高血压与血脂异常相关性研究新进展

心血管疾病已成为现代社会的首要死亡原因.心血管疾病的主要危险因素包括脂质代谢紊乱、高血压、糖尿病和吸烟;多种危险因素联合存在的个体将具有更高的危险性.脂质代谢紊乱与高血压常合并存在,高血压患者比血压正常者有更高的胆固醇水平[1,2],血压与血脂之间存在着生物学上的相互关联[3].     

老年糖尿病患者合并高血压的危险因素及随访分析

目的探讨老年糖尿病患者合并高血压的患病率、危险因素及随访分析。方法选择开滦集团退休职工健康体检者26 074例,根据诊断分为糖尿病组3658例和无糖尿病组22 416例。分析糖尿病患者高血压患病率、危险因素及靶器官损害。随访5年,记录糖尿病患者心肌梗死、脑卒中及心血管死亡等事件的发生,无高血压患者高血压的累计发病率及危险因素。结果糖尿病组高血压患病率明显高于无糖尿病组(70.5%vs 60.2%,P<0.01)。吸烟、打鼾、肥胖、高TG血症、高LDL-C血症为老年糖尿病合并高血压的危险因素(P<0.05,P<0.01)。随访5年,老年糖尿病合并高血压患者脑卒中发生率明显高于无高血压患者(6.4%vs 4.6%,P<0.05)。老年糖尿病无高血压患者高血压累计发病率为40.1%。肥胖、高LDL-C血症是老年糖尿病患者随访5年发生高血压的2个主要危险因素(P<0.01)。结论老年糖尿病患者高血压患病率显著增加,常合并心肌梗死、脑卒中、肾脏功能不全等靶器官损害,更容易发生脑卒中。     

高血压合并代谢紊乱及对心肾血管的影响

目的 观察高血压合并代谢紊乱的状况及其对心肾血管的影响.方法 住院高血压患者1033例分为单纯高血压组102例、高血压合并血脂紊乱组117例、高血压合并腹型肥胖组119例、高血压合并糖尿病组135例和高血压合并代谢综合征组(MS)560例.应用彩色多普勒超声检测心脏和血管的结构和功能,应用免疫比浊法测定微量白蛋白尿(MAU),评估心肾血管损害情况.结果 (1)住院病人中单纯高血压仅为9.9%,90.1%的高血压患者合并有代谢紊乱.(2)高血压合并腹型肥胖时左室质量(LVM)和左室质量指数(LVMI)显著高于高血压合并血脂紊乱组、高血压合并糖尿病组和高血压合并MS组(P＜0.05或P＜0.01).高血压合并糖尿病组及高血压合并MS组的颈动脉斑块检出率分别为65.7%和58.5%,明显高于高血压合并血脂紊乱组(35.0%)和高血压合并腹型肥胖组(45.8%)(P＜0.05或P＜0.01);高血压合并糖尿病组及高血压合并MS组的MAU阳性率(分别为48.0%和41.8%)显著高于单纯高血压组(9.5%)、高血压合并血脂紊乱组(25%)和高血压合并腹型肥胖组(22.4%)(P＜0.05或P＜0.01).结论 超过90%的高血压住院患者合并有不同形式的代谢紊乱,高血压合并腹型肥胖将加重左室肥厚(LVH),合并糖尿病和MS加重大血管及微血管的损害,纠正代谢紊乱对高血压的治疗有重要意义.     

慢性心力衰竭合并慢性阻塞性肺疾病老年患者预后影响因素

目的评价因慢性心力衰竭(CHF)住院的病人慢性阻塞性肺疾病(COPD)的患病率及预后的影响因素。方法收集2008年1月至2011年12月因CHF住院的918例老年(>60岁)病人,其中CHF合并COPD患者217例,另外701例CHF患者未合并COPD,随访观察1年后两组结局事件发生率及预后。结果年龄、糖尿病、外周血管疾病、脑卒中与合并COPD是老年CHF病人死亡的危险因素(P<0.05)。合并COPD的老年CHF病人的死亡、发生急性心肌梗死或脑卒中,因CHF再次住院的危险性比未合并COPD的老年CHF病人显著增高(P<0.05),对因其他原因再次住院无显著影响(P>0.05)。结论 COPD是CHF常见的并存疾病,而且是因CHF住院老年病人发生死亡或心血管疾病的危险因素。     

老年糖尿病死亡病例分析

目的了解老年糖尿病（DM）住院患者的死亡原因及其死亡危险因素。方法以预设表格方式对哈尔滨医科大学附属第二医院老年病房1993年1月1日至2006年12月31日期间住院的老年DM死亡病例进行回顾性调查。结果①老年DM住院患者死亡86例，占全部死亡病例的20．98％，其中以心血管疾病（33．72％）、脑血管疾病（17．44％）、呼吸系统疾病（13.95％）为前3位最主要死因。②在DM与非DM组的比较中，心血管疾病、脑血管疾病、呼吸系统疾病和泌尿系统疾病较非DM组显著增多，肿瘤患者在非DM组明显增多。③DM病程对高血压、心肌梗死、糖尿病肾病（DN）、脑梗死有显著影响。结论DM是增加老年心血管疾病、脑血管疾病、呼吸系统疾病、泌尿系统疾病的发生率和死亡率的一个重要因素。DM的病程增加也大大增加了高血压、心肌梗死、DN、脑梗死的发生率，从而显著增加了老年人的死亡风险。     

慢性阻塞性肺疾病合并高血压的临床特征及危险因素分析

目的观察慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)合并高血压的临床特征,同时分析其相关的危险因素。 方法收集陆军军医大学新桥医院2016年1月至2018年12月住院的COPD合并高血压患者122例,观察COPD合并高血压的临床特征,同时以单纯COPD患者40例为对照组,应用多因素Logistic回归分析COPD合并高血压的危险因素。 结果122例COPD合并高血压患者中,29.41%合并冠心病、22.99%合并肾疾病和糖尿病、21.39%合并肺心病、14.97%合并脑梗死、4.28%合并心绞痛、4.28%合并心肌梗死、9.63%合并其他心血管疾病。合并冠心病、心肌梗死、其他心血管疾病患者平均年龄显著高于COPD合并高血压患者对照组(P<0.05);合并肺心病患者病程显著长于对照组(P<0.05);合并冠心病、糖尿病、脑梗死、心绞痛、心肌梗死患者每年急性加重次数显著多余对照组(P<0.05);合并心绞痛和其他心血管疾病患者住院时间显著长于对照组(P<0.05)。多因素Logistic回归分析显示年龄(>80岁)、吸烟支数(>700支/年)、饮酒史、CRP(>50 mg/L)、BNP(>100 ng/L)、高血糖是COPD患者合并高血压的危险因素。 结论COPD合并高血压易引起其他相关性疾病而加重病情,及早关注其危险因素可提高患者预后。     

老年心血管疾病患者合并抑郁症状的初步研究

目的研究老年心血管疾病患者合并抑郁症状的相关危险因素。方法以老年抑郁量表随机调查参加正常体检的482例老年人为研究对象,其中有老年心血管者416例,无心血管疾病者66例,分别调查其抑郁症状发生情况,并探讨抑郁症状与冠心病、心律失常和高血压的关系。结果本组老年心血管疾病患者合并抑郁症状的比例明显高于无心血管疾病者,差异有统计学意义(P=0.01,OR=7.619,95%CI 1.826-31.785)。随着年龄的增长,老年心血管疾病患者合并抑郁症状的比例逐渐增高(P0.01)。老年心血管疾病合并抑郁症状患者在冠心病与非冠心病亚组间差异有显著性(P0.01),对是否合并心律失常、高血压和高血脂的危险因素进行比较,两组之间无统计学差异。结论老年心血管疾病患者合并抑郁症状比例显著高于同龄无心血管疾病对照人群,并随年龄增长逐渐增加。     

老年糖尿病患者健康管理的效果分析

目的:探讨对老年糖尿病患者的生活方式、多种心血管疾病危险因素进行健康管理的效果。方法:对212例老年糖尿病患者的生活方式、血糖、血压、血脂异常等危险因素进行了5年健康管理。对患者进行定期监测、随访,并分析其心血管疾病危险因素的变化及心血管事件发生率。结果:与健康管理前比较,5年健康管理后,糖尿病患者饮食清淡者比例(60.85%比73.51%)明显增多,吸烟(11.32%比5.41%)、肥胖(60.38%比49.73%)比例明显减少(P0.05或0.01);空腹血糖达标率(60.38%比70.27%)、总胆固醇达标率(65.57%比75.68%)明显提高(P均0.05);心脑血管事件发生率和死亡率下降,但差异未达到统计学意义(P0.05)。结论:健康管理能显著改善老年糖尿病患者生活方式,有效控制心血管疾病危险因素。     

糖尿病合并高血压的降压治疗

糖尿病合并高血压的患病率逐年增加,糖尿病合并高血压时,进一步促进糖尿病血管并发症的发生,增加致残和病死率,其危害远远超过其它引起糖尿病血管并发症危险因素的影响.在糖尿病合并高血压(简称HDS)的研究中,对3 648例新诊断的Ⅱ型糖尿病患者的研究发现,与血压正常的非糖尿病者相比较,有糖尿病而血压正常者其心血管事件相对危险性增加2倍,而有高血压的糖尿病患者则其危险性增加4倍;在平均4.6年的随访中,糖尿病、高血压患者中风危险性增加200%,心肌梗死危险性增加50%.此外,高血压可以促进糖尿病、肾病和糖尿病视网膜病变的发生和发展.     

抗高血压药物在减少2型糖尿病心血管并发症的作用及再认识

1.对糖尿病患者降压治疗的重要性 心血管疾病是糖尿病患者的最主要死亡原因(占86%).糖尿病人的心血管事件危险性是正常人的2倍,而合并高血压时则危险性增加至4倍.     

糖尿病患者血压控制目标的争论

我国糖尿病患病率和患者数量正逐年增长,已成为我国主要公共健康问题之一,心血管疾病是导致糖尿病患者发病和死亡的主要原因。糖尿病、高血压均为心血管疾病危险因素,常相互伴发,研究表明对糖尿病患者进行降压治疗可降低其心血管事件风险。既往诸多学术组织建议糖尿病合并高血压患者血压值应〈130／80mmHg（1mmHg=0．1333kPa）,但近几年相关试验研究及Meta分析结果对此提出质疑,2013版ADA指南及ESH／ESC高血压指南对糖尿病患者血压目标值也进行了修订。     

High blood pressure and diabetes mellitus: are all antihypertensive drugs created equal?

OBJECTIVE: To analyze the available data to assess the benefits of antihypertensive therapy in hypertensive patients with diabetes mellitus. METHODS: A MEDLINE search of English-language articles published until June 1999 was undertaken with the use of the terms diabetes mellitus, hypertension or blood pressure, and therapy. Pertinent articles cited in the identified reports were also reviewed. Included were only prospective randomized studies of more than 12 months' duration that evaluated the effect of drug treatment on morbidity and mortality in diabetic hypertensive patients. We estimated the risk associated with combination of diabetes mellitus and hypertension and the effect of treatment on morbidity and mortality. RESULTS: The coexistence of diabetes mellitus doubled the risk of cardiovascular events, cardiovascular mortality, and total mortality in hypertensive patients (approximate relative risk of 1.73-2.77 for cardiovascular events, 2.25-3.66 for cardiovascular mortality, and 1.73-2.18 for total mortality). Intensive blood pressure control to levels lower than 130/85 mm Hg was beneficial in diabetic hypertensive patients. All 4 drug classes-diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, and calcium antagonists-were effective in reducing cardiovascular events in diabetic hypertensive patients. In elderly diabetic patients with isolated systolic hypertension, calcium antagonists reduced the rate of cardiac end points by 63%, stroke by 73%, and total mortality by 55%. In more than 60% of diabetic hypertensive patients, combination therapy was required to control blood pressure. CONCLUSIONS: Intensive control of blood pressure reduced cardiovascular morbidity and mortality in diabetic patients regardless of whether low-dose diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, or calcium antagonists were used as a first-line treatment. A combination of more than 1 drug is frequently required to control blood pressure and may be more beneficial than monotherapy.     

Heart disease in diabetic patients

Both type 1 and type 2 diabetic patients have an increased incidence of ischemic heart disease and congestive heart failure. Cardiovascular disease accounts for up to 80% of the excess mortality in patients with type 2 diabetes. The burden of cardiovascular disease is especially pronounced in diabetic women. Factors that underlie diabetic heart disease include multiple vessel coronary artery disease, long-standing hypertension, metabolic derangements such as hyperglycemia and dyslipidemia, microvascular disease, and autonomic neuropathy. There is also increased sudden death associated with diabetes, which is due, in part, to the underlying autonomic neuropathy. This article reviews diabetic cardiac disease, with an emphasis on type 2 diabetes.     

Diabetic heart dysfunction: is cell transplantation a potential therapy?

The presence of long-standing diabetes mellitus leads to the development of a number of typical end organ complications. These complications include coronary heart disease, stroke, peripheral arterial disease, diabetic retinopathy, diabetic nephropathy, diabetic neuropathy and diabetic cardiomyopathy. From an epidemiological and clinical standpoint, cardiovascular disease remains the most important complication of diabetes. Cardiovascular complications are the most common causes of morbidity and mortality in diabetics, accounting for up to 85% of the mortality in diabetic patients [1]. The increasing prevalence of obesity and sedentary lifestyle in Western society are leading to an increase in the prevalence in diabetes. As such diabetes is an increasing cause of cardiovascular disease [2].     

Learning from large cardiovascular clinical trials: classical cardiovascular risk factors

The number of cardiovascular risk factors significantly influences age adjusted cardiovascular death rates according to the data of the MRFIT Trial. Up to 60% of patients with Type 2 diabetes have concomitant hypertension. In the HOT (Hypertension Optimal Treatment) Study lowering of blood pressure was particularly beneficial in the subgroup of diabetes mellitus: there was a 51% reduction in major cardiovascular events in target group相似文献   

Cardiac disease in diabetic patients with renal disease

Patients with diabetes represent an increasing proportion of end-stage renal disease (ESRD) patients. Cardiovascular risk, already formidable among patients on dialysis, is significantly higher among those who also have diabetes. Diabetic ESRD patients are not only at higher risk of ischaemic events, but are also subject to haemodynamic overload, because of anaemia, hypertension, and arteriovenous dialysis connections. Mortality rates are also significantly higher in these patients. Hypertension and anaemia stand out as opportunities for intervention in these patients. Anaemia per se is associated with an increased risk of cardiovascular abnormalities, including left ventricular hypertrophy, and with an increased risk of mortality. The interplay of multiple risk factors in diabetic patients with ESRD demands a multidisciplinary approach for the early identification and management of cardiovascular risk factors--hypercholsterolaemia, hypertension, blood glucose and anaemia--in order to optimise outcomes in these patients.     

Complex relationship between blood pressure and mortality in type 2 diabetic patients: a follow-up of the Botnia Study

The presence of hypertension aggravates the high cardiovascular risk in type 2 diabetic patients. Pulse pressure is a marker of arterial stiffness and constitutes a risk factor for cardiovascular mortality. This study examines the relationship between different blood pressure indices and mortality in a cohort of type 2 diabetic patients. A total of 1294 type 2 diabetic patients with a median age of 69.1 years participated in the Botnia Study from 1990 to 1997. In 2004, after a median follow-up of 9.5 years, data on mortality was collected from the national population registry and hospital records. Systolic and diastolic blood pressure correlated negatively with mortality after adjustment for other risk factors. The association between low systolic and diastolic blood pressure and mortality was pronounced in patients with previous cardiovascular disease. A U-shaped association between pulse pressure and mortality was observed in elderly patients. These observations could be linked to arterial stiffness and heart failure. Low blood pressure in high-risk patients is likely to be a marker of poor health rather than the cause of mortality. The results suggest that the role of blood pressure as a risk marker in elderly type 2 diabetic patients with cardiovascular disease needs to be reevaluated.     

HOPE and MICRO-HOPE: review of the results and implications for people with diabetes

Cardiovascular disease remains the commonest cause of mortality in people with diabetes. Previous attempts to reduce the burden of heart disease in people with diabetes have tended to concentrate on the reduction of conventional cardiovascular risk factors, and less attention has been paid to wider aspects of cardiovascular disease in this group of people. The Heart Outcomes Prevention Evaluation (HOPE) study was a large, randomized trial with wide entry criteria which examined the hypothesis that ACE inhibition using ramipril would reduce cardiovascular events in patients at high risk who would not previously be treated with ACE inhibitors. Diabetes was a pre-defined subgroup, and over three thousand patients with diabetes were recruited who had evidence of vascular disease, or had diabetes and one other cardiovascular risk factor (cholesterol > 5.2, hypertension, microalbuminuria, smoking). The study was discontinued prematurely because of a significant reduction in the composite primary end-point of myocardial infarction, stroke, and death from cardiovascular disease. In the diabetic patients the primary event rate of the combination of myocardial infarction, stroke and cardiovascular death was reduced by a quarter in patients on ramipril, and this reduction was seen both in patients with and without previous cardiovascular disease. The benefit was greater than could be accounted for by the minor decrease in blood pressure, suggesting wider effects on the cardiovascular system. Ramipril also reduced the development of overt nephropathy in diabetic subjects with microalbuminuria. Ramipril should be considered for diabetic patients with existing cardiovascular disease, or who have a high risk of disease because of the presence of cardiovascular risk factors. Copyright 2001 Harcourt Publishers Ltd Copyright 2001 Harcourt Publishers Ltd doi: 10.1054/chec.2001.0111, available online at http://www.idealibrary.com on     

Diabetes and hypertension: pathogenesis, prevention and treatment

Hypertension occurs in approximately 30% of patients with type 1 diabetes and from 50 to 80% of patients with type 2 diabetes. Although the pathogenesis of hypertension is distinct in each type, hypertension markedly enhances the already high risk of cardiovascular and renal disease in types 1 and 2 and implications for treatment are similar in both. The threshold for blood pressure treatment in diabetic patients is generally agreed to be 140/90 mm/hg with a target BP of < 130/80. So-called "lifestyle modifications" play an important role in therapy, particularly in type 2 patients, by decreasing blood pressure and improving other risk factors for cardiovascular disease. Indeed non-pharmacologic interventions have been demonstrated to prevent the development of type 2 diabetes in patients at high risk to develop the disease. Aggressive anti-hypertensive drug treatment is warranted given the high risk associated with the combination of diabetes and hypertension and the demonstrated effectiveness of anti-hypertensive treatment in reducing cardiovascular morbidity and mortality in this group of patients. ACE inhibitors and ARBs are the cornerstones of pharmacologic management, in no small part because of the renoprotective effects of these agents in antagonizing the development and progression of diabetic renal disease. Multiple agents, including diuretics, will usually be required to attain target blood pressure levels.     

Diabetes and Hypertension: Pathogenesis,Prevention and Treatment

Hypertension occurs in approximately 30% of patients with type 1 diabetes and from 50 to 80% of patients with type 2 diabetes. Although the pathogenesis of hypertension is distinct in each type, hypertension markedly enhances the already high risk of cardiovascular and renal disease in types 1 and 2 and implications for treatment are similar in both. The threshold for blood pressure treatment in diabetic patients is generally agreed to be 140/90 mm/hg with a target BP of < 130/80. So‐called “lifestyle modifications” play an important role in therapy, particularly in type 2 patients, by decreasing blood pressure and improving other risk factors for cardiovascular disease. Indeed non‐pharmacologic interventions have been demonstrated to prevent the development of type 2 diabetes in patients at high risk to develop the disease. Aggressive anti‐hypertensive drug treatment is warranted given the high risk associated with the combination of diabetes and hypertension and the demonstrated effectiveness of anti‐hypertensive treatment in reducing cardiovascular morbidity and mortality in this group of patients. ACE inhibitors and ARBs are the cornerstones of pharmacologic management, in no small part because of the renoprotective effects of these agents in antagonizing the development and progression of diabetic renal disease. Multiple agents, including diuretics, will usually be required to attain target blood pressure levels.