老年高血压患者血脂水平与血压变异性的相关性

目的:探讨老年高血压患者血脂水平与血压变异性的关系.方法:将300例老年高血压患者根据血脂水平检测结果分为血脂异常组和血脂正常组,对两组患者进行24 h动态血压监测,根据监测结果分析老年高血压患者血脂水平与血压变异性的相关性.结果:两组间一般资料比较差异无显著性(P＞0.05);血脂异常组24 h收缩压、24 h舒张压、24 h平均脉压差、白昼平均脉压差、夜间平均脉压差、白昼收缩压、夜间收缩压、24 h收缩压变异性、24 h舒张压变异性均显著高于血脂正常组(P＜0.05或0.01).结论:老年高血压患者血脂水平与血压变异性呈显著正相关,临床上在降压治疗的同时应进一步关注血脂水平的变化.     

血压变异性研究进展

血压变异性（BPV）是描述血压在一段时间内波动程度的量化指标,按照评价时间的长短分为短时血压变异和长时血压变异,各自受到不同因素的影响。获取血压变异信息的方式也不尽相同,24小时无创动态血压监测、家庭自测血压和长期诊室随访血压测定是常用的方法。临床研究显示,高血压患者的长时血压变异大小主要与患者的动脉血管结构与功能有关,且血压变异增大与卒中等心血管终点事件相关。近年来,有关BPV的研究受到重视,BPV的临床意义及应用、与高血压患者靶器官损害和预后的关系合理的临床评价指标等热点问题尚存争议。     

老年男性动脉硬化血压波动与脑梗死发生的关系

目的 探讨血压波动对老年男性脑梗死发生的影响.方法 1527例患有动脉硬化的老年(年龄＞65岁)男性患者,所有患者监测动态血压,根据有无脑梗死将入选患者分为2组:脑梗死组(607例)和非脑梗死组(920例),用数学平滑曲线方法先将每一个体24 h血压数据进行分析,再描绘出一条适合个体血压变化趋势的曲线,计算实际血压值与该趋势曲线相应位置所形成差值的标准差即为血压波动值,然后比较2组血压波动的情况.结果 脑梗死组中24 h的收缩压波动值明显高于非脑梗死组[(8.4±2.2)与(8.0±2.0)mm Hg,t=-2.909,P＜0.01];其中自昼收缩压血压波动明显升高[(8.2±2.2)与(7.8±2.1)mm Hg,t=-2.969,P＜0.01];而夜间收缩压波动2组差异无统计学意义[(8.9±3.9)与(8.7±3.7)mm Hg,P＞0.05];各阶段舒张期血压波动差异无统计学意义[24 h舒张压波动值(5.5±3.8)与(5.5±1.5)mm Hg,P＞0.05;白昼舒张压波动值(5.4±1.5)与(5.3±1.4)mm Hg,P＞0.05;夜间舒张压波动值(6.1±2.7)与(6.1±2.6)mm Hg,P＞0.05].结论 在老年男性动脉硬化相关疾病患者中,脑梗死的发生与白昼收缩压的波动密切相关,而与夜间收缩压和舒张压波动无关.

Abstract：

Objective , To investigate the influence of blood pressure variability on cerebral infarction in older men. Methods Ambulatory blood pressure was measured in 1527 elderly men ( older than 65 yrs) with atherosclerosis. All cases were divided into 2 groups: Six hundred and seven patients with cerebral infarction ( group A)and 920 patients without cerebral infarction ( group B). Smooth curve method was used to analyze each patient's ambulatory blood pressure data and the trend of each patient's blood pressure curve was portrayed. The differences between the actual blood pressure and the blood pressure on the curve was defined as blood pressure variability,and the blood pressure variability between the 2 groups was compared. Results The systolic blood pressure variability in 24 hours in group A was significantly higher than that in group B( [8.4'±2. 2]mm Hg vs [ 8.0 ± 2. 0 ] mm Hg, P ＜ 0. 01 ), especially for the systolic blood pressure variability in daytime( [ 8. 2 ± 2. 2 ] mm Hg vs [ 7. 8 ± 2. 1 ] mm Hg, P ＜ 0. 01 ). However, the systolic blood pressure variability at night was not significantly different between the 2 groups( [ 8.9 ± 3. 9 ] mm Hg vs [ 8. 7 ± 3.7 ] mm Hg,P ＞ 0. 05 ). There were no significant difference between the diastolic blood pressure of 24 hours( [5. 5 ± 3.8 ] mm Hg vs [5.5 ± 1.5 ]mm Hg,P ＞0. 05),during daytime([5.4 ± 1.5]mm Hg vs [5.3 ± 1.4] mm Hg,P ＞0.05)and nighttime ( [ 6. 1 ± 2.7 ] mm Hg vs [ 6. 1 ± 2. 6 ] mm Hg, P ＞ 0. 05 ). Conclusion In elderly men with atherosclerosis,cerebral infarction was closely related to systolic blood pressure variability,but independent of nighttime systolic blood pressure and diastolic blood pressure variability.     

老年高血压病的不同血压参数变异度与左室肥厚的关系

目的探讨老年高血压患者动态血压各参数变异度及脉压与左室肥厚的关系。方法采用动态血压、超声心动图检查 82例年龄大于 60岁的原发性高血压患者 ,其中 5 1例无左室肥厚 ,31例有左室肥厚 ,对两组动态血压参数进行组间比较及昼夜间比较 ,并对各参数与左室质量指数 ( L VMI)进行相关性分析。结果 1昼、夜收缩压水平、脉压与 LVMI呈强相关 ,左室肥厚组的收缩压、舒张压水平及脉压明显高于无左室肥厚组 ;2两组之间血压变异无差异 ;3所有病例收缩压变异大于舒张压变异 ,收缩压变异白昼大于夜间 ,而昼夜间舒张压变异、脉压水平改变不明显。结论老年高血压患者左室肥厚与血压变异相关性较小 ,主要与收缩压水平与脉压水平相关 ,老年高血压患者 2 4小时舒张压变异与脉压水平处于相对恒定的水平 ,脉压可能是预测老年高血压性左室肥厚的一个简便易行的指标。     

Stroke and blood pressure variability

Sleep apnoea is associated with increased cardiovascular risk. Sleep apnoea is common after stroke and associated with increased blood pressure variability as described by Turkington and co-workers in this issue of Clinical Science. Both sleep apnoea and blood pressure variability confer a poor prognosis after stroke and are potentially treatable. Many studies of CPAP (continuous positive airway pressure) demonstrate decreases in cardiovascular risk markers in other patient groups. Although difficult to apply in these patients in the short term, CPAP has some potential benefits in medium-term rehabilitation and secondary prevention following stroke, which warrants further study.     

老年单纯收缩期高血压患者血压变异性与左心室肥厚的关系

目的：研究老年单纯收缩期高血压患者血压变异性与左心室肥厚（LVHC）的关系,。方法：对31例老年收缩期高血压患者和24例老年正常血压组,分别进行动态血压测定,计算出平均血压、24小时、白天、夜间收缩压和舒张压变异性,超声心动图测量左室内径、室间厚度、左室后壁厚度、计算出左室重量指数（LVMI）。结果：老年收缩期高血压组血压变异性,LVM和LVMI大于老年正常血压组,结论血压变异性和平均血压水平与左室肥厚有关。     

强化阿托伐他汀治疗对老年高血压患者血压变异性的影响

目的 探讨强化阿托伐他汀治疗对老年高血压患者血压变异性的影响.方法 入选河北省人民医院老年病科门诊就诊或住院的高血压病Ⅱ级以上的老年患者.所有入选患者随机分为标准治疗组(标准组,n =71)和强化治疗组(强化组,n =67),两组均服用左旋氨氯地平2.5～5 mg,每日1次,或加贝那普利5～10 mg,每日1次,将患者的血压控制在140/90 mmHg(1 mmHg=0.133 kPa)以下.标准组加服阿托伐他汀20 mg 1次/晚,强化组应用阿托伐他汀40 mg 1/晚.入选时记录两组患者临床基线资料.治疗前和治疗后8周,测定高敏C反应蛋白(hs-CRP)和同型半胱氨酸(Hcy)水平,比较两组患者治疗前和治疗后8周肝肾功能和血脂水平变化.所有患者均于入选时和治疗后8周分别进行动态血压监测,记录和比较相关参数.结果 两组患者临床基线资料、基线血压和血压变异性差异均无统计学意义(P＞0.05).经过8周治疗,标准组患者夜间SBP、晨峰SBP、白昼DBP、夜间DBP以及晨峰DBP均较治疗前明显下降(均P＜0.05),强化组患者SBP、DBP以及晨峰血压水平均显著下降(均P＜0.05),且强化组患者24 hSBP、白昼SBP、夜间SBP、白昼DBP和夜间DBP水平明显低于标准组(均P＜0.05).经过8周治疗,标准组患者24 hSBPV、白昼SBPV、24 hDBPV、白昼DBPV较治疗前明显改善,强化组患者24 hSBPV、白昼SBPV、夜间SBPV、24 hDBPV、白昼DBPV较治疗前显著改善(均P＜0.05).与标准组相比,强化组患者白昼SBPV和DBPV改善更加明显(均P ＜0.05).治疗8周后,两组患者血清hs-CRP和Hcy水平均降低(均P＜0.05),强化组hs-CRP水平下降更加明显(P ＜0.05).两组患者治疗后均出现丙氨酸转氨酶和天冬氨酸转氨酶一定水平的升高,但是升高幅度无临床意义.结论 强化他汀治疗可以在一定程度上提高老年高血压患者降压效果,改善血压变异性.     

Intra-individual variability in troponin T concentration in dialysis patients

PurposeHaemodialysis patients often have increased TnT concentrations in the absence of symptoms suggestive of acute coronary syndrome. To evaluate the potential usefulness of establishing patient specific baselines, we investigated intra-individual variability of TnT concentration in stable haemodialysis patients.MethodsWe measured pre-dialysis troponin T concentrations weekly for 15 weeks in 61 stable haemodialysis patients.ResultsThirty two of 61 patients had at least one result greater than the diagnostic cut-off for significant myocardial damage of 0.04 μg/L. The intra-individual variability was small; 99% of all the variance from each patient's median was ≤ 0.063 μg/L.ConclusionsIntra-individual variability in TnT concentration is small enough to merit establishment a of baseline concentration for each haemodialysis patient. This baseline is stable over at least 15 weeks; samples need be collected no more frequently than this. A change in concentration of more than 0.06 μg/L from the individual's baseline is significant.     

Endogenous vasopressin affects postural control of blood pressure in man

1. Six healthy volunteers received intravenous infusions of isotonic (0.9% NaCl) and hypertonic (3% NaCl) saline on separate days. There were no significant changes in blood pressure or forearm blood flow, despite an increase in plasma arginine vasopressin (AVP) during hypertonic saline. 2. Immediately and 10 min after passive tilting to 50 degrees, mean forearm blood flow fell by 17.1 and 14.3% compared with the values in the supine position during isotonic saline and by 40.3 and 43.3% during hypertonic saline. Forearm vascular resistance rose by 23.6 and 17.8% with isotonic saline and by 80.2 and 88.2% with hypertonic saline for the two readings in the tilted compared with the supine position. 3. Tilting was associated with a 14.9 and 12.1% rise in diastolic blood pressure immediately and 10 min after assuming this position during hypertonic saline, and a rise of 6.4% in mean arterial pressure. 4. The results from this study are similar to those obtained previously, when small amounts of AVP were infused. They provide further evidence that AVP may have a physiological role in the postural regulation of blood pressure.     

Mechanisms of initial blood pressure response to postural change

The influence of supine rest on the blood pressure response to standing and 70 degrees head-up tilt was studied in detail for the first 30 s after the change of posture. Following 20 min of supine rest, the active transition to standing was accompanied by an immediate increase in systolic pressure of 29 +/- 6 mmHg (mean +/- SEM). This was followed by large fluctuations in systolic pressure: to -28 +/- 2 mmHg below control after 7 s and to 22 +/- 2 mmHg above control after 22 s (17 mmHg in excess of the systolic pressure level after head-up tilt). Following 1 min of supine rest, there was no difference in the immediate increase in systolic pressure. However, the magnitude of the subsequent changes was significantly diminished. With head-up tilt the immediate increase in blood pressure was absent and afterwards small changes were found that were also significantly influenced by the period of prior rest. Taken in conjunction with earlier studies, the following mechanisms are suggested. The immediate blood pressure increase resulted from compression of arteries by the contracting postural muscles. The subsequent blood pressure fall was caused by at least two mechanisms: (a) the fall was predominantly of reflex origin, because the immediate pressure increase stimulated the systemic baroreceptors; (b) supine rest possibly augmented the translocation of blood from the thorax which contributed, approx. 5 s from standing, to the reflex fall of blood pressure.     

Clinical significance of blood pressure variability in hypertension

AIM: To specify blood pressure (BP) rhythm and variabily at 24-hour monitoring. MATERIALS AND METHODS: 24-hour BP monitoring, cardiac echocardiography, measurements of central hemodynamics and vegetative regulation of cardiac rhythm and psychic status were performed in 178 hypertensive subjects. RESULTS: Progression of cardiac function impairment is associated with reduced lowering of night blood pressure and sleep variability, stable BP variability in awake patients. A close negative relationship exists between night BP fall and peripheral resistance, BP night variability and anxiety level. CONCLUSION: Decreased lowering of night BP seems to reflect morphological changes in the vascular wall, increased variability of wakeful BP reflects less exercise tolerance, that of night BP variability--of growing somatogenically conditioned sympathicotonia and associated anxiety disorders.     

厄贝沙坦对老年高血压患者昼夜血压及心率变异性的影响

目的:观察厄贝沙坦对老年高血压病患者血压及心率变异性的影响。方法:140例原发性高血压患者服厄贝沙坦1次/d,共8周。治疗前和治疗8周后行24h动态心电图检查和24h动态血压监测。结果:厄贝沙坦能明显降低高压病患者的24h平均血压(P<0.01)、白昼平均血压(P<0.01)和夜间平均血压(P<0.01)。对夜间血压高于正常值的高血压病患者,厄贝沙坦能明显降低夜间血压(P<0.01),而对夜间血压已属正常者,厄贝沙坦无进一步降压作用(P>0.05),并使心率变异性时域指标SDNN、SDANN、SDNNI升高(P<0.05),频域指标HF升高(P<0.05),VLF和LF下降(P<0.05)。结论:厄贝沙坦在对老年原发性高血压患者控制血压的同时,也对改善心率变异性产生有益作用。     

老年男性高血压患者降压治疗后血压变异性与心室重构的相关性研究

目的探讨老年男性高血压患者降压治疗后动态血压变异性与心室重构的关系。方法入选老年男性原发性高血压患者212例(高血压组),均单用长效钙通道阻滞剂降压治疗超过1年,行动态血压监测(ABPM),根据24h收缩压平均实际变异性(24 hSBP AVR)的第50百分位数(P50)将高血压组分为两组:高AVR组(AVR≥10.17 mmHg)和低AVR组(AVR<10.17 mmHg),各106例。另入选48例同期年龄相匹配的非高血压老年男性患者为对照组。测定入选患者所有血压水平、24 hSBP AVR等血压变异性指标及舒张期室间隔厚度(IVST)、舒张期左心室后壁厚度(LVPWT)、左心室舒张末内径(LVEDd),计算左心室质量指数(LVMI),比较各组差异。结果与对照组比较,高血压组24 h、日间及夜间平均收缩压,24 hSBP AVR值均高于对照组(P<0.05),高AVR组IVST及IVEDd高于低AVR组(P<0.05)。相关分析显示,LVMI与24 hSBP(r=0.361,P<0.05)及24 hSBP AVR(r=0.210,P<0.05)呈正相关。结论老年男性原发性高血压患者降压治疗后收缩压水平及收缩压变异性与左心室重构有关。     

Significance of blood pressure variability in patients with sepsis

BACKGROUND:

This study was undertaken to observe the characteristics of blood pressure variability (BPV) and sepsis and to investigate changes in blood pressure and its value on the severity of illness in patients with sepsis.

METHODS:

Blood parameters, APACHE II score, and 24-hour ambulatory BP were analyzed in 89 patients with sepsis.

RESULTS:

In patients with APACHE II score>19, the values of systolic blood pressure (SBPV), diasystolic blood pressure (DBPV), non-dipper percentage, cortisol (COR), lactate (LAC), platelet count (PLT) and glucose (GLU) were significantly higher than in those with APACHE II score ≤19 (P<0.05), whereas the values of procalcitonin (PCT), white blood cell (WBC), creatinine (Cr), PaO₂, C-reactive protein (CRP), adrenocorticotropic hormone (ACTH) and tumor necrosis factor α (TNF-α) were not statistically significant (P>0.05). Correlation analysis showed that APACHE II scores correlated significantly with SBPV and DBPV (P<0.01, r=0.732 and P<0.01, r=0.762). SBPV and DBPV were correlated with COR (P=0.018 and r=0.318; P=0.008 and r=0.353 respectively). However, SBPV and DBPV were not correlated with TNF-α, IL-10, and PCT (P>0.05). Logistic regression analysis of SBPV, DBPV, APACHE II score, and LAC was used to predict prognosis in terms of survival and non-survival rates. Receiver operating characteristics curve (ROC) showed that DBPV was a better predictor of survival rate with an AUC value of 0.890. However, AUC of SBPV, APACHE II score, and LAC was 0.746, 0.831 and 0.915, respectively.

CONCLUSIONS:

The values of SBPV, DBPV and non-dipper percentage are higher in patients with sepsis. DBPV and SBPV can be used to predict the survival rate of patients with sepsis.KEYWORDS: Sepsis, Systolic blood pressure variability, Diastolic blood pressure variability, APACHE II score, Inflammatory factor     

Circadian blood pressure rhythms in elderly hypertensive patients

Blood pressure was recorded for 24 h in 121 essential hypertensive patients aged between 20 and 90 years. To characterize the circadian blood pressure rhythm, the differences between the daytime blood pressures (recorded at 8-min intervals between 8 a.m. and 10 p.m.) and the night-time blood pressures (recorded at 30-min intervals between 10 p.m. and 8 a.m.) were calculated. The difference between daytime and night-time blood pressures was significantly (P less than 0.01) decreased in elderly hypertensive patients aged between 65 and 90 years compared with in those aged 20-39 years. In patients with heart insufficiency the circadian blood pressure rhythmicity was significantly (P less than 0.05) further reduced compared with in uncomplicated hypertensives. This may be explained by increased sympathetic tonus in patients with heart insufficiency and reduced vascular compliance may be the cause of the overall reduced circadian blood pressure rhythmicity in elderly hypertensive patients.