Effect of dilren on hemodynamics of patients with essential hypertension

Changes in hemodynamics and circadian rhythms in the course of dilren-300 treatment were studied in 20 patients with hypertension stage II. Tetrapolar chest rheography, echo-CG, ECG, measurements of arterial pressure by N. S. Korotkov were made 6 times a days (at 2, 6, 10 a.m. and 2, 6, 10 p.m.). The information was processed statistically. Dilren -300, administered at 8.00 a.m. for 10 days, had a hypotensive, vasodilating and weak negative chronotropic effect. The drug reduced myocardial energy consumption, eliminated circadian rhythms of heart rate, arterial pressure, cardiac performance and others observed before the treatment.     

Effects of dilevalol and propranolol on hemodynamics in patients with essential hypertension

Eighteen patients with essential hypertension received 50 to 200 mg of dilevalol or 60 to 90 mg of propranolol daily for six weeks. Mean arterial blood pressure and venous pressure were significantly reduced in the dilevalol-treated patients at six weeks but were unchanged in the propranolol-treated patients. The cardiac index and systemic vascular resistance remained unchanged in the dilevalol group, but were significantly reduced (cardiac index) or increased (systemic vascular resistance) in the propranolol group. No changes in heart rate were noted in either treatment group. It is concluded that dilevalol has some ideal features for the treatment of hypertension, but further research is needed to determine the causes of fatal hepatotoxicity reported in a few cases.     

原发性高血压患者肾动脉血流动力学研究

目的 探讨原发性高血压患者肾动脉血流指标变化的临床意义.方法 2006年5月至2010年7月我院门诊及住院的原发性高血压患者90例,其中1、2、3级高血压各30例,另选30名健康查体者作为健康对照组,应用彩色多普勒超声检测各组研究对象的双侧主肾动脉、段动脉和叶间动脉的血流频谱,获得各组血流参数,包括收缩期最大血流速度(Vmax)、舒张末期最低血流速度(Vmin)、舒张末期最低血流速度/收缩期最大血流速度(Vmin/Vmax)、阻力指数,并进行比较分析.结果 健康对照组主肾动脉的Vmax、Vmin、Vmin/Vmax及阻力指数分别为(63.99±7.68)cm/s、(23.86±3.07)cm/s,0.38±0.05、0.62±0.05;段动脉的Vmax、Vmin、Vmin/Vmax及阻力指数分别为(52.93±4.24)cm/s、(2 0.89±2.47)cm/s,0.40±0.04、0.60±0.04;叶间动脉的Vmax、Vmin、Vmin/Vmax及阻力指数分别为(35.32±4.22)cm/s、(15.07±2.54)cm/s,0.43±0.04、0.57±0.04.与健康对照组比较,1级高血压组仅叶间动脉的Vmin、Vmax/Vmin降低,阻力指数增高,差异具有统计学意义(P均＜0.05);2级高血压组除主肾动脉的Vmax外,其余各肾动脉的血流参数差异均有统计学意义(P＜0.05或0.01);3级高血压组各级肾动脉的各项血流参数差异均有统计学意义(P＜0.05或0.01);Vmax、Vmin及Vmin/Vmax随着血压分级的增加而减低,阻力指数随着血压分级的增加而升高.结论 彩色多普勒超声肾动脉血流动力学指标可为临床评价高血压患者肾损害提供一定的依据.

Abstract：

Objective To explore the clinical significance of the changes of renal artery blood stream parameters in patients with essential hypertensive by color Doppler ultrasonography. Methods Ninety patients with essential hypertension were enrolled and divided into three groups (grade 1,2,3 ) according to their clinical blood pressure from May 2006 to July 2010 and each group included 30 cases. Thirty normal individuals were assigned to the control group. Color Doppler ultrasonography was used to determine the blood flow spectrum of bilateral main renal arteries, segmental arteries and interlobar arteries of kidneys. The parameters included Vmax, Vmin, Vmin/Vmax, resistance index (RI) were recorded and analyzed. Results In the control group, the Vmax,Vmin,Vmin/Vmax and RI in main renal arteries were (63.99 ± 7.68)cm/s, (23.86 ± 3.07) cm/s,0. 38 ± 0. 05 and 0. 62 ± 0. 05 ;in segmental arteries were ( 52. 93 ± 4. 24) cm/s, ( 20. 89 ± 2. 47 ) cm/s,0. 40 ±0. 04 and 0. 60 ±0. 04;in interlobar arteries were (35. 32 ±4. 22)cm/s, ( 15.07 ±2. 54) cm/s,0. 43 ±0. 04 and 0. 57 ± 0. 04. Compared to the control, only Vmin, Vmin/Vmax and RI in interlobar arteries were statistically changed in grade 1 hypertension group ( P ＜ 0. 05 ). While in grade 2 hypertension group, all the blood flow parameters except Vmax in main renal arteries statistically changed compared to the control group(P ＜ 0.05 ). In grade 3 hypertension group, all the blood flow parameters showed statistically differences when compared to control group (P ＜ 0. 05 ). The Vmax, Vmin, Vmin/Vmax decreased along with the blood pressure increased,however, the RI increased along with BP. Conclusion The renal artery blood stream parameters determined by color Doppler ultrasonography can provide important information to evaluate abnormal renal function in patients with hypertension.     

老年高血压病患者血流动力学特征及护理

目的比较老年和青中年人群高血压患者心脏血流动力学的特征,并寻求老年高血压患者的最佳护理方案。方法选取老年和青中年人群高血压患者共135例,其中男性80例,女性55例,年龄20~80岁,使用T3001心脏血流动力监测仪测定SV、CI、PEP/LVET、HI、AMPA、A/C、AC、TPR并进行比较研究。结果老年高血压病人与青中年高血压患者相比,心功能指标:CO、CI、HI和AC均显著降低;AMPA、A/C、TPR均显著升高(P<0.05或P<0.01)。其中以TPR增加、AC下降最突出,其次表现为心脏的收缩和舒张功能下降。结论老年高血压患者的血流动力学指标有着不同于青中年患者的改变,因此,在老年高血压患者的护理方面也有其特点。     

E-Flow成像技术对原发性高血压患者指端微血管血流动力学变化的评价

目的 探讨原发性高血压患者指端微血管病变的血流动力学变化与高血压程度的相关性.方法 应用E-Flow成像技术观察39例原发性高血压患者右手无名指末节指腹动脉和甲床动脉的收缩期峰值流速(PSV)、舒张期峰值流速(EDV)及阻力指数(RI),并与35例健康人作对照.结果 与彩色及能量多普勒相比,E-Flow能更清晰地显示指端微血管的分布及走行,且随着病程的加重,原发性高血压患者指腹动脉、甲床动脉PSV、EDV的测量值均减低(P＜0.05),RI则升高(P＜0.05).结论 指端微血管血流动力学的变化可作为衡量原发性高血压外周阻力变化的指标.E-Flow成像技术可作为一种新的方法对指端微血管血流动力学进行评价.     

空腹血糖正常的原发性高血压患者糖代谢异常状况研究

目的研究原发性高血压伴有糖代谢异常患者的各项指标,为全面干预心血管危险因素提供依据。方法选择既往无糖代谢异常病史,空腹血糖〈5.6 mmol/L的原发性高血压患者398例,测定口服葡萄糖耐量试验（OGTT）后2小时血糖（2 hPG）水平。观察年龄、性别、体质量指数、血压、血脂、尿酸、动脉硬化等参数与OGTT后2hPG的关系。结果 398例患者中检出糖耐量减低99例（24.9%）;2型糖尿病52例（13.1%）。糖代谢异常的患者动脉硬化的比例（71.5%）高于血糖正常组（52.6%）。结论原发性高血压患者合并糖代谢异常的比例高,对于空腹血糖正常的原发性高血压患者,应常规行OGTT测定,以早期发现和干预糖代谢紊乱,减少动脉硬化的发生。     

Blood redistribution between peripheral areas in patients with stage II essential hypertension during treatment with anapriline

Impedance plethysmography was used to examine 38 patients (27 men and 11 women) with stage II essential hypertension according to the WHO classification. The patients' age ranged from 31 to 60 years (6.3 +/- 1.08 on the average), with the disease lasting from 1 to 16 years. It has been established that administration of propranolol at the daily dose of 120 to 160 mg for 10 to 12 days produces a varying effect on the cardiac output (CO) and peripheral blood supply depending on their initial magnitudes. In the majority of patients with the hyper- and eukinetic versions, the CO and peripheral blood supply decrease in all the areas examined (in the abdominal cavity, leg, finger and head) whereas in patients with the hypokinetic version, they rise. The relatively normal regional blood supply drops whereas in the majority of patients it increases provided it was at a lower level before. Blood redistribution ameliorates the blood supply to the areas marked by a low initial level but makes it worse in the areas with a relatively normal magnitude. The peripheral blood supply gets deteriorated in the majority of patients. In contract to the arterial blood supply, the specific blood volume that primarily characterizes the amount of the venous blood in the given area undergoes redistribution in the peripheral areas in the majority of propranolol-treated patients with all the types of hemodynamics. The pattern of its alterations in the chest and, in the majority of patients, in the abdominal cavity is always related to the initial level.(ABSTRACT TRUNCATED AT 250 WORDS)     

Pro-inflammatory cytokines in patients with essential hypertension

BACKGROUND: It has been suggested that abnormalities in the immune response play a role in the pathogenesis of essential hypertension (EH). The aim of this study was to assess circulating concentrations and ex vivo production of the pro-inflammatory cytokines tumour necrosis factor-alpha (TNF-alpha) and interleukin-1beta (IL-1beta), and of the anti-inflammatory cytokines IL-1 receptor antagonist (IL-1ra) and IL-6, in patients with EH and compare them with healthy volunteers. PATIENTS AND METHODS: Plasma cytokine concentrations were measured in EH patients and control volunteers by specific radioimmunoassays and ELISA. Ex vivo cytokine production was assessed after stimulation of whole-blood with lipopolysaccharide. RESULTS: Circulating concentrations of TNF, IL-1 and IL-6 did not differ between EH patients and controls. In contrast, IL-1ra circulating levels were higher in EH patients. Hypertensive patients had an increased IL-1 and IL-6 production capacity when whole blood was stimulated ex vivo with lipopolysaccharide, while TNF production was lower. IL-1ra production capacity did not differ between patients and controls. CONCLUSIONS: Patients with EH have an altered profile of pro-and anti-inflammatory cytokines, consistent with monocyte activation in the circulation. The importance of these changes for the pathogenesis of EH and/or its secondary complications remains to be elucidated.     

Capillary hypertension and abnormal pressure dynamics in patients with essential hypertension

1. Pressure was measured within 28 capillaries of the nailfolds of nine patients with essential hypertension and in 33 capillaries of nine age- and sex-matched normotensive control subjects, using direct micropuncture, a dynamic servo-nulling system and computerized analysis. 2. Average pressure at the apex of the capillary was found to be elevated in the patients with hypertension (21.1 +/- 4.9 mmHg compared with 13.0 +/- 2.0 mmHg in the control subjects; mean +/- SD, P less than 0.01). If the two groups were combined, there was an overall correlation between average capillary pressure and mean blood pressure (r = 0.68, P less than 0.01, n = 18), but within each group separately there was no significant relation between these parameters. 3. There were also abnormalities in the waveforms of pulsations in capillary pressure in the group with hypertension, with an increased attenuation of high-frequency harmonics. Pulses appeared to be conducted more rapidly along the vascular tree in the patients with hypertension. 4. The elevation of capillary pressure in essential hypertension demonstrated in this study is in agreement with indirect evidence of capillary hyperfiltration provided by other studies which showed a reduced plasma volume and increased transcapillary escape rate of plasma proteins. 5. The finding of elevated capillary pressure demands the inclusion of the postcapillary segment (and possibly vascular density) in the resistance equation in essential hypertension.     

原发性高血压病程早期外周血单核细胞的预激活状态

目的:观察病程早期原发性高血压患者外周血单核细胞黏附活性及分泌活性,分析此时期单核细胞是否处于预激活状态。方法:①选择2003-01/2004-10华中科技大学同济医学院附属同济医院心血管内科门诊就诊原发性高血压患者30例。男16例,女14例;病程6～56个月。均为高血压Ⅰ～Ⅱ级,且对检测项目知情同意。选择同期本院血压正常的健康体检者30人为对照组,男女各15人;平均年龄(45±8)岁。均对检测项目知情同意。②分离出纳入对象静脉外周血单核细胞,培养后,调整细胞数至4×107L-1,接种到24孔培养板上。每份标本设3孔,分别为基础分泌孔、血管紧张素Ⅱ刺激孔(加入血管紧张素Ⅱ1×10-8mol/L)、氯沙坦预处理孔(在1×10-8mol/L血管紧张素Ⅱ刺激前先将外周血单核细胞与氯沙坦共同孵育30min)。③培养人脐静脉内皮细胞,待细胞生长至对数增长期后,每孔加入100μL外周血单核细胞悬液,37℃下分别孵育2,4h,经显微镜-计算机图像分析系统计数黏附细胞。高倍镜下每孔计数40个视野,取其平均值。④采用双抗体夹心酶链免疫吸附法,严格按照试剂盒说明测定外周血单核细胞培养上清肿瘤坏死因子α、白细胞介素1β及白细胞介素6水平。⑤采用反转录聚合酶链反应检测外周血单核细胞细胞因子基因表达。⑥组间计量资料差异性比较采用t检验。结果:原发性高血压患者30例和健康体检者30人均进入结果分析。①孵育2和4h,外周血单核细胞与内皮细胞黏附数:高血压组在基础状态下均与对照组相当(P>0.05);血管紧张素Ⅱ刺激后两组均升高,且高血压组明显多于对照组(t=2.445,5.656,P<0.05,0.01);氯沙坦预处理后两组又降至同一水平(P>0.05)。②外周血单核细胞培养上清肿瘤坏死因子α、白细胞介素1β及白细胞介素6水平:基础状态时,两组均较低,且差异不明显;经血管紧张素Ⅱ刺激后,高血压组明显高于对照组(t=2.537～6.984,P<0.05～0.01);氯沙坦预处理后两组均有不同程度降低,组间差异不明显。③外周血单核肿瘤坏死因子α、白细胞介素1β及白细胞介素6mRNA表达:在基础条件下两组处于同一水平;血管紧张素Ⅱ刺激后高血压组明显高于对照组(t=2.381～3.974,P<0.05～0.01);氯沙坦预处理后两组均减低,但差异不明显。结论:病程早期原发性高血压患者外周血单核细胞处于预激活状态。     

原发性高血压病程早期外周血单核细胞的预激活状态

目的：观察病程早期原发性高血压患者外周血单核细胞黏附活性及分泌活性，分析此时期单核细胞是否处于预激活状态。 方法：①选择2003—01／2004-10华中科技大学同济医学院附属同济医院心血管内科门诊就诊原发性高血压患者30例。男16例，女14例；病程6-56个月。均为高血压Ⅰ-Ⅱ级，且对检测项目知情同意。选择同期本院血压正常的健康体检者30人为对照组，男女各15人；平均年龄（45&;#177;8）岁。均对检测项目知情同意。②分离出纳入对象静脉外周血单核细胞，培养后，调整细胞数至4&;#215;10^7L^-1，接种到24孔培养板上。每份标本设3孔，分别为基础分泌孔、血管紧张素Ⅱ刺激孔（加入血管紧张素Ⅱ1&;#215;10^-8 mol／L）、氯沙坦预处理孔（在1&;#215;10^-8 mol／L血管紧张素Ⅱ刺激前先将外周血单核细胞与氯沙坦共同孵育30min）。③培养人脐静脉内皮细胞，待细胞生长至对数增长期后，每孔加入100μL外周血单核细胞悬液，37℃下分别孵育2，4h，经显微镜-计算机图像分析系统计数黏附细胞。高倍镜下每孔计数40个视野，取其平均值。④采用双抗体夹心酶链免疫吸附法，严格按照试剂盒说明测定外周血单核细胞培养上清肿瘤坏死因子α、白细胞介素1β及白细胞介素6水平。⑤采用反转录聚合酶链反应检测外周血单核细胞细胞因子基因表达。⑥组间计量资料差异性比较采用t检验。 结果：原发性高血压患者30例和健康体检者30人均进入结果分析。①孵育2和4h，外周血单核细胞与内皮细胞黏附数：高血压组在基础状态下均与对照组相当（P〉0．05）；血管紧张素Ⅱ刺激后两组均升高，且高血压组明显多于对照组（t=2．445，5．656, P〈0．05，0．01）；氯沙坦预处理后两组又降至同一水平（P〉0．05）。②外周血单核细胞培养上清肿瘤坏死因子α、白细胞介素1β及白细胞介素6水平：基础状态时，两组均较低，且差异不明显；经血管紧张素Ⅱ刺激后，高血压组明显高于对照组（t=2．537-6．984, P〈0．05-0．01）；氯沙坦预处理后两组均有不同程度降低，组间差异不明显。③外周血单核肿瘤坏死因子α、白细胞介素1β及白细胞介素6mRNA表达：在基础条件下两组处于同一水平；血管紧张素Ⅱ刺激后高血压组明显高于对照组（t=2．381—3．974, P〈0．05—0．01）；氯沙坦预处理后两组均减低，但差异不明显。 结论：病程早期原发性高血压患者外周血单核细胞处于预激活状态。     

外周血单核细胞激活效应在原发性高血压患者丹参酮干预过程中的反应

背景:外周血单核细胞预激活是动脉粥样硬化形成的重要早期事件和促进因素之一,丹参酮是从传统中药丹参中提取的一种脂溶性成分,具有确切的抗动脉粥样硬化作用。目的:通过检测外周血单核细胞的黏附活性与分泌活性,分析原发性高血压患者病程早期是否存在外周血单核细胞预激活,并探讨丹参酮对体外培养条件下外周血单核细胞激活的抑制作用。设计:病例对照分析。单位:华中科技大学同济医学院附属同济医院急诊科与中医药研究室。对象:选取2003-01/2004-10华中科技大学同济医学院附属同济医院心血管内科收治的未经治疗或已停用降压药物2周以上的原发性高血压患者30例,男16例,女14例;平均年龄(44.6±7.4)岁;体质量指数(26.2±4.5)kg/m2;平均病程(38.5±16.9)个月;对本实验均知情同意。根据1999年WHO/ISH的高血压诊断标准,均为高血压Ⅰ～Ⅱ级。排除继发性高血压、器质性心脏病、高脂血症、糖尿病、肝肾功能障碍、感染等临床情况以及高血压所致的心、脑、肾、血管等靶器官损害。另选择30例血压正常的健康体检者作为正常对照组。人脐静脉内皮细胞(武汉大学物种保存中心);丹参酮注射液(雅安三九药业有限公司,批号020724)。方法:①入选者均抽取静脉血4.0～5.0mL,采用Ficoll-Hypaque密度梯度离心法和塑料吸附法分离单个核细胞,37℃孵育40～60min后收集贴壁细胞即为外周血单核细胞。瑞氏染色后镜下观察细胞形态符合单核细胞特征,锥虫蓝拒染试验测定活细胞数>95%。将新鲜分离的外周血单核细胞重悬,按4×107 L-1接种到24孔培养板上,每份标本设3孔:第1孔为基础分泌孔,第2孔为血管紧张素Ⅱ刺激孔,第3孔为丹参酮预处理孔。在血管紧张素Ⅱ刺激前先将外周血单核细胞与丹参酮共同孵育30min。血管紧张素Ⅱ、丹参酮终浓度分别为1×10-8mol/L和1×10-8g/L,外周血单核细胞终浓度为2×107 L-1。37℃下置于体积分数为0.05的CO2培养箱内24h,分别收集培养上清和细胞成分。②制备外周血单核细胞悬液,密度调整至2.5×109 L-1。在24孔培养板上用含体积分数为0.1小牛血清的M199培养基培养人脐静脉内皮细胞,待细胞生长至对数增长期后,铺板汇成单层,每孔加入100μL外周血单核细胞悬液,37℃下分别孵育2,4h,去除未黏附细胞,戊二醛固定后计数黏附细胞,高倍镜下每孔计数40个视野,取其平均值。③采用双抗体夹心ELISA法和反转录-聚合酶链技术检测外周血单核细胞培养上清中肿瘤坏死因子α、白细胞介素1β、白细胞介素6的浓度及其mRNA的表达水平。主要观察指标:①外周血单核细胞黏附活性的变化。②外周血单核细胞培养上清中细胞因子浓度及其mRNA的表达。结果:①孵育2,4h时外周血单核细胞与内皮细胞的黏附数,在基础状态下高血压组和正常对照组基本相似(t=1.153～1.577,P均>0.05);血管紧张素Ⅱ刺激后高血压组明显多于正常对照组(t=3.842～4.536,P均<0.01);丹参酮预处理后两组又降至同一水平(t=0.855～1.702,P均>0.05)。②基础状态时,两组培养上清中肿瘤坏死因子α、白细胞介素1β、白细胞介素6的浓度均较低(t=0.981～1.829,P均>0.05);血管紧张素Ⅱ刺激后,高血压组各细胞因子浓度均明显高于正常对照组(t=2.442～5.075,P<0.01,0.01,0.05);丹参酮预处理后两组各细胞因子浓度均有不同程度降低,但差异无显著性意义(t=1.227～1.940,P均>0.05)。两组外周血单核细胞中各细胞因子mRNA的表达与浓度变化基本相似。结论:①基础状态下原发性高血压患者外周血单核细胞与内皮细胞的黏附数及各炎性细胞因子浓度和mRNA表达处于正常人群水平,经血管紧张素Ⅱ刺激后显著升高,提示原发性高血压患者病程早期外周血单核细胞处于预激活状态。②丹参酮干预可使原发性高血压患者外周血单核细胞的黏附活性与分泌活性降至正常水平,证明丹参酮能够抑制预激活的外周血单核细胞进一步激活,一定程度上可防止动脉粥样硬化的发生。