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该文研究原发性高血压(EH)患者的内皮依赖性血管舒张功能与运动后血压反应的关系。研究采用高分辨率血管超声对53例EH(EH组，男29例，女24例，平均年龄(56.4±6.3)岁，体重指数(23.7±4.9)kg／m~2患者及42例正常人(对照组，男28例，女14例，平均年龄(52.5±7.4)岁，体重指数(22.7±9.1)kg／m~2进行内皮依赖性血管舒张功能的检测，采用平板运动试验系统进行亚极量运动负荷试验，于运动前、达亚极量负荷后即刻及休息6min后测定血压。结果：除2例患者运动前血压≥160/100 mm Hg被除外，其余患者均完成试验。与运动前比较，运动后即刻收缩压在对照组及EH组     

原发性高血压患者肱动脉流量介导的舒张活性变化

目的:探讨原发性高血压(EH)患者内皮依赖性血管舒张功能的改变。方法:应用无创性高分辨率超声检测61例EH患者(EH组)和38例正常血压者(对照组)肱动脉流量介导的舒张(FMD)活性,以评价其血管内皮功能。结果:①对照者、Ⅰ级EH者、Ⅱ级EH者的FMD呈逐渐明显降低(P<0.05或<0.01)。②Ⅰ级、Ⅱ级EH组的FMD峰值时间较对照组均明显延迟(分别P<0.05和<0.01)。结论:EH患者存在着明显的内皮功能障碍,并随着病程进展损害逐渐加重。     

2型糖尿病患者肱动脉内皮依赖性血管舒张功能与无症状运动心电图阳性关系的研究

目的:研究肱动脉内皮依赖性血管舒张功能在预测2型糖尿病患者并发冠心病中的作用。方法:选择静息心电图正常的2型糖尿病患者98例进行踏车运动实验,筛选无症状运动心电图阳性(ECG+)者(ECG+组,39例),及无症状心电图阴性者(ECG-组,59例)。同时,选择性别、年龄匹配的踏车运动实验正常的健康个体31例作为对照。采用高分辨血管外超声法检测肱动脉血流介导的内皮依赖性血管舒张功能和硝酸甘油介导的内皮非依赖性血管舒张功能。结果:①与对照组比较,ECG+组总胆固醇、低密度脂蛋白胆固醇、甘油三酯、空腹血糖,餐后2小时血糖及C反应蛋白水平明显增高(P<0.05);高密度脂蛋白担固醇水平明显低于对照组(P<0.05)。与ECG-组比较,ECG+组C反应蛋白明显增高(P<0,05)。②ECG-组内皮依赖性血管舒张功能明显低于对照组(P<0.001),ECG+组内皮依赖性血管舒张功能又明显低于对照组和ECG-组(P<0.01)。多元Logistic回归分析结果显示,年龄、低密度脂蛋白胆固醇、脂蛋白(a)、C-反应蛋白、收缩压、舒张压与无症状运动ECG+呈正相关,高密度脂蛋白胆固醇、内皮依赖性血管舒张功能与无症状运动ECG+呈负相关。结论:在2型糖尿病人群中,肱动脉内皮依赖性血管舒张功能与无症状运动ECG+关联,提示肱动脉内皮依赖性血管舒张功能是早期冠心病的预测因子之一。     

卡维地洛对老年单纯收缩期高血压病人血管内皮依赖性舒张功能影响的观察

目的观察卡维地洛对老年单纯收缩期高血压病人血管内皮依赖性舒张功能的影响。方法单纯收缩期高血压(ISH)64例,年龄60~80岁,随机分为A、B两组。两组均以卡维地洛治疗,其中32例为A组,在卡维地洛的基础上,联合应用硝苯地平缓释片;B组32例,单用卡维地洛内服,两组均连续用药12周,治疗前后对相关指标进行检测与对比观察,并采用高分辨超声测定患者用药前后的反应性充血和含服硝酸甘油后肱动脉内径的变化。结果与治疗前比较,两组的收缩压(SBP)与舒张压(DBP)均显著下降(P<0.01与P<0.05),组间比较,A组SBP下降更为显著(P<0.01),而DBP的下降两组无显著性差异(P>0.05)。血管内皮依赖性舒张功能指标(FMD)值在A组用药前后比较差异非常显著(P<0.01),B组差异亦有非常显著性(P<0.01),组间比较,A组FMD改善程度优于B组(P<0.05)。两组的非依赖性血管内皮舒张功能用药后均无显著变化(P>0.05)。治疗期间未见卡维地洛严重不良反应。结论ISH患者血管内皮依赖性舒张功能受损,卡维地洛有显著改善其血管内皮依赖性舒张功能作用。     

阿托伐他汀对冠心病患者的血管舒张功能的影响

目的观察阿托伐他汀对冠心病患者血管舒张功能的作用。方法将入选60例冠心病并高胆固醇血症患者随机分为阿托伐他汀治疗组(A组)和对照组(B组)。分别测定血清胆固醇、三酰甘油、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇。并应用高分辨率超声技术,检测治疗前、后两组肱动脉血流介导和硝酸甘油介导的舒张功能。结果治疗前,冠心病并高胆固醇血症患者肱动脉血流介导和硝酸甘油介导的舒张功能均低于健康对照组(P<0.01)。经阿托伐他汀治疗6个月后A组血浆总胆固醇、三酰甘油和低密度脂蛋白胆固醇显著降低(P<0.01),高密度脂蛋白胆固醇显著升高(P<0.01)。随着血脂的改善,肱动脉内皮依赖性血管舒张功能显著提高(P<0.01),但硝酸甘油介导的血管舒张功能未见改善(P>0.05)。结论冠心病并高胆固醇血症患者存在内皮依赖性血管舒张功能障碍,经阿托伐他汀调脂治疗后,受损的内皮依赖性血管舒张功能得到明显改善。     

奥利司他对超重合并高血压患者内皮依赖性血管舒张功能的影响

目的观察超重合并高血压患者服用奥利司他治疗前后血压和超声肱动脉内皮依赖性血管舒张功能的变化.方法30例超重合并轻度高血压患者(超重高血压组)服用脂肪酶抑制剂--奥利司他(orlistat,商品名赛尼可 )120 mg,每日3次,共12周,服药前后诊所测量身高、体重、腰围及血压,并行肱动脉超声检查,测定血流介导的血管舒张功能.15例非超重的高血压患者作为对照组.结果超重高血压组治疗前加压反应性充血后肱动脉内径平均增加(9.6±1.7)%,流速增加(29.7±3.05)%,增加幅度低于对照组,与对照组比有显著性差异(P＜0.01).超重高血压组奥利司他治疗12周后,加压反应性充血后肱动脉内径增加达(14.2±2.0)%、流速增加达(56.7±4.14)%,血流介导的血管舒张功能较治疗前显著改善(P均＜0.01).超重高血压组患者治疗后平均减重5.3 kg,腰围减少6.3 cm,收缩压/舒张压平均下降13.3/5.7 mmHg(1 mmHg=0.133 kPa),与治疗前比有显著性差异(P均＜0.05～0.01).结论奥利司他能降低超重合并高血压患者的体重,并能改善血流介导的内皮依赖性动脉舒张功能.     

运动血压与高敏-C反应蛋白、血管内皮功能的相关性研究

目的研究运动血压与高敏-C反应蛋白(hs-CRP)、血管内皮功能(FMD)的关系。方法将102例受试者分为正常血压组和高血压组,采用胶乳比浊法测定hs-CRP,当日或次日行高分辨率血管超声检测FMD,行活动平板试验,测定运动前、达亚极量负荷后即刻及休息6min时的血压。根据运动高血压的定义将两组分别分为运动血压正常亚组和运动高血压亚组。分别比较:高血压组与正常血压组之间,正常血压组内的运动血压正常亚组(A组)与运动高血压亚组(B组)之间,高血压组内的运动血压正常亚组(C组)与运动高血压亚组(D组)之间的hs-CRP、FMD差异有无统计学意义。结果①与正常血压组相比,高血压组的hs-CRP显著升高,FMD显著减低(P<0.01)。②在正常血压组内,B组的hs-CRP较A组显著升高,FMD显著减低(P<0.05)。③在高血压组内,D组的hs-CRP较C组显著升高,FMD显著减低(P<0.05)。结论运动高血压与hs-CRP、内皮依赖性血管舒张功能密切相关,可作为高血压的预测指标,对高血压的治疗及预后起着重要的作用。     

糖尿病患者内皮tPA、NO储备与血管舒张功能变化

目的　探讨糖尿病患者血管舒张功能和内皮组织纤溶酶原激活物 (tPA)、一氧化氮 (NO)储备释放功能与糖尿病性血管病变的关系。方法　对 15名正常人和 2 3例 2型糖尿病患者 ,采用高频超声方法测定血流介导和硝酸甘油介导的血管舒张功能和颈总动脉内膜厚度 ,以及采用静脉闭塞试验测定tPA和NO储备释放。结果　与正常对照组比较 ,糖尿病组的非内皮依赖性血管舒张功能无显著变化 ,而内皮依赖性血管舒张功能和tPA、NO释放明显低下 (P <0 .0 5或P <0 .0 1) ,颈总动脉内膜增厚 ,但差异无显著性。正常组血tPA水平与NO水平 ,以及tPA释放与NO释放呈显著正相关 ,而糖尿病组收缩压、舒张压均与内皮依赖性血管舒张功能和非内皮依赖性血管舒张功能呈显著负相关。结论　糖尿病患者存在明显的内皮tPA、NO储备释放功能和内皮依赖性舒张功能障碍 ,此与糖尿病性血管病变密切相关     

卡维地洛对急性心肌梗死患者内皮功能及氧化指标的影响

目的观察卡维地洛对急性心肌梗死(AMI)患者血管内皮依赖性舒张功能及血清氧化指标——丙二醛(MDA)的影响。方法将52例AMI患者随机分成卡维地洛治疗组(28例)和常规治疗组(24例),比较观测治疗8周前后超声检测肱动脉流量介导性扩张的血管内皮依赖舒张功能及血清MDA的变化。结果治疗前两组比较,内皮依赖性血管舒张功能差异无统计学意义;卡维地洛治疗8周后内皮依赖性血管舒张功能明显改善;血清MDA水平明显降低,与治疗前比较,差异均有统计学意义(P<0.05或P<0.01)。结论卡维地洛在治疗8周后通过降低血清MDA水平的抗氧自由作用,可明显改善AMI患者血管内皮依赖舒张功能。     

良性前列腺增生合并原发性高血压患者血管内皮功能变化的临床研究

目的研究良性前列腺增生(BPH)合并原发性高血压(EH)患者血管内皮功能的变化,探讨血管内皮功能失调在BPH和EH两种疾病发病机制中的作用。方法检测BPH合并EH患者48例,BPH患者53例,男性EH患者40例和正常对照组(35名)的血浆内皮素1(ET-1)、一氧化氮(NO)、血管性假血友病因子(vWF)水平,应用二维超声测量肱动脉血流依赖性舒张功能(FMD),对其血管内皮功能进行评估,进行组间比较。结果与对照组相比,BPH合并EH组、BPH组和EH组ET-1、NO、vWF和FMD水平均有差异(P<0.01);BPH组和EH组间各指标差异无统计学意义;BPH合并EH组分别与BPH组和EH组相比,差异无统计学意义。结论BPH合并EH、BPH、EH3组患者均出现血管内皮功能受损,提示血管内皮功能失调是BPH及EH的共同发病机制之一。     

二甲双胍对原发性高血压伴糖耐量减低患者血压的影响

目的:观察二甲双胍单独或与苯那普利联合应用对原发性高血压(EH)患者的降压作用。方法:将120例伴糖耐量减低非糖尿病EH患者随机分为二甲双胍组(59例)和苯那普利组(61例),分别以二甲双胍500mg,3次/d和苯那普利10mg,1次/d治疗。治疗1个月后对收缩压≥140mmHg(1mmHg=0.133kPa)和(或)舒张压≥90mmHg者,给予上述2种药物联合治疗,剂量同上;达标者继续原治疗不变。总疗程为2个月。观察2组治疗前后血压和胰岛素敏感性变化。结果:①与治疗前比较,二甲双胍组和苯那普利组在治疗1个月后收缩压分别下降(12.5±6.4)mmHg和(14.9±6.5)mmHg,舒张压分别下降(8.5±6.2)mmHg和(9.9±3.8)mmHg;在治疗2个月后收缩压分别下降(16.9±5.0)mmHg和(19.9±6.4)mmHg,舒张压分别下降(13.1±5.3)mmHg和(14.3±1.2)mmHg,2组比较均差异无统计学意义(均P>0.05)。2组联合用药率均为56%。②与治疗前比较,空腹胰岛素、糖负荷1h胰岛素、糖负荷2h胰岛素、胰岛素曲线下面积在二甲双胍组于治疗1、2个月后明显下降(均P<0.01);在苯那普利组除糖负荷1h胰岛素于治疗1个月后开始下降外(P<0.05),其余于治疗2个月后明显下降(均P<0.01)。胰岛素敏感性指数在二甲双胍组于治疗1个月后明显高于苯那普利组(P<0.05),在治疗2个月后2组间比较差异无统计学意义(P>0.05)。结论:二甲双胍与苯那普利对伴糖耐量减低EH患者具有相似的降压效应和良好的协同作用。     

高血压合并代谢综合征患者血管功能及靶器官损害的变化

目的探讨高血压合并代谢综合征对血管内皮功能及靶器官损害的影响。方法根据代谢综合征的诊断标准将156例高血压病患者分为高血压合并代谢综合征（EH＋MS组,n=61例）、高血压非代谢综合征（EH＋nonMS组,n=95例）两组,31例健康体检者作为对照组（NC组）,用彩色多普勒超声测定反应性充血前后肱动脉内径、血流量及阻力变化,并测定颈动脉粥样斑块及左室重量指数。结果（1）除空腹血糖（FBG）、体重指数（BMI）、甘油三酯（TG）外,EH＋MS组的收缩压、舒张压、TC、HDL-C、LDL-C、Fib、年龄、性别比、吸烟习惯等指标与EH＋nonMS组均衡可比。（2）内皮依赖性血管舒张功能（FMD％）：EH＋MS组明显低于EH＋nonMS组组及NC[（7．08±3．21）％比（8．18±1．74）％和（10．41±4．52）％,P分别〈0．05和0．01],EH＋nonMS组也低于NC组（P〈0．05）。（3）EH＋MS组反应性充血后血流量变化率（％）明显低于EH＋nonMS组及NC组[（154．19±78．94）％比（196．44±64．22）％和（221．81±89．64）％,P值分别〈0．05和0．01],但EH＋nonMS组与NC组间差异无统计学意义。（4）前臂血管扩张能力的高低顺序为NC组（3．21±0．90）〉EH＋nonMS组（2．89±0．73）〉EH＋MS组（2．58±0．76）。（5）颈动脉粥样斑块发生率分别为17／61（27．9％）、19／95（20．2％）及1／31（3．2％）,P〈0．05。（6）左室肥厚发生率从高到低排列分别为EH＋MS组（59％）〉EH＋nonMS组（37．9％）〉NC组（9．7％）。（7）FMD与年龄、性别、吸烟、收缩压、舒张压、TG、血浆纤维蛋白原有相关性;颈动脉内膜中层厚度与年龄、吸烟、收缩压、舒张压、BMI、TG、血浆纤维蛋白原呈正相关;左室重量指数与年龄、吸烟、SBP、DBP、BMI、TG呈正相关;FMD与颈动脉内膜中层厚度、左室重量指数呈负相关。结论代谢综合征明显加重了高血压病患者血管功能和靶器官损害。     

Byproducts of oxidative protein damage and antioxidant enzyme activities in plasma of patients with different degrees of essential hypertension

Despite evidence that essential hypertension (EH) is a state of increased oxidative stress, the data on oxidative protein modifications is lacking. Besides, the role of extracellular antioxidant enzymes in EH has not been systematically studied. Study was performed in 45 subjects with EH and 25 normotensive controls. Patients were divided into three groups according to the 2003 ESH/ESC guidelines (grade 1-3). Plasma protein reactive carbonyl derivatives (RCD) and SH-groups (as byproducts of oxidative protein damage) as well as antioxidant enzyme activities superoxide dismutase (SOD), glutathione peroxidase (GPX) and catalase were studied spectrophotometrically and correlated with blood pressure (BP). RCD levels were increased in EH patients compared to controls and correlated significantly with both systolic blood pressure (SBP) (r = 0.495, P<0.01) and diastolic blood pressure (DBP) (r = 0.534, P<0.01). Plasma SH-groups content was significantly lower in all patients with EH, with no correlation with BP. SOD and catalase activity in patients with grade 1 EH were similar to that of controls. Patients with grade 2 and 3 of EH had lower SOD and catalase activity. However, significant correlation with SBP and DBP was observed for catalase only (r = -0.331; P<0.05 and r = -0.365; P<0.05, respectively). EH patients exhibited higher plasma GPX activity compared to those in controls, and it correlated with SBP (r = 0.328; P<0.05). The results presented show that increased oxidative protein damage is present in all grades of EH. In mild hypertension extracellular antioxidant enzyme activities are not decreased, suggesting they are probably not critical in early EH, but could be important in moderate to severe EH.     

Exaggerated exercise blood pressure response in middle-aged men as a predictor of future blood pressure: a 10-year follow-up

Objective: The prognostic value of an exaggerated exercise systolic blood pressure response (EESBPR) remains controversial. This study was designed to assess whether an EESBPR is associated with the predictor of future blood pressure. Methods: From an initial population of 1,534 male-subjects with normal BP or no medication who underwent ergometric exercise, 733 subjects (mean age: 41 years old) at baseline to follow-up BP after an average of 10 years were selected. A 12-min exercise tolerance test with three phases of estimated load from predictive maximum oxygen intake was performed at baseline, and exercise BP was measured. Results: Exercise BP response was classified by three group: Low group (G) (exercise SBP < 180 mmHg), Middle G (exercise BP:180–199 mmHg), High G (exercise BP:200 mmHg ≦). BP after 10 years in Low G was 123 ± 12/79 ± 7 mmHg, in Middle G:127 ± 13/81 ± 8 mmHg, in High G :134 ± 15/84 ± 10 mmHg. Compared with in Low G, BP after 10 years in High G significantly increased (p < 0.05). Multiple regression analysis was carried out to clarify the relationship of exercise SBP at baseline to BP after 10 years. In multivariate-adjusted models, the relationship of SBP at follow-up was stronger to exercise SBP (β = 0.271, P < 0.001) than to resting SBP (β = 0.148, P < 0.001). Maximum oxygen intake (β = ?0.193, P = 0.003) and resting SBP correlated with SBP after 10 years. Conclusions: In middle-aged men, exercise SBP would be a stronger predictor of future SBP, DBP rather than BP at rest. In optimal of classification of BP (SBP < 120 mmHg), exercise BP response was clearly associated with BP after 10 years.     

Effect of exercise on blood pressure in older persons: a randomized controlled trial

BACKGROUND: Because of age-related differences in the cause of hypertension, it is uncertain whether current exercise guidelines for reducing blood pressure (BP) are applicable to older persons. Few exercise studies in older persons have evaluated BP changes in relation to changes in body composition or fitness. METHODS: This was a 6-month randomized controlled trial of combined aerobic and resistance training; controls followed usual care physical activity and diet advice. Participants (aged 55-75 years) had untreated systolic BP (SBP) of 130 to 159 mm Hg or diastolic BP (DBP) of 85 to 99 mm Hg. RESULTS: Fifty-one exercisers and 53 controls completed the trial. Exercisers significantly improved aerobic and strength fitness, increased lean mass, and reduced general and abdominal obesity. Mean decreases in SBP and DBP, respectively, were 5.3 and 3.7 mm Hg among exercisers and 4.5 and 1.5 mm Hg among controls (P < .001 for all). There were no significant group differences in mean SBP change from baseline (-0.8 mm Hg; P=.67). The mean DBP reduction was greater among exercisers (-2.2 mm Hg; P=.02). Aortic stiffness, indexed by aortofemoral pulse-wave velocity, was unchanged in both groups. Body composition improvements explained 8% of the SBP reduction (P = .006) and 17% of the DBP reduction (P<.001). CONCLUSIONS: A 6-month program of aerobic and resistance training lowered DBP but not SBP in older adults with mild hypertension more than in controls. The concomitant lack of improvement in aortic stiffness in exercisers suggests that older persons may be resistant to exercise-induced reductions in SBP. Body composition improvements were associated with BP reductions and may be a pathway by which exercise training improves cardiovascular health in older men and women.     

Blood pressure and heart rate of students undergoing a medical licensing examination

AIMS: To assess the effect of a real life mental stress situation on blood pressure (BP) and heart rate (HR) in students undergoing a medical licensing examination. METHOD: Prospective observational study of 121 medical students taking the final licensing exam. BP and HR were taken before and after the exam. Additionally, BP was measured by ambulatory BP monitoring device and HR was recorded continuously by an HR monitor belt in 25 students throughout the examination. MAJOR FINDINGS: Diastolic BP (DBP) increased from 81 +/- 10 mmHg before the exam to 86 +/- 9 mmHg (p = 0.008) during the exam and to 88 +/- 11 mmHg, (p = 0.007) 15 min after the exam. Systolic BP (SBP) did not increase significantly during (from 131 +/- 14 before the exam to 136 +/- 18 mmHg) and after the exam (135 +/- 16 mmHg). HR decreased during (to 100 +/- 18 beats/min, p < 0.001), and after the exam (to 95 +/- 19 beats/min, p < 0.001) compared to values before the exam (114 +/- 19 beats/min). SBP was higher in male students compared to female students before (138 +/- 10 vs 125 +/- 18 mmHg) and after (126 +/- 18 vs 115 +/- 17 mmHg) the exam (p < 0.01). CONCLUSION: Only DBP increased during medical licensing examination, albeit within a small range. SBP did not change significantly and HR decreased during the exam. Male students showed a higher SBP compared to female students.     

动脉粥样硬化性肾动脉狭窄患者24小时动态血压特征及靶器官损害相关研究

目的探讨动脉粥样硬化性肾动脉狭窄(ARAS)患者24 h动态血压、昼夜节律变化特征及靶器官损害。方法选择2014年1月~2018年12月在上海交通大学医学院附属瑞金医院高血压科连续住院的ARAS患者121例(ARAS组),另选择同期年龄、性别、体质量指数和高血压病程等匹配的原发性高血压(EH)患者418例(EH组),观察并比较2组诊室及24 h动态血压及靶器官损害的差异。结果与EH组比较,ARAS组诊室收缩压[(155±23)mm Hg(1mm Hg=0.133k Pa)vs(145±22)mm Hg,P<0.01]、诊室脉压[(75±20)mm Hg vs(65±18)mm Hg,P<0.01]、24h收缩压[(143±19)mm Hg vs(130±16)mm Hg,P<0.01]、昼间收缩压[(145±18)mm Hg vs(133±16)mm Hg,P<0.01]、夜间收缩压[(138±21)mm Hg vs(123±18)mm Hg,P<0.01]、夜间舒张压[(75±12)mm Hg vs(73±10)mm Hg,P<0.05]明显升高,差异有统计学意义。与EH组比较,ARAS组杓型血压比例明显降低,反杓型血压比例明显升高(P<0.05)。校正相关因素后,与EH组比较,ARAS组颈动脉内膜中层厚度、左心室质量指数及血浆N末端B型钠尿肽前体水平明显升高,差异有统计学意义(P<0.01)。结论ARAS患者收缩压及夜间血压较高,更多表现为反杓型血压。有独立于血压及肾功能水平更严重的靶器官损害。     

Effect of antihypertensive treatment in elderly hypertensive patients with cardiac hypertrophy]

In elderly hypertensive patients effect of antihypertensive treatment with Ca antagonist or ACE inhibitor on the heart were examined. Twenty-four elderly hypertensive patients with cardiac hypertrophy, aged 65-79 years old (mean +/- SEM, 71 +/- 1) were treated with Ca antagonist (nifedipine or nicardipine) or ACE inhibitor (captopril or enalapril) for 3 months. Thirteen patients had essential hypertension (EH: SBP greater than or equal to 160 mmHg and DBP greater than or equal to 95 mmHg, 70 +/- 1 years) and 11 had isolated systolic hypertension (ISH: SBP greater than or equal to 160 mmHg and DBP less than 95 mmHg, 74 +/- 2 years). Blood pressure (BP) and heart rate were measured every two weeks. In all patients, M-mode echocardiography was performed to measure left ventricular mass index (LVMI) and ejection fraction (EF), and the sympathetic nervous (plasma norepinephrine and epinephrine) and the renin-angiotensin system (plasma renin activity and aldosterone concentration), were assessed before and after 3 months of treatment. BP significantly decreased from 174 +/- 3/97 +/- 1 to 149 +/- 4/84 +/- 2 mmHg in EH and from 167 +/- 3/82 +/- 2 to 144 +/- 4/74 +/- 2 mmHg in ISH. LVMI was significantly reduced from 204 +/- 14 to 174 +/- 16 g/m2 in EH and from 179 +/- 14 to 156 +/- 12 g/m2 in ISH. EF showed no significant changes in either group. In ISH, the change in LVMI was significantly correlated with the change in systolic BP (r = 0.74, p less than 0.05). In EH, there was no significant relation between BP and LVMI changes.(ABSTRACT TRUNCATED AT 250 WORDS)     

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。     

Clinical Characteristics of Young-Onset and Medical Treatment-Requiring Hypertension Identified By Targeted Screening in University Health Check-Up

Based on targeted screening for hypertension at a university health check-up, we previously reported a high incidence of white-coat hypertension and estimated prevalence of hypertension requiring medical treatments (HT) as around 0.1% in young population aged less than 30. In spite of such low prevalence, continuous screening for seven consecutive years (2003–2009) increased the number of HT students to 20 (19 males and 1 female). We presently assessed the clinical characteristics of these HTs. Renovascular hypertension was found in the only female HT and aortic valve regurgitation in two HTs. Resting 17 HTs were diagnosed as having essential hypertension (EH). A father and/or a mother had EH in 16 out of 17 EHs, and blood pressure (BP) at home was slightly elevated (135–145 mm Hg in systolic) except three obese EHs (body mass index more than 30) who demonstrated more than 160 mm Hg in systolic. Plasma aldosterone-renin ratio (ARR) of EHs did not differ from that of normal controls, and Pearson correlation coefficient (R) between ARR and systolic BP (SBP) was ?0.2. Its partial correlation coefficient, however, was statistically significant (R = ?0.55, P = .026) after correcting for body mass index, which was significantly correlated with both SBP (P = .006, after correcting for ARR) and ARR (P = .004, after correcting for SBP). In conclusion, most of young-onset HTs are male EHs, and aortic valve regurgitation should be carefully checked. Excess plasma renin activity would be one of additional characteristics of young-onset EH to male gender, genetic background, and increased body mass.