高血压病以昼夜血压模式指导治疗初探

目的：探讨高血压以昼夜血压模式指导药物治疗的疗效。方法：124例高血压患者被随机分为两组：观察组80例,采用以昼夜血压模式为依据,指导选用药物进行治疗,着重加强异常升高血压部份的降压治疗,同时加强血压监测;对照组仍按照常规方法治疗,6周为1疗程,治疗前和治疗后都检测血压和24小时动态血压。结果：观察组降压的总有效率和昼夜血压模式转为正常杓形态明显高于对照组,结论：高血压病患者以昼夜血压模式为依据指导用药降压治疗有较好的医疗效果。     

Comparison of subclinical left and right ventricular systolic dysfunction in non-dipper and dipper hypertensives: impact of isovolumic acceleration

Objectives: To evaluate subclinical left ventricular and right ventricular systolic impairment in dipper and non-dipper hypertensives by using isovolumic acceleration.

Methods: About 45 normotensive healthy volunteers (20 men, mean age 43?±?9 years), 45 dipper (27 men, mean age 45?±?9 years) and 45 non-dipper (25 men, 47?±?7 years) hypertensives were enrolled. Isovolumic acceleration was measured by dividing the peak myocardial isovolumic contraction velocity by isovolumic acceleration time.

Results: Non-dippers indicated lower left ventricular (2.2?±?0.4?m/s² versus 2.8?±?1.0?m/s², p?2 versus 3.5?±?1.0?m/s², p?=?0.012) compared with dippers. Left ventricular mass index (p?=?0.001), interventricular septal thickness (p?=?0.002) and myocardial performance index (p?p?=?0.002), mass index (p?=?0.001) and right ventricular myocardial performance index (p?Conclusion: The present study demonstrates that non-dipper hypertensives have increased left and right ventricular subclinical systolic dysfunction compared with dippers. Isovolumic acceleration is the only echocardiographic parameter in predicting this subtle impairment.     

Avaliação de Padrões Pressóricos Dipper e Não-Dipper e Qualidade de Vida entre Pacientes com Doença Pulmonar Obstrutiva Crônica

BackgroundNon-dipper blood pressure is defined by less than a 10% reduction in nighttime blood pressure, and it is associated with cardiovascular disease. Inflammation is thought to play a role in the pathogenesis of both chronic obstructive pulmonary disease (COPD) and non-dipper blood pressure pattern, and both diseases are associated with lower quality of life.ObjectiveThe aim of this study was to investigate the effects of non-dipper blood pressure pattern in patients with COPD.MethodsA cross-sectional study was carried out with 142 patients with COPD. The Saint George Respiratory Questionnaire and the Euro Quality of Life Scale were used to collect data. To understand arterial stiffness, the augmentation index and pulse wave velocity were measured, and 24-hour ambulatory blood pressure monitoring was subsequently performed. A multivariable logistic regression model was used to understand the relationship between different independent variables and blood pressure pattern. P values lower than 0.05 were considered statistically significant.ResultsAs a result, 76.1% (n = 108) of the patients had non-dipper blood pressure pattern. Non-dipper patients had higher C-reactive protein (OR:1.123; 95% CI:1.016;1.242), augmentation index (OR: 1.057; 95% CI: 1.011;1.105) and Saint George Respiratory Questionnaire total score (OR: 1.021; 95% CI: 1.001;1.042) than dipper patients. Also, as the number of people living at home increased, non-dipper blood pressure pattern was found to be more frequent (OR: 1.339; 95% CI: 1.009;1.777).ConclusionNon-dipper blood pressure pattern may increase cardiovascular risk by triggering inflammation and may adversely affect the prognosis of COPD by lowering the disease-related quality of life. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)     

Circadian variability of blood pressure in obese children

Background and aimsThe aim of the present study was to evaluate the circadian rhythm of blood pressure pattern in obese children, and to investigate if the lack of normal diurnal rhythm of blood pressure is associated with cardiovascular risk factors.Methods and results73 obese children (body weight [mean ± SD]: 89.0 ± 17.8 kg; age [mean ± SD]: 14.2 ± 2.3 years), 42 dippers and 31 non-dippers were investigated. Following ambulatory blood pressure monitoring (ABPM), physical fitness testing was performed on a treadmill. Physical working capacity at 130, -150, -170 beat/min (PWC-130, -150, -170), resting and peak oxygen consumption (VO₂rest, VO₂peak) were determined.Forty-two percent of obese children were non-dipper. PWC-130 (74.8 ± 48.8 watts; 48.0 ± 38.5 watts), PWC-150 (132.9 ± 52.1 watts; 104.2 ± 49.3 watts), PWC-170 (185.9 ± 49.5 watts; 154.9 ± 53.4 watts) and VO₂rest, ([mean ± SD]: 0.29 ± 0.08 L/min; 0.26 ± 0.07 L/min), and VO₂ peak (2.77 ± 0.61 L/min; 2.44 ± 0.62 L/min) were significantly lower in the non-dipper group, as compared to dippers (p < 0.05). The prevalence of hypertension, on the basis of ABPM, was significantly higher in the non-dipper group (45.2% vs 83.9%, p < 0.001). This is due to increased prevalence of masked hypertension in the non-dipper group (19.0% vs 32.3%, p < 0.001).ConclusionThe normal circadian variation of the blood pressure is frequently absent in obese children. Most of the non-dipper obese children are hypertensive, and their physical fitness is decreased.     

杓型,非杓型高血压患者左室肥厚类型及几何形态间关系的研究

本文应用２４小时动态血压监测（２４ｈＡＢＰＭ）和ＵＣＧ检测６０例健康者，２５０例高血压患者，对杓型、非杓型高血压患者左室肥厚类型及几何形态间关系进行研究。结果表明：６０例健康者左心室重量和几何形态正常。高血压组中正常几何形态（３１．２％）和向心性重构（１７％）主要见于杓型高血压者，向心性肥厚（１７．８％）和离心性肥厚（３４％）主要见于非杓型高血压者。结果提示：能够影响心室腔大小或每搏量的诸因素（如血容量，静脉回流，后负荷，舒张和收缩功能）与左室形态的调控有关。     

Psychophysical evidence for a non-linear representation of facial identity

It has been proposed that faces are represented in the visual brain as points within a multi-dimensional “face space”, with the average at its origin. We adapted a psychophysical procedure that measures non-linearities in contrast transduction (by measuring discrimination around different reference/pedestal levels of contrast) to examine the encoding of facial-identity within such a notional space. Specifically we had subjects perform identity discrimination at various pedestal levels of identity (varying from average/0% to caricature/125% identity) to derive “identity dipper functions”. Results indicate that subjects are generally best at spotting identity change in neither average nor full-identity faces, but rather in faces containing an intermediate level of identity (which varies from face-to-face). The overall pattern of results is consistent with the neural encoding of faces involving a single modest non-linear transformation of identity that is consistent across faces and subjects, but that it scaled according to the distinctiveness of the face.     

"太一"与"招摇"关系考

"太一"又作"大一"、"天一",指天神和天极,被视为天帝的居处.古时最接近北极而且充当授时主星的是北斗;北斗的第一星天枢,是北斗拱极运动的枢纽,因而充当了当年的极星而被称为"北极枢".北斗授时所体现的帝王及主气之神的特征,与万物之神"太一"相吻合,所以成为太一的化身."招摇"本是北斗的第七星摇光,后成为北斗的代称.如此,"招摇"与"太一"借北斗而相连,构成两物一体的关系,以致在古代文献中常常相互表示.     

血压昼夜节律变化与颅内动脉粥样硬化斑块特征的相关性研究

目的 调查血压昼夜节律变化与颅内动脉粥样硬化斑块负荷及易损性的相关性。方法 回顾性分析一个颅内动脉粥样硬化卒中影像队列中的267例卒中患者的临床及影像特征,根据24 h动态血压将其分为杓型血压组、非杓型血压组和反杓型血压组,通过高分辨磁共振血管壁成像及图像分析获得颅内动脉Willis环近端血管壁斑块特征,包括最大管壁厚度、斑块内出血、中重度狭窄（狭窄程度≥50%）、多发斑块（斑块数量≥3个）等指标。比较3组基线特征及颅内动脉粥样硬化斑块特征,校正混杂因素后,采用logistic回归分析血压昼夜节律变化模式与颅内动脉粥样硬化斑块特征的关系。结果 杓型血压组、非杓型血压组和反杓型血压组分别有36、119及112例。(1)反杓型血压组年龄更大（反杓型血压组∶非杓型血压组∶杓型血压组=67.3∶64.6∶61.9岁,P=0.042）,合并糖尿病比例更高（反杓型血压组∶非杓型血压组∶杓型血压组=46.4%∶41.2%∶22.2%,P=0.037）;血压指标中,反杓型血压组24 h平均收缩压更高（反杓型血压组∶非杓型血压组∶杓型血压组=144∶139∶136 mmHg,P=0.025）。(2)杓型...     

"太一"与"招摇"关系考

"太一"又作"大一"、"天一",指天神和天极,被视为天帝的居处.古时最接近北极而且充当授时主星的是北斗;北斗的第一星天枢,是北斗拱极运动的枢纽,因而充当了当年的极星而被称为"北极枢".北斗授时所体现的帝王及主气之神的特征,与万物之神"太一"相吻合,所以成为太一的化身."招摇"本是北斗的第七星摇光,后成为北斗的代称.如此,"招摇"与"太一"借北斗而相连,构成两物一体的关系,以致在古代文献中常常相互表示.