伊贝沙坦治疗轻中度高血压的临床疗效及安全性观察

目的评价伊贝沙坦治疗高血压的有效性和安全性。方法采用随机、对照法观察伊贝沙坦治疗轻、中度原发性高血压8周的疗效。46例原发性轻中度高血压的患者随机分为两组，分别服用伊贝沙坦（150mg，1次／d）或卡托普利（25mg，2次／d），治疗8周。治疗前及8周末进行各项实验室检查，每2周随访1次，记录受试者的血压、心率、不良反应。结果两组治疗前后收缩压与舒张压的下降均差异有显著性，伊贝沙坦组有效率为89％，卡托普利组有效率为80％，组间比较差异无显著性。两组治疗前后心率及各项实验室检测结果无显著性变化。不良反应轻微，均能耐受至试验结束。结论伊贝沙坦是新型的ARB类药物，在治疗轻、中度高血压的过程中安全有效，不良反应轻微，患者能很好耐受。     

老年高血压合并糖尿病患者血尿酸水平的临床观察

目的探讨老年高血压、糖尿病及高血压合并糖尿病患者的血尿酸(UA)水平。方法随机选择老年男性高血压36例、糖尿病33例、高血压合并糖尿病患者41例,对照组27例,比较4组血UA水平。结果3个试验组与对照组比较,血UA水平均明显升高,高血压合并糖尿病组差异显著(P<0.01);高血压合并糖尿病组与高血压组、糖尿病组比较均有显著性差异(P<0.01);高血压组与糖尿病组间无显著性差异。结论血UA水平与高血压、糖尿病密切相关。监测血UA水平有利于及时对原发病进行有效干预并改善其预后。     

原发性高血压的自主神经功能研究

目的研究原发性高血压的自主神经功能变化情况。方法采用计算机化心动周期信号混沌分析系统，对４４例原发性高血压的自主神经功能变化进行了分析，比较了原发性高血压Ⅰ、Ⅱ、Ⅲ期的混沌特征参数及功率谱参数的变化情况。结果原发性高血压普遍存在自主神经功能损害，以交感活性增加，迷走活性降低为主，各期高血压自主神经功能损害发生率相近，但Ⅱ、Ⅲ期高血压的损害程度重于Ⅰ期高血压。结论自主神经功能的损害在高血压初期就已存在，并随病情的进展而加重。     

噻托溴铵治疗哮喘的疗效及自主神经功能变化研究

目的研究噻托溴铵治疗哮喘的临床疗效及自主神经功能变化。方法将2013年2月~2015年1月我院收治的哮喘患者118例纳入研究对象,按照随机数字表法分为实验组与对照组各59例,两组一般资料比较无统计学差异(P0.05)。实验组在给予抗感染、吸氧、β_2受体激动剂、糖皮质激素以及营养支持等常规治疗基础上使用噻托溴铵粉吸入剂治疗,对照组仅行常规治疗。观察两组临床疗效、治疗前后PaO_2、PaCO_2、FVC、FEV_1、FEV_1%、SDANN、PNN50、IL-6、IL-8、TNF-α及不良反应。结果治疗后,两组患者PaO_2、PaCO_2、FVC、FEV_1、FEV_1%、IL-6、IL-8、TNF-α显著优于治疗前(P0.05),实验组PaO_2、PaCO_2、FVC、FEV_1、FEV_1%、IL-6、IL-8、TNF-α显著优于对照组(P0.05),实验组PNN50较治疗前显著降低(P0.05),且降低水平优于对照组(P0.05),实验组SDANN较治疗前显著升高(P0.05),且升高水平优于对照组(P0.05)。实验组总控制率(93.22%)显著高于对照组(79.66%)(P0.05),实验组不良反应(11.86%)与对照组(6.78%)无统计学差异(P0.05)。结论噻托溴铵治疗哮喘可有效降低自主神经的兴奋性,改善患者临床症状、炎性因子水平、血气水平及通气功能,不良反应发生率低。     

Evaluation of autonomic nervous function in patients with essential hypertension complicated with peptic ulcer

BACKGROUND AND AIMS: The relationship between peptic ulcer, autonomic activity and the incidence of Helicobacter pylori infection in untreated hypertensive patients complicated with peptic ulcer were evaluated. METHODS: Ten hypertensive patients with peptic ulcer (HT-PU group), 15 untreated essential hypertensive patients without peptic ulcer (HT group) and 10 normal subjects (N group) were enrolled, and a power spectral analysis was performed in each subject. A biopsy urease test was used to detect infection by H. pylori. RESULTS: No significant differences were observed in the values of mean low-frequency (LF) power between the three groups. However, the mean high-frequency (HF) power in the HT-PU group was significantly greater than those of the HT and N groups (P<0.01). The mean LF/HF ratios in the HT-PU and HT groups were significantly greater than that of the N group (P<0.01). With respect to H. pylori infection, no significant differences between the three groups were observed. Sympathetic activity (LF power) was increased in the HT and HT-PU groups. Furthermore, parasympathetic activity (HF power) was increased in the HT-PU group. CONCLUSIONS: These findings suggest the participation of increased parasympathetic activity in peptic ulcer patients. Therefore, it is suggested that new techniques, such as spectral analysis of heart rate variability, as used in this study, will clarify the relationship between peptic ulcer and autonomic nervous function.     

老年高血压患者动态脉压与血尿酸和超敏C反应蛋白的关系

目的探讨老年原发性高血压(EH)患者动态脉压(APP)与血尿酸(UA)、超敏C反应蛋白(hsCRP)水平的关系。方法入选112例老年EH患者,根据24 h动态血压监测结果计算APP,按照APP水平分为:30 mmHg≤APP60 mmHg组(PP1组)52例和APP≥60 mmHg组(PP2组)60例。分别测定2组的血清UA、hsCRP水平及相关临床生化指标,并进行比较。结果 PP2组的24 h平均收缩压(24hMSBP)显著高于PP1组(P0.05),24 h平均舒张压(24hMDBP)显著低于PP1组(P0.05);与PP1组相比,PP2组的血UA、hs-CRP水平显著升高,分别为(371.63±86.85)μmol/L和(311.25±74.36)μmol/L(P0.05)、(4.19±1.85)mg/L和(2.23±1.53)mg/L(P0.01)。相关性分析显示血UA、hs-CRP水平与APP均显著相关(P0.05或P0.01)。结论血UA、hs-CRP水平与APP关系密切,可能参与了老年EH患者脉压升高的病理生理过程。     

老年原发性高血压患者血清 Hcy、UA与炎症因子的变化

目的：探讨老年原发性高血压患者血清高同型半胱氨酸(Hcy)、尿酸(UA)与炎症因子的变化意义。方法：2011年8月到2015年2月选择在我院诊治的老年原发性高血压患者140例作为观察组,同期选择在我院进行体检的健康老年人140例作为对照组,两组都进行血清尿酸、高同型半胱氨酸与C-反应蛋白水平的检测,并进行了临床资料的调查与相关性分析。结果：观察组的血清尿酸、高同型半胱氨酸与C-反应蛋白水平都明显高于对照组,对比差异都有统计学意义(P<0.05)。在观察组中,二元线性相关分析显示血清尿酸、高同型半胱氨酸与C-反应蛋白在两两之间都呈现明显正相关性(P<0.05)。多元Logistic回归模型分析结果显示血清尿酸、高同型半胱氨酸、C-反应蛋白水平都为导致老年原发性高血压发生的独立危险因素(P<0.05)。结论：老年原发性高血压患者都伴随有血清尿酸、高同型半胱氨酸与C-反应蛋白的升高,三者可互相影响,都是高血压发病的危险因素,都参与了高血压的发生。     

Significant correlation between uric acid levels and flow-mediated dilatation in patients with masked hypertension

Background: Serum uric acid (UA) level is associated with prognosis in cardiovascular disorders such as sustained hypertension, diabetes mellitus and chronic kidney diseases. Increased UA levels in sustained hypertension may reflect early renal vascular alterations. However, it remains unclear if serum UA is associated with endothelial dysfunction in masked hypertensive patients. Methods: A total of 100 individuals (57% men and 43% women; mean 45?±?8 years) with masked hypertension were included in the present study. The clinical and laboratory data were collected. Endothelial function was estimated by flow-mediated dilatation (FMD) of the brachial artery and expressed as percentage change relative to baseline diameter. Results: Univariate regression analysis showed that the FMD was significantly negative correlated with uric acid (r?=??0.300, p?=?0.002), ambulatory 24-h systolic blood pressure (SBP) (r?=??0.275, p?=?0.008), hs-CRP (r?=??0.222, p?=?0.033) and diastolic aortic diameter (r?=??0.243, p?=?0.019). In multivariate linear regression analysis, only uric acid levels and ambulatory 24-h SBP were significantly associated with FMD. Conclusion: There was an independent correlation between UA and FMD, and a higher UA level was related to worse endothelial function which may contribute to hypertension and cardiovascular morbidity.     

Clinical cardiac safety profile of nilotinib

Background

Nilotinib is a second-generation tyrosine kinase inhibitor with significant efficacy as first- or second-line treatment in patients with chronic myeloid leukemia. Despite preclinical evidence indicating a risk of prolongation of the QT interval, which was confirmed in clinical trials, detailed information on nilotinib’s cardiac safety profile is lacking.

Design and Methods

Here, we retrospectively assessed cardiovascular risk factors in 81 patients who were being or had previously been treated with nilotinib therapy and evaluated cardiovascular parameters by longitudinal monitoring of the QT interval and left ventricular ejection fraction. Detailed information on the occurrence and management of defined cardiac adverse events was extracted.

Results

The median duration of nilotinib therapy was 26 months (range, 1–72). The median QT interval at baseline was 413 msec (range, 368–499 msec). During follow-up, the median QT was not significantly different from the baseline value at any time-point. Sixteen of 81 patients (20%) had new electrocardiographic changes. Cardiac function, as assessed by measurement of left ventricular ejection fraction, did not change significantly from baseline at any time-point. During a median follow-up of 44 months (range, 2–73), seven patients (9%), all of whom had received prior imatinib therapy, developed 11 clinical cardiac adverse events requiring treatment. The median time from the start of nilotinib therapy to an event was 14.5 months (range, 2–68). Five of seven patients were able to continue nilotinib therapy with only one brief interruption.

Conclusions

Whereas new electrocardiographic abnormalities were recorded in 20% of all patients and some of them developed severe or even life-threatening coronary artery disease, QT prolongation, changes in left ventricular ejection fraction, and clinical cardiac adverse events were uncommon in patients treated with nilotinib.     

人群三年降压治疗的疗效观察

目的 对比观察4种降压药物联合方案长期治疗原发性高血压病(EH)的疗效。方法 选择EHⅡ期、Ⅲ期患者892例，按入选顺序分为4组：A组为尼群地平加卡托普利，B组为尼群地平加氨酰心安，C组为硝苯地平加卡托警利加双氢克尿噻，D组为复方降压片，各种原因退出以上4组的为E组；在治疗前后检测血压、血尿常规、肾功髓、24小时尿蛋白、眼底检查及心脏B超。部分患者检测了神经内分泌因子。结果 在治疗后1、3年，5组患者动辣血压均较治疗前明显下降；LVMI和A／E比值均下降，CO和LVEF无变化，血BUN、Cr无变化；各组间无统计学差异。其中A、B、C组的24小时尿蛋白、血尿酸明显下降，眼底情况明显改善，而D、E组则反之；心脑血管疾病死亡例数D、E组明显高于A、B、C组。结论 坚持长期降压治疗可明显减少高危患者的病死率和并发症，并保护其靶器官受损，制定合、理、安全、有效、经济的降压方案对EH患者的管理率、服药率、控制率都有着重要的临床价值和社会意义。     

Three-Year Safety and Effectiveness of Fixed-Dose Losartan/Hydrochlorothiazide Combination Therapy in Japanese Patients with Hypertension Under Clinical Setting (PALM-1 Extension Study)

Concerns about metabolic complications often disturb prolonged use of diuretics in Japan. We investigated 3-year safety and efficacy in Japanese patients with hypertension who were uncontrolled with angiotensin receptor blocker or angiotensin-converting enzyme inhibitor regimens and then switched to losartan (50 mg)/hydrochlorothiazide (12.5 mg; HCTZ) combinations. Blood pressure decreased favorably and maintained a steady state for 3 years (157 ± 16/88 ± 11 mm Hg to 132 ± 13/75 ± 9 mm Hg, P < .0001). Metabolic parameters maintained a limited range of changes after 3 years, and adverse events were markedly decreased after 1-year treatment. The losartan/HCTZ combination minimized diuretic-related adverse effects and thus may be useful for the treatment of Japanese patients with hypertension.     

急性心肌梗死并发高尿酸血症患者的相关因素

目的分析急性心肌梗死（AMI）并发高尿酸（UA）血症患者的相关因素。方法将177例AMI患者按血UA水平分为两组:低UA组87例,UA<300μmol/L;高UA组90例,UA≥300μmol/L,回顾性分析两组在年龄、心率、心功能、肾功能及性别、并发高血压病或糖尿病、溶栓、再通比例的差别。结果①与低UA组相比,高UA组患者年龄较大,心率快,心功能killip分级差,血尿素氮和肌酐高,并发高血压病者比例高,两组有显著性差异（P<0.05,P<0.01）。②两组在心肌酶谱、血脂和性别比例与并发糖尿病、溶栓和再通的比例无显著性差异。结论伴发UA增高的AMI患者,年龄大,并发高血压病者比例高,心肾功能差,预后差。     

美托洛尔治疗高血压临床观察

40例高血压病患者服用美托洛尔8周，显效率和总有效率分别为60％和82．5％，其中Ⅰ，Ⅱ期高血压病患者疗效更好，无严重副作用，该药可作为Ⅰ，Ⅱ期高血压病的首选药物之一。     

美托洛尔治疗高血压120例临床分析

单用美托洛尔0．05g，2／d治疗高血压患者120例．4周后有效率为68.3％，收缩压及舒张压显著下降。对疗效不显者增加剂量0．1g，2／d，疗效无明显改善。加用硝苯地平10mg，3／d，血压显著下降，总有效率达90．9％。     

原发性高血压患者血清胆红素、尿酸及超敏C反应蛋白变化的临床意义

目的探讨原发性高血压（EH）患者血清胆红索、尿酸（UA）及超敏C反应蛋白（hs-CRP）变化的临床意义。方法选择EH患者101例（EH组）、阵发性室上性心动过速患者103例（对照组）,检测其血清胆红素、UA及hs-CRP。结果与对照组比较,EH组血清总胆红素、直接胆红素和间接胆红素明显降低,且随高血压分级升高而逐渐降低（P〈0．05）;血清UA、hs—CRP明显升高,且随高血压分级升高而逐渐升高（P〈0．05）。结论血清胆红素、UA和hs—CRP是反映EH患者代谢异常的重要指标,可用于评估其病情的严重程度。     

老年高血压患者颈动脉粥样硬化与血尿酸及相关炎症因子的关系

目的分析老年原发性高血压患者的颈动脉粥样硬化(CAS)与血尿酸(SUA)及相关炎症因子的关系。方法选取老年原发性高血压患者42例及血压正常者38例,应用高频多普勒超声检测颈动脉内膜-中层厚度(IMT)及斑块情况,测定血清三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、SUA、超敏C反应蛋白(Hs-CRP)、白介素6(IL-6)和肿瘤坏死因子-α(TNF-α)。结果老年高血压组的SUA、TNF-α、IL-6、Hs-CRP、颈动脉IMT及CAS的发生率明显高于对照组,差异有统计学意义(P<0.05);颈动脉IMT与收缩压(SBP)、SUA、Hs-CRP呈正相关。结论老年高血压CAS的发生和发展除了血压增高的影响因素外,体内SUA的增高及相关炎症因子也参与了CAS的病理生理过程。     

老年高血压患者利尿剂的使用及其对血钾和尿酸的影响

目的探讨老年高血压患者利尿剂的使用及其对血钾和尿酸的影响。方法选择年龄≥70岁的高血压患者713例,根据入选时患者服用降压药物的情况,分为3组:利尿剂组332例、非利尿剂组270例和未用药组111例,测定血钾、尿酸和其他生化指标,并进行比较。结果利尿剂组和非利尿剂组患者血压显著低于未用药组(P0.05)。与未用药组和非利尿剂组比较,利尿剂组患者尿酸、TG明显升高,血钾明显降低,差异有统计学意义(P0.05,P0.01)。利尿剂组低钾血症发生率明显高于非利尿剂组和未用药组(18.1% vs 10.4% vs 9.9%,P0.05,P0.01)。结论老年高血压患者中,使用利尿剂控制血压与使用非利尿降压药效果相似,但血钾水平低、低钾血症发生率高,血清尿酸升高;长期使用需注意血钾降低的防治。     

Diet‐independent relevance of serum uric acid for blood pressure in a representative population sample

A direct relationship between serum uric acid and blood pressure (BP) has been reported, but the possible confounding impact of diet on this association is unclear. The authors performed a cross‐sectional analysis in the representative German Health Interview and Examination Survey for Adults (n=6788, aged 18–79 years). In adjusted regression models considering dietary factors, each 1‐mg/dL higher uric acid value was associated with a 1.10‐mm Hg (P=.0002) and a 0.60‐mm Hg (P=.04) higher systolic BP among participants younger than 50 years and participants 50 years and older, respectively. For diastolic BP, uric acid was a significant predictor (β=0.71 mm Hg, P=.0001) among participants younger than 50 years and for participants 50 years and older without antihypertensive treatment. Adjusted odds ratios of hypertension for participants with hyperuricemia were broadly similar in younger (odds ratio, 1.71; P=.02) and older (odds ratio, 1.81; P=.0003) participants. Uric acid is a significant predictor of systolic BP and hypertension prevalence in the general adult population in Germany independently of several known dietary BP influences.     

Serum uric acid is independently associated with hypertension in patients with polymyositis and dermatomyositis

Serum uric acid (UA), as an antioxidant, has been associated with hypertension in the general population. Hypertension is highly prevalent in patients with polymyositis and dermatomyositis (PM/DM). Owning elevated levels of reactive oxygen species, patients with PM/DM have lower concentrations of UA in comparison with healthy people. We explored a potential association between UA levels and hypertension in PM/DM and evaluated whether this association is independent of hypertension risk factors, PM/DM characteristics and relevant drugs. A total of 472 PM/DM patients were assessed. UA and related laboratory data were measured. Demographic, hypertension-related factors, PM/DM characteristics and drug use were assessed as potential covariates. Results were analyzed using logistic models to test the independence of the association between UA and hypertension. UA levels were higher in hypertension subjects compared to non-hypertensive PM/DM patients [284.70 (239.93-357.38) vs 264.00(222.50-322.75), p = .017]. When adjusted for hypertension risk factors, PM/DM characteristics and drugs, the odds of being a hypertensive PM/DM patient per 1 μmol/L UA increase were significantly increased: odds ratio = 1.473 (95% confidence interval:1.063-2.042, p = .020). This cross-sectional study suggests that UA levels are independently associated with hypertension in PM/DM patients.