Altered calcium metabolism in red blood cells of hypertensives: Persistent marker or sequel of essential hypertension?

Summary The characteristics of the increased calcium (Ca) influx observed in metabolically depleted red blood cells (RBCs) of hypertensive patients were investigated. Twenty-four normotensives, 16 untreated essential hypertensives, and 10 essential hypertensives under sufficient blood pressure control by 50–100 mg/day atenolol were studied. Free intracellular concentrations of Ca, sodium (Na), and potassium (K) were assessed using ion-selective electrodes in freeze-thawed RBCs, which were metabolically depleted by 30 mM desoxy-glucose at 37°C for 48 h. In the treated hypertensives values for Ca and K at 24 and 48 h were not different from values for the normotensives, whereas elevated Ca was found in RBCs of untreated hypertensives. Na in treated hypertensives was significantly increased at 0 and 48 h, thus, being similar to values for untreated hypertensives. Additionally, RBCs of six normals were stressed in a glass/teflon potter. Before metabolic depletion electrolytes were not affected by this procedure, while Ca at 24 and 48 h of metabolic depletion increased to significantly higher values for the hypertensive patients as compared to the controls. These results suggest that the altered Ca metabolism in the RBCs of hypertensives may reflect a secondary phenomenon due to the mechanical damage to RBCs by the elevated blood pressure.     

1-(2-羟基-3-芳氧基丙基)-4-芳酰基哌嗪的合成

根据拼合原理,设计并合成了19个1-(2-羟基-3-芳氧基丙基)-4-芳酰基哌嗪类化合物。对其中8个化合物I₁～I₈进行了药理试验,发现它们有明显的降压活性及α-受体阻滞活性。     

Hemodynamic factors in the pathogenesis of diabetic nephropathy

Summary The pathogenesis of the diabetic glomerular lesion is unknown. However, cumulative indirect evidence favors hemodynamic factors associated with the abnormal endocrine environment as the cause of diabetic angiopathy. Experimental evidence suggests that the increased hydrostatic pressures in capillary beds, a hallmark of the early stages of insulin-dependent diabetes, are associated with macromolecular leakage leading to the typical thickening of glomerular capillary basement membrane and increased glomerular mesangial matrix even prior to the occurrence of systemic hypertension. Patients with renal or carotid artery stenosis seem to be protected against diabetic nephropathy and retinopathy on the stenosed side. The first signal of diabetic nephropathy even before deterioration of the renal function is microalbuminuria detected by sensitive methods such as radioimmunoassay. Not only in hypertensive, but even in normotensive diabetic patients with microalbuminuria antihypertensive therapy has been shown to reduce albumin excretion rate and to slow the progression of diabetic nephropathy. Once overt diabetic nephropathy has been established, hypertension is a constant accompaniment of the disease. Thus, hypertension may be a cause as well as a result of diabetic nephropathy. Tight control of blood sugar in close association with antihypertensive treatment reducing blood pressure to a lower normal limit, possibly with agents that specifically decrease glomerular capillary hydraulic pressure are the corner stone in protection against progression of the diabetic angiopathy.Abbreviations ECF extracellular fluid - ESRD end-stage renal disease     

基质金属蛋白酶-2在盐型高血压大鼠心脏中的表达及不同种类降压药物的影响

目的探讨基质金属蛋白酶-2/基质金属蛋白酶-2特异性组织抑制因子(MMP-2/TI MP-2)在脱氧皮质酮(DOCA)-盐型高血压大鼠(DHR)心脏微小血管重塑中的作用及其可能的调节机制。方法30只雄性SD大鼠,等分和制作为对照组、模型组、波生坦组、氨氯地平组和雷米普利组。5周末处死动物,检测心脏微小血管密度和MMP-2/TI MP-2蛋白与基因的表达。结果在DHR左心室心内膜下心肌中存在微小动脉密度增加和毛细血管密度减少,MMP-2的mRNA和MMP-2/TI MP-2的蛋白表达上调;波生坦和氨氯地平能明显减轻微小血管损害,下调MMP-2/TI MP-2的mRNA和蛋白表达;雷米普利不能减轻微小血管损害,也不影响MMP-2/TI MP-2的mRNA和蛋白表达;MMP-2的表达同微小血管密度间具有良好的相关性。结论在DHR心脏中存在微小血管病变,MMP-2/TI MP-2表达可能参与微小血管病变的病理机制,内皮素-1和血压可能是通过调节MMP-2/TI MP-2表达参与微小血管病变。     

Antihypertensive drug therapy and hypoglycemia in elderly diabetic patients treated with insulin and/or sulfonylureas

We performed this case–control study to evaluate the risk of hypoglycemia associated with the use of antihypertensive drugs in older hospitalized diabetic patients treated with sulfonylureas and/or insulin. All diabetic patients admitted during 4 months in 1988, 1 month in 1991, 4 months in 1993 and 4 months in 1995 (n = 3477, mean age 71.4 ± 0.2 years, 1542 males and 1935 females) were enrolled in the study. During the four annual surveys 86 patients (mean age 71.1 ± 1.4 years, 33 males and 53 females) presented hypoglycemia during hospital stay. The patients who presented hypoglycemia were less frequently users of sulfonylureas and more frequently users of a combination of insulin and sulfonylureas. Use of antihypertensive drugs was similar in the two groups studied, and among potentially interacting drugs considered in the analysis, sulfonamides were more frequently used in patients who experienced hypoglycemia. Moreover, patients with hypoglycemia used a higher number of drugs, had a longer length of stay and had a greater prevalence of hypoglycemia as admission problem. Finally, although not significant, liver and renal diseases were more frequent among patients with hypoglycemia. In the multivariate analysis, contemporary use of insulin and sulfonylureas, liver disease and length of stay were significantly associated with hypoglycemia, while none of the antihypertensive drugs showed a significant association with the occurrence of hypoglycemia during hospital stay. Our results indicate that antihypertensive drugs do not increase the risk of hypoglycemia in elderly diabetic patients.     

清脑熄风汤治疗肝火上炎型高血压随机平行对照研究

[目的]观察清脑熄风汤治疗肝火上炎型高血压疗效。[方法]使用随机平行对照方法,将60例门诊患者按抽签法简单随机分为两组。对照组30例牛黄降压丸,3.2g/次,2~3次/d。治疗组30例清脑熄风汤(白蒺藜、磁石各10g,石昌蒲9g,珍珠母30g,菊花、桑叶各9g;四肢麻木加僵蚕、鸡血藤、桑枝;肝肾阴虚加桑椹子、杞果、生地;痰浊盛加志远炒、半夏制、竹茹;肝阳亢甚加生牡蛎、钩藤、生龙骨),1剂/d,水煎200mL,早晚温服。连续治疗42d为1疗程。观测临床症状、相关指标(胆固醇、血糖)、不良反应。治疗1疗程,判定疗效。[结果]降压疗效:治疗组显效15例,有效12例,无效3例,总有效率90.00%。对照组显效6例,有效15例,无效9例,总有效率70.00%。治疗组疗效优于对照组(P0.05)。症状疗效:治疗组显效14例,有效13例,无效3例,总有效率90.00%。对照组显效5例,有效15例,无效9例,总有效率70.00%。治疗组疗效优于对照组(P0.05)。[结论]清脑熄风汤治疗肝火上炎型高血压效果显著,值得推广。     

2002年~2004年西南地区62家医院抗高血压药利用分析

目的:评价西南地区抗高血压药用药现状及其趋势。方法:对2002年~2004年西南地区62家医院抗高血压药销售金额、品种、用药频度、日均费用等进行统计、分析。结果:抗高血压药销售金额占心血管药总金额的18%~20%,年均增长率达20%以上;依那普利、氨氯地平位居2004年用药频度前2位;跨国公司产品销售金额占销售金额排序前10位厂家销售总额的81.9%。结论:抗高血压药和心血管药销售金额呈快速增长态势,钙拮抗药和血管紧张素转化酶抑制药占西南地区抗高血压药市场的主导地位。     

我院心内科病房2005-2009年抗高血压药应用分析

目的:调查我院心内科病房抗高血压药的应用情况,为医院药品管理和临床合理用药提供参考。方法:提取我院2005-2009年心内科病房抗高血压药的应用数据,采用限定日剂量法对药品销售金额、用药频度(DDDs)和日均费用(DDC)进行统计、分析。结果:各年度销售金额和DDDs排序均以钙离子拮抗药(CCB)居首位;2006-2009年单药销售金额及DDDs以苯磺酸氨氯地平居首位;不同于门诊,病房抗高血压药DDC排序列前10位的药品中注射剂所占比例较大。结论:我院心内科病房抗高血压药应用合理,CCB、血管紧张素Ⅱ受体拮抗药处于越来越重要的地位。     

中国人群降压药临床疗效评价的Meta分析

目的：系统评价我国人群使用的各类降压药治疗原发性高血压痛的降压效果及安全性。方法：运用Meta分析法，对36项国内治疗原发性高血压的临床随机化试验结果进行综合分析。结果：钙拮抗药(CCBs)和ACE抑制药(ACEI)收缩压和舒张压净差值分别为0.36mmHg(P＞0.05)和2．24mmHg(P＜0．05)，疗效率差为7．79％(P＜0．05)；短效CCBs与ACEIADR发生的RR值1．99(P＜0．05)。ACEI和AⅡ拮抗药(AR-Ⅱ)收缩压与舒张压的净差值分别为-0.38和0.4mmHg(P＞0.05)；疗效率差3．16％(P＞0．05)；ADR发生的RR值3．55(P＜0．05)。国产、合资降压药与进口同类药品的收缩压和舒张压净差值分别为0．30mmHg(P＞0.05)和1．74 mmHg(P＜0．05)；疗效率差为-0.5％(P＞0.05)；ADR发生的RR值0.89(P＞0．05)。高价与低、中价降压药收缩压和舒张压的血压净差异值分别为2.13 mmHg(P＜0．05)和0．77 mmHg(P＞0．05)；疗效率差6.63％(P＞0．05)；ADR发生的RR值0.64(P＞0．05)。结论：CCBs对舒张压降压明显，总疗效高于ACEI，ACEI疗效略高于AR-Ⅱ；同类国产或合资降压药与进口药物相比，对舒张压降压略明显，降压总疗效基本一致；中价降压药总疗效与高价药基本一致；对于轻中度高血压患者，低中价格的降压药同样可以达到一定的临床有效控制率。     

Ambulatory blood pressure monitoring for the management of hypertension

Ambulatory blood pressure monitoring (ABPM) has become indispensable in the current management of hypertension. ABPM is particularly useful in the accurate diagnosis of hypertension. Its diagnostic thresholds had been recently established based on hard clinical outcomes. Cross-classification of patients according to office and ambulatory blood pressure identifies white-coat, masked, and sustained hypertension. ABPM is also useful in cardiovascular (CV) risk assessment. It provides information on...