代谢综合征对原发性高血压患者颈动脉硬化的影响研究

目的 探讨代谢综合征(MS)对原发性高血压(EH)患者颈动脉内膜中层厚度(IMT)及动脉硬化程度的影响.方法 入选EH患者66例,分为MS组(EH+MS,31例)和单纯EH组(35例),另选取健康体检中心对照30名,测定体质量指数(BMI)、收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、总胆固醇(TC)、甘油...     

螺内酯对伴左心室肥厚的原发性高血压患者心肌胶原纤维代谢的影响

目的观察在常规抗高血压治疗的基础上联合应用螺内酯对伴左心室肥厚的原发性高血压（EH）患者血清Ⅰ型前胶原羧基端肽（PICP）、Ⅲ型前胶原氨基端肽（PⅢNP）和左心室质量指数（LVMI）的改变，了解螺内酯对EH患者心肌胶原纤维代谢的影响。方法71例伴左心室肥厚的EH患者随机分为2组。常规治疗组35例，接受钙离子阻滞剂、13受体阻滞剂、ACEI和抗血小板药物等常规药物治疗。螺内酯组36例，在常规药物治疗基础上联合应用螺内酯。2组的治疗时间均为24周。测量治疗前及治疗24周时血清PICP、PⅢNP和LVMI。33例健康人作为对照组。结果与对照组比较，常规治疗组和螺内酯组治疗前的PICP、PⅢNP和LVMI均明显增高，差异均有显著性（P〈0．01）。常规治疗组和螺内酯组治疗后与治疗前比较PICP、PⅢNP和LVMI均明显下降（P〈0．05和0．01），但螺内酯组下降更为明显，各指标差异均有显著性（P〈0．05）。在观察期间，常规治疗组和螺内酯组患者血钠、血氯、血肌酐和丙氨酸氨基转移酶水平均无明显变化。结论在常规抗高血压治疗的基础上联合应用螺内酯能进一步降低伴左心室肥厚的EH患者血清PICP和PⅢNP水平以及LVMI，副作用轻，是安全、有效、更理想的高血压治疗方法。     

缬沙坦长期治疗原发性高血压病人的安全性和疗效

目的 :评估缬沙坦长期治疗原发性高血压的安全性与疗效。方法 :门诊轻、中度高血压的病人3 2例 (男性 2 3例 ,女性 9例 ,年龄 5 1a±s 9a) ,服用缬沙坦 80mg·d-1,wk 4后血压控制不满意者加量至 1 60mg·d-1,共治疗 2 4wk。结果 :舒张压下降程度在治疗后wk 4,8,1 6,2 4末分别为 :1 .6kPa±0 .9kPa,2 .0kPa± 0 .8kPa,2 .1kPa± 1 .0kPa,1 .8kPa± 0 .8kPa,较治疗前差异均有非常显著意义 (P<0 .0 1 )。wk 4,2 4治疗有效率分别为 78%与 75% (P >0 .0 5 )。未见干咳发生 ,不良反应少 ,耐受性良好。结论 :缬沙坦长期治疗轻、中度原发性高血压安全有效     

Magnesium depletion in patients on long-term chlorthalidone therapy for essential hypertension

Summary Sixty patients were treated for 1 year for essential uncomplicated hypertension, 30 with beta-blockers alone (BB) and 30 with BB and chlorthalidone (CTD). BB did not affect serum K⁺ or Mg⁺⁺. In the BB-group there was a statistically significant trend towards retention of Mg⁺⁺ in a loading test, but the effect was clinically marginal. BB + CTD reduced serum K⁺ and Mg⁺⁺ and caused significant Mg⁺⁺ depletion, as shown by the Mg⁺⁺ loading test. All the effects were highly significant and were clinically important. The metabolic perturbations due to CTD are potentially dangerous and make this drug unattractive as first choice treatment for hypertension.     

厄贝沙坦联合氢氯噻嗪治疗原发性高血压病的临床观察

目的观察厄贝沙坦与氢氯噻嗪联合治疗原发性高血压病的临床疗效。方法 120例原发性高血压病患者,随机分为治疗组60例,给予厄贝沙坦联合氢氯噻嗪治疗;对照组60例,单用厄贝沙坦治疗。疗程均为12周。结果总有效率治疗组91.7%,对照组76.7%,两组比较差异有统计学意义（P〈0.05）。结论厄贝沙坦联合氢氯噻嗪治疗原发性高血压,疗效优于单用厄贝沙坦。     

Telmisartan/Hydrochlorothiazide: a review of its use as fixed-dose combinations in essential hypertension

Fixed-dose combinations of telmisartan and hydrochlorothiazide (HCTZ) [Micardis Plus((R)), Micardis((R)) HCT, PritorPlus((R))] are available in many countries for the treatment of patients with essential hypertension. Combining the angiotensin II receptor antagonist (angiotensin II receptor blocker [ARB]) telmisartan with the thiazide diuretic HCTZ provides antihypertensive therapy with complementary mechanisms of action. In the US and EU, telmisartan/HCTZ is approved for patients whose hypertension is not adequately controlled with telmisartan monotherapy; US labelling for the fixed-dose combination also includes inadequate control of blood pressure (BP) with HCTZ monotherapy.The antihypertensive efficacy of once-daily telmisartan/HCTZ has been demonstrated in several large, randomized trials in patients with stages 1 and 2 hypertension. The addition of HCTZ to telmisartan achieved significant reductions in BP in nonresponders to telmisartan monotherapy, and the antihypertensive efficacy of telmisartan/HCTZ was similar to or significantly greater than that of various comparator agents. Moreover, in studies that used ambulatory BP monitoring, telmisartan/HCTZ provided consistent 24-hour BP reductions throughout morning, daytime and night-time periods. The BP-lowering efficacy over the entire 24-hour dose administration interval is consistent with the pharmacokinetic profile of telmisartan, which has the longest elimination half-life among currently available ARBs and a unique chemical structure. Adverse events with telmisartan/HCTZ in clinical trials were typically mild and transient, and no unexpected events occurred that had not been previously reported with either telmisartan or HCTZ. Extensive tolerability data are available for telmisartan, in particular from the ONTARGET study, the largest clinical outcomes trial with an ARB. As such, fixed-dose combinations of telmisartan/HCTZ provide an effective, rational and generally well tolerated treatment option for the management of patients with hypertension.     

国产尼索地平片对轻中度原发性高血压近期和长期的疗效

目的:观察国产尼索地平片对轻、中度原发性高血压的疗效和不良反应.方法:采用自身对照开放试验.在268例舒张压(DBP)12.6～15.2 kPa之间的高血压患者中.经过7～10 d的安慰剂观察期后.给予国产尼索地平片10～20mg,bid.治疗6wk.结果:收缩压(SBP)和DBP分别从(21.6±2.3)和(13.7±0.9)kPa降至(18.6±1.6)和(11.7±1.2)kPa(P<0.005).显效率达75.37%(202/268).有效率达21.27%(57/268),总有效率达 96.63%.不良反应多为轻中度头痛、面红、踝部浮肿等.其中60例患者在接受单用尼索地平片6mo的长期治疗中.血压得到稳定的控制,SBP和DBP分别平均波动在18.1～18.8kPa和11.4～11.7kPa.结论:国产尼索地平片是一种有效且不良反应较轻的抗高血压药物.     

Acute and long-term hypotensive effects and plasma concentrations of nifedipine in patients with essential hypertension

Summary A double-blind, cross-over study in 16 patients with essential hypertension was carried out, to evaluate any possible interference by indomethacin, a known prostaglandin-synthetase inhibitor, with the antihypertensive effect of oxprenolol, a non-selective beta-adrenoceptor blocking agent. Both indomethacin and oxprenolol, as well as the two drugs combined, inhibited plasma renin activity; no change was found in urinary sodium excretion or body weight. Oxprenolol alone caused a highly significant decrease in the systolic (–10.4 mmHg,p<0.001), diastolic (–7.4 mmHg,p<0.001) and mean (–7.7 mmHg,p<0.01) blood pressures, whereas indomethacin did not influence blood pressure. When the two drugs were given in combination, blood pressure decreased (systolic: –5.9 mmHg; diastolic: –4.0 mmHg; mean: –4.6 mmHg), but the changes induced in blood pressure were reduced by about 50% when compared with those in the oxprenolol alone period. The data show that indomethacin seems to interfere with the antihypertensive effect of oxprenolol, by an action which may be due to the inhibition of prostaglandin synthesis.     

Nicardipine versus nifedipine: multicentre controlled trial in essential hypertension

Ninety-five hypertensive outpatients of both sexes, aged 23 to 65 years with diastolic blood pressures above 105 but below 120 mmHg (greater than 14.0 but less than 16.0 kPa), after one week on a placebo were randomly assigned either to nicardipine plus a placebo (40 mg/day - 48 patients) or nifedipine sustained-release plus a placebo (20 mg/day - 47 patients) for an additional six weeks. The study groups were homogeneous and comparable. After the run-in period the average blood pressure was 181 +/- 17/116 +/- 9 mmHg (24.1 +/- 2.3/15.5 +/- 1.2 kPa) in the nicardipine and 177 +/- 22/116 +/- 9 mmHg (23.6 +/- 2.9/15.5 +/- 1.2 kPa) in the nifedipine group (p greater than 0.10). In the acute oral test (nicardipine 40 mg to all the subjects; blood pressure measured at 30 min intervals during two hours) almost identical hypotensive effects within and between groups were observed (mean arterial pressure decrease of 11%, after 120 min; p less than 0.05). At the end of this trial blood pressure decreased further to 152 +/- 12/94 +/- 11 mgHg (20.3 +/- 1.6/12.5 +/- 1.5 kPa) (mean decrease of 20%; p less than 0.01) on nicardipine and to 145 +/- 12/94 +/- 11 mmHg (19.3 +/- 1.6/12.5 +/- 1.5 kPa) (mean decrease of 20%; p less than 0.01) on nifedipine. There were no significant changes in pulse rate. The observed between-group differences were trivial (p greater than 0.10). The laboratory data did not alter appreciably during this study. Three patients on nicardipine and four on nifedipine reported headache, palpitations and flushing: one patient on nicardipine and two on nifedipine were as a result excluded from the trial. It was concluded that nicardipine and nifedipine sustained-release were comparably effective and well-tolerated drugs suitable as the first-line agents for the management of mild to moderate hypertension.     

Metabolic effects of long-term angiotensin-converting enzyme inhibition with fosinopril in patients with essential hypertension: relationship to angiotensin-converting enzyme inhibition

Fifty patients with mild to moderate essential hypertension were randomized to receive either 20 mg fosinopril daily for 16 weeks or placebo for 4 weeks followed by 12 weeks of 50 mg atenolol daily. Prior to these 16 weeks there was a placebo wash-out period of 2–6 weeks. Blood pressure measurements, euglycaemic, hyperinsulinaemic glucose clamps, and intravenous glucose tolerance tests (IVGTT) were performed at baseline and after 4 and 16 weeks. Blood lipid status was evaluated at baseline and 16 weeks.The insulin sensitivity index (M/I) increased by 12% during the prolonged placebo period, and subsequently decreased by 12% during treatment with atenolol in that group. A post-hoc analysis of covariance indicated that the increase in insulin sensitivity during the initial 4 weeks may have been due to carry over effects from previous anti-hypertensive treatment. Fosinopril increased glucose disappearance during IVGTT at 4 and 16 weeks (k values 1.46 and 1.33 vs 1.10 at baseline) but had no effect on insulin sensitivity. The change in insulin sensitivity and serum triglycerides during treatment with fosinopril was related to angiotensin-converting enzyme inhibition in serum.In conclusion, carry-over effects from previous anti-hypertensive medication were indicated in this study, probably because of an insufficient wash-out period in many patients. Therefore, 4 weeks of placebo wash-out in all patients is advisable in this kind of investigation.     

Pharmacokinetics of ketanserin in patients with essential hypertension

Summary The pharmacokinetics of ketanserin and its main metabolite ketanserin-ol, and the antihypertensive effects of intravenous, single oral and chronic oral (40 mg once daily) administration of ketanserin, have been investigated in a single blind study of 10 patients with uncomplicated mild hypertension. Ketanserin had a terminal half-life of 29.2 h, a plasma clearance of 518 ml/min and a volume of distribution of 18.0 l/kg. Chronic oral intake of 40 mg ketanserin (tablet formulation) gave a peak concentration of unchanged ketanserin of 88 ng/ml after 1.1 h. Its absolute bioavailability was 48%.During chronic therapy the maximal concentration of ketanserin-ol was 208 ng/ml and its half-life of elimination was 35.0 h. As this metabolite can be oxidized back to ketanserin, it contributes to the prolonged half-life of unchanged ketanserin seen during chronic therapy.The blood pressure was reduced by approximately 15% by oral ketanserin. The maximal reduction in blood pressure coincided with the peak concentration of unchanged ketanserin. During chronic therapy with 40 mg once daily blood pressure was reduced over 24 h. The heart rate was slightly reduced and the cardiovascular responses and the plasma noradrenaline concentrations during isometric exercise were only slightly influenced by ketanserin therapy.Thus, unchanged ketanserin has a relatively long half-life during chronic oral therapy and its pharmacokinetics in middle-aged hypertensive patients is similar to that in normal young volunteers.     

厄贝沙坦氢氯噻嗪片治疗原发性高血压127例临床分析

目的 观察厄贝沙坦氢氯噻嗪片治疗原发性高血压的临床疗效.方法 选择符合标准的原发性高血压患者127例,随机分为A、B两组,A组65例,B组62例.A组口服厄贝沙坦150 mg氢氯噻嗪12.5 mg片开始,每日1次.B组口服厄贝沙坦片150 mg,每日1次.血压未达标者,2周后药量加倍.连续用药12周.观察两组降压疗效和...     

Enalapril versus captopril: a double-blind multicentre comparison in essential hypertension

A collective, multicentre (Ljubljana, Split, Zagreb) comparison of the antihypertensive effects between two angiotensin converting enzyme inhibitors (ACEI) captopril and enalapril was made in 69 hypertensives of both sexes, having a diastolic blood pressure (DBP), following two weeks on a placebo, of between 110 and 130 mm Hg (14.7 and 17.3 kPa). There were 35 patients on enalapril (20-40 mg), and 34 on captopril (50-100 mg). Both drugs under study decreased significantly the mean DBP already after the first week of ACEI treatment (p less than 0.001). By the end of the trial (9th week) captopril had decreased the DBP in the supine position from the initial 180.3 +/- 15.3/117.7 +/- 6.4 mm Hg to 151.6 +/- 11.1/96.8 +/- 7.2 mm Hg. Enalapril had lowered the DBP more efficiently: from 182.7 +/- 16.7/118.7 +/- 7.7 to 145.6 +/- 12.8/92.2 +/- 6.4 mm Hg (p less than 0.05). The average reduction in mean DBP was 16.9% on captopril, and 20.9% on enalapril. Low dose ACEI monotherapy (i.e. 50 mg and 20 mg) achieved DBP normalization in 11.8% on captopril and in 26.4% on enalapril (p less than 0.01). There were no significant heart rate changes. The laboratory results did not change appreciably and there were no relevant side-effects, although particular attention was paid to the expected adverse reactions, such as cough, ageusia or proteinuria. It is concluded that the ACEIs under study showed comparable effectiveness within the used dose range, enalapril being more potent, longer acting, and possibly safer.     

卡托普利与螺内酯联合用药方案治疗原发性高血压合并心力衰竭的临床观察

目的观察卡托普利与螺内酯联合用药方案治疗原发性高血压合并心力衰竭的临床效果。方法将96例原发性高血压合并心力衰竭患者随机分为观察组和对照组各48例。2组均给予基础治疗+地高辛+硝酸异山梨醇酯+呋塞米+卡托普利治疗,观察组在上述基础上加用螺内酯口服治疗。观察并比较2组治疗前后临床症状及血压、心功能改善情况。结果观察组总有效率为70.83%,高于对照组的58.33%,差异有统计学意义(P<0.05)。2组治疗后血压SBP、DBP、心率(HR)低于治疗前,心功能分级优于治疗前,左室射血分数高于治疗前;且观察组血压及心功能变化优于对照组,差异均有统计学意义(P<0.05和P<0.01)。结论卡托普利与螺内酯联合用药方案治疗原发性高血压合并心力衰竭的临床效果好,不良反应少。     

代谢综合征对高血压患者颈动脉内膜中层厚度及脉搏波速度的影响

目的 探讨代谢综合征(MS)对原发性高血压(EH)患者颈动脉内膜中层厚度(IMT)及臂踝脉搏波速度(baPWV)的影响.方法 入选EH患者328例,分MS组(EH+MS,156例)和非MS组(172例),测定体重指数(BMI)、腰围(WC)、收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、IMT以及baPWV,比较两组一般临床资料、IMT和baPWV的情况.结果 两组患者年龄、性别、高血压病程及血压水平无差异性;MS组BMI、WC、FPG、TC、TG、LDL-C明显高于非MS组,而HDL-C明显低于非MS组(P<0.05);MS组IMT和baPWV均明显高于非MS组(P<0.01);IMT与年龄、SBP、FPG、TG及baPWV与年龄、SBP、FPG均呈正相关.结论 MS对EH患者IMT和baPWV有显著影响,纠正代谢紊乱有助于针对性防治EH患者动脉粥样硬化.     

Withdrawal of guanfacine after long-term treatment in essential hypertension

Summary 1. Guanfacine (2–6 mg/day) a centrally acting antihypertensive drug, was effective in controlling blood pressure in 5 essential hypertensives and lowered plasma noradrenaline and urinary catecholamine excretion. 2. Withdrawal of guanfacine by blind substitution of identical placebo tablets under observation in hospital led to a gradual recovery of blood pressure over 2–4 days. 3. Salivary flow, which was reduced on guanfacine, returned to pretreatment levels by 2 days after withdrawal and significantly exceeded control for the next two days. 4. Urinary catecholamine excretion returned to pretreatment levels by 3 days but did not exceed control levels during the period of study. 5. Plasma noradrenaline returned gradually to pretreatment levels, and by day 4 significantly exceeded them. 6. No patient experienced symptoms suggesting catecholamine excess although four out of five reported a headache from the second day onwards. 7. Guanfacine, a centrally acting drug which pharmacologically resembles clonidine, has a slow offset of hypotensive effect over 2–3 days. Symptoms or biochemical evidence of catecholamine excess were not encountered within 48 h of withdrawal, possibly reflecting the longer duration of action and plasma half-life of guanfacine.     

Irbesartan/Hydrochlorothiazide : in moderate to severe hypertension

* The fixed-dose combination of irbesartan/hydrochlorothiazide (HCTZ) is approved in the US for use as initial therapy in patients who are likely to need multiple agents to achieve their blood pressure (BP) goals. * In a 12-week, randomized, double-blind, multicentre trial in 538 patients with moderate hypertension that was untreated or uncontrolled by monotherapy, the mean reduction from baseline in seated systolic BP (SeSBP) at week 8 (primary endpoint) was significantly greater with irbesartan/HCTZ than with either irbesartan or HCTZ as monotherapy. * In addition, the proportion of patients with moderate hypertension achieving controlled BP (SeSBP < 140 mmHg/seated diastolic BP [SeDBP] < 90 mmHg) at 12 weeks was significantly greater with irbesartan/HCTZ combination therapy than with irbesartan or HCTZ monotherapy. * In a 7-week, randomized, double-blind, multicentre trial in 697 patients with severe hypertension that was untreated or uncontrolled by monotherapy, a significantly greater proportion achieved a trough SeDBP of < 90 mmHg following 5 weeks of combination therapy with irbesartan/HCTZ compared with irbesartan monotherapy (primary endpoint). * Furthermore, the proportion of patients with severe hypertension achieving controlled BP of < 140/90 mmHg was significantly greater at all timepoints of the trial compared with irbesartan monotherapy. * Irbesartan/HCTZ combination therapy had a similar tolerability profile to irbesartan and HCTZ monotherapy. Most adverse events were of mild to moderate intensity.     

高血压病患者心血管功能变化特点的研究

目的 应用脉搏波检测技术探讨高血压病患者心血管功能的改变.方法 将106例高血压病患者按血压水平分为高血压病1、2、3级组,并将62例健康体检者设为正常对照组,分别检测各组心血管功能.结果 与正常对照组相比,高血压病组、高血压病1级组、高血压病2级组、高血压病3级组患者的每搏输出量[(114±25)ml、(117±24)ml、(111±21)ml、(112±31)ml比(95±25)ml]、心脏指数[(5.1±0.9)L/min·m2、(5.2±0.8)L/min·m2、(5.4 ±0.8)L/min·m2、(4.8 ±0.8)L/min·m2比(4.6±1.0)L/min·m2]、左心室舒张末压[(18±7)mm Hg(1mm Hg=0.133 kPa)、(15±6)mm Hg、(20±4)mm Hg、(20±8)mm Hg 比(12±4)mm Hg]、肺毛细血管楔嵌压[(18±7)mm Hg、(15±6)mm Hg、(20±4)mm Hg、(20±8)mm Hg比(12 ±4)mm Hg]、平均动脉压[(131±16)mm Hg、(119±6)mm Hg、(132±8)mm Hg、(151±13)mm Hg比(95±11)mm Hg]、肺动脉压[(30±11)mm Hg、(26±10)mm Hg、(33 ±7)mm Hg、(34±13)mm Hg比(20±7)mm Hg]、还原血黏度[(4.33±0.94)mPa·s、(4.10±0.85)mPa·s、(3.95±0.69)mPa·s、(5.08±0.90)mPa·s比(3.76±0.73)mPa·s]等均增高(P＜0.05);血管弹性扩张系数[(0.65±0.34)、(0.68±0.35)、(0.57±0.22)、(0.66±0.40)比(0.49±0.28)]、血管顺应度[(1.10±0.31)、(1.30±0.29)、(0.94±0.15)、(0.90±0.23)比(1.39±0.21)]较正常对照组明显降低(P＜0.01).结论 脉搏波检测技术作为临床心血管功能的检验手段之一,具有一定的应用价值.     

奥美沙坦酯与缬沙坦治疗轻中度原发性高血压的疗效与安全性比较

目的 评价奥美沙坦酯与缬沙坦(均为抗高血压药,血管紧张素Ⅱ受体拮抗剂)治疗轻中度原发性高血压的疗效和安全性比较.方法 人选240例轻、中度原发性高血压患者,按照1∶1随机分组,分别接受奥美沙坦酯20～40mg.d-1或缬沙坦80～160 mg·d-1治疗,共8周.结果 治疗4周后,奥美沙坦酯组与缬沙坦组SeDBP平均下降(10.58±6.82)mmHg及(9.38±7.16)mmHg;奥美沙坦组与缬沙坦组分别有60%及61.74%患者剂量加倍,加量有效率分别为52.22%及51.85%.治疗8周后,2组SeDBP平均下降(15.72±6.03)mmHg及(14.12±6.79)mmHg.治疗4周后,奥美沙坦酯组与缬沙坦组的药物不良反应发生率分别为3.33%及7.5%(P＞0.05).结论 每日1次口服奥美沙坦酯胶囊20～40 mg·d-1,能24 h平稳降压,其8周总有效率79.65%;与缬沙坦80～160 mg·d-1的降压疗效相近.2组药物不良反应发生率无显著差异.