高血压患者血同型半胱氨酸水平对血压变异性的影响

目的研究高血压患者同型半胱氨酸与动态血压关系。方法入选高血压患者113例,根据Hcy水平分为单纯高血压组(血Hcy≤10μmol/L),H型高血压组(血Hcy10μmol/L),分析比较两组间的血压变异性。结果 H型高血压组24h平均收缩压、日间平均收缩压高于单纯高血压组,H型高血压组24h收缩压变异系数、日间收缩压变异系数高于单纯高血压组,差别有统计学意义(P0.05)。结论高Hcy增加高血压患者平均血压及血压变异性,hcy是导致血压波动的影响因素之一。     

高血压伴左心室肥大的平均心率血压乘积改变

目的探讨高血压伴左心室肥大患者和单纯高血压(不伴有左心室肥大)平均心率、平均心率血压乘积及其昼夜变化规律和临床意义。方法选取高血压伴左心室肥大31例、单纯高血压30例和对照组30例,比较各组24h平均心率、24h平均心率血压乘积及其昼夜变化规律。结果单纯高血压组24h平均心率(75.1±10.8/次/min)、24h平均心率血压乘积值(9531.2±1321.8/次/min.mmHg)高于对照组(P<0.05),高血压伴左心室肥大组(79.1±10.9/次/min,11027.2±1562.7/次/min.mmHg)则较后两组更高,同时昼夜节律减弱或消失。结论平均心率、平均心率血压乘积增高及其昼夜节律减弱对高血压及其左心室受累程度有判断价值。     

高血压血脂异常与血压变异性和血压晨峰相关性研究

目的分析高脂血症对原发性高血压患者血压变异性(BPV)和血压晨峰的影响。方法选择原发性高血压患者194例,根据其血脂水平,分为高血压血脂正常组90例与高血压伴高脂血症组104例,比较两组间的血压均值、BPV和血压晨峰指标。结果与高血压血脂正常组比较,高血压伴高脂血症组患者有更高的24h平均收缩压、白昼平均收缩压。与高血压血脂正常组比较,高血压合并血脂异常组有更高的24h收缩压标准差、白昼收缩压标准差、血压晨峰。结论血脂代谢异常可增加高血压患者BPV、血压晨峰,调脂治疗有可能改善患者BPV及血压晨峰。     

老年隐匿性高血压及白大衣性高血压对血管弹性及内皮功能的影响

目的探讨隐匿性高血压及白大衣性高血压对血管弹性及内皮功能的影响。方法选择健康体检老人487例,根据诊室血压和24h动态血压水平分为正常血压组128例,白大衣性高血压组115例,隐匿性高血压组112例和高血压组132例。检测所有受试者肱动脉血流介导的血管舒张功能(FMD)、NO、内皮素1及颈股动脉脉搏波传导速度(cfPWV)。结果与正常血压组比较,白大衣性高血压组、隐匿性高血压组及高血压组FMD、NO显著降低,内皮素1、cfPWV显著升高(P0.05)。白大衣性高血压组和隐匿性高血压组FMD、NO较高血压组显著升高(P0.05)。内皮素1、cfPWV较高血压组显著降低[(45.63±6.76)ng/L、(45.20±7.00)ng/L vs(49.04±6.93)ng/L,(10.91±1.08)cm/s、(10.87±0.96)cm/s vs(11.75±1.35)cm/s,P0.05]。回归分析显示,以正常血压为参照,校正混杂因素后,白大衣性高血压、隐匿性高血压及高血压是FMD、NO、内皮素1及cfPWV的独立影响因素(P0.01)。结论白大衣性高血压及隐匿性高血压是血管弹性下降及内皮紊乱的危险因素。     

原发性高血压患者血压晨峰与心血管疾病危险因素相关性分析

该文探讨原发性高血压患者血压晨峰和心血管疾病危险因素之间的相关性。方法:对入选的原发性高血压患者监测24h动态血压,根据监测结果,将患者分为晨峰组(149例)和非晨峰组(173例)。测血生化。结果:晨峰组年龄、空腹血糖均明显高于非晨峰组(P<0.01);24h平均收缩压、白昼平均收缩压、夜间平均收缩压,24h平均脉压、白昼平均脉压、夜间平均     

两种不同降压方案对高血压患者降压疗效的对比观察

目的比较氨氯地平联合培哚普利与氢氯噻嗪联合氯沙坦治疗原发性轻、中度高血压的降压疗效及对血生化的影响。方法80例原发性轻、中度高血压患者随机分为两组,A组(氨氯地平联合培哚普利)每天早晨口服1次氨氯地平5mg和培哚普利4mg,B组(氢氯噻嗪联合氯沙坦)每天早晨口服1次氢氯噻嗪12.5mg和氯沙坦50mg。两组治疗时间为8周。治疗8周以后比较两组治疗前后的24h动态血压、血清天冬氨酸转氨酶、丙氨酸转氨酶、尿素氮、肌酐、血糖、血脂等检查结果。结果A组患者治疗后与治疗前比较全天平均血压、日间平均血压、夜间平均血压分别降低18.88/10.35mmHg、18.11/10.85mmHg、18.58/9.79mmHg;B组患者治疗后与治疗前比较全天平均血压、日间平均血压、夜间平均血压分别降低19.60/9.20mmHg、18.61/9.81mmHg、18.60/9.41mmHg。两组用药后血压均明显下降(P0.01),两组降压效果无统计学意义(P0.05)。经统计学分析两组用药后对血生化各指标均无明显影响。结论氨氯地平联合培哚普利与氢氯噻嗪联合氯沙坦均有明显的降压效果,并且两组降压效果无明显差异,同时两种降压方案对血生化水平无明显影响。     

高血压合并阻塞性睡眠呼吸暂停低通气综合征患者血压水平及血压变异性分析

目的探讨高血压合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血压水平和血压变异性特点。方法选择在我院高血压科诊治的126例高血压患者,经多导睡眠呼吸监测仪监测,分为4组:单纯高血压组34例,高血压合并轻度OSAHS组35例,高血压合并中度OSAHS组25例,高血压合并重度OSAHS组32例。对研究资料行单因素方差分析和多元线性回归分析,比较4组患者日间、夜间平均血压和血压变异,探讨夜间血压变异的影响因素。结果高血压合并重度OSAHS组日间、夜间平均血压(144.7/100.3±12.5/10.0 mm Hg,136.5/91.1±13.3/9.5mm Hg)较单纯高血压组(131.2/92.4±15.6/8.6 mm Hg,124.9/84.7±18.3/11.7 mm Hg)明显升高(P<0.05),而高血压合并轻、中度OSAHS组与单纯高血压组的日间血压、夜间血压比较差异无统计学意义(均为P>0.05)。高血压合并重度OSAHS组患者日间血压变异性(13.0/10.5±3.0/2.0 mm Hg)较单纯高血压组(11.3/9.3±3.2/1.8mm Hg)明显增加(P<0.05),高血压合并重度OSAHS组夜间血压变异性(12.6/12.4±4.2/4.2 mm Hg)与单纯高血压组(12.1/9.9±2.8/2.3 mm Hg)、高血压合并轻度OSAHS组(11.3/10.0±2.8/3.0 mm Hg)、高血压合并中度OSAHS组(11.9/9.4±3.6/2.5 mm Hg)比较均显著增加(均为P<0.05)。多元线性回归分析显示,夜间最低血氧饱和度是影响OSAHS患者夜间收缩压变异和舒张压变异的重要因素(B=-0.103,P<0.00;B=-0.086,P<0.003)。结论高血压患者如合并重度OSAHS,全天血压水平均明显增高,血压变异性明显增加,夜间缺氧是高血压合并OSAHS患者夜间血压变异性增加的重要原因。     

高血压病合并阻塞性睡眠呼吸暂停低通气综合症患者血压季节性变化规律研究

目的:比较高血压合并阻塞性睡眠呼吸暂停低通气综合症(OSAS)患者及原发性高血压患者的动态血压季节变化,总结两组血压的季节性变化规律及差异.方法:研究采用回顾性研究的方法,入选高血压合并OSAS患者174例,并匹配原发性高血压患者348例.男性354例,女性168例,年龄(48.0+ 13.8)岁,分析冬季、夏季平均血...     

恶性高血压和高血压伴有慢性肾功能衰竭时可交换钠与肾素—血管紧张素系统的异常关系

作者将研究对象分成血压正常及高血压两组。后者限于恶性高血压及高血压伴有慢性肾功能衰竭者。分别测定可交换钠(以下简称NaE以毫克当量/公斤表示)、血浆肾素活性(用生物鉴定法,以单位/升表示)、血管紧张素Ⅱ(以微微克/毫升表示)及血压(取早晨第一次测NaE时平卧位的血压),并比较其相互关系。正常血压组66例,包括2名健康人和64名各种慢性病患者。高血压组(舒张压>96毫米汞柱)包括14例恶性高血压(双侧视网膜出血、渗出,但无一例血尿素氮>100毫克/毫升者)及14例伴有慢性肾功能衰竭的高血压(血尿素氮>100毫克/毫升)。测得结果如下:     

老年高血压患者心脏作功指数昼夜节律的观察

目的探讨经过治疗的老年高血压患者心脏作功指数的昼夜变化及临床意义。方法选择老年高血压患者143例为高血压组,老年健康体检者143例为对照组,进行24h动态血压监测,计算心脏作功指数(心率血压乘积表示)。结果高血压组24h平均心率血压乘积明显高于对照组[(97.27±17.64)mm Hg/min vs(86.26±12.09)mm Hg/min,1mm Hg=0.133kPa,P0.01];高血压组08:00心脏作功指数明显高于其他时间段(P0.01);高血压组血压未达标患者24h平均心率血压乘积明显高于血压达标患者(P0.01)。结论老年高血压患者心脏作功指数呈昼夜变化节律,可以作为反映心脏负荷的一种间接指标。     

非胰岛素依赖型糖尿病患者高血压的多因素分析

应用多因素逐步回归的分析方法对54例非胰岛素依赖型糖尿病(NIDDM)患者有关高血压的危险因素(年龄、病程、体重指数、血糖、血清放免胰岛素(IRI)、C肽、血脂及脂蛋日、载脂蛋白及尿系列蛋白)作了探讨.观察到:(1)NIDDM患者有较高的高血压发生率;(2)在21个因素中,年龄、总胆固醇、餐后血糖、空腹IRI、24小时尿Alb/Cr及TRF/Cr对血压影响较大,其中餐后血糖对血压影响最大,其次为 24小时尿Alb/Cr和总胆固醇.提示:糖尿病患者高血压的发生与皿糖控制不佳、血脂异常及糖尿病肾病相关.     

嗜铬细胞瘤患者血浆心钠素及内源性类洋地黄物质的变化及其意义

采用心钠素(ANP)及内源性类洋地黄物质(EDLC)放射免疫分析法,观察了38例嗜铬细胞瘤在高血压状态、非高血压状态及肿瘤切除后血浆ANP及EDLC的变化及与血压、尿儿茶酚胺的关系。结果表明,该病患者于高血压状态时血浆ANP明显高于正常人和非高血压状态(P<0.01),而肿瘤切除后则接近正常。高血压状态时血浆ANP与血压及尿儿茶酚胺呈正相关。高血压状态时血浆EDLC水平明显低于正常人,且与血浆ANP、血压、尿儿茶酚胺均呈负相关,而非高血压状态及手术后恢复正常或接近正常。     

SALT-SENSITIVITY AND OTHER PREDICTORS OF STRESS-RELATED CARDIOVASCULAR REACTIVITY IN HEALTHY YOUNG MALES

Individuals whose mean arterial blood pressure is depending on oral salt intake are considered salt-sensitive and are at risk of developing essential hypertension.

This study investigates the role of salt-sensitivity with respect to systolic blood pressure reactions under standardized mental stress. Forty-three healthy young males, previously characterized as salt-sensitive (n=16) or salt-resistant (n=27) by a dietary regimen, were subjected to multimodal physiological measurement during a computerized stress test and underwent comprehensive psychometrical testing.

The most important predictors for systolic blood pressure reactions to stress were the degree of salt-sensitivity, body mass index and psychological characteristics like anxiety. The highest correlations with the degree of salt-sensitivity were found for the parameters age, systolic blood pressure reaction under stress, high frequency band of heart rate variability and two psychological variables.

The concept of salt-sensitivity is a novel biological component that might contribute to reactivity research in subjects at high risk for essential hypertension.     

老年高血压患者血压昼夜节律与颈动脉粥样硬化的相关性研究

目的探讨老年高血压患者血压昼夜节律与颈动脉粥样硬化的相关性。方法2003￣2004年来我院老年高血压患者共72例(男68例女4例),根据动态血压监测(ABPM)结果分为正常昼夜节律组,即杓型组(n=37,男35例女2例)和异常昼夜节律组,即非杓型组(n=35,男33例女2例)。对所有患者均行颈动脉超声检查,测定右侧颈总动脉(RCCA)、颈内动脉(RICA)内膜中层厚度(IMT)、管腔内径(D),并计算各自的IMT/D值,测定右侧颈动脉分叉处(RBIF)的IMT,观察并记录双侧颈动脉系统斑块的大小、数量。结果(1)两组年龄(Age)、体重指数(BMI)、总胆固醇(TC)、甘油三酯(TG)、全天平均收缩压(24hMSP)、全天平均舒张压(24hMDP)比较均无显著性差异(P>0.05)。(2)两组的RCCA及RICA的IMT、D、IMT/D比较均无显著性差异(P>0.05)。而右颈动脉分叉处IMT,非杓型组明显高于杓型组(P<0.001)。(3)两组总斑块检出率无显著差异,但多发性斑块检出率非杓型组显著高于杓型组(P<0.05)。结论老年高血压患者血压昼夜节律与颈动脉粥样硬化明显相关,异常的血压昼夜节律提示可能存在更严重的靶器官损害。     

BLOOD FLOW SHEAR RATES IN ARTERIOLES OF SPONTANEOUSLY HYPERTENSIVE RATS AT EARLY AND ESTABLISHED STAGES OF HYPERTENSION

Alterations of blood rheological properties can affect blood flow shear rates and therefore alter changes in the interactions between blood and vascular wall components during the development of hypertension. This study was done to evaluate alterations of blood flow shear rates in resistance vessels during the development of genetic hypertension in rats. In the current study, measurements were carried out on spontaneously hypertensive rats (SHR) during an early (3 weeks of age) and an established stage (12 weeks of age) of hypertension development. Age matched normotensive Wistar Kyoto (WKY) rats were used as controls. Intravital television microscopy was used to quantitate blood flow shear rates in first-(1A), second-(2A) and third-order (3A) arterioles of the cremaster muscle. In the young SHRs mean arterial blood pressure was not different from age matched WKY rats, but there was a significant increase of shear rate values in all observed (1A, 2A, 3A) arterioles of SHRs. However, shear rate values were significantly less in arterioles (1A, 2A, 3A) of SHRs with an established hypertension compared to the 3-week-old SHR group. We conclude that shear rates are elevated in resistance vessels prior to an increase in mean arterial pressure during the development of genetic hypertension. These results suggest that a change in blood rheology may cause a change in peripheral vascular resistance and thus contribute to the pathogenesis of hypertension.     

AMILORIDE IN THE TREATMENT OF PRIMARY HYPERALDOSTERONISM AND ESSENTIAL HYPERTENSION

Amiloride (40 mg/day) was given to nineteen patients with primary hyperaldosteronism. There were significant falls in systolic and diastolic blood pressure, in total exchangeable sodium, and in serum sodium and bicarbonate; while total exchangeable potassium, total body potassium, serum potassium, chloride and urea, and plasma renin, angiotensin II and aldosterone all increased significantly. Amiloride was effective in reducing blood pressure in patients with and without adrenocortical adenoma. No carry-over effect was seen on withdrawing amiloride. Similar changes were associated with amiloride treatment in five patients with essential hypertension; hyperkalaemia was not observed. Only negligible side-effects were encountered in the entire series of twenty-four patients.     

Prevalence of sustained hypertension and obesity in urban and rural school going children in Ludhiana

BACKGROUND: Increasing trend of hypertension is a worldwide phenomenon. The data on sustained hypertension in school going children is scanty in India. The present study was conducted to evaluate the prevalence of sustained hypertension and obesity in apparently healthy school children in rural and urban areas of Ludhiana using standard criteria. METHODS AND RESULTS: A total of 2467 apparently healthy adolescent school children aged between 11-17 years from urban area and 859 students from rural area were taken as subjects. Out of total 3326 students, 189 were found to have sustained hypertension; in urban areas prevalence of sustained hypertension was 6.69% (n=165) and in rural area it was 2.56% (n=24). Males outnumbered females in both rural and urban areas. The mean systolic and diastolic blood pressure of hypertensive population in both urban and rural population was significantly higher than systolic and diastolic blood pressure in their normotensive counterparts (urban normotensive systolic blood pressure:115.48+/-22.74 mmHg, urban hypertensive systolic blood pressure: 137.59+/-11.91 mmHg, rural normotensive systolic blood pressure: 106.31+/-19.86 mmHg, rural hypertensive systolic blood pressure: 131.63+/-10.13 mmHg, urban normotensive diastolic blood pressure: 74.18+/-17.41 mmHg, urban hypertensive diastolic blood pressure: 84.58+/-8.14 mmHg, rural normotensive diastolic blood pressure: 68.84+/-16.96 mmHg, rural hypertensive diastolic blood pressure: 79.15+/-7.41 mmHg). Overweight populationwas significantly higher in urban area. There were 287 (11.63%) overweight students and 58 (2.35%) were obese. In rural population overweight and obese students were 44 (4.7%) and 34 (3.63%) respectively. There was significant increase in prevalence of hypertension in both rural and urban population with increased body mass index in urban students; those with normal body mass index had prevalence of hypertension of 4.52% (n=96), in overweight it was 15.33% (n=44) and in obese it was 43.10% (n=25). In rural area, the overweight students showed prevalence of sustained hypertension in 6.82% (n=3) and in obese group it was 61.76% (n=21). None of the student with normal body mass index in rural area was found to be hypertensive. The mean body mass index of hypertensive population in both rural and urban areas was significantly higher than respective normotensive population (mean body mass index in urban normotensive group: 20.34+/-3.72 kg/m2, hypertensive group: 24.91+/-4.92 kg/m2; mean body mass index in rural normotensive group: 18.41+/-3.41 kg/m2, hypertensive group: 21.37+/-3.71 kg/m2, p<0.01). CONCLUSIONS: Prevalence of sustained hypertension is on the rise in urban area even in younger age groups. Blood pressure is frequently elevated in obese children as compared to lean subjects. This is possibly related to their sedentary lifestyle, altered eating habits, increased fat content of diet and decreased physical activities.     

气道正压通气对阻塞性睡眠呼吸暂停低通气综合征合并高血压患者脉压的影响

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）合并高血压患者脉压的变化及经鼻持续气道正压通气（nCPAP）的影响。方法选择85例经多导睡眠图仪（PSG）诊断的OSAHS患者，同时随机选取15例中重度OSAHS患者进行nCPAP治疗，在PSG监测前后及期间每2小时测量其血压，计算出脉压、脉压变化幅度、平均收缩压及平均舒张压，并计算体重指数。结果41％OSAHS患者同时合并有高血压；OSAHS合并高血压组患者的呼吸紊乱指数、脉压及体重指数明显高于单纯OSAHS患者，其最低血氧饱和度以及平均血氧饱和度均低于单纯OSAHS患者；重度OSAHS患者的脉压、体重指数、平均收缩压及平均舒张压均明显大于轻、中度OSAHS患者，而轻、中OSAHS患者之间差异无显著性意义。nCPAP可提高OSAHS患者最低血氧饱和度，同时降低其呼吸紊乱指数、平均收缩压、平均舒张压及脉压。相关分析结果表明，呼吸紊乱指数与脉压（r=0．395，P〈0．01）、平均收缩压（r=0．403，P〈0．01）、平均舒张压（r=0．313，P〈0．01）呈正相关，与最低氧饱和度（r=-0．424，P〈0．01）呈负相关，与体重指数、平均氧饱和度无相关。结论脉压是OSAHS的严重程度及是否并发高血压心血管事件的预测因子；nCPAP能下调OSAHS患者脉压及血压，是缓解OSAHS病情进展的有效治疗措施。     

BENEFICIAL EFFECTS OF FENOLDOPAM TREATMENT ON RENAL FUNCTION IN STREPTOZOTOCIN-INDUCED DIABETIC RATS

We have studied the effect of chronic treatment with dopamine D1 receptor agonist fenoldopam (1?mg/kg, i.p. daily for 6 weeks) on renal function and metabolic parameters in streptozotocin (STZ)-diabetic rats. Diabetes was induced by a single tail vein injection of STZ (45?mg/kg). STZ produced severe hyperglycemia, hypoinsulinemia, hypercholesterolemia, hypertriglyceridemia, hypertension and bradycardia. Fenoldopam treatment significantly reduced fasting but not fed blood glucose levels and lowered the blood pressure in diabetic animals. Significant change was not observed in insulin, cholesterol, triglyceride levels. Diabetic animals showed increase in AUC_glucose and decrease in AUC_insulin during oral glucose tolerance test. Fenoldopam treatment did not significantly change these values in diabetic animals. STZ produced increase in serum urea, creatinine and blood urea nitrogen. Diuresis and urinary sodium retention was observed in diabetic animals. Renal hypertrophy was observed as seen from increased kidney weight/body weight ratio and increased total RNA content as well as decreased total DNA content. Fenoldopam treatment significantly lowered serum urea, creatinine and blood urea nitrogen. Urinary sodium retention was significantly reduced and renal hypertrophy was prevented with fenoldopam treatment as seen from the improved kidney weight/body weight ratio. Fenoldopam treatment significantly prevented reduction in total DNA content and increase in total RNA content further substantiating reduced renal hypertrophy. Our data suggest that STZ induced diabetes is associated with renal dysfunctions and fenoldopam treatment could be beneficial in a condition where diabetes mellitus co-exists with hypertension and compromised renal function.     

Long-term changes in clinic blood pressure in patients with white-coat hypertension

BACKGROUND: White-coat hypertension, defined as hypertensive blood pressure values in a clinical setting but normal self-measured blood pressures, is relatively common among young patients but long-term spontaneous changes in clinic blood pressure in these patients with white-coat hypertension have not been assessed. DESIGN: A prospective study, with two clinical examinations (with a 5-year interval between the examinations).METHODS: We examined 188 male patients (mean age 16 years) with clinic blood pressures > 140/90 mmHg at baseline by determining clinic and home blood pressures, heart rates, heights and weights. These parameters were re-examined 5 years later. White-coat hypertension (n = 139) was defined as an average home blood pressure < 130/90 mmHg.RESULTS: A decrease in clinic systolic blood pressure to < 140 mmHg during the 5-yea follow-up was observed in 101 of the 139 patients with white-coat hypertension (73%) and 26 of the 49 patients with sustained hypertension (53%, P < 0.02). There was no difference between clinic heart rates and body mass indices at baseline of the patients who remained hypertensive in the clinic and those who became normotensive. Both the white-coat and the sustained hypertensive patients who remained hypertensive had higher baseline home blood pressures and an increase in body mass index during the 5-year period and maintained the baseline clinic heart rate, whereas those who became normotensive exhibited a reduction in clinic heart rate and maintained the baseline body mass indexd. The clinic systolic blood pressure at 5-year follow-up was correlated significantly to the clinic and home systolic blood pressures at baseline, the heart rate and body mass indexd at 5-year follow-up and the changes in bodyh mass index during the 5-year period. CONCLUSION: The prevalence of clinic systolic blood pressures < 140 mmHg during the 5-year period among patients with white-coat hypertension was higher than that among those with sustained hypertension. The clinic and home blood pressures at baseline and body mass indices and clinic heart rates at 5-year follow-up were related to the clinic systolic blood pressures at 5-year follow-up. These results suggest that control of body weight is important in the management both of young patients with white-coat hypertension and of those with sustained hypertension.