老年人单纯收缩期高血压88例治疗初探

目的 :提高对老年人单纯收缩期高血压 (isolatedsystolichypertensionintheelderly ,EISH)治疗的认识。方法 :EISH患者 88例 ,选用二氢吡啶类钙拮抗药 (dihydropyridinescalciumchannelblocker,CCB)和 (或 )小剂量利尿药 ,根据有否并发症和气温变化对血压的影响 ,进行选择性联合用药 ,实行个体化用药治疗 ,并根据昼夜血压变化规律服药。结果 :病人依从性和治疗率达 10 0 % ,总有效控制率达 90 %。患者治疗前后收缩压分别为 (2 2 8± 1 8)kPa、 (19 0± 1 9)kPa ,差异有统计学意义(P <0 0 1)。冬、春季加强降压和通血管治疗 ,无 1例发生脑卒中、急性心肌梗死和肾功能不全 ,长效CCB不良反应水肿仅占 13%。结论 :长效CCB和 (或 )小剂量利尿药降压 ,不良反应小 ,降压效果好 ,是治疗EISH的首选。密切医患关系 ,健康保健和疾病治疗相结合 ,配合健康生活方式 ,是提高治疗率和控制率的关键。     

厄贝沙坦治疗老年单纯收缩期高血压的效果及其对胰岛素抵抗的影响

目的探讨厄贝沙坦降压的同时对患者胰岛素抵抗的影响,以及对其安全性进行临床评价。方法老年单纯收缩期高血压(ISH)160例,分2组,每组80例。一组给予口服厄贝沙坦片,每日1次,每次150 mg;另一组给予硝苯地平片,每次10~20 mg,2次/d或3次/d,总疗程均为8周。治疗期间跟踪观察,并记录患者的血压、心率、空腹血糖、空腹胰岛素及药物相关不良反应。结果患者口服厄贝沙坦1周后收缩压开始明显降低于治疗前(P<0.05);治疗结束时,患者空腹胰岛素水平和胰岛素敏感指数明显低于治疗前(P<0.05);治疗前后心率、血糖均无明显差异,差异无统计学意义(P>0.05)。随访期间出现咳嗽1例。头晕1例,不良反应总发生率为2.5%。与硝苯地平组比较,厄贝沙坦的降压效果与硝苯地平的相似,但对胰岛素水平和胰岛素敏感性改善更明显,同时不良反应也比硝苯地平的轻。结论厄贝沙坦治疗老年患者单纯收缩期高血压疗效确切,可明显降低老年单纯收缩期高血压,改善胰岛素敏感性,对心率和血糖无明显影响,药物不良反应轻微。     

氨氯地平与硝苯地平治疗原发性高血压的疗效比较

本文报道氨氯地平与硝苯地平治疗原发性高血压的疗效比较，氨氯地平降压总有效率９５％，较后者高，且不良反应少，安全性高，每天仅服药１次，能维持２４小时控制血压。     

苯磺酸氨氯地平片和硝苯地平控释片长期降压疗效比较

目的比较苯磺酸氨氯地平片和硝苯地平控释片两者在老年高血压病患者中的降压疗效。方法采用随机和平行对照的方法,通过24 h动态血压检测,比较分别服用苯磺酸氨氯地平片和硝苯地平控释片12个月后的疗效。结果两种药物均能有效控制24 h平均血压、白天平均血压和夜间平均血压,并维持良好的血压昼夜节律,苯磺酸氨氯地平片在降低夜间舒张压方面要明显强于硝苯地平控释片（P〈0.05）。结论络活喜和拜新同每日服用1次（1片）,均能有效控制全天24 h血压,其中夜间舒张压较高的患者可首选苯磺酸氨氯地平。     

苯磺酸氨氯地平联合厄贝沙坦治疗老年单纯收缩期高血压

老年单纯收缩期高血压（收缩压〉140mmHg和舒张压〈90mmHg）为临床上常见的疾病。有证据表明．60岁及60岁以上的老年人,收缩压是较舒张压预测心脑血管事件更为显著的指标,但对单纯收缩期高血压的控制与达标仍是临床上的难题,我们应用苯磺酸氨氯地平联合厄贝沙坦治疗老年单纯收缩期高血压取得了较好的疗效,现报告如下。     

卡托普利治疗老年性收缩期高血压

高血压是老年人的常见病、多发病。现代认为单纯性收缩压升高是许多老年性心,脑疾患并发症如冠心病,猝死、心衰,中风等重要危险因素。我院采用卡托普利治疗老年性收缩期高血压124例,收到较满意的疗效,现报道如下,并对其降压机制进行探讨。 1 资料与方法 1.1 一般资料 124例中男86例,女38例;年龄60～92岁,平均76±16岁。按1984年第三次美国联合委员会(JNC Ⅲ)规定,均经坐位测右侧肱动脉血压3次证实为收缩压≥21kPa(160mmHg),舒张压<12kPa(90mmHg)而选为治疗组。     

老年人纯收缩期高血压脑血流动力学变化特征

老年人纯收缩期高血压，作为高血压病的一种特殊类型，是因为收缩期高血压和收缩压为主型高血压，较易导致缺血性卒中，尤其是老年人，其卒中病死率较其它高血压类型为高〔１〕。我们采用ＴＣＤ超声血流诊断仪，对５８例老年纯收缩期高血压患者，双侧大脑中动脉及颈内动脉...     

左旋氨氯地平联合氢氯噻嗪治疗老年收缩期高血压的观察

目的探讨左旋氨氯地平联合氢氯噻嗪治疗老年单纯收缩期高血压的疗效。方法随机选择51例1～2级老年单纯收缩期高血压患者,采用自身对照、开放实验方法。所有患者停药2周后口服苯磺酸左旋氨氯地平（施慧达5mg1次／d）、氢氯噻嗪（12．5mg1次／d）共4周,观察治疗前、后的血压变化和不良反应。结果本组显效32例,有效15例,无效4例,总有效率92．2％。前后复查肝、肾功能,心电图均未出现明显变化。结论左旋氨氯地平与氢氯噻嗪配伍治疗老年人单纯收缩期高血压效果确切,不良反应小,患者服药方便、依从性好。     

苯磺酸氨氯地平治疗原发性高血压256例分析

目的：应用苯磺酸氨氯地平治疗原发性高血压,观察其疗效。方法：所有入选患者每天早晨固定时间5：00～6：00服药2．5～10mg,连续服用8周。结果：苯磺酸氨氯地平治疗8周后,平均坐位血压由治疗前169．6／102．4mmHg降至138．8／85．9mmHg,总有效率为96．5％。结论：苯磺酸氨氯地平的降压作用确切、安全、有效,是治疗高血压的有效药物之一。     

左旋氨氯地平联合氢氯噻嗪治疗老年收缩期高血压的观察

目的 探讨左旋氨氯地平联合氢氯噻嗪治疗老年单纯收缩期高血压的疗效.方法 随机选择51例1～2级老年单纯收缩期高血压患者,采用自身对照、开放实验方法.所有患者停药2周后口服苯磺酸左旋氨氯地平(施慧达5 mg 1次/d)、氢氯噻嗪(12.5 mg 1次/d)共4周,观察治疗前、后的血压变化和不良反应.结果 本组显效32例,有效15例,无效4例,总有效率92.2%.前后复查肝、肾功能,心电图均未出现明显变化.结论 左旋氨氯地平与氢氯噻嗪配伍治疗老年人单纯收缩期高血压效果确切,不良反应小,患者服药方便、依从性好.     

Isolated systolic hypertension in the elderly: pathophysiology and treatment

Isolated systolic hypertension (ISH) is a common clinical finding in the elderly population and appears to be a risk factor for cardiovascular morbidity and mortality. It appears feasible and safe to treat patients with various antihypertensive drugs; however, the morbidity and mortality benefits still need to be determined.     

Randomized,comparative, double-blind study of amlodipine vs. nicardipine as a treatment of isolated systolic hypertension in the elderly

A 90-day, multicenter, randomized, double-blind, parallel-group study was conducted to compare the efficacy of amlodipine (once a day) with nicardipine (two to three times a day), in the treatment of isolated systolic hypertension (ISH) in the elderly. Patients (n = 133) aged > or = 60 years, with ISH were randomized to receive either amlodipine 5 mg/day, or nicardipine 60 mg/day (titrated if necessary to 10 mg/day and 100 mg/day, respectively) for 90 days. Efficacy was assessed by measuring office blood pressure (BP), and 24-h ambulatory blood pressure monitoring (ABPM). The two treatments substantially and comparably reduced office systolic blood pressure (SBP) and pulse pressure (PP), and also produced a slight decrease in diastolic blood pressure (DBP). Amlodipine reduced SBP, as assessed by ABPM, to a significantly greater extent than nicardipine. Both treatments were well-tolerated. The sustained effect of amlodipine, compared with nicardipine, was reflected in its significantly greater antihypertensive activity, particularly during the nocturnal period, as assessed by ABPM. The study demonstrates that once a day dose of amlodipine is an effective antihypertensive treatment for elderly ISH patients.     

Evidence-based care for the elderly with isolated systolic hypertension

This paper reviews the epidemiology, pathophysiology and clinical significance of isolated systolic hypertension (ISH) in the elderly. Aging is associated with structural and functional changes in the arterial tree. Intimal thickening, migration of small muscle cells to the intima, medial fibrosis, and elastic fiber degeneration result in increased arterial stiffness and ISH. The augmented systemic vascular resistance in the elderly is mediated by increased arterial stiffness. Aging is correlated with overactivity of the sympathetic nervous system, reduced neuronal plasma norepinephrine uptake, and baroreceptor dysfunction. These functional changes all contribute to the development of ISH in elderly persons. Prospective and epidemiological studies have demonstrated that ISH is associated with coronary and cerebrovascular morbidity and mortality. There is good evidence indicating that lifestyle modifications such as weight reduction, increased physical activity, moderation of dietary sodium, and decreased alcohol intake, in combination with pharmacological therapy can effectively reduce blood pressure in elderly individuals with ISH. Primary health care providers can make significant contributions to the care of elderly persons with ISH. These contributions involve educating elderly people to control hypertension through lifestyle modification, monitoring the efficacy of antihypertensive therapy, and preventing complications associated with non-compliance with therapeutic regimens.     

Comparison of amlodipine and enalapril in the treatment of isolated systolic hypertension in the elderly: an open-label, randomized, parallel-group study

Background: The benefits of treating isolated systolic hypertension (ISH) are well established, but the most appropriate drug choice is still uncertain.Objective: The purpose of this study was to compare amlodipine, a calcium channel blocker, with enalapril, an angiotensin-converting enzyme inhibitor, in the treatment of ISH in a cohort of elderly patients (≥60 years of age).Methods: Ambulatory patients with ISH (seated systolic blood pressure [SBP] >160 mm Hg and <220 mm Hg; diastolic blood pressure [DBP] <95 mm Hg) who had not been treated previously or who had stopped their medication at least 4 weeks before the study were enrolled. Patients were randomized to receive amlodipine 5 mg/d or enalapril 10 mg/d. After 4 weeks of treatment, the dose was doubled for those patients whose sitting SBP had not decreased to <150 mm Hg or by >20 mm Hg, and treatment was continued for an additional 4 weeks.Results: A total of 89 patients were randomized to treatment, 46 to amlodipine and 43 to enalapril; 1 patient in the enalapril group died due to ischemic stroke despite adequate blood pressure control. The absolute reductions in seated and standing SBP/DBP were similar with both drugs after 8 weeks: 27 mm Hg/4.6 mm Hg with amlodipine and 23.9 mm Hg/3.9 mm Hg with enalapril (sitting) and 25.1 mm Hg/4.1 mm Hg and 21.3 mm Hg/4.2 mm Hg (standing) with amlodipine and enalapril, respectively (P = NS). At 4 weeks, 24 patients (52.2%) in the amlodipine group and 33 patients (76.7%) in the enalapril group had their medication dose doubled because their SBP was not adequately controlled with the initial dose (P < 0.01). At the end of the study, 24 patients were taking 10 mg amlodipine and 22 patients were taking 5 mg (mean dose 7.6 ± 2.5 mg); 33 patients were taking 20 mg enalapril and 10 patients were taking 10 mg (mean dose 17.8 ± 4.1 mg). Side effects occurred significantly more frequently in the amlodipine group (P = 0.01).Conclusion: The results of this study suggest that amlodipine and enalapril are similarly effective in treating ISH in elderly patients, with few side effects.     

缬沙坦联合氨氯地平治疗老年高血压的临床效果

目的 分析缬沙坦联合氨氯地平治疗老年高血压的临床效果.方法 选取2018年10月至2019年9月于我院接受治疗的180例老年高血压患者,根据随机数字表法将其分为对照组和观察组,各90例.对照组采用缬沙坦+氢氯噻嗪治疗,观察组采用缬沙坦+氨氯地平治疗,两组均持续治疗8周.比较两组患者治疗前、后的血压变异性、血管弹性、生活...     

Prevalence,pathophysiology and treatment of isolated systolic hypertension in the elderly

Isolated systolic hypertension is the predominant type of hypertension in the elderly and is associated with cardiovascular complications such as stroke, coronary heart disease and heart failure. In this review, the role of arterial stiffness, endothelial function, atherosclerosis and oxidative stress in the pathogenesis of isolated systolic hypertension is extensively discussed. Placebo-controlled intervention trials such as the Systolic Hypertension in Europe Trial and the Systolic Hypertension in the Elderly Program have clearly shown that pharmacological treatment of isolated systolic hypertension improves outcome in the elderly. Nevertheless, isolated systolic hypertension remains the major subtype of untreated and uncontrolled hypertension.     

Prevalence, pathophysiology and treatment of isolated systolic hypertension in the elderly

Isolated systolic hypertension is the predominant type of hypertension in the elderly and is associated with cardiovascular complications such as stroke, coronary heart disease and heart failure. In this review, the role of arterial stiffness, endothelial function, atherosclerosis and oxidative stress in the pathogenesis of isolated systolic hypertension is extensively discussed. Placebo-controlled intervention trials such as the Systolic Hypertension in Europe Trial and the Systolic Hypertension in the Elderly Program have clearly shown that pharmacological treatment of isolated systolic hypertension improves outcome in the elderly. Nevertheless, isolated systolic hypertension remains the major subtype of untreated and uncontrolled hypertension.     

Hydrochlorothiazide plus methyldopa in the treatment of isolated systolic hypertension in the elderly

An open-label clinical trail comparing the effectiveness of the combination of methyldopa with hydrochlorothiazide in low doses with that of hydrochlorothiazide therapy alone was conducted in 21 elderly patients with isolated systolic hypertension. The combination therapy reduced the systolic blood pressure to levels markedly lower than those measured at baseline and after two weeks of hydrochlorothiazide therapy. Standing blood pressure fell from a mean of 166/90 mmHg at baseline to a mean of 164/88 mmHg after two weeks of hydrochlorothiazide treatment and to a mean of 132/80 mmHg after 16 weeks of treatment with hydrochlorothiazide and methyldopa. Side effects were mild, and there were no significant changes in laboratory findings.     

Treatment of isolated systolic hypertension in the elderly

Systolic hypertension is a major health economy problem within our aging society. Increased arterial stiffness is the vascular phenotype of systolic hypertension, especially of the large arteries. Elevated systolic blood pressure is even more associated with cardiovascular morbidity and mortality than diastolic blood pressure. Treatment of systolic hypertension in the elderly should be based on nonpharmacological measures and medical therapy if the systolic hypertension cannot be controlled by conservative therapy alone. The HYVET study provided evidence-based medicine data showing that, in the very elderly, lowering blood pressure to a level of 150/80 mmHg is still very beneficial. Antihypertensive therapy needs to be tailored in the elderly because of comorbid conditions, such as ischemic heart disease, heart failure, atrial fibrillation, renal insufficiency and diabetes. Angiotensin-converting enzyme inhibitors or angiotensin II-receptor blockers should be considered in combination with diuretics or with a dihydropyridine calcium antagonist. β-blockers seem to be less effective for cardiovascular disease protection in comparison with other antihypertensive drug classes, such as diuretics, dihydropyridines, angiotensin-converting enzyme inhibitors or angiotensin II-receptor blockers. Major effort is required to reduce the therapeutic inertia and increase therapeutic adherence for better blood pressure control in the elderly with systolic hypertension.