5-单硝异山梨醇酯对老年收缩期高血压患者脉压的影响

在中老年正常血压及高血压患者中，脉压(PP)预测价值大于收缩压(SBP)、舒张压(DBP)及平均压(MAP)。近来发现，口服硝酸酯类药物可选择性地降低SBP，减小PP。本文观察降压药物培垛普利片联合应用5-单硝异山梨醇酯片对老年收缩期高血压(ISH)患者PP的改善作用。     

苯磺酸氨氯地平联合辛伐他汀、单硝酸异山梨酯治疗老年单纯收缩期高血压的疗效观察

<正>单纯收缩期高血压(ISH)是老年高血压患者中最常见的一种类型,定义为收缩压(SBP)≥140mmHg,舒张压(DBP)<90mmHg,指收缩压升高而舒张压不高,甚至降低的一种状态[1]。目前多数降压药物在降低SBP的同时,也降低DBP。过度降低舒张压会导致心肌缺血、甚至心肌梗死。在老年的治疗过程中不     

单硝酸异山梨酯治疗舒张压≤70mmHg的老年单纯收缩期高血压47例

研究表明,老年高血压患者的舒张压(DBP)与其预后呈负相关,提示DBP不宜降至70 mmHg以下[1].老年单纯收缩期高血压(ISH)主要由大动脉硬化,血管的顺应性及弹性降低引起[2,3],老年ISH患者在降压治疗时可能DBP的过度下降.研究显示,硝酸酯类药物可选择性作用于大动脉,改善动脉弹性,降低脉压[4].本研究旨在观察单硝酸异山梨酯(ISMN)对规律服用降压药,DBP≤70 mmHg,但收缩压(SBP)≥140 mmHg的老年ISH患者血压的作用.     

单硝酸异山梨酯与赖诺普利治疗老年单纯收缩期高血压的疗效比较

目的:观察长效心痛治(单硝酸异山梨酯片)和赖诺普利对老年单纯收缩期高血压(EISH)病人的疗效。方法:62例EISH患者随机分为两组,每组各31例,第一组给予长效心痛治20mg,2次/d,口服;第二组给予赖诺普利10mg,1次/d,口服,疗程4周。结果:两组间收缩压(SBP)下降幅度无明显差别(P>0.05);舒张压(DBP)下降幅度第一组小于第二组,差别有显著性(P<0.01);脉压(PP)下降幅度在治疗后2周无明显差别(P>0.05),第3周开始第一组PP下降幅度即大于第2组(P<0.05),第4周差距进一步加大,差别有显著性(P<0.01)。结论:长效心痛治在有效降低SBP的同时降低DBP不明显,使PP减小,因而在治疗DBP基本正常的EISH病人时,优于赖诺普利。     

5-ISMN联合非洛地平治疗老年单纯收缩期高血压临床观察

老年单纯收缩期高血压 (ＩＳＨ)治疗的临床试验已成功地降低了心血管事件的发生率及病死率。但由于目前的降压药均不能做到只降收缩压 (ＳＢＰ)而不影响舒张压 (ＤＢＰ) [1] ,在ＳＢＰ降低的同时 ,容易使ＤＢＰ过低 ,脉压 (ＰＰ)增宽 ,从而造成新的心血管危险。进一步控制ＳＢＰ和ＰＰ已成为高血压治疗研究中的重要课题。本文就 5 单硝酸异山梨酯 (5 ＩＳＭＮ ,鲁南欣康 )联合非洛地平缓释片 (波依定 )治疗老年ＩＳＨ的观察结果报道如下。1　对象与方法1 1　对象　 82例老年ＩＳＨ患者中男 5 0例 ,女 32例 ,年龄 60～ 88岁 (平均 66.3岁 )…     

硝酸酯类药物对老年单纯收缩期高血压的有益作用

目的观察硝酸酯类药物对老年单纯收缩期高血压(ISH)患者降压治疗的有益作用.方法87例ISH患者随机分为对照组46例和治疗组41例,对照组给予非洛地平缓释片5 mg,每日一次口服,治疗组在上述治疗的基础上给予加用单硝酸异山梨酯(ISMN)20 mg,每日二次口服,疗程8周.结果(1)治疗组从第2周开始收缩压(SBP)下降幅度即大于对照组,且先于对照组于第4周降至正常,差别有显著性(P＜0.05);(2)从第2周开始治疗组舒张压(DBP)下降幅度即小于对照组(P＜0.05),第6周开始差距进一步加大,差别有显著性(P＜0.01),整个观察期内治疗组DBP下降幅度始终小于对照组,且从第4周开始处于相对稳定状态;(3)第2周开始治疗组PP下降幅度即大于对照组(P＜0.05),第4周开始差距进一步加大,差别有显著性(P＜0.01).结论硝酸酯类药物能降低ISH患者的SBP,而对DBP影响不大,使PP减小,对ISH患者降压治疗的有益.     

硝酸酯类药物对老年单纯收缩期高血压的有益作用

目的　观察硝酸酯类药物对老年单纯收缩期高血压 (ISH)患者降压治疗的有益作用。方法　 87例ISH患者随机分为对照组 4 6例和治疗组 4 1例 ,对照组给予非洛地平缓释片 5mg ,每日一次口服 ,治疗组在上述治疗的基础上给予加用单硝酸异山梨酯 (ISMN) 2 0mg ,每日二次口服 ,疗程8周。结果　 (1)治疗组从第 2周开始收缩压 (SBP)下降幅度即大于对照组 ,且先于对照组于第 4周降至正常 ,差别有显著性 (P <0 0 5 ) ;(2 )从第 2周开始治疗组舒张压 (DBP)下降幅度即小于对照组(P <0 0 5 ) ,第 6周开始差距进一步加大 ,差别有显著性 (P <0 0 1) ,整个观察期内治疗组DBP下降幅度始终小于对照组 ,且从第 4周开始处于相对稳定状态 ;(3)第 2周开始治疗组PP下降幅度即大于对照组 (P <0 0 5 ) ,第 4周开始差距进一步加大 ,差别有显著性 (P <0 0 1)。结论　硝酸酯类药物能降低ISH患者的SBP ,而对DBP影响不大 ,使PP减小 ,对ISH患者降压治疗的有益。     

5-单硝酸异山梨酯治疗心肌缺血42例

我科自1995年4月至1996年3月用山东鲁南药厂生产的鲁南欣康片(5-单硝酸异山梨酯IS-5-MN)治疗心肌缺血42例，观察结果如下。     

老年单纯收缩期高血压研究进展

高血压是一个十分严重的公众健康问题,导致心、脑、肾靶器官的损害,最终导致死亡。单纯收缩期高血压是老年高血压最常见的一种类型,随着我国人口的日益老龄化,单纯收缩期高血压日渐增多,其临床治疗中如何平衡降低过高的收缩压而使原本就偏低的舒张压不至于过低,一直是困扰心血管学术界的一大难题。现就老年单纯收缩期高血压近年的流行病学状况、发病机制及治疗进展做一简要概述。     

依那普利联合苯磺酸氨氯地平治疗老年单纯收缩期高血压的疗效观察

目的观察依那普利联合苯磺酸氨氯地平治疗老年单纯收缩期高血压的临床疗效。方法将168例老年单纯收缩期高血压患者随机分为依那普利组（A组）、苯磺酸氨氯地平（B组）、依那普利加苯磺酸氨氯地平组（C组）。每组各56例,6周为1个疗程,比较3组降压疗效。结果依那普利加苯磺酸氨氯地平组降压效果明显优于依那普利组和苯磺酸氨氯地平组。结论依那普利联合苯磺酸氨氯地平治疗老年单纯收缩期高血压疗效优于单用依那普利或苯磺酸氨氯地平。两者具有良好的协同降低收缩压的作用,安全有效,不良反应小。     

Antihypertensive effect of sustained-release isosorbide dinitrate for isolated systolic systemic hypertension in the elderly

A double-blind, randomized trial was performed in 40 patients, mean age (+/- standard deviation) 80 +/- 4 years, with isolated systolic systemic hypertension to evaluate the antihypertensive effect of oral sustained-release isosorbide dinitrate (ISDN), 20 to 40 mg twice daily, vs placebo. After 12 weeks of treatment, supine systolic blood pressure (BP) decreased from 192 +/- 10 to 162 +/- 12 mm Hg with ISDN (p less than 0.001) and from 189 +/- 10 to 175 +/- 15 mm Hg with placebo (p less than 0.001). On the basis of variance analysis, the decrease in systolic BP was significantly lower with ISDN (27 mm Hg) than with placebo (13 mm Hg). Similar results were observed for supine and erect systolic BP measured at 8 AM and 4 PM, 8 and 12 hours after drug intake. No significant differences in diastolic BP, heart rate or side effects occurred. After the ISDN tapering off-period (2 weeks), systolic BP increased significantly but did not change with placebo. The study provided evidence that in elderly patients with systolic hypertension, sustained-release ISDN induced a selective and sustained decrease in systolic BP, antihypertensive effect was observed 8 and 12 hours after drug administration, and no tolerance phenomenon was noted.     

Antihypertensive efficacy and tolerability of different drug regimens in isolated systolic hypertension in the elderly

The pharmacological treatment, mainly based on diuretics, ofisolated systolic hypertension (ISH) has recently been shownto reduce the risk of stroke and coronary heart disease in theelderly. The purpose of this study was to compare the antithypertensiveeffect and tolerability of different drug regimens in elderlysubjects with ISH (systolic blood pressure—SBP —160mmHg and diastolic blood pressure — DBP — <90mmHg). A multicentre, randomized, controlled open trial wasplanned in the general practice setting. Four widely used treatmentschedules were tested: hydrochlorothiazide 25 mg plus amiloride2·5 mg (H+Am), nifedipine slow release 20 mg (N), atenolol50 mg (At) and atenolol 25mg plus chlorthalidone 6·25mg (At+C). After a baseline evaluation, 308 patients (76·3% female,mean age 75·3 ± 7·1 years) were randomizedand followed up for 6 months. After 3 months the drug dosagewas doubled if the systolic blood pressure goal (SBP<160mmHg and SBP reduction of at least 20 mmHg) had not been reachedNinety-four subjects (30·5%) presented contraindicationsto ß-blockers. At the 3rd- and 6th-month visits alltreatment groups, except At, showed a significant reductionin SBP compared to the control group; DBP showed no significantreduction in any group at any time. At the end of the follow-upthe percentage of hypertensives who had reached the BP goalwas 14·6% in the control group, 52·9% in H+Am,54·8% in N, 28·6% in At and 52·2% in At+C.Over two-thirds of the patients on H+Am or N, and about 50%of those on At or At+ C at 6 months were taking the medicationat low dose. The rate of therapy discontinuation due to side effects duringfollow-up was significantly different among the drug regimenstested: 1·9% in the H+Am group compared to 12·5%,19·2% and 14·8% respectively in N, At and At+Cgroups (P<0·05 for H+Am vs At). The proportion ofsubjects who spontaneously reported, mild adverse effects after3 and 6 months of therapy was not signficantly different inthe study groups, even if an excess was observed in the N groupat 3 months. In conclusion, these data suggest that. diuretics are a firstchoice in the treatment of ISH, because of their hypotensiveefficacy and acceptability; nifedipine, if well tolerated, isan effective alternative to diuretics; a high proportion ofelderly patient with ISH present contraindications to ß-blockers,and atenolol has a poor antihypertensive effect.     

The effects of oral isosorbide 5-mononitrate on mortality following acute myocardial infarction: A multicentre study

We have conducted a randomized, double-blind, placebo-controlledmulticentre trial of oral isosorbide 5-mononitrate (ISMN) in360 patients with suspected acute myocardial infarction. Patientswere stratified prior to analysis according to the presenceor absence of left ventricular failure on admission. ISMN causeda significant reduction in systolic and diastolic blood pressureduring the first 12 h. There was no significant effect on heartrate.Overall mortality was 4-9% in the ISMN group compared with40% in controls at 5 days, and 141% compared with 10-5% at 6months (NS). A non-significant reduction in mortality in theISMN group with heart failure (ISMN 7-9%, placebo 12-9%, at5 days) contrasted with a non-significant increase in mortalityin patients without heart failure treated with ISMN (ISMN 4-1%,placebo 2-1%, at 5 days). Lignocaine was used in twice as manypatients in the ISM N group as in placebo group (P<0-0I),both with and without heart failure. Diamorphine usage was similarin the ISMN and control groups.Oral ISMN has similar haemodynamiceffects to intravenous nitroglycerin, and can be of benefitin acute myocardial infarction with heart failure. However,our results question the use of nitrates in acute myocardialinfarction in the absence of heart failure     

老年单纯收缩期高血压患者动脉僵硬度的临床研究

目的探讨老年单纯收缩期高血压患者动脉僵硬度的改变。方法应用脉搏波速度自动分析仪测定颈动脉-股动脉脉搏波速度(CFPWV)和颈动脉-桡动脉脉搏波速度(CRPWV)分别作为评估中央弹性大动脉和外周中等肌性动脉僵硬度的指标,对43例健康老年人:男24例,女19例,年龄60～79岁,平均(68.2±4.6)岁和87例(单纯收缩期高血压患者40例,非单纯收缩期高血压患者47例)老年高血压患者:男41例,女46例,年龄60～78岁,平均(68.1±5.2)岁,进行脉搏波速度检测。结果老年单纯收缩期高血压患者CFPWV显著高于非单纯收缩期高血压及正常血压者(均P<0.01),CRPWV在3组间无显著差异(P>0.05);CFPWV与脉压(r=0.229,P=0.009)及年龄(r=0.203,P=0.020)呈显著正相关,CRPWV与脉压及年龄无显著相关性(均P>0.05)。多元逐步回归分析显示,脉压是CFPWV最主要的影响因素。结论老年单纯收缩期高血压患者大动脉僵硬度明显升高。     

Vascular dynamics in isolated systolic arterial hypertension

With a growing elderly population, the incidence of isolated systolic hypertension (ISH) has increased. This study characterizes dynamic vascular changes that occur with advanced age and with ISH. Fifty-five healthy individuals and seven with ISH were distributed in seven age groups from the second to the seventh decade. An index of aortic stiffness (ΔP/ΔV) was derived using a mercury sphygmomanometer to obtain pulse pressure, and ultrasonographic measurements were used to estimate aortic volumes applying the “cylinder formula.” The mathematic derivation of this formula is explained in detail. Pulse pressure showed no significant change with age, but showed a significant increase with ISH. A decrease in volume change from systole to diastole was found with advanced age. Normotensive subjects aged 65 ± 2 years had a 2.6-fold increase in aortic stiffness compared with young individuals. Elderly patients with ISH had a 7-fold increase in aortic stiffness compared with Group 1 (15 ± 2 years) (p<0.001) and a 2.7-fold increase compared with Group 6 (normotensive subjects aged 65 ± 2 years). A strong correlation between systolic pressure and arterial stiffness was observed (r = 0.953) (p<0.001). The proposed stiffness index was compared with the one described by Hirai, obtaining a high correlation, that is, r = 0.989 (p<0.001). When compared with Stefanadis's index of distensibility, our index showed a correlation of r = 0.932 (p<0.003). It is concluded that while systolic pressure is a main determinant of arterial stiffness, the ΔP/ΔV is a more sensitive method to estimate dynamic changes in elastic arteries such as the aorta.     

Somatostatin plus isosorbide 5-mononitrate versus somatostatin in the control of acute gastro-oesophageal variceal bleeding: a double blind, randomised, placebo controlled clinical trial

BACKGROUND: Variceal bleeding is a severe complication of portal hypertension. Somatostatin reduces portal pressure by decreasing splanchnic blood flow, and nitrates by diminishing intrahepatic resistance. Experimental studies have shown that the combination of somatostatin and nitrates has an additive effect in decreasing portal pressure. AIM: To compare the therapeutic efficacy of either intravenous infusion of somatostatin plus oral isosorbide 5-mononitrate or somatostatin alone in gastro-oesophageal variceal bleeding associated with liver cirrhosis. METHODS: A unicentre, double blind, placebo controlled, clinical trial was conducted. Sixty patients bleeding from oesophageal or gastric varices were randomised to receive intravenous infusion of somatostatin (250 microg/hour) plus oral isosorbide 5-mononitrate (40 mg/12 hours) (group I) or somatostatin infusion plus placebo (group II) for 72 hours. RESULTS: The two groups of patients had similar clinical, endoscopic, and haematological characteristics. Control of bleeding was achieved in 18 out of 30 patients (60%) in group I and 26 out of 30 patients (87%) in group II (p<0.05). There was no significant difference in mean transfusion requirements between the two groups: 2.6 (2.2) v 1.8 (1.6) respectively; means (SD). Mortality and side effects were similar in the two groups, but development of ascites was higher in group I (30%) than in group II (7%) (p<0.05). CONCLUSION: In cirrhotic patients with acute gastro-oesophageal variceal bleeding, addition of isosorbide 5-mononitrate to somatostatin does not improve therapeutic efficacy, induces more adverse effects, and should not be used.     

Isolated systolic hypertension in Asia

Isolated systolic hypertension (ISH) is the most common type of essential hypertension in the elderly and young adults. With rapid industrialization and population aging, the prevalence of ISH in Asia will rise substantially. Asian populations have distinct epidemiological features, risk factors and are especially vulnerable to ISH. There is a pressing need for Asian countries to formulate their unique strategies for control of ISH. In this review, we focus on the (1) epidemiology and pathophysiology, (2) risk factors and impact on outcomes, and (3) treatment goal and strategy for ISH in Asia.     

Treatment of isolated systolic hypertension in diabetes mellitus type 2

Age-related arterial stiffness is more pronounced in diabetics compared to non-diabetics, which could explain the prevalence of isolated systolic hypertension (ISH, systolic blood pressure > or =140 mmHg and diastolic blood pressure <90 mmHg) being approximately twice that of the general population without diabetes. Large-scale interventional outcome trials have also shown that diabetics usually have higher pulse pressure and higher systolic blood pressure than non-diabetics. Advanced glycation end-product formation has been implicated in vascular and cardiac complications of diabetes including loss of arterial elasticity, suggesting possibilities for new therapeutic options. With increasing age, there is a shift to from diastolic to systolic blood pressure and pulse pressure as predictors of cardiovascular disease. This may affect drug treatment as different antihypertensive drugs may have differential effects on arterial stiffness that can be dissociated from their effects on blood pressure. While thiazide diuretics are associated with little or no change in arterial stiffness despite a robust antihypertensive effect, angiotensin converting enzyme inhibitors, angiotensin II receptor blockers and calcium-channel blockers have been shown to reduce arterial stiffness. However, combination therapy is nearly always necessary to obtain adequate blood pressure control in diabetics. There are no randomized controlled trials looking specifically at treatment of ISH in diabetics. Recommendations regarding treatment of ISH in diabetes mellitus type 2 are based on extrapolation from studies in non-diabetics, post-hoc analyses and prespecified subgroup analysis in large-scale studies, and metaanalysis. These analyses have clearly demonstrated that blood pressure lowering in ISH confers improved prognosis and reduced cardiovascular and renal outcomes in both diabetics and non-diabetics.     

Controversies in hypertension: mild hypertension, isolated systolic hypertension, and the choice of a step one drug

The realization that cardiovascular morbidity and mortality increases in patients with mild elevation of either systolic or diastolic blood pressure has led to a consideration to treat millions of patients with mild diastolic or isolated systolic hypertension. The cost of administering a successful antihypertensive treatment program and the potential adverse effects of pharmacologic agents is of great concern. It has been emphasized that the risk of premature mortality differs in individual patients according to the number of associated cardiovascular risk factors at any level of blood pressure. This has led to a suggestion that only high risk patients be treated. However, a significant number of low risk patients with mild hypertension develop a more severe or complicated form of their disease even over a follow-up period of five to ten years. There is no good way to identify these patients. Trials of antihypertensive therapy suggest a beneficial effect of blood pressure lowering in mild hypertension. No trials of antihypertensive therapy in elderly patients with isolated systolic hypertension have been reported, but the elevation in systolic blood pressure appears to be an independent risk factor for cardiovascular mortality. Even the choice of the first step agent in treatment is debatable. Diuretics or beta blockers effectively lower blood pressure in the majority of hypertensive patients, particularly if modest dietary sodium restriction is achieved. The incidence of side effects, either symptomatic or biochemical, is similar but diuretics are unquestionably cheaper and probably more effective. Successful application of an antihypertensive treatment program may continue to reduce our unacceptably great incidence of cardiovascular disease.     

左旋氨氯地平联合氢氯噻嗪与海捷亚治疗老年单纯收缩期高血压的疗效观察

目的 对比观察左旋氨氯地平联合氢氯噻嗪和海捷亚治疗老年单纯收缩期高血压的临床疗效及安全性。方法 将96例老年单纯收缩期高血压患者随机分成两组，A组50例，给予左旋氨氯地平2．5mg加氢氯噻嗪12．5mg，1次／d，晨服；B组46例，给予海捷亚1片，1次／d，晨服，均治疗12周。第4周A组根据血压情况调整剂量为左旋氨氯地平5mg加氢氯噻嗪25mg，1次／d；B组海捷亚调整为2片，1次／d，治疗9周。分别检测治疗前后血压、心率、空腹血糖、血脂、血尿酸、血钾、血肌酐，并记录不良反应。结果 两组患者治疗前后SBP、PP间差异均有显著统计学意义（P〈0．01），A组有效率为88．0％，B组有效率为87．0％，两组有效率差异无统计学意义（P〉0．05）。两组治疗前后心率、生化指标无明显变化，A组不良反应发生率为6．0％，B组为4．3％。结论 A、B组降压效果显著，且疗效相似，不良反应少，耐受性好，对心率与血生化指标无明显影响。