替米沙坦对高血压患者血清C反应蛋白的影响

目的：通过观察两组联合用药后对高血压患者的血清C反应蛋白（CRP）的影响,探讨血管紧张素Ⅱ受体拮抗剂（ARB）类药物可能存在的抗动脉粥样硬化机制。方法：112例2级及2级以上的高血压患者,分为实验组（ARB＋CCB,56例）及对照组（利尿剂＋CCB,56例）,随访2年,观察两组血压、心率、CRP及血糖、血脂情况,并进行统计学分析。结果：血压治疗前后两组组内比较,差异均有统计学意义（P〈0．05）,两组间比较,差异无统计学意义（P〉0．05）;CRP治疗前后两组组内及组间比较,差异均有统计学意义（P〈0．05）;心率、血糖及血脂治疗前后两组组内及组间比较,差异均无统计学意义（P〉0．05）。结论：两种降压药物组合均可良好控制血压,且耐受性好。替米沙坦可明显降低CRP的浓度,有抑制体内炎症反应的作用,且无降压依赖性。     

Targeting podocyte-associated diseases

Injury to the podocytes is the initiating cause of many renal diseases, leading to proteinuria with possible progression to end-stage renal disease. Podocytes are highly specialized cells, with an important role in maintaining the glomerular filtration barrier and producing growth factors for both mesangial cells and endothelial cells. With their foot processes they cover the glomerular basement membrane, and form slit diaphragms with neighboring podocytes.Human podocytopathies include focal and segmental glomerulosclerosis, minimal change disease, membranous nephropathy, collapsing glomerulopathy and diabetic nephropathy. Research in the last two decades has demonstrated great progress in understanding the molecular mechanisms leading to podocytopathies. These include single gene defects in slit diaphragm proteins, but also discovery of apoptotic, enzymatic and other pathways involved in podocyte injury. With this progress, a great number of animal models is now available to study either specific podocytopathies, e.g. in mouse models with single gene mutations, or more general podocyte injury patterns, such as the lipopolysaccharide or protamine sulfate model of foot process effacement.In this review, the morphology of the glomerulus will be discussed, with a focus on the podocyte, its interactions with surrounding cells, and the highly differentiated slit diaphragm separating the apical from the basal membrane. We also provide an overview of human podocytopathies and animal models to study these diseases. In the last part we discuss targeted therapies addressing pathways and proteins affected in podocyte injury.     

Evidence for the efficacy of ARBs across the cardiovascular continuum

Abstract

Introduction:

Angiotensin II receptor blockers (ARBs) are antihypertensive agents with considerable evidence of efficacy and safety for the reduction of cardiovascular (CV) disease risk in numerous patient populations from one end of the CV continuum (i.e., primary prevention among patients with CV risk factors) to the other (i.e., secondary prevention in the post-MI setting). There are several agents within the ARB class, all of which have contributed to various degrees to this evidence base.     

Effect of β-Blockers and Other Antihypertensive Drugs On the Risk of Melanoma Recurrence and Death

ObjectiveTo verify preliminary studies on patients with melanoma exposed to β-blockers that suggested a reduced risk of disease recurrence and death.Patients and MethodsData were obtained from all consecutive patients diagnosed as having melanoma between January 1, 1993, and December 31, 2009, at the Department of Dermatology of the University of Florence, Azienda Sanitaria di Firenze. Participants were excluded if at baseline they reported a previous diagnosis of cutaneous malignant melanoma or another malignant disease. We also excluded participants with evidence of visceral, lymph nodal, and in-transit metastasis at the time of the diagnosis.ResultsOf 741 consecutive patients with melanoma, 79 (11%) were prescribed β-blockers (for hypertension in most cases) for 1 or more years (treated) and 662 (89%) were not (untreated). The multivariate Cox model indicated that the treated group had improved overall survival after a median follow-up of 4 years (P=.005). For each year of β-blocker use, the risk of death was reduced by 38%. The presence of hypertension, the use of antihypertensive agents for 1 or more years, or the use of other commonly used medicines were not associated with a better outcome for patients with melanoma.ConclusionThe results confirm and strengthen previous findings that β-blocker use is associated with a reduced risk of melanoma recurrence and death. The results also indicate the strong need for a randomized clinical trial to conclusively assess whether β-blockers afford protection against melanoma recurrence and death.     

6分钟步行试验评价老年高血压心力衰竭疗效的探讨

目的探讨6分钟步行试验(6MWT)评价老年高血压心力衰竭疗效的价值。方法采用缬沙坦治疗老年高血压心力衰竭患者20例,比较治疗前后6MWT的变化,并以纽约心脏病学会(NYHA)心功能分级作为对比。结果治疗后患者的大多数患者的收缩压、舒张压及心率均较治疗前明显下降(p<0.05);治疗后NYHA分级构成较治疗前有统计学差异(Z=-3.416,p=0.001);治疗前患者6MWT为(198.67±87.51)米,治疗后上升为(451.20±73.77)米,显著高于治疗前(t=2.664,p=0.011);相关性分析显示6MWT与NYHA分级呈显著负相关性(r=-0.658,p=0.016)。结论 6MWT评价心衰疗效具有客观化及量化的优势,适合于评价老年高血压心力衰竭的疗效。     

Clinical Course of Patients With Worsening Heart Failure With Reduced Ejection Fraction

Background

Epidemiology of patients with worsening heart failure and reduced ejection fraction (HFrEF) in the real-world setting is not well described.

国产ARB类降压药物在轻中度高血压患者中的应用效果研究

目的:比较国产血管紧张素Ⅱ受体拮抗剂(angiotensin reccptor blocker,ARB)药物与进口ARB药物的疗效.方法:选取在我院接受治疗的98例轻中度高血压患者,分为两组,观察组和对照组.观察组给予国产缬沙坦片药物治疗,对照组给予进口缬沙坦片药物治疗,观察组比较两组患者的治疗效果.结果:观察组与对照组的诊室坐诊收缩压、舒张压及服药后8周降压有效率,无显著差异(P＞0.05).结论:轻中度高血压患者服用国产ARB类药物安全有效,与进口ARB类药物无显著差异,值得临床推广.