原发性高血压血管紧张素转化酶基因I/D多态性与厄贝沙坦降压疗效及血浆肾素血管紧张素-醛固酮系统水平的相关性

目的分析原发性高血压(EH)ACE基因I/D多态性与厄贝沙坦降压疗效及血浆肾素-血管紧张素-醛固酮系统(RAAS)水平的相关性。方法纳入云南汉族、白族及傣族EH患者450例,检测ACE基因多态性,根据基因型进行分组,所有患者给予厄贝沙坦治疗8 w后评估降压疗效,监测治疗前后血浆RAAS活性的变化。结果 EH患者中ACE基因I/D多态性分布与种族无明显关系(P>0.05);不同基因型中厄贝沙坦降压疗效、治疗前后血浆RAAS活性降低程度具有差异性,表现为DD型>ID型>Ⅱ型;采用Logistic回归分析治疗有效率的影响因素,血管紧张素Ⅱ活性改变与治疗有效率呈正相关(OR值1.038)。结论 ACE I/D多态性可能是影响EH患者对厄贝沙坦降压反应的重要指标,通过调节血管紧张素Ⅱ活性形成。     

原发性高血压的基因机制-RAAS系统基因多态性

原发性高血压(EH)是遗传和环境因素相互作用所致的多因素疾病,对其基因机制的研究有助于从分子水平探讨EH的发病机制.近年来对于EH候选基因多态性的研究逐渐增多,本文即对肾素-血管紧张素-醛固酮系统(RAAS)基因多态性与EH之间的关系的研究进展作一综述.     

肾素-血管紧张素-醛固酮系统与原发性高血压和脑血管病:基因研究进展

脑血管病是由遗传因素和环境因素共同作用的结果,高血压是公认的脑血管病独立危险因素.文章从分子遗传学角度就肾素-血管紧张素-醛固酮系统的一些基因与原发性高血压和脑血管病的关系进行了综述.     

肾素-血管紧张素系统基因多态性与原发性高血压的关系

原发性高血压是一种多基因病,受遗传以及外界多种因素的影响,本文介绍了影响原发性高血压基因中的肾素-血管紧张素系统基因,分别就肾素基因、血管紧张素原基因、血管紧张素转换酶基因、血管紧张素受体基因的研究进展作一综述.     

肾素-血管紧张素系统基因多态性与原发性高血压的关系

原发性高血压是一种多基因病,受遗传以及外界多种因素的影响,本文介绍了影响原发性高血压基因中的肾素-血管紧张素系统基因,分别就肾素基因、血管紧张素原基因、血管紧张素转换酶基因、血管紧张素受体基因的研究进展作一综述。     

年龄与肾素-血管紧张素-醛固酮系统及血压的研究进展

近年来对于肾素-血管紧张素-醛固酮系统的研究逐渐增多,现对肾素-血管紧张素-醛固酮系统与年龄之间关系的研究进展作一综述.     

青年高血压1级患者进驻高原高寒地区后血压变化及其可能机制

目的 研究高原高寒地区短期驻训对罹患高血压Ⅰ级青年官兵血压的影响并分析其可能机制。方法 测定13名高血压Ⅰ级青年官兵基础血压和高原驻训期间血压和心率（驻训10 ,30,60 d）,并采集相应时间点血样检测血管紧张素Ⅰ、血管紧张素Ⅱ、醛固酮和皮质醇水平。结果 进驻高原10 d后官兵收缩压和舒张压均较基线水平显著升高（P<0.05）,此后驻训30 d和驻训60 d患者收缩、舒张压数值均高于基线水平（P<0.05）。比较驻训高原前后全天平均心率未见组间明显差异。分析机制发现,高原驻训10 d起血管紧张素Ⅰ和血管紧张素Ⅱ水平均较驻训前显著升高（P<0.05）,且此后持续高于驻训前水平（P<0.05）,而血清醛固酮和皮质醇水平在驻训60 d时较驻训前显著升高（P<0.05）。结论 高原高寒环境作为应激刺激会导致高血压1级青年官兵血压出现持续升高,其机制可能与肾素-血管紧张素-醛固酮系统激活及应激激素水平升高相关。     

肾素-血管紧张素系统基因多态性与高血压病患者伊贝沙坦降压幅度关系的研究

目的：对原发性高血压患者采用血管紧张素Ⅱ受体拮抗剂（伊贝沙坦）单药治疗，在观察降压疗效的同时测定RAS基因多态性靶位点：ACEI／D、ACTM235T、AT1R 1166A／C、573T／C、1062A／G、-521C／T的基因型，旨在发现与血管紧张素Ⅱ受体拮抗剂降压疗效相关的基因多态性位点。方法：符合WHO／ISH高血压诊断标准轻、中度高血压患者117例，服用伊贝沙坦单药治疗8周，在临床观察疗效的同时，应用RFLP及PCR的方法对患者血白细胞基因组DNA进行RAS基因多态性位点ACEI／D、AGT M235T、AT1R 1166A／C、573T／C、1062A／G、-521C／T基因型的分析。结果：含ACED等位基因、的患者服用伊贝沙坦后SBP下降幅度明显大于Ⅱ型基因型患者，两者之间有统计学差异（P〈0．05）；含AT1R 573T等位基因的患者服用伊贝沙坦后收缩压下降幅度明显大于CC纯合基因型患者，两者之间有统计学差异（P〈0．05）；AGT M235T、AT1R 1166A／C、-521C／T各基因型之间BP下降幅度均无显著差异。所有入选患者未发现AT1R 1062A→G的变异。结论：肾素-血管紧张素系统基因多态性位点ACEI／D及AT1R 573T／C与ARB类药物的药物敏感性有一定相关性。     

肾素血管紧张素系统基因多态性与高血压及血管紧张素转换酶抑制剂的降压疗效的关系

高血压病是一种环境与遗传因素相互作用的疾病 ,它是冠心病、脑卒中、左心室肥厚、急性心肌梗死等心血管疾病的独立危险因素 ,寻找其相关及致病基因为近年研究的热点 ,特别是肾素血管紧张素系统基因的多态性与高血压的相互关系成为分子生物学研究的热点。这些研究表明高血压可能是基因与基因、基因与环境共同作用的结果。在高血压的治疗中个体对血管紧张素转换酶抑制剂类药物降压疗效的反应存在着差异 ,遗传因素决定了部分差异。     

血管紧张素Ⅱ1型受体和血管紧张素转换酶基因多态性与伊贝沙坦降压疗效的关系

目的探讨与血管紧张素Ⅱ1型受体(AT1R)拮抗剂伊贝沙坦降压疗效相关的基因多态性位点。方法152例轻、中度高血压病患者服用伊贝沙坦治疗8周,观察降压疗效,同时采用聚合酶链反应-限制性片断长度多态性对患者血管紧张素-醛固酮系统基因多态性位点AT1R T573C、血管紧张素转换酶(ACE)I/D基因型进行分析。结果携带AT1R 573T等位基因的患者服用伊贝沙坦后,收缩压及脉压降幅明显大于CC基因型患者;在男性患者,基因型为ACE DD的患者舒张压降幅明显大于II型患者;同时携带AT1R 573T和ACE D等位基因的男性患者降压疗效最佳。结论携带AT1R 573T和ACE D等位基因的高血压病患者对伊贝沙坦的降压反应最佳。     

Blood Pressure and Metabolic Effect of a Combination of Lercanidipine with Different Antihypertensive Drugs in Clinical Practice

The aim of this study is to assess the blood pressure (BP) and metabolic effects of lercanidipine when combined with other classes of first-line antihypertensive drugs in day-to-day clinical practice. For this study, we consecutively enrolled 162 patients with uncomplicated primary hypertension, who are partial responders to the treatment with lercanidipine over a period of 24 months. Patients were then allocated to the combination of lercanidipine (10–20 mg/day) with β-blockers, diuretics, angiotensin-converting enzyme inhibitors, and angiotensin-II receptor blockers according to compelling indications (if any) and/or suggestions of European Society of Hypertension–European Society of Cardiology (ESH–ESC) guidelines. All the enrolled patients completed the study and no adverse drug reaction was registered during the research period. The association of a second drug with lercanidipine determined an additional BP decrease of either systolic BP or diastolic BP independently from the type of drug added (P always <.05). The additional effect of lercanidipine appears widely distributed with no significant differences in the size of BP decrease. From the metabolic point of view, the addition of a second drug did not determine a significant variation in the serum levels of total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol (P always >.05). Conversely, a significant decrease in fasting plasma glucose and serum levels of triglycerides has been observed in patients where lercanidipine has been combined with an angiotensin-converting enzyme inhibitor or an angiotensin-II receptor blocker. In conclusion, in our study we observed that lercanidipine-based protocols are well tolerated and efficacious in reducing BP. Moreover, the association of lercanidipine with renin–angiotensin system blockers is also associated with significant improvements in triglycerides and fasting plasma glucose.     

高血压病患者大血管顺应性变化及其对降压的反应

应用颈动脉搏动图(CPT)反应高血压(EH)病人大血管的顺应性及功能变化。结果显示:EH病人大血管阻力指数增加、顺应性下降。顺应性的改变与细胞内Na~+浓度(Na~+_1)异常有关,降压治疗可通过降低Na~+_1,改善EH的血管顺应性     

各种降压药对原发性高血压患者动脉弹性功能的影响

目的评价不同类型降压药对原发性高血压患者大小动脉弹性功能的影响。方法 105例1～2级原发性高血压患者,随机分为5组:氢氯噻嗪组(12.5 mg 1次/d,n=18)、比索洛尔组(5 mg 1次/d,n=20)、氨氯地平组(5 mg 1次/d,n=24)、苯那普利组(10 mg 1次/d,n=22)、缬沙坦组(80 mg 1次/d,n=21)。治疗4周后,如血压仍>140/90 mmHg,剂量加倍,疗程共12周。治疗前后观察大、小动脉弹性指数(C_1,C_2)及肱踝脉搏波传导速度(baPWV)。结果1)治疗12周后各组血压均有显著的降低,但各组间的血压变化无显著差别。比索洛尔组治疗后心率明显减慢[治疗后(66±4)比治疗前(74±7)次/mm,P<0.05]。2)调整血压降低幅度及 C_1、C_2、baPWV 基础值后,氨氯地平、苯那普利、缬沙坦对 C_1、C_2、baPWV 仍有显著性改善作用,比索洛尔及氢氯噻嗪对 C_1、C_2、baPWV则无显著性改善作用。3)baPWV 变化百分比与 DBP 下降幅度呈正相关(r=0.314,P<0.05),与 SBP 下降幅度无关(r=0.108,P>0.05)。结...     

动态血压监测观察苯那普利的降压疗效

目的观察苯那普利的降压效果及对肝、肾功能的影响。方法４４例高血压患者用药前进行２４ｈ动态血压监测，并检查肝、肾功能及血糖，然后口服苯那普利１０～２０ｍｇ／ｄ，４周后再行动态血压监测并复查肝、肾功能及血糖，比较治疗前后各项指标的变化。结果Ⅰ、Ⅱ期高血压患者血压呈白天高、夜间低的变化规律；Ⅲ期患者舒张压失去昼夜变化规律；苯那普利对昼夜血压均显示良好的降压效果，对肝、肾功能无不良影响。结论苯那普利具有良好的降压效果，对肝肾功能及血糖无不良影响。     

Associations Between Day-by-Day Variability in Blood Pressure Measured at Home and Antihypertensive Drugs: The J-HOME-Morning Study

We identified the factors associated with home blood pressure (BP) variability in 1933 patients treated with hypertensive drugs (mean age, 67 years; women, 55%). Multivariate regression analysis showed that female gender, advanced age, home BP value, and home heart rate variability were positively associated with home BP variability, whereas home heart rate, body mass index, and duration of antihypertensive treatment were negatively associated with home BP variability. Moreover, not being medicated with amlodipine and being medicated with angiotensin II receptor blockers were associated with increased home systolic BP variability only among patients who were treated for less than 12 months.     

Genetics of Blood Pressure and Associated Phenotypes in the Lyon Rat

The Lyon model of genetic hypertension is made of 3 simultaneously selected strains, one hypertensive (LH) one normotensive (LN) and one with low blood pressure (LL). Since LN and LL rats exhibit the same blood pressure (BP) LH rats can be compared to 2 genetically pure and different strains of control animals. This proved to be useful for the interpretation of the data of molecular genetic studies, eg: since the renin gene was polymorphic between LH and LN but not between LH and LL rats it could be suggested that the reported linkage of renin gene polymorphism and high BP in F2 hybrids may involve another closely located gene. LH rats associate to high BP spontaneous increases in body weight, plasma cholesterol, fibrinogen and hematocrit. During the phenotyping of F1 and F2 hybrids from a LH × LN cross and of back-crosses to LH rats it was observed that ali these phenotypes were recessive, except the large body weight of LH rats which was dominant and, thus, unrelated to BP. On the contrary, BP was significantly related to plasma cholesterol in both F2 and back-cross rats and, in this latter cohort, plasma cholesterol correlated also with fibrinogen and hematocrit levels. Therefore, the study of the Lyon rat may be useful not only to determine the genes involved in hypertension but also those which contribute to other cardiovascular risk factors such as elevated fibrinogen and hematocrit.     

不同人群降压目标值的探讨

高血压是严重威胁人类健康的疾病,同时作为心脑血管疾病的高危因素,高血压患者往往合并有一种或多种慢性疾病,由此引起的病死率已升至所有疾病病死率的首位,因此合理的控制血压显得至关重要。近来,关于高血压人群降压目标值的问题引起广泛争议,现将对缺血性心脏病患者、糖尿病患者、脑血管疾病患者、慢性肾病患者和老年人高血压的降压目标值做一综述。     

Associations Between Visit-to-visit Variability in Blood Pressure Measured in the Office and Antihypertensive Drugs: The J-HOME-Morning Study

The factors associated with visit-to-visit variability in blood pressure (BP) measured in the office between the two visits were identified in 1379 treated hypertensive patients (mean age, 66.1 ± 11.0 y; women, 53.8%). Multivariate regression analysis showed that office BP and visit-to-visit heart rate variability were positively associated with visit-to-visit BP variability, whereas body mass index, duration of antihypertensive medication, and taking amlodipine were negatively associated with visit-to-visit BP variability. Further prospective studies are required to clarify the causal relationships between these factors and visit-to-visit BP variability among treated hypertensive patients.     

老年原发性高血压患者动态血压参数与部分体液因素的相关性研究

目的观察老年原发性高血压患者动态血压参数与血浆肾素、血管紧张素Ⅱ及醛固酮的相关性及其临床意义。方法将162例患者分为A纽82例（〉60岁）,B组80例（〈60岁）,采用放射免疫法检测162例原发性高血压患者的血浆肾素、血管紧张素Ⅱ及醛固酮水平,同时测定24h动态血压,进行相关分析。结果（1）老年高血压具有是脉压增大,波动性大,晨峰高血压现象及并发症多的特点;（2）A组血浆肾素、血管紧张素Ⅱ及醛固酮水平明显高于B组;（3）血浆肾素、血管紧张素Ⅱ及醛固酮与老年高血压的特点,特别是脉压增大、波动性大、晨峰高血压现象有关。结论老年原发性高血压患者血浆肾素和血管紧张素Ⅱ浓度升高,提示血浆肾素、血管紧张素一醛固酮系统对老年原发性高血压心血管系统有影响,导致老年原发性高血压患者血压特征性的变化,血浆肾素、血管紧张素Ⅱ和醛固酮的测定可作为老年原发性高血压患者病情监测及治疗指标之一。