中青年单纯舒张期高血压特点分析

目的探讨单纯舒张期高血压(IDH)临床特点,为高血压的防治提供依据。方法根据血压水平分为3组。正常血压对照组136例(血压≤139/89mmHg);IDH组138例,收缩压<140mmHg、舒张压≥90mmHg;高血压(双期、SDH)组64例(血压≥140/90mmHg)。早晨空腹采血,测血压、身高、体重、腰围,做腹部B超,描记心电图。结果与正常血压组比较,单纯舒张期高血压组及高血压组心率、体重指数(BMI)、腰围、血尿酸、总胆固醇、三酰甘油、低密度脂蛋白、血糖均有显著升高(P<0.05或P<0.01);单纯舒张期高血压组、高血压组肥胖、脂肪肝、代谢综合征和左心室肥厚发生率较对照组明显升高(P<0.05或P<0.01);单纯舒张期高血压组其舒张压与BMI呈相关趋势(r=0.134,P>0.05)。结论中青年单纯舒张期高血压及高血压存在明显体质及代谢异常,控制体重及改善不良生活方式甚为重要。控制体重及改善不良生活方式亦同样适应于正常血压超重及肥胖者。     

高血压健康教育治疗作用的分析

目的 探讨高血压健康教育在单纯舒张期高血压患者治疗中的作用.方法 将单纯舒张期高血压患者102例随机分成实验组与对照组.两组原有高血压治疗方法不变,但对实验组采用为时1周的正规集体教育以及随机健康教育相结合的方式,进行高血压健康教育.结果 2年后实验组生活方式、精神状态明显好转,高血压控制有效率显著高于对照组(P<0.05).结论 健康教育有利于单纯舒张期高血压的治疗,应重视并推广之.     

我国成人收缩期和舒张期高血压的分布

目的 了解收缩期和舒张期高血压在我国成人中的分布状况。方法 在第3次全国高血压抽样调查数据基础上，选用18岁及以上868131名成年人的资料进行分析。高血压的亚型分为3类，分别是单纯收缩期高血压（ISH）；单纯舒张期高血压（IDH）和收缩期舒张期高血压（SDH）。结果 在我国人群中，ISH、IDH和SDH的患病率分别为5．1％、2．8％和5．0％。55岁及以上的高血压患者占高血压总人数的53．2％。在高血压患者中．随着年龄的增长ISH的比例显著增高和IDH的比例显著降低，在≥55岁的高血压患者中ISH占52．7％。而〈、55岁的患者则以舒张期高血压为主（占75．2％），它们分别是IDH（占36．9％）和SDH（占38．3％）。结论 我周的中老年（≥55岁）患者占18岁及以上高血压患者总数的一半以上，在中老年患者中ISH是较为常见的高血压类型。     

单纯收缩期和舒张期高血压的影响因素与防治

目的探讨单纯收缩期高血压(ISH)和单纯舒张期高血压(IDH)的危险因素的差异,为有针对性地控制高血压提供理论基础。方法用分类树分析方法(CART),以整群随机抽取的20 364例35岁以上人群为样本,探讨ISH和IDH之间危险因素的差异。结果ISH的主要危险因素相对集中,以年龄、家庭人口、婚姻状况、居住面积等社会因素为主,重要性分值分别为:100、48.82、31.58、15.39;IDH的主要危险因素相对分散,主要以饮用水的类型、食用油的类型、吃海产品、水果、鱼虾、奶类产品的频率有关,重要性分值分别为:100、61.39、64.69、37.24、34.37、29.14。结论社会因素是ISH主要危险因素,而饮食结构因素等因素是IDH的主要危险因素。由于ISH是IDH患病率的2.18倍,所以在高血压的防治策略上应该重视社会心理因素的干预和控制。     

单纯收缩期和舒张期高血压的影响因素与防治

目的探讨单纯收缩期高血压(ISH)和单纯舒张期高血压(IDH)的危险因素的差异,为有针对性地控制高血压提供理论基础.方法用分类树分析方法(CART),以整群随机抽取的20364例35岁以上人群为样本,探讨ISH和IDH之间危险因素的差异.结果 ISH的主要危险因素相对集中,以年龄、家庭人口、婚姻状况、居住面积等社会因素为主,重要性分值分别为:100、48.82、31.58、15.39;IDH的主要危险因素相对分散,主要以饮用水的类型、食用油的类型、吃海产品、水果、鱼虾、奶类产品的频率有关,重要性分值分别为:100、61.39、64.69、37.24、34.37、29.14.结论社会因素是ISH主要危险因素,而饮食结构因素等因素是IDH的主要危险因素.由于ISH是IDH患病率的2.18倍,所以在高血压的防治策略上应该重视社会心理因素的干预和控制.     

抗高血压药对单纯舒张期高血压短期降压疗效的对比研究

目的比较不同类高血压药物在未治疗的单纯舒张期高血压患者中的短期疗效。方法纳入初发单纯舒张期高血压患者104例,年龄40岁～75岁,随机分为四个药物治疗组：①双氢克尿噻组（n=37）：予双氢克尿噻（12.5～25）mg/d;②阿替洛尔组（n=19）：予阿替洛尔（12.5～25）mg/d;③硝苯地平缓释片组（n=27）：予硝苯地平缓释片（20～40）mg/d;④卡托普利组（n=21）：予卡托普利（25～50）mg/d。比较干预4周后的治疗效果差异。结果治疗4周后所有患者舒张压均有明显下降（P＜0.001）,校正年龄、性别、体质指数、腰围、腰臀比、治疗前相应的血压值、血脂、血糖、吸烟、饮酒等传统危险因素后,四组间无统计学差异,但双氢克尿噻和硝苯地平较阿替洛尔和卡托普利降低收缩压的作用更明显（P＜0.05）。结论阿替洛尔和卡托普利对收缩压影响较小,更适合单纯舒张期高血压患者的降压治疗。     

高血压健康教育治疗作用的分析

目的探讨高血压健康教育在单纯舒张期高血压患者治疗中的作用。方法将单纯舒张期高血压患者102例随机分成实验组与对照组。两组原有高血压治疗方法不变,但对实验组采用为时1周的正规集体教育以及随机健康教育相结合的方式,进行高血压健康教育。结果 2年后实验组生活方式、精神状态明显好转,高血压控制有效率显著高于对照组(P<0.05)。结论健康教育有利于单纯舒张期高血压的治疗,应重视并推广之。     

糖尿病人群不同类型高血压发病率及影响因素的研究

目的 探讨糖尿病人群不同类型高血压的发病率及影响因素。方法 选择基线血压正常的糖尿病患者2367例,观察平均25.6月后进展为不同类型高血压的发病率及影响因素。 结果 进展为单纯收缩期高血压（ISH）、单纯舒张期高血压（IDH）及收缩期-舒张期双期高血压（SDH）的标化发病率（/1000人年）分别为80.2、89.2、130.8,男性为81.7、97.9、145.6,女性为66.8、55.6、80.3。影响糖尿病人群进展为ISH的危险因素是年龄、SBP及BMI （RR分别为2.409、2.757、1.807,P〈0.05）;进展为IDH的危险因素是男性、DBP、BMI、SUA（RR分别为2.064、1.771、1.569、1.463,P〈0.05）;进展为IDH的保护因素是年龄、糖尿病病程5年以上（RR分别为0.809、0.552,P〈0.05）;进展为SDH的危险因素是男性、SBP、BMI、TG、LDL-C（RR分别为1.882、2.720、1.549、1.284、1.410,P〈0.05）。 结论 糖尿病人群SDH的标化发病率最高,高血压各亚型发病影响因素不同,且有性别差异。     

不同界值诊断的单纯舒张期高血压与颈动脉内膜中层厚度的关系

目的 探讨不同界值诊断的单纯舒张期高血压(IDH)与颈动脉内膜中层厚度(CIMT)的关系。方法 以开滦研究队列中参加2010年体检及后续随访,且接受了颈动脉超声检查者23 622人作为观察对象。分别参照我国高血压防治指南和2017年美国心脏病学会(ACC)/美国心脏协会(AHA)高血压管理指南标准将研究对象分为4组：正常血压组、IDH组、单纯收缩期高血压(ISH)组和收缩舒张期高血压(SDH)组。采用多因素logistic回归分析总人群和不同年龄段不同标准IDH对CIMT的影响。结果 最终入选研究对象21 649人。按照中国高血压防治指南和2017年ACC/AHA高血压管理指南标准,IDH组人群分别为938例(4.3%)和2 815例(13.0%),IDH组CIMT增厚人群分别为202例(21.5%)和410例(14.6%)。以CIMT是否增厚为因变量,分别以两种标准定义的高血压分组为自变量代入多因素logistic回归模型,在校正了多种混杂因素后,结果显示,两种标准诊断的IDH均与CIMT增厚不相关(P>0.05)。分层分析显示,我国高血压防治指南标准诊断的IDH是年龄<...     

单纯舒张期高血压

高血压病分为三种亚型:单纯舒张期高血压(IDH,SBP<140 mmHg、DBP≥90 mmHg);单纯收缩期高血压(ISH,SBP≥140 mmHg、DBP<90 mmHg);收缩、舒张双期高血压(SDH,SBP≥1140 mmHg并DBP≥90 mmHg).现就IDH的概况作一简述.     

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隐蔽性高血压是高血压的一种特殊的临床类型,并非少见,往往伴有多重危险因素或靶器官损害。目前其发病机制尚不清楚,临床特点是诊室血压正常,而家庭血压或24 h动态血压高于正常值。此型高血压易漏诊,应注意筛查。     

Association of isolated diastolic hypertension based on different guideline definitions with incident cardiovascular risk in a Chinese rural cohort

The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline lowered the threshold (systolic blood pressure [SBP] <130 mm Hg and diastolic blood pressure [DBP] ≥80 mm Hg) for isolated diastolic hypertension (IDH), whereas the 2018 Chinese guideline still recommends the old threshold (SBP <140 mm Hg and DBP ≥90 mm Hg). This study aimed to investigate the association between IDH, as defined by both guidelines, and the risk of incident cardiovascular disease (CVD) in rural areas of northeast China. This prospective study included participants whose baseline data were collected between 2004 and 2006. The exclusion criteria were baseline CVD, incomplete data, and systolic hypertension. The primary end point was incident CVD, a composite end point including nonfatal myocardial infarction (MI), nonfatal stroke, and CVD death. Multivariate Cox models were used to evaluate the association of IDH with CVD risk. The authors analyzed 19 688 participants (7140 participants with IDH) according to the ACC/AHA guideline. Compared with normotensive participants, individuals with ACC/AHA‐defined IDH were at a high risk of CVD (HR = 1.177, 95% CI: 1.035–1.339). A similar difference in CVD risk was noted when normotensive participants were compared with those with IDH, determined based on the 2018 Chinese guideline (HR = 1.218, 95% CI: 1.050–1.413). Similar results were found in participants who did not take antihypertensives at baseline. Moreover, IDH defined by either guideline was significantly associated with nonfatal MI. ACC/AHA‐defined IDH was associated with a risk of CVD, implying that blood pressure management should be improved in rural areas of China.     

Optimal treatment of hypertension in the elderly: A Korean perspective

With the progression of the aging population, common diseases of the elderly have become the center of attention in most developed countries. Hypertension is one of the most common morbid conditions in the elderly and has a great impact on their health status because it is the main risk factor of cardiovascular and cerebrovascular diseases. However, a considerable amount of uncertainty remains regarding hypertension in the elderly, such as the benefits of hypertension control in oldest-old populations, the optimal level of blood pressure control, and the efficacy of antihypertensive drugs for the prevention of cognitive dysfunction. While there are many controversial issues concerning the optimal management of hypertension in the elderly, the number of elderly hypertensive patients that require treatment is expected to increase due to the aging population. As a result, knowledge regarding the mechanisms of hypertension in the elderly and specific consideration in managing hypertensive elderly patients are needed to improve the clinical outcome. Furthermore, new therapeutic interventions that are aimed at attenuating age-related vascular changes should be investigated, because hypertension in the elderly, especially isolated systolic hypertension has specific characteristics of increased arterial stiffness in most cases.     

维生素D缺乏与高血压相关研究进展

维生素D是一种脂溶性维生素,目前已知其在调节骨骼代谢、钙盐平衡方面起着重要的作用。近年来,虽然许多研究者发现高血压患者中维生素D缺乏的发生率很高,维生素D缺乏可能导致高血压的发生、发展,但是补充维生素D与高血压的研究结果不一致。因此文章就维生素D缺乏与高血压的相关研究进展作一综述。     

Associations of the systolic and diastolic components of orthostatic hypotension with markers of cardiovascular risk in older men: A cross‐sectional analysis from The British Regional Heart Study

The mechanisms underlying the association between orthostatic hypotension (OH) and cardiovascular disease are unclear. We investigated whether OH is associated with circulating cardiovascular risk markers. This was a cross‐sectional analysis of 3857 older, community‐dwelling men. “Consensus OH” was defined as a sitting‐to‐standing decrease in systolic blood pressure ≥20 mm Hg and/or diastolic blood pressure ≥10 mm Hg that occurred within three minutes of standing. Multiple generalized linear regression and logistic models were used to examine the association between cardiovascular risk markers and OH. Consensus OH was present in 20.2%, consisting of isolated systolic OH in 12.6%, isolated diastolic OH in 4.6%, and combined systolic and diastolic OH in 3.0%. Concentration of von Willebrand factor, a marker of endothelial dysfunction, was positively associated with isolated systolic OH (OR 1.35, 95% CI 1.05‐1.73) and combined systolic and diastolic OH (OR 2.27, 95% CI 1.35‐3.83); high circulating phosphate concentration, which may reflect vascular calcification, was associated with isolated diastolic OH (OR 1.53, 95% CI 1.04‐2.25) and combined systolic and diastolic OH (OR 2.12, 95% CI 1.31‐3.44), high‐sensitivity troponin T, a marker of myocardial injury, was positively associated with isolated diastolic OH (OR 1.69, 95% CI 1.07‐2.65) and N‐terminal pro‐brain natriuretic peptide, a marker of cardiac stress, was positively associated with combined systolic and diastolic OH (OR 2.14, 95% CI 1.14‐4.03). In conclusion, OH is associated with some cardiovascular risk markers implicated in endothelial dysfunction, vascular calcification, myocardial injury, and cardiac stress. Clinicians should consider assessing cardiovascular risk in patients with OH.     

Pregnancy-related factors and the risk of isolated systolic hypertension

Background. Isolated systolic hypertension (ISH) is known to be a strong predictor of cerebrovascular and cardiac events, especially in women. Metabolic and hormonal changes associated with reproductive history may contribute to the development of cardiovascular diseases. The aim of this study was to identify associations between pregnancy-related factors and ISH. Methods. A cross-sectional study based on a random sample of 3937 Finnish women aged 30-99 was carried out. Associations between pregnancy-related factors and ISH were analyzed using multivariate analyses. Results. Of 3470 subjects, 26% had ISH. Younger age at first delivery predicted a higher risk of ISH (odds ratio after adjustment for age, education, smoking, height and weight = 1.31, 95% CI 1.07-1.61). Age at first and last delivery was significantly associated with age, education, marital status and use at any time of hormone replacement therapy (HRT); age at first delivery was also associated with toxemia in any pregnancy, weight and body mass index (BMI). In the univariate analyses, ISH was significantly associated with age, height, weight, BMI, education, marital status, oral contraceptive pills use at any time and HRT use at any time. Conclusion. This population-based study showed that early age at first delivery increased the risk of ISH, which may in turn increase cerebrovascular and cardiac events after menopause. Age at first delivery is heavily dependent on education, which may be linked to the risk of developing of cardiovascular disease throughout adulthood. The other plausible mechanism may be adiposity due to pregnancy.     

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本文总结了近十余年来对白领高血压临床研究结果。初步认为青壮年白领高血压特点:(1)白领高血压特点以舒张压增高者及脉压小为主,收缩压和舒张压同时增高及单纯收缩压增高者相对较少。(2)心率偏快。(3)临床多有乏力、胸闷、头晕、周身不适等症状。(4)心脏后前位像显示升主动脉增宽者多。(5)肾上腺素能α、β-受体阻滞剂治疗效果较好。而老年白领工作者舒张压随年龄增长而逐渐降低,脉压逐渐加大,单纯收缩期高血压者逐渐增多。其特点与普通老年高血压人群基本相似。白领高血压在治疗上应根据患者不同年龄段的不同特点进行有针对性的防治。     

低舒张压的单纯收缩期高血压研究新进展

在有些高龄患者中,会出现舒张压（DBP）＜60mmHg高血压患者,即低DBP的单纯收缩期高血压（ISH）。越来越多的证据表明DBP＜70mmHg对机体是不利的,而低DBP的ISH患者常具有更多的心血管危险因素和更多的心血管事件风险,成为老年高血压降压治疗的难点,使用硝酸酯类药物进行治疗可能是一个有益的选择。