组一般临床资料,检测同型半胱氨酸(Hcy)水平,进行24 h动态血压监测,比较3组24 h、夜间、昼间平均血压、收缩压标准差和舒张压标准差及LVMI。结果3组年龄、体质量指数、吸烟、尿酸、血红蛋白、血脂、糖化血红蛋白及各时间段内平均血压比较,差异无统计学意义(P>0.05);3组性别、糖尿病比例、Hcy、肌酐、LVMI及24 h、夜间、昼间收缩压标准差和舒张压标准差比较,差异有统计学意义(P<0.05,P<0.01)。LVH组男性比例、Hcy、LVMI及24 h、夜间、昼间收缩压标准差和舒张压标准差明显高于无LVH组和对照组(P<0.05),LVH组和无LVH组糖尿病比例和肌酐水平明显高于对照组,差异有统计学意义[59.5%和56.6%vs 7.5%,(92.0±4.8)μmol/L和(81.3±15.9)μmol/L vs(65.4±13.2)μmol/L,P<0.05]。无LVH组与对照组LVMI及24 h、夜间、昼间收缩压标准差和舒张压标准差比较,差异无统计学意义(P>0.01)。LVH组非杓型高血压比例明显高于无LVH组和对照组(85.7%vs 34.0%、5.0%,P=0.000)。结论BPV与高血压患者的LVH关系密切,其可能作为靶器官损伤最新的独立预测因素。