糖尿病患者的血压控制目标

糖尿病的患病率在全世界范围都在不断地增长,成为一个非常重要的公共卫生问题。在中国,由于经济的高速发展、生活水平的快速提高,人均寿命的不断延长,糖尿病的发病率的增高速度更快,甚至超出了我们的想象。据杨文英教授新近发表的有关中国糖尿病患病率的文献报道,中国20岁以上的成年人中2型糖尿病的人数可以达到9200万,另外还有将近1500万的糖尿病前期患者。中国将成为或者可能已经是世界上糖尿病人数最多的国家。     

Roundtable discussion: blood pressure goal attainment: meeting the challenge of the JNC 7's blood pressure goals and the role of renin-angiotensin-aldosterone system blockade

This roundtable discussion, held in December 2003, was convened to discuss the impact of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure's (JNC 7) challenging blood pressure goal objectives for the clinical management of hypertensive patients. The discussion was moderated by Michael Weber, MD, of the State University of New York Downstate College of Medicine in New York City. Participants included leading experts in the field Joseph Izzo, Jr., MD, of the School of Medicine and Biomedical Sciences at the State University of New York at Buffalo; Suzanne Oparil, MD, of the Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, University of Alabama at Birmingham; and Jan Basile, MD, of the Ralph H. Johnson VA Medical Center and Department of General Internal Medicine/Geriatrics, Medical University of South Carolina in Charleston. The primary intention of this roundtable is to educate physicians about the importance of achieving the blood pressure goals agreed upon by the JNC 7 Committee and to present practical ways for the attainment of such goals in clinical practice.     

Prevalence of dyslipidemia and goal attainment after initiating lipid-modifying therapy: a thai multicenter study

Previous studies focused on attaining low-density lipoprotein cholesterol (LDL-C) goals after lipid-modifying therapy (LMT), but data on achieving normal levels of triglyceride and high-density lipoprotein cholesterol (HDL-C) are limited. We reviewed medical records of patients initiated on LMT. High risk was defined as patients with coronary heart disease, diabetes, or 10-year Framingham risk >20%. Among 806 patients enrolled, 429 were at high risk. Prior to initiation of LMT, 66%, 35%, and 44% overall and 69%, 35%, and 45% in the high-risk group had elevated LDL-C, elevated triglyceride, and low HDL-C, respectively. After 12 months of LMT, 21%, 32%, and 39% overall and 26%, 25%, and 43% in the high-risk group still had elevated LDL-C, elevated triglyceride, and low HDL-C, respectively. Approximately 1 of 5 patients continued to experience elevated LDL-C coupled with elevated triglyceride and/or low HDL-C. In conclusion, a substantial proportion of patients initiated on LMT continued to have lipid abnormalities.     

Blood pressure control in patients with comorbidities

Hypertension frequently coexists with obesity, diabetes, hyperlipidemia, or the metabolic syndrome; their association with cardiovascular disease is well established. The identification and management of these risk factors is an important part of the overall management of hypertensive patients. Because patients in these special populations are more predisposed to target organ damage (TOD), stringent targets for blood pressure (BP) control have been set in clinical guidelines. However, clinical trial and real-life evidence suggest that these targets are difficult to achieve. Patients with these comorbidities are more likely to require combination therapy, yet physicians are often reluctant to adjust the number and doses of medications to achieve target BP. There is a particular need for effective 24-hour BP control in these patients, due to the increased likelihood of nondipping status, which is a risk factor for TOD and mortality. Not all available antihypertensives are equally effective in controlling BP over 24 hours, and some may exacerbate underlying metabolic abnormalities.     

Prevalence of hyperinsulinaemia in patients with high blood pressure.

A total of 41 patients with hypertension were identified in a survey of 732 healthy factory workers. Twenty-three of these individuals were receiving antihypertensive medication, whereas 18 cases were newly discovered. Plasma glucose and insulin responses to oral glucose and fasting plasma triglyceride (TG), cholesterol, and high-density-lipoprotein (HDL) cholesterol concentrations of these 41 individuals were compared with those of 41 other factor workers, with normal blood pressure, matched with the hypertensive group in terms of gender, age, degree of obesity, job in the factory, and leisure-time activity. Patients with hypertension had significantly higher plasma glucose (P less than 0.05) and insulin (P less than 0.05) concentrations in response to oral glucose, as well as a higher plasma TG concentration (P less than 0.05). Similar findings were obtained when the treated and untreated hypertensive groups were analysed separately and compared with their respective control groups. However, there were no differences between the treated and untreated hypertensive groups. Ninety per cent of the normotensive group had a plasma insulin concentration of less than 500 pmol l-1 2 h after the glucose load. Using this value as the criterion for definition of hyperinsulinaemia, 41% of the patients with high blood pressure were hyperinsulinaemic. In addition to meeting this cut-off point, the patients with hypertension and hyperinsulinaemia were also glucose intolerant and dyslipidaemic. In conclusion, approximately 50% of an unselected group of patients with hypertension were hyperinsulinaemic. Insulin levels were comparable in treated and untreated patients with high blood pressure, and hyperinsulinaemic patients also tended to be glucose intolerant and dyslipidaemic.     

失眠对高血压患者血压的影响

目的 研究失眠对高血压患者血压的影响及睡眠改善后患者血压的变化.方法 高血压失眠患者271例 ,随机分为治疗组(137例)和对照组(134例),分别采用艾司唑仑和安慰剂治疗,观察患者第4、8、15天血压的变 化:袖带坐位收缩压谷值和舒张压谷值与基线血压的变化、目标血压达标率,同时对患者进行睡眠障碍量表(sleep dys-funtion rating scale,SDRS)和汉密尔顿焦虑量表(Hamilton anxiety rating scale,HAMA)评价.结果 在 治疗第8、15天,治疗组患者的收缩压谷值和舒张压谷值显著下降,而对照组下降不明显;治疗组目标血压的达标率也明 显高于对照组(P<0.01).同时在治疗第8、15天,治疗组的SDRS和HAMA评分也较基线总分有显著下降;治疗组治疗失眠的总有效率为67.2%,对照组总有效率为16.4%,治疗组优于对照组(P<0.01).结论 艾司唑仑治 疗高血压失眠患者有显著疗效.失眠可严重影响高血压患者的血压变化,改善睡眠有利于改善患者的血压状态.     

Blood pressure and lipid goal attainment in the hypertensive population in the primary care setting in Spain

Although blood pressure (BP) control is crucial in hypertensive patients, clinical practice guidelines agree that the goal of treatment should be aimed at not only decreasing BP but reducing global cardiovascular risk. The aim of this cross-sectional study was to evaluate BP, low-density lipoprotein cholesterol (LDL-C), and composite control rates in a hypertensive population in a primary care setting in Spain. Good BP control was defined as <140/90 mm Hg (<130/80 mm Hg for diabetics).LDL-C control rate was established according to the third report of the National Cholesterol Education Program Adult Treatment Panel criteria. A total of 12,954 patients (49.9% women, aged 62.1+/-10.7 years) were included. BP was controlled in 24.8% of patients, LDL-C in 26% of patients and, when combined, in only 8.6%. The rates of control were significantly worse in high-risk subgroups, such as high-coronary-risk, diabetic, or metabolic syndrome patients. The BP and LDL-C control rates in the hypertensive population attended to daily in primary care settings in Spain are low.     

Prevalence of comorbidities and their associations with health-related quality of life and healthcare expenditures in patients with rheumatoid arthritis

Clinical Rheumatology - Rheumatoid arthritis (RA) is known to be associated with an increased risk of comorbidities, premature mortality, and disability. We investigated the prevalence of...     

Prevalence of comorbidities and evaluation of screening in Chinese patients with spondyloarthritis

The aim of the study was to determine whether the presence of spondyloarthritis (SpA) is associated with particular comorbidities and evaluate the prevalence of comorbidities, risk factors, and monitoring status in China. Three hundred forty-six patients fulfilling ASAS criteria for SpA were recruited from the Third Affiliated Hospital of Sun Yat-sen University. The prevalence of comorbidities and percentage of patients optimally monitored for comorbidities were calculated. The most frequent comorbidities were osteoporosis (31.0%) and hepatitis B virus infection (18.5%). Only 1 patient was found to have active tuberculosis. Several cancer screenings were performed in very few patients. Among 45 patients ever exposed to a biological DMARDs, 35 (77%) and 36 (80%) underwent a screening test for viral hepatitis and tuberculosis. Among patients without a history of hypertension, elevated blood pressure was detected in 5.8% of the patients. Hyperglycemia and hyperlipidemia were also found in patients during the study. One hundred twenty-two (35.3%) of the 346 patients never had either calcium or vitamin D for prevention of osteoporosis. Patients with SpA have high risks of comorbidities but have not monitored properly. More attention should be paid for systematic screening and an early detection of comorbidities in patients with SpA.     

冠心病患者血压和血脂及血糖达标率分析

目的分析经冠状动脉造影诊断为冠心病患者的血压、血脂和血糖达标率情况,评价其3个危险因素达标率对冠心病的影响。方法选择冠心病患者2916例,根据指南规定的达标标准,分析入院时的血压、血脂和血糖水平及出院时的血压水平。结果 291 6例冠心病患者血压以<130/80 mm Hg(1 mm Hg=0.13 kPa)为达标,入院时达标率28.4%,出院时87.5%;以<140/90 mm Hg为达标,入院时达标率65.8%,出院时90.0%。HDL-C和TG入院时达标率分别为23.0%和58.0%;978例高危患者LDL-C和TC入院时达标率分别为54.3%和49.5%,1 938例极高危患者LDL-C和TC入院时达标率分别为17.4%和5.8%。糖尿病患者538例,占冠心病的18.5%,入院时达标率仅为1.9%;糖尿病和空腹血糖受损者共1138例,占冠心病的39.0%。结论冠心病患者入院时血压、血脂和血糖的达标率相对较低,尤其以空腹血糖理想达标率及极高危患者LDL-C和TC达标率低为特点,提高冠心病患者的血糖、血脂和血压达标率,对于冠心病的二级预防极为重要。     

The effect of meals at different mealtimes on blood pressure and symptoms in geriatric patients with postprandial hypotension

BACKGROUND: The variability of postprandial hypotension (PPH) during the day in elderly patients is unknown. We examined the effect of meals administered at different mealtimes on postprandial blood pressure (BP) responses in geriatric patients. METHODS: In 14 geriatric patients (6 men and 8 women, aged 66-97) previously diagnosed with PPH, standardized liquid test meals were given in random order at breakfast, lunchtime, or dinnertime on 3 separate days. Systolic BP (SBP), diastolic BP (DBP), and heart rate (HR) were measured with an ambulatory BP device every 10 minutes from 20 minutes before until 90 minutes after each meal. Postprandial symptoms were observed continuously. RESULTS: Significant decreases in SBP and DBP were present after each meal (p <.050). The maximum SBP decrease was significantly smaller at dinnertime (-18 +/- 3 mmHg) than at breakfast (-29 +/- 2 mmHg) or lunchtime (-34 +/- 4 mmHg) (p <.005 between groups). Eight patients showed no PPH in the evening, whereas all patients had PPH after breakfast and lunch. The duration of PPH was significantly shorter (p <.001), and postprandial symptoms were less frequent and less severe after dinner compared to breakfast and lunch. CONCLUSIONS: In geriatric patients, postprandial BP responses show a variation during the day, with significantly less PPH and fewer symptoms in the evening. Clinical implication is that, in the diagnostic process and management of PPH, the variation of the occurrence of PPH during the day should be taken into account. Through adjustment of BP decreasing activities to the time PPH is least prevalent, the risk of developing symptomatic PPH can be reduced.     

氯沙坦的降压疗效及其对血压谷/峰比值的影响

目的:以动态血压观察氯沙坦片对原发性高血压病患者的疗效及其对血压谷峰比值的影响。方法:60例原发性高血压病患者被随机均分为氯沙坦片组和苯那普利片组(各30例),分别给予氯沙坦片50～100mg和苯那普利片10～20mg,晨服,1次/日,疗程16周。结果:治疗后两组病人的血压均有明显下降,氯沙坦片组,收缩压(SBP)由治疗前的168.2±16.3 mmHg降至138.3±17.2mmHg,舒张压(DBP)由治疗前的99.8±8.1mmHg降至治疗后的85.3±6.4mmHg,SBP、DBP谷/峰比值分别为0.73和0.68;苯那普利组;SBP由治疗前的169.4±16.7mmHg降至139.3±16mmHg,DBP由治疗前的98.7±9.2mmHg降至治疗后的84.6±6.3mmHg,SBP、DBP谷/峰比值分别为0.67、0.63,与治疗前比较,P均<0.01,但组间比较差异不显著(P>0.05)。氯沙坦组无明显副作用,苯那普利组有6例出现咳嗽,2例咳嗽较剧烈,退出观察。结论:氯沙坦片能安全、有效、平稳地降低高血压病人的血压,其疗效与苯那普利疗效相似,但副作用明显少于后者,是高血压治疗的理想用药。