单纯收缩期高血压病人年龄与血管内皮功能对大动脉僵硬度的影响

目的 探讨单纯收缩期高血压(ISH)患者大动脉僵硬度与年龄、血管内皮功能之间的关系.方法 对老年单纯收缩期高血压病人71例,进行大动脉僵硬度(主动脉脉搏波传导速度,baPWV)和内皮依赖性血管舒张功能(FMD)检测.同期年龄配对的健康老年人30例和健康中年人50例作为对照组.结果 老年单纯收缩期高血压组、老年健康组、中年健康组baPWV依次减慢[老年ISH:(2459.2±436.8)比老年健康:(2097.2±315.7)比中年健康:(1619.7±214.2)cm/s,P<0.01或<0.05),而FMD则依次增大(老年ISH:6.2±2.2比老年健康:9.8±2.5比中年健康:14.4±1.9,P<0.05或<0.01).在老年单纯收缩期高血压组中.baPWV与FMD呈显著性负相关、与收缩压(SBP)、脉压(PP)呈显著性正相关.多元逐步回归分析证明:年龄、FMD、SBP、PP是大动脉僵硬度的危险因素.结论 在老年单纯收缩期高血压病人中增龄与FMD失调明显增加了大动脉僵硬度,因此,在控制ISH的同时,改善FMD可以降低大动脉僵硬度,从而进一步降低心血管事件的风险.     

单纯收缩期高血压病人年龄与血管内皮功能对大动脉僵硬度的影响

目的探讨单纯收缩期高血压(ISH)患者大动脉僵硬度与年龄、血管内皮功能之间的关系。方法对老年单纯收缩期高血压病人71例,进行大动脉僵硬度(主动脉脉搏波传导速度,baPWV)和内皮依赖性血管舒张功能(FMD)检测。同期年龄配对的健康老年人30例和健康中年人50例作为对照组。结果老年单纯收缩期高血压组、老年健康组、中年健康组 baPWV 依次减慢[老年 ISH:(2459.2±436.8)比老年健康:(2097.2±315.7)比中年健康:(1619.7±214.2)cm/s,P<0.01或<0.05),而 FMD 则依次增大(老年 ISH:6.2±2.2比老年健康:9.8±2.5比中年健康:14.4±1.9,P<0.05或<0.01)。在老年单纯收缩期高血压组中,baPWV 与 FMD呈显著性负相关、与收缩压(SBP)、脉压(PP)呈显著性正相关。多元逐步回归分析证明:年龄、FMD、SBP、PP 是大动脉僵硬度的危险因素。结论在老年单纯收缩期高血压病人中增龄与 FMD 失调明显增加了大动脉僵硬度,因此,在控制 ISH 的同时,改善 FMD 可以降低大动脉僵硬度,从而进一步降低心血管事件的风险。     

氨氯地平和硫氮酮缓释片联合治疗对单纯收缩期高血压患者动脉弹性功能及尿蛋白的影响

目的:探讨氨氯地平(络活喜)与硫氮草酮缓释片(合贝爽)联合治疗对单纯收缩期高血压(ISH)患者血压、动脉弹性功能、尿蛋白的影响.方法:选取74例单纯收缩期高血压患者,分别用氨氯地平(氨氯地平组,5 mg早晨一次,n=25)、硫氮草酮缓释片(硫氮草酮缓释片组,90 mg每日2次,n=23)、氨氯地平和硫氮草酮缓释片联合治疗组(氨氯地平5 mg早晨一次+硫氮酮缓释片90 mg每日2次,n=26例)治疗8周,观察治疗前后血压,大小动脉弹性功能指数(C1、C2),尿α1-微球蛋白、尿微量白蛋白的变化.结果:氨氯地平组、硫氮革酮缓释片组及联合治疗组治疗8周后均能显著地降低单纯收缩期高血压患者的血压水平,与治疗前比较差异有统计学意义(P＜0.05);联合治疗组较氨氯地平组及硫氮草酮缓释片组更显著降低患者的收缩压水平和脉压差,差异有统计学意义(P＜0.05).三组治疗8周后均可明显降低单纯收缩期高血压患者的尿α1-微球蛋白、尿微量白蛋白水平,改善患者大小动脉弹性功能指数,与治疗前比较差异有统计学意义(P＜0.05);联合治疗组较氨氯地平组及硫氮草酮缓释片组更显著,差异有统计学意义(P＜0.05).收缩压、舒张压和脉压差与大动脉弹性功能指数呈负相关(P＜0.05),而与小动脉弹性功能指数无相关性;治疗后尿蛋白的下降程度与动脉弹性功能指标呈正相关(P＜0.05),但尿蛋白的下降幅度与血压变化之间的相关性无统计学意义.结论:氨氯地平和硫氮草酮缓释片联合治疗在控制单纯收缩期高血压患者收缩压,降低尿α1-微球蛋白、尿微量白蛋白,改善动脉弹性功能方面均具有协同作用.     

氨氯地平和依那普利对老年纯收缩期高血压患者动态血压的影响

目的　比较氨氯地平和依那普利对老年纯收缩期高血压患者的 2 4h动态血压的影响。方法　将 6 0例轻中度纯收缩期高血压老年患者随机分为两组 ,每组 30例。分别选用氨氯地平片 5mg和依那普利片 10mg ,每日一次 ,共 4周。用药前后进行 2 4h动态血压监测。结果　两组药物治疗第 4周末 2 4h动态血压发现 ,2 4h平均收缩压、脉压、舒张压、平均动脉压均较服药前明显降低 ,统计学上有显著性差异。氨氯地平组治疗后总体收缩压和舒张压分别下降 17.0 3± 8.5 5mmHg和 4 .83± 4 .82mmHg ;平均动脉压下降了 8.86± 4 .76mmHg ,依那普利组治疗后总体收缩压和舒张压分别下降 14 .30± 7.2 6mmHg和 5 .97± 2 .87mmHg ,平均动脉压下降了 8.74± 3.0 7mmHg ,组间比较收缩压下降幅度无差异 (P =0 .187) ,脉压下降幅度有统计学意义 (P =0 .0 0 5 )。氨氯地平组脉压差下降幅度大于依那普利组 (16 .97± 14 .0 6mmHg比 8.33± 7.84mmHg ,P =0 .0 0 5 ) ,两药对舒张压的影响组间比较无统计学差异。两组有效率相似 (76 .7%比 73.3% ,P =0 .76 6 ) ,达标率的差异无统计学意义 (6 6 .7%比 5 6 .7% ,P =0 .4 2 6 )。氨氯地平组发生胫前水肿 2例 ,依那普利组咳嗽 5例。结论　氨氯地平与依那普利对老年纯收缩期高血压均有效 ,尤其     

氨氯地平联合辛伐他汀治疗对高血压合并动脉粥样硬化患者氧化应激水平和血管内皮依赖性舒张功能的影响

目的探讨氨氯地平联合辛伐他汀在治疗高血压合并动脉粥样硬化时,对患者氧化应激水平和内皮依赖性血管舒张功能的影响。方法选取2015年12月-2017年12月就诊于遵义医学院附属医院的原发性高血压患者270例,随机分为两组,各135例。对照组给予氨氯地平治疗,观察组给予氨氯地平和辛伐他汀治疗。比较治疗前后氧化应激指标[晚期氧化蛋白产物(AOPP)、丙二醛、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-P)]、收缩压、舒张压及肱动脉血流介导的内皮依赖性血管舒张功能(FMD)及颈动脉内膜中层厚度(IMT)的变化。结果治疗前,两组患者AOPP、丙二醛、SOD、GSH-P水平差异无统计学意义(均P0.05)。持续治疗6个月后,观察组丙二醛、AOPP水平低于对照组;观察组GSH-P、SOD水平高于对照组(均P0.05)。治疗后观察组患者的收缩压、舒张压、颈动脉IMT、三酰甘油、总胆固醇、低密度脂蛋白胆固醇(LDL-C)低于对照组(均P0.05)。治疗后观察组患者的FMD高于对照组(P0.05)。结论氨氯地平联合辛伐他汀可降低高血压合并动脉粥样硬化患者的氧化应激水平,改善血管内皮功能。     

氨氯地平对高血压患者大动脉内皮功能和粥样硬化斑块的影响

目的　探讨氨氯地平对高血压病患者大动脉内皮功能和粥样硬化斑块的影响。方法　将高血压病患者随机分为A组 (氨氯地平治疗组 ,n =35 )和B组 (培哚普利治疗组 ,n =35 ) ,另设年龄、性别与之匹配的正常人作为对照组 (C组 ,n =30 )。用高分辨超声技术检测各组对象的肱动脉内皮依赖性舒张功能、颈动脉平均内中膜厚度、颈动脉斑块发生率及Crouse积分。对A、B组分别在治疗 3个月、1年及 2年后复查血压和血管超声的上述指标。结果　与C组比较 ,A组与B组肱动脉内皮依赖性舒张功能减退 ,颈动脉内中膜增厚 (P <0 0 1)。氨氯地平组与培哚普利组在降低血压及改善血管内皮依赖性舒张功能方面作用相同 (P >0 0 5 ) ,但氨氯地平组在逆转颈动脉内中膜厚度、降低新的粥样斑块发生率方面作用优于培哚普利组 (P <0 0 1)。结论　氨氯地平除能有效降低高血压患者的血压外 ,还能逆转大动脉功能和结构异常 ,延缓动脉粥样硬化进展     

氨氯地平对老年高血压患者内皮功能及颈动脉内中膜的影响

目的了解氨氯地平降压治疗对老年高血压患者血管内皮依赖性舒张功能、颈动脉内膜中层厚度(IMT)及血浆内皮素(ET)、一氧化氮(NO)、神经肽Y(NPY)的影响. 方法采用高分辨率超声技术,检测42例原发性高血压患者降压治疗前后及40例对照者休息状态、反应性充血后的肱动脉内径变化并检测颈动脉IMT值,测定高血压患者治疗前后血浆ET、NO、NPY浓度变化.结果与对照组比较,服氨氯地平5～10 mg/d,治疗4个月后,血压明显下降,肱动脉内皮依赖性舒张较治疗前明显改善,但仍低于对照.血浆ET、NPY水平明显下降,NO水平明显升高.治疗前后颈动脉IMT无显著性改变.结论经氨氯地平降压治疗4个月后,血管内皮功能明显改善,而颈动脉IMT无明显改善.     

阿托伐汀联用依那普利对老年单纯收缩期高血压的作用

目的 观察阿托伐汀联用依那普利对老年单纯收缩期高血压患者血压的影响.方法 老年单纯收缩期高血压78例,血清胆固醇正常.单用依那普利组38例,口服依那普利10 mg/d;联用阿托伐汀组40例,口服依那普利片10 mg/d和阿托伐汀20 mg/d.观察12周,每2周记录血压1次.结果 治疗12周后.两组患者收缩压、舒张压和脉压均较治疗前下降(P＜0.05);单用依那普利组脉压从治疗前(74±8)mm Hg降至(68±6)mm Hg;联用阿伐他汀组脉压从治疗前(75±7)mm Hg降至(60±6)mm Hg;两组间差异有统计学意义(t=5.255,P＜0.01).结论 阿托伐汀联用依那普利有助于改善单纯收缩期高血压老年人脉压,可降低老年心脑血管事件的危险性.     

缬沙坦对原发性高血压老年患者大动脉弹性的影响

目的探讨血管紧张素Ⅱ受体拮抗剂缬沙坦对老年高血压患者大动脉弹性的影响。方法选择40例正在规律服用降压药物治疗老年高血压患者,分为对照组（20例,服安慰剂1片/d）和缬沙坦组（20例,服缬沙坦氟80mg/d）,采用自动脉搏波传导速度测定仪检测治疗前和治疗12周后患者的颈动脉至股动脉脉搏波传导速度（C-FPWV）,以判断其大动脉弹性变化。结果与治疗前相比,治疗12周后患者的收缩压、脉压、平均压、C-FPWV及舒张压显著降低（P〈0.05～P〈0.01）。结论缬沙坦不仅能良好地控制血压,亦能明显改善大动脉弹性功能。     

氨氯地平逆转颈动脉内中膜增厚作用与血管紧张素转换酶基因型的相关性

目的 探讨氨氯地平的抗颈动脉粥样硬化作用与老年高血压病患者血管紧张素转换酶(ACE)基因多态性的关系.方法 220例老年高血压病患者服用氨氯地平2.5～10.0 mg,每日1次,共12个月.将资料完整的208例患者按基因型分为Ⅱ型、ID型、DD型三组,比较不同基因型组间及各基因型组在治疗前、后的颈动脉参数变化.结果 三组患者的平均颈动脉内-中膜厚度(MIMT)治疗后与治疗前比较均有下降,但仅在Ⅱ组差异有统计学意义(0.96±0.12对0.92±0.13,P<0.01),Ⅱ组与ID、DD组比较,下降幅度(AMIMT)大,差异具有统计学意义(P<0.01);Ⅱ组的斑块积分治疗后与治疗前比较有下降(4.85±2.51对3.90±2.36,P<0.05).多元线性回归结果表明,Ⅱ基因型、治疗前后收缩压差值(ASBP)和治疗前收缩压水平是影响△MIMT值的主要因素.结论 氨氯地平的抗颈动脉粥样硬化作用在不同ACE基因型的老年高血压病患者问存在差异,Ⅱ基因型患者获益最大.     

老年单纯收缩期高血压降压对颈动脉粥样硬化的影响

目的:观察老年单纯收缩期高血压(EISH)患者降压治疗前、后颈动脉粥样硬化的改变。方法:以彩色多普勒超声仪检查109例EISH患者降压治疗前、后颈动脉的形态、结构和血流动力学等指标,并进行分析。结果:降压治疗使斑块性质改变(P<0.01),阻力指数(RI)降低、搏动指数(PI)降低(P<0.01)。结论:EISH患者在良好控制血压后,可改善颈动脉硬化程度。     

Advanced glycation endproduct crosslink breaker (alagebrium) improves endothelial function in patients with isolated systolic hypertension

OBJECTIVES: Arterial stiffening and endothelial dysfunction are hallmarks of aging, and advanced glycation endproducts (AGE) may contribute to these changes. We tested the hypothesis that AGE crosslink breakers enhance endothelial flow-mediated dilation (FMD) in humans and examined the potential mechanisms for this effect. METHODS: Thirteen adults (nine men, aged 65 +/- 2 years) with isolated systolic hypertension (systolic blood pressure > 140 mmHg, diastolic blood pressure < 90 mmHg or pulse pressure > 60 mmHg) on stable antihypertensive therapy were studied. Subjects received placebo (2 weeks) then oral alagebrium (ALT-711; 210 mg twice a day for 8 weeks). Subjects and data analyses were blinded to treatment. Arterial stiffness was assessed by carotid augmentation index (AI) and brachial artery distensibility (ArtD) using applanation tonometry and Doppler echo, and endothelial function by brachial FMD. Serum markers of collagen metabolism and vascular inflammation were assessed. RESULTS: Alagebrium reduced carotid AI by 37% (P = 0.007) and augmented pressure (16.4 +/- 10 to 9.6 +/- 9 mmHg; P < 0.001). Heart rate, arterial pressures, and ArtD, were unchanged. FMD increased from 4.6 +/- 1.1 to 7.1 +/- 1.1% with alagebrium (P < 0.05), and was unrelated to altered shear stress or regional arterial distensibility. However, FMD change was inversely related to markers of collagen synthesis, p-selectin and intracellular cell adhesion molecule (all P < 0.05). Alagebrium-associated changes in plasma nitrite plus nitrate was inversely correlated with plasma matrix metalloproteinase 9 and type I collagen (P = 0.007). CONCLUSIONS: Alagebrium enhances peripheral artery endothelial function and improves overall impedance matching. Improved endothelial function correlates better with reduced vascular fibrosis and inflammation markers than with vessel distensibility. AGE-crosslink breakers may reduce cardiovascular risk in older adults by reduced central arterial stiffness and vascular remodeling.     

Non-invasive evaluation of endothelial function in hypertensive elderly patients

Impaired endothelium-dependent vasomotion is a diffuse disease process resulting in abnormal regulation of blood vessel tone and loss of several atheroprotective effects of the normal endothelium. The aim of the present study was to investigate the effects of aging and hypertension on endothelial function. Sixty-six geriatric subjects with ages over 60 (48 hypertensive and 18 healthy) and 40 middle-aged subjects (16 hypertensive and 24 healthy) were included in the study. Systemic vascular endothelial function was evaluated through measuring brachial arterial vasodilation, a physiologic answer to reactive hyperemia occured with increased blood flow in the vessel after transient ischemia (flow-mediated dilation, FMD%), and with carotid artery intima-media thickness (IMT) measurement, using high-resolution ultrasonography. Endothelial independent vasodilation was also measured after administration of sublingual isosorbide dinitrate (isosorbide dinitrate mediated dilation, IDNMD%). FMD% was significantly decreased in elderly and/or hypertensive (HT) patients (geriatric HT: 9.5 +/- 4.7%, geriatric non-HT: 12.7 +/- 5.5%, middle-aged HT: 12.9 +/- 4.3% and middle-aged non-HT: 18.9 +/- 8.1%) (geriatric HT versus geriatric non-HT (P = 0.02), geriatric HT versus middle-aged HT (P = 0.01), geriatric non-HT versus middle-aged non-HT (P = 0.008)). Both FMD% and IDNMD% were inversely correlated with age, baseline vessel diameter and carotid artery intima-media thickness. FMD% was also inversely correlated with diastolic blood pressure. No correlation was found between FMD% and systolic blood pressure, serum cholesterol and triglyceride levels. Endothelium dependent (EDD) and independent dilatation of large arteries decreased with aging even in the healthy elderly, and FMD further declined in HT elderly patients, indicating that age and hypertension independently impair endothelial function. Positive correlations with age and hypertension, and significant inverse correlation with FMD, makes carotid artery IMT a possible indicator of endothelial function.     

老年单纯收缩期高血压患者左心收缩功能的评价

目的 研究探讨老年单纯收缩期高血压（EISH）血流动力学改变。方法 应用彩色超声多普勒检测30例EISH患者及28例老年健康对照组左心收缩功能及相关血流动力学参。结果 EISH组左心收缩功能指标：SV、CO、EF、CI明显高于对照组,直线相关分析显示EISH组脉压差水平与上述各参数呈显著正相关,r值分别为0．43,0．56,0．46,0．45,同时研究组心率水平明显高于对照组（P＜0．05）。结论 EISH存在显著的血流动力学异常,主要表现在左室收缩功能亢进,长期处于高心排血量及高负荷状态。     

老年单纯收缩期高血压患者左心收缩功能的评价

目的研究探讨老年单纯收缩期高血压(EISH)血流动力学改变。方法应用彩色超声多普勒检测30例EISH患者及28例老年健康对照组左心收缩功能及相关血流动力学参数。结果EISH组左心收缩功能指标SV、CO、EF、CI明显高于对照组,直线相关分析显示EISH组脉压差水平与上述各参数呈显著正相关,r值分别为0.43,0.56,0.46,0.45,同时研究组心率水平明显高于对照组(P<0.05)。结论EISH存在显著的血流动力学异常,主要表现在左室收缩功能亢进,长期处于高心排血量及高负荷状态。     

Systolic and diastolic hypertension impair endothelial vasodilatory function in different types of vessels in the elderly: the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study

BACKGROUND: Endothelium-dependent vasodilation (EDV) is known to be impaired in middle-aged hypertensive individuals, but less is known regarding hypertension in the elderly. OBJECTIVE: In the Prospective Study of the Vasculature in Uppsala Seniors (PIVUS) study, different techniques to evaluate EDV in resistance and conduit arteries were applied in elderly subjects and were related to the type of hypertension. DESIGN AND METHODS: In this population-based study, 1016 subjects aged 70 years were evaluated by the invasive forearm technique with acetylcholine (EDV), brachial artery ultrasound to assess flow-mediated dilatation (FMD) and pulse wave analysis with a beta-2 receptor agonist challenge, terbutaline. Those without antihypertensive treatment were divided into three groups: normotensive individuals (n = 256), and those with isolated systolic hypertension (n = 309) or combined systolic/diastolic hypertension (n = 79). RESULTS: Compared with normotensive individuals, EDV was reduced in those with combined systolic/diastolic hypertension only (P = 0.0019), whereas FMD was mainly reduced in those with isolated systolic hypertension (P = 0.013). Furthermore, in regression analysis, EDV was related to diastolic blood pressure only (r = -0.10, P = 0.017), whereas FMD was mainly related to systolic blood pressure (r = -0.13, P = 0.0023). The pulse wave-based method to analyse vasoreactivity was not consistently affected by hypertension. CONCLUSIONS: In elderly subjects, systolic hypertension mainly impairs conduit artery endothelial vasodilatory function, whereas diastolic hypertension mainly induces dysfunction in resistance arteries.     

缬沙坦治疗老年人单纯收缩期高血压的临床研究

目的研究缬沙坦对老年单纯收缩期高血压患者的降压作用及其对心血管系统的影响。方法49例老年单纯收缩期高血压患者,平均年龄（76.2±6.0）岁。受试对象均给予缬沙坦80～160mg或加用利尿剂氢氯噻嗪12.5mg治疗,疗程为12个月。治疗前后分别作诊室随测血压、24h动态血压监测、心脏超声检查、颈动脉、椎动脉、肾动脉超声和眼动脉超声检查。结果（1）缬沙坦治疗12个月以后,患者诊室随测收缩压显著下降（P〈0.05）;但24h总体血压、白天及夜间血压均无明显变化;（2）左室短轴缩短率显著升高（P〈0.001）;（3）颈动脉、椎动脉和肾动脉搏动指数（PI）、阻力指数（RI）显著下降（P〈0.05）,肾段间动脉及眼动脉PI及RI无明显变化。结论缬沙坦可有效控制老年单纯收缩期高血压患者诊室血压,并改善其左室收缩功能和动脉顺应性。     

贝那普利联合阿托伐他汀对老年高血压患者血管内皮舒张功能及高敏C反应蛋白、胰岛素水平改善的研究

目的观察贝那普利联合阿托伐他汀对老年高血压的降压作用及对高敏C反应蛋白、血管内皮舒张功能和胰岛素抵抗的改善作用。方法选择1-2级老年高血压患者84例,随机分为贝那普利组和贝那普利阿托伐他汀联合组,分别治疗12周,每周测血压2次,观察2组患者治疗前后血压、血脂、胰岛素敏感性的变化,以及高敏C反应蛋白、血管内皮依赖性舒张功能的变化。结果治疗12周后,除联合组显示降脂外,2组在降低血压、改善胰岛素抵抗、降低高敏C反应蛋白、改善内皮依赖性血管舒张功能方面,治疗后较治疗前差异均有统计学意义（P〈0.01）,但联合组治疗后较贝那普利组治疗后改善更显著（P〈0.01）。结论贝那普利和阿托伐他汀联合应用能有效降低1~2级老年高血压患者的血压,降低高敏C反应蛋白水平、改善胰岛素抵抗和内皮依赖性血管舒张功能。     

辛伐他汀对高血压合并动脉粥样硬化患者内皮功能的影响

目的探讨合并动脉粥样硬化的高血压患者内皮舒张功能与颈动脉硬化、hsCRP的关系以及辛伐他汀的干预作用。方法选取46例合并颈动脉斑块的高血压患者(研究组)和20例无颈动脉斑块的高血压患者(对照组),采用彩色多普勒超声检查颈动脉内膜中层厚度(IMT)、颈动脉斑块积分、血管内皮依赖性舒张功能(FMD)测定血超敏C反应蛋白(hsCRP)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、空腹血糖(FBG)等,研究组予以辛伐他汀20mg/晚口服,12周后复查上述指标。结果两组比较,研究组FMD低于对照组(7.6±1.9%vs9.7±2.2%),而IMT(1.32±0.51 vs 0.62±0.42mm)、hsCRP(5.81±1.62 vs 2.42±1.32mg/L)值高于对照组,差异有显著性(P<0.05);研究组辛伐他汀治疗后显著改善FMD(7.6±1.9%vs 10.5±2.6%),减低IMT、颈动脉斑块积分和hsCRP,分别为1.32±0.51 vs 1.13±0.32mm、6.85±0.61 vs 4.67±0.62mm和5.81±1.62 vs 3.03±1.41mg/L,P<0.05;相关分析示FMD与IMT(r=-0.53)、hsCRP(r=-0.45)、SBP(r=-0.36)、TC(r=-0.29)负相关(P<0.05)。结论合并动脉硬化的高血压患者内皮功能障碍较重,且内皮功能与多种心血管危险因素成负相关,辛伐他汀可以改善内皮功能,稳定动脉斑块。