中老年高血压患者动态血压的昼夜节律分析

目的 分析中老年高血压患者动态血压的昼夜节律性.方法 选取40~91岁的原发性高血压病人118 例进行24 h态血压监测,其中男性68 例,占57.6%;女性50 例,占42.4%.并将年龄分为中年（40~64岁）、老年（65~79岁）和高龄（80~91岁）三组.结果 男性24 h、白昼和夜间平均舒张压都高于女性,组间差异均有统计学意义,而收缩压组间比较,差异均无统计学意义.中年组、老年组和高龄组高血压病人收缩压随年龄组增高而上升,舒张压则表现为下降趋势.中年组、老年组和高龄组非杓型高血压检出率分别为65.1%、75.0%和93.5%,随着年龄组增高非杓型高血压检出率呈增高趋势（趋势χ2 =7.759,P〈0.01）.结论 高血压病人昼夜节律异常率随着年龄增加而增高,临床上应根据病人的昼夜节律特点制定个体化的治疗方案.     

硝苯地平缓释片对高血压昼夜节律的作用

本文用24h动态血压监测方法观察了硝苯地平缓释片对高血压病人血压昼夜节律的作用，结果表明，与硝苯地平片相比，硝苯地平缓释片能选择性降低非构型高血压病人的夜间高血压，而对构型的夜间血压无显著影响。认为硝苯地平缓释片有改善高血压昼夜节律的作用。     

血压昼夜节律与左室肥厚关系的研究

目的 探讨轻中度高血压患者左室肥厚与血压昼夜节律的关系。方法 对９１例轻中度高血压左室肥厚患者进行动态血压监测（ＡＢＰＭ）监测,根据监测结果将其分为两组：血压节律正常组（Ａ组）３５例,异常组（Ｂ组）５６例,将这两组患者ＡＢＰＭ和左室肥厚的参数进行比较。结果 Ｂ组比Ａ组有较高的２４ｈＳＢＰ、ｎＳＢＰ、ｎＤＢＰ、收缩压负荷以及明显的ＬＶＭＩ（Ｐ〈０．０５,Ｐ〈０．０１）。结论 轻中度高血压患者其异常血     

Gender differences in blood pressure and heart rate in spontaneously hypertensive and Wistar-Kyoto rats

1. In general, premenopausal women are known to have lower blood pressure than men and animal models have shown a similar sexual dimorphism. However, many studies in animals have been performed using anaesthetized or restrained models. Current experiments were conducted to investigate the relationships among resting heart rate, blood pressure and gender in conscious, unrestrained normotensive Wistar-Kyoto (WKY) rats and spontaneously hypertensive rats (SHR). 2. Biotelemetry transmitters were implanted in 6-month-old animals. Values for heart rate, diastolic blood pressure, systolic blood pressure and pulse pressure were recorded continuously at 10 min intervals after all animals recovered completely from surgery. 3. Normal circadian rhythms in heart rate were found in all rats, with no significant differences among the four groups; the circadian variation in blood pressure was evident in all groups, although much smaller. Heart rate was found to be higher in WKY female rats than in the other three groups. Male WKY rats, male SHR and female SHR had similar heart rates. Male SHR had significantly higher systolic and diastolic blood pressures than female SHR. Male and female WKY rats had similar diastolic blood pressure, but males had slightly higher systolic pressure than females. No significant difference in pulse pressure was found in WKY male and female rats. Male SHR showed significantly higher pulse pressure than female SHR at most times during the day. 4. In conclusion, these results indicate that hypertension is exacerbated in male SHR compared with females under conscious resting conditions and demonstrate that the higher heart rate observed in WKY female rats is not present in the SHR model.     

老年反杓型节律高血压患者的药物选择对血压控制及心脏重构的影响

目的观察老年反杓型血压节律者中,日间血压控制是否达标的影响因素、用药选择以及对心脏重构的影响。方法连续入选2016年1月至2019年1月在我院老年内科住院的年龄≥65岁的高血压患者,通过24小时动态血压监测(24 h ABPM)筛选出反杓型血压节律患者共300例,根据日间手测血压结果是否达标分为达标组148例和未达标组152例。比较2组患者的特征及药物使用的差异,通过超声心动图方法比较血压控制是否达标对心脏结构和功能的影响。结果2组日间手测血压比较,未达标组收缩压更高,而舒张压差异无统计学意义;ABPM结果显示,2组间除舒张压外,不同时段的平均收缩压和平均脉压之间差异均有统计学意义(均P<0.05)。2组患者中,年龄、性别、冠心病、外周血管疾病、肾功能不全共患病率、血脂水平之间差异均无统计学意义(均P>0.05);糖尿病共患病率、体重指数(BMI)、氮末端脑钠肽(NT-pro-BNP)水平在血压未达标组中明显高于达标组,差异均有统计学意义(均P<0.05)。药物治疗方面,绝大多数患者(272例,90.67%)为联合用药,钙离子拮抗剂、血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂(ACEI/ARB)以及α受体拮抗剂的应用比例差异均无统计学意义,而噻嗪类利尿剂和β受体阻滞剂的应用,在日间血压达标组较未达标组明显增多。应用超声心动图评估心脏结构功能,2组患者的左心室射血分数(LVEF)之间差异无统计学意义;室间隔厚度、左心室重量指数(left ventricular mass index,LVMI)、左心房内径、E/e’值在血压未达标组均高于达标组(均P<0.05)。结论在老年反杓型节律高血压患者中,噻嗪类利尿剂及β受体阻滞剂的应用更有利于血压降至目标值。血压控制未达标患者的NT-pro-BNP水平升高,且室间隔厚度、LVMI、左心房内径和E/e’值均明显升高,显示即使同为反杓型血压节律患者中,血压控制未达目标值对心脏重构的影响更加显著。     

Statistical evaluation of circadian blood pressure rhythm during isradipine long-term therapy

In this study, using the two-step truncated Fourier series with four harmonics, we analysed the diurnal blood pressure profile in 13 mild-moderate essential hypertensive patients during isradipine long-term therapy. Circadian parameters such as the amplitudes and phases of the four harmonics and the overall amplitude and phase were obtained from the model. The total duration of the study was 26 weeks. Ambulatory blood pressure was measured at 15-min, intervals using a Takeda TM 2420 device after 2 weeks of placebo and after 6 and 26 weeks of isradipine (5 mg daily) respectively. After 6 and 26 weeks therapy the blood pressure values showed a significant decrease, although the daily blood pressure curves obtained from Fourier analysis showed that the circadian rhythm was not altered by isradipine treatment. Both the night/day differences and the overall amplitude/acrophases were statistically significant at 0,6 and 26 weeks. According the nocturnal blood pressure fall, we found that long-term therapy with isradipine increased the number of patients with nocturnal blood pressure fall and reducing the early morning blood pressure rise.In conclusion, the two-step method Fourier analysis represents a novel and useful statistical approach to evaluate the presence of a significant diurnal blood pressure rhythm and to provide the circadian parameters of the 24-h blood pressure profile during pharmacological therapy.     

高血压患者昼夜血压节律与无症状性心肌缺血的相关性研究

目的：研究高血压患者昼夜血压节律与无症状性心肌缺血的相关性。方法选取2012年3月—2014年3月就诊的164例原发性高血压患者为研究对象,采用问卷调查和临床检查的方式收集患者的信息,通过单因素分析和Logistic回归分析患者昼夜血压节律与无症状性心肌缺血的关系。结果在调整了年龄、文化水平、婚姻状况、吸烟状况、饮酒状况、体质指数（ BMI）、收缩压水平、舒张压水平以及血糖水平等因素后,二元Logistic回归分析结果显示相比于杓型的患者,昼夜节律为反杓型、非杓型和超杓型的患者患有心肌缺血的风险都明显升高,其OR值和95％CI分别为1．38（1．15～1．61）、1．24（1．09～1．39）和1．57（1．36～1．78）。结论对于原发性高血压病的患者,预防并发心肌缺血的关键除控制血压外,还应重视血压昼夜节律是否异常。     

比索洛尔不同服用时间对慢性心衰患者心率和神经内分泌因子昼夜节律的影响

目的 探讨比索洛尔不同服用时间对慢性心衰患者心率和神经内分泌因子昼夜节律的影响。方法 入选96例慢性心衰患者和50例健康者分别作为研究组与对照组,同时根据比索洛尔不同服药时间将研究组分成日间服药组（7：00~8：00）与夜间服药组（19：00~20：00）,每组48例。比较研究组与对照组间的动态心电图结果、血浆去甲肾上腺素（NE）、血管紧张素Ⅱ（AngⅡ）、醛固酮及肾上腺素水平,以及2个亚组治疗前后上述指标的变化。结果 与对照组比较,研究组24 h心率明显加快,差异有统计学意义（P<0.05）;夜昼心率比值增大,非杓型心率比例明显增加,差异有统计学意义（P<0.05）;NE、AngⅡ、醛固酮、肾上腺素水平明显升高,差异有统计学意义（P<0.05）,研究组神经内分泌因子不存在昼夜节律。与治疗前比较,日间服药组和夜间服药组24 h心率均明显减慢,差异有统计学意义（P<0.05）;夜昼心率比值下降,非杓型心率比例降低,NE、AngⅡ、醛固酮、肾上腺素水平均明显降低,组内差异均有统计学意义（P<0.05）;组间比较均无明显差异,且均未恢复昼夜节律。结论 慢性心衰患者心率和神经内分泌因子的昼夜节律消失,夜间服用比索洛尔较日间服用并不会明显恢复其心率和神经内分泌因子的昼夜节律。     

Endothelin ETB receptors contribute to sex differences in blood pressure elevation in angiotensin II hypertensive rats on a high‐salt diet

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比索洛尔联合大黄灌服对大鼠血压昼夜节律及心肌组织内皮系统的影响

目的 观察比索洛尔联用中药大黄治疗前后大鼠血压、一氧化氮(NO)和内皮素(ET)的时间生物学特征的变化.方法 健康雄性SD大鼠96只,随机分为组Ⅰ(对照组,给予安慰剂)、组Ⅱ(灌服比索洛尔组,3 mg·kg-1·d-1)和组Ⅲ(300 mg·kg-1·d-1),每组32只.每大组又随机分为4小组,每组8只.服药前1 d,分别于同日内不同时间点(02:00,08:00,14:00,20:00)用鼠尾血压仪测各大组中各一小组大鼠收缩压.4周后,分别于同日内不同时间点(02:00,08:00,14:00,20:00)用鼠尾血压仪测各大组中各一小组大鼠收缩压并处死,留取心肌组织,匀浆后取上清液,分别采用放免法和硝酸还原法检测血中ET-1、NO的水平.结果 与组Ⅰ比较,组Ⅱ、组Ⅲ在服药4周后,收缩压均下降,心肌组织内ET-1浓度降低,心肌组织NO明显上升,与组Ⅰ比较差异均有统计学意义(P<0.05).经治疗后组Ⅲ的血压较组Ⅱ下降更明显,差异有统计学意义(P<0.05),组Ⅲ的心肌组织ET-1浓度较组Ⅱ低,差异有统计学意义(P<0.05),组Ⅲ的心肌组织NO较组Ⅱ上升更显著,差异有统计学意义(P<0.05).余弦拟合曲线的特征值分析:组Ⅱ、组Ⅲ治疗后收缩压中值、心肌组织中ET-1曲线的中值较组Ⅰ减小,心肌组织中NO曲线的中值较组Ⅰ增加,差异均有统计学意义(P<0.05),但组Ⅱ各指标的变化幅度较组Ⅲ小,差异有统计学意义(P<0.05).组Ⅱ、组Ⅲ大鼠治疗后收缩压、心肌组织ET-1和NO曲线的振幅、峰值相位、峰值时间均发生不同程度的位移(P<0.05).结论 比索洛尔联合大黄具有协同作用,能更明显降低血压,同时对于维持血压昼夜节律、改善组织内皮系统功能有明显影响.     

Apparent racial difference in response to angiotensin I infusion

Summary Angiotensin I was infused into 16 healthy volunteers, 8 blacks and 8 whites with diastolic blood pressures below 75 mm Hg and the infusion rate increased at 3 min intervals until a diastolic blood pressure of equal to or greater than 95 mm Hg was achieved.Blacks exhibited a significantly greater angiotensin I sensitivity needing 1.8 g/min as opposed to 3.9 g/min in whites to achieve the target blood pressure.Plasma renin activities were similar in the two groups, but blacks had significantly higher urinary sodium values than whites, 223 mmol per 24 h as compared to 121 mmol per 24 h.It is concluded that the differences in response could be largely due to differences in dietary sodium intake. These factors need to be carefully considered when using angiotensin I infusion as a pharmacodynamic model for studying the effects of ACE inhibitors.     

Ginkgo biloba extract attenuates the development of hypertension in deoxycorticosterone acetate-salt hypertensive rats

1. We examined the effects of Ginkgo biloba extract (GBE) on the development of hypertension, platelet activation and renal dysfunction in deoxycorticosterone acetate (DOCA)-salt hypertensive rats. Both DOCA-salt hypertensive rats and normotensive rats were fed a 2% GBE diet for 20 days. Blood pressure (BP) was measured by two methods, namely by the tail-cuff and telemetry methods. 2. Development of hypertension was attenuated in rats fed a 2% GBE diet. In addition, an increase in heart weight, an indicator of sustained high BP, was inhibited significantly by feeding of the GBE diet. 3. Decreases in 5-hydroxytryptamine content in platelets, a marker of platelet activation in vivo associated with hypertension, were also prevented by feeding of the GBE diet. Ginkgo biloba extract itself did not inhibit ADP- and collagen-induced platelet aggregation examined in vitro. Feeding of the GBE diet tended to inhibit increases in plasma urea nitrogen due to hypertension. 4. The telemetry study demonstrated that BP and heart rate (HR) showed a clear circadian rhythm and the antihypertensive effect of GBE was prominent in the daytime, a resting period for rats. This anti-hypertensive effect of GBE was not detected in normotensive rats. In contrast, the inhibitory effect of GBE on HR was independent of time and was observed in both normotensive and hypertensive rats. 5. These results indicate that GBE has an anti-hypertensive and bradycardiac action, which are time dependent and independent, respectively. Thus, it appears that the chronopharmacological action of GBE may be ascribed not to pharmacokinetic factors, but rather to a circadian susceptibility rhythm to GBE in DOCA-salt hypertensive rats.     

行为转变理论对高血压前期患者血压昼夜节律变化的影响

目的 探讨行为转变理论(TTM)对高血压前期患者血压昼夜节律变化的影响效果.方法 选择120例高血压前期患者为研究对象,按时间顺序分为对照组和干预组各60例,对照组按常规健康指导,干预组按照行为转变理论模式的不同阶段采取相应干预措施.干预后测评患者的动态血压特点、血压昼夜节律变化、晨峰与昼夜节律出现频率.结果 干预后干预组非杓型患者仅有1l例,10例出现晨峰现象,41例出现血压昼夜节律变化,与对照组比较差异均有统计学意义(均P＜0.01).结论 行为转变理论对高血压前期患者血压昼夜节律变化有明显效果,利于血压的控制.     

高血压患者中活动与血压和心率的相关性探讨

目的 了解高血压个体中活动与收缩压、舒张压以及心率的相关性,同时了解高血压群体中活动对收缩压、舒张压以及心率的影响.方法 使用动态血压监测仪对42例高血压患者和21例健康志愿者进行24 h的动态血压监测,每30 min测量一次血压,同时使用静息活动监测仪对患者日常活动进行监测,把血压测量前5 min的平均活动值与血压值和心率值进行相关性分析,从而了解高血压个体和群体中活动与血压和心率的关系.结果 对多数高血压个体而言,活动与血压和心率成正相关,但是相关的程度,个体间相差很大;在高血压群体中,白天活动以及24 h的活动与血压和心率间均有显著相关性.结论 静息活动监测仪监测的日常活动对高血压患者的收缩压、舒张压以及心率均有重要影响.     

Frequent ventricular premature beats increase blood pressure variability in rats

INTRODUCTIONBlood pressure variability (BPV) is increased inseveral conditions, including hypertension[1-3], aging[4],diabetes[5,6], spinal cord injury[7], and alcohol consump-tion[8], and linked with the severity of the underlyingdiseases, such as hypertension[1,2]. Causes for high BPVare manifold and varied in different conditions. It iswell known that arterial baroreflex is important in thestabilization of blood pressure (BP), and interruption ofarterial baroreflex by sinoaortic d…     

Cardiac angiotensin II receptors are downregulated by chronic angiotensin II infusion in rats

We studied the effect of chronic (7 days) angiotensin II infusion in a subpressor (200 ng/kg per minute) dose on angiotensin II receptors in the left ventricle in rats. Infusion of angiotensin II caused an elevation in systolic blood pressure after 3 days, usually to values of about 150 mmHg, and the increase continued during the drug administration. The number of angiotensin II type 1 and angiotensin II type 2 receptors was significantly decreased by 20-30% in the angiotensin II-infused left ventricular membranes without affecting the affinity. Thus, these data suggest that angiotensin II may regulate the number of its own receptors in rat left ventricles.     

原发性高血压患者213例动态血压监测分析

目的 分析原发性高血压患者24 h动态血压监测（ABPM）变化规律及临床意义。方法 2011年1月至2013年9月对213例原发性高血压患者进行24 h ABPM,观察其24 h平均收缩压（24 h MSP）、24 h平均舒张压（24 h MDP）、白昼平均收缩压（dMSP）、白昼平均舒张压（dMDP）、夜间平均收缩压（nMSP）、夜间平均舒张压（nMDP）、夜间血压下降率。结果 213例原发性高血压患者中100例为杓型血压,78例为非杓型血压,35例为反杓型血压。随年龄增长反杓型血压发生率明显升高,其中老年组（≥60岁）患者反杓型血压发生率较中青年组（＜60岁）高,而老年组患者杓型血压发生率较中青年组患者低,差异均有统计学意义（P＜0.05）。不同年龄段女性患者反杓型血压发生率较男性高,但二者比较,差异均无统计学意义（P＞0.05）。结论 原发性高血压患者平时血压波动情况通过24 h ABPM能更加真实地反映出来。随着年龄的增长,原发性高血压患者24 h动态血压昼夜节律异常发生率不断增高,提示增龄可明确影响到原发性高血压患者的血压节律变化,应尽早进行干预治疗。     

血灵侧脑室注射对大鼠动脉血压和心率的影响

目的：血灵是降血压中药制剂。本实验探讨血灵对心血管中枢的作用及其机理。方法：将药物微量地注射入麻醉大鼠侧脑室,观察注药后６０ｍｉｎ内血压和心率的变化。结果：（１）侧脑室注射血灵（１０ｍｇ／２０ｕｌ）引起动脉血压明显升高,２５ｍｉｎ时达到峰值,增幅为２６．５９％;心率增加,增幅为１５．７６％,侧脑室注射相同窖的ＮＳ。血压和心率无明显影响。（２）血压升高与侧脑室注射血灵的剂量呈明显的剂量－效应关系。（     

下丘脑前核微量注射褪黑素及其受体拮抗剂对大鼠血压和心率的影响

目的：研究下丘脑前核微量注射褪黑素及其受体拮抗剂对正常血压和应激性高血压大鼠心血管活动的影响。方法：微量注射褪黑色及其受体拮抗剂至下丘脑前区前核,记录血压、平均动脉压和心率。结果：微量注射褪黑素可降低平均动脉压,其竞争性ML1受体拮抗剂luzindole可完全阻断褪黑素的降压反应,而其ML2受体拮抗剂prazosin不能阻断褪黑素的降压反应。结论：褪黑素为一种降压因子,其降压反应主要通过激活ML1受体,而不是ML2受体来介导的。下丘脑前核是褪黑素影响心血管活动的重要中枢闰。