酒精依赖与高血压患者血压控制的关系

目的探讨徐州市高血压患者的酒精依赖与血压控制的关系。方法 2013年4-6月采用多阶段分层整群随机抽样方法抽取徐州市规律接受治疗的原发性高血压患者,酒精依赖程度采用密西根酒精依赖调查表(MAST)评定,其他因素由自行设计的问卷进行调查。将高血压患者分为3组,不饮酒组、饮酒无依赖组和酒精依赖组,酒精依赖组又继续分为低度依赖组、轻度依赖组和中度及以上依赖组。结果共调查高血压患者4405例,收缩压均值为(143.0±16.8)mm Hg,舒张压均值为(88.0±10.9)mm Hg,饮酒率16.5%(95%CI15.4%~17.6%),酒精依赖率13.8%(95%CI12.8%~14.9%),血压控制者1259例,控制率28.6%(95%CI27.3%~29.9%)。饮酒但无依赖患者血压控制率最高为40.7%;不饮酒组血压控制率为28.6%;酒精依赖组控制率为25.9%(χ~2=10.67,P0.01);在依赖组,不同依赖程度之间血压控制率差异无统计学意义(χ~2=0.06,P=0.97)。以不饮酒作为参照,Logistic回归分析显示:随着酒精依赖程度的加重,OR值逐渐增大:酒精无依赖(OR=0.59,95%CI 0.40~0.85,P0.01);低度依赖(OR=1.90,95%CI1.17~3.09,P0.01);轻度依赖(OR=1.99,95%CI 1.27~3.13,P0.01);中度及以上依赖(OR=2.00,95%CI 1.17~3.41,P0.01);在调整年龄、体质量指数、文化程度、体育锻炼、收入水平等因素后,酒精依赖仍然是血压控制的不利因素:酒精无依赖(OR=0.59,95%CI 0.41~0.86,P0.01);低度依赖(OR=1.89,95%CI 1.16~3.09,P0.01);轻度依赖(OR=1.96,95%CI 1.25~3.10,P0.01);中度及以上依赖(OR=1.98,95%CI1.15~3.39,P0.01)。结论饮酒无依赖有利于高血压患者的血压控制,酒精依赖不利于高血压患者的血压控制。     

伴阻塞性睡眠呼吸暂停低通气综合征高血压患者的血压控制研究

目的探讨伴阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的高血压患者,同时服用降压药和接受持续气道正压通气(CPAP)是否能有效控制血压。方法选取2014年1月至2015年6月南京医科大学第一附属医院睡眠中心就诊的伴有OSAHS高血压患者180例,根据服用降压药物后血压是否被有效控制,分为控制组(n=87)和未控制组(n=93),两组在服用降压药同时接受CPAP 6个月,比较服用不同降压药方案和CPAP治疗前后血压是否得到有效控制的关系。结果所有患者共使用13种不同的降压药方案进行治疗。控制组与未控制组患者降压药方案差异无统计学意义(P0.05),多因素logistic回归分析表明降压药方案不是影响伴OSAHS高血压患者血压控制的独立预测因子(OR=1.897,P=0.094)。使用CPAP后控制组、非控制组夜间收缩压(SBP)和舒张压(DBP)均下降,差异有统计学意义(P0.01)。结论伴OSAHS高血压病患者的降压治疗方案与血压控制无明显相关性,而CPAP治疗可使降压药有效组和无效组患者的夜间血压都降低。     

农村高血压患者血压控制的影响因素

目的分析农村高血压患者血压控制的影响因素。方法收集北京市某农村的264例高血压患者病例,其中男性136例,女性128例。依据治疗方法不同分为治疗组(140例)和对照组(124例),其中治疗组失访8例,对照组失访16例,最终入选治疗组(132例)和对照组(108例)。两组均实施社区高血压规范化管理。治疗组同时给予社区干预治疗,患者2周随访一次,共4次,每次随访进行社区干预。干预前后测定血压和评价疗效,计算血压控制率。结果与干预前比较,两组干预后收缩压和舒张压均下降,差异有统计学意义(P均0.05)。干预后,治疗组较对照组收缩压和舒张压下降更明显,差异有统计学意义(P均0.05)。与对照组比较,治疗组总有效率和血压控制率升高,70.37%vs.86.36%,18.52%vs.39.39%,差异有统计学意义(P均0.05)。Logistic回归分析结果表明,农村高血压患者血压控制与患者吸烟(OR=0.83,95%CI:0.41~1.67)、饮酒(OR=0.76,95%CI:0.62~1.15)、病程≥5年(OR=0.85,95%CI:0.61~1.18)、自测血压(OR=2.31,95%CI:1.41~2.94)、健康教育(OR=3.42,95%CI:2.17~4.35)与行为指导(OR=2.96,95%CI:2.03~3.59)均密切相关。结论影响农村高血压患者血压控制的因素较多,对其进行社区干预能够提高血压控制率。     

中国中年人正常高值血压检出率及影响因素研究——基于中国健康与养老追踪调查数据分析

目的了解中国中年人正常高值血压检出情况及影响因素。方法利用2015年"中国健康与养老追踪调查(CHARLS)"数据,整理7178名45~59岁的中年人血压、腰围、身高、体质量等基本情况和健康行为因素。正常高值血压定义为:收缩压120~139和(或)舒张压80~89mm Hg,且排除高血压病史或正在服用降压药物。结果中年人正常高值血压检出率为45.2%。男性正常高值血压检出率(48.3%)高于女性(42.6%)。在女性中,正常高值血压检出率随着年龄增长而升高(P0.01),在男性中相对稳定。多因素回归分析显示:在男性中,偏瘦(OR=0.264,95%CI0.075~0.929)是正常高值血压的保护因素;腹型肥胖(OR=1.554,95%CI1.027~2.350)、超重(OR=1.734,95%CI1.139~2.640)和肥胖(OR=2.350,95%CI 1.266~4.363)是正常高值血压的危险因素。在女性中,偏瘦(OR=0.509,95%CI 0.280~0.926)是正常高值血压的保护因素;年龄55~59岁(OR=1.553,95%CI1.227~1.966)和肥胖(OR=2.655,95%CI1.976~3.568)是正常高值血压的危险因素。结论中国中年人正常高值血压检出率较高,腹型肥胖、超重和肥胖是中年男性正常高值血压的危险因素,而年龄55~59岁和肥胖为中年女性正常高值血压的危险因素。     

青年人群冷加压试验血压反应性的影响因素

目的 探讨青年人群冷加压试验(cold pressor test，CPT)血压反应性的影响因素。方法 对483例17~28岁的青年进行问卷调查及身高、体质量测量、CPT检测，分析影响青年人群CPT血压反应性的因素。结果 总人群收缩压(SBP)高反应率为8.9%(43/483)，舒张压(DBP)高反应率为6.0%(29/483)。多因素分析显示，男性、饮酒与CPT血压反应性呈正相关（P<0.05），其中男性SBP高反应风险是女性的2.9倍(OR=2.916，OR95%CI 1.382~6.152，P<0.05)，饮酒者DBP高反应性风险是不饮酒者的12.6倍(OR=12.600，OR95%CI 2.236~70.994，P<0.01)。而较高的基线血压与CPT高反应性负相关(P<0.05)，基线DBP较高者DBP高反应风险是基线DBP较低者的0.9倍(OR=0.877，OR95%CI 0.834~0.923，P<0.001)。结论 在青年人群中，男性、饮酒与CPT血压反应性正相关，较高的基线血压与CPT血压反应性负相关。     

社区高血压患者苯磺酸左旋氨氯地平服药依从性的观察

目的探讨服用苯磺酸左旋氨氯地平的社区高血压患者服药依从性及血压控制情况的影响因素。方法纳入2015年9-12月上海市9个社区卫生服务中心管理的710例服用苯磺酸左旋氨氯地平的高血压患者,进行问卷调查和血压检测。应用Logistic回归分析高血压患者服药依从性和血压控制的影响因素。结果服用苯磺酸左旋氨氯地平的患者710例服药依从性佳的比例为71.1%,血压控制率为63.4%。多因素分析结果显示:控制社会人口学特征后,与服药≥2次/d的患者相比,服药1次/d的患者服药依从性更佳(OR=5.99,95%CI 2.46~4.59);自报药物价格越贵、自报服药越不方便,患者服药依从性越差;与未发生不良反应的患者相比,发生不良反应的患者服药依从性差(OR=0.36,95%CI0.13~0.97)。患病年限≥20年(OR=0.48,95%CI 0.30~0.77)、自报服药不方便(OR=0.34,95%CI0.16~0.71)是血压控制的危险因素,服药依从性佳(OR=1.33,95%CI 1.03~1.72)是血压控制的保护因素(均P0.01)。结论患者对药物本身特征的认知可影响患者的服药依从性,服药依从性是影响血压控制的重要因素。     

血压管理对高血压脑出血患者血肿周围水肿的影响

目的 探讨高血压脑出血急件期血压管理对血肿周围水肿的影响.方法 采用回顾性研究方法,对2005年6月-2007年12月期间高血压脑出血住院患者的年龄、天数、降压药、脱水药和血压等因素进行logistic回归分析.结果 多因素分析发现,氨氯地平(OR=0.208,95%CI0.063～0.684)和血管紧张素转换酶抑制药(OR=0.280,95%CI 0.085～0.920)均为血肿周围水肿的保护因素;病程天数10～20 d(OR=7.413,95%CI 1.362～40.360)、舒张压控制小良(OR=6.449,95%CI 1.011～41.145)均为血肿周围水肿的危险因素.结论 服用氨氯地平和血管紧张素转换酶抑制药能降低脑出血血肿周围水肿的风险,而舒张压控制不良和病程10～20 d为血肿周围水肿的危险因素.     

老年单纯收缩期高血压患者动态血压参数对脑白质病变的影响

目的探讨老年单纯收缩期高血压(ISH)患者24h动态血压参数对脑白质病变(WML)的影响。方法选择老年ISH患者96例,根据WML评分标准分为无-轻度WML组49例和中-重度WML组47例,比较2组患者一般情况及动态血压参数。结果中-重度WML组24h收缩压、昼间收缩压、夜间收缩压、昼间收缩压变异系数、夜间收缩压变异系数、非杓型、反杓型比例明显升高,而24h舒张压、昼间舒张压、夜间舒张压及杓型比例明显降低(P<0.05)。多因素logistic回归分析显示,24h收缩压(OR=2.89,95%CI:1.14~5.89,P=0.016)、昼间收缩压变异系数(OR=1.75,95%CI:1.30~3.42,P=0.005)、夜间收缩压变异系数(OR=1.46,95%CI:0.99~1.55,P=0.001)及年龄(OR=1.13,95%CI:0.82~1.57,P=0.021)是WML的独立危险因素。结论老年ISH患者24h收缩压、昼间收缩压变异系数、夜间收缩压变异系数是WML的独立危险因素,高收缩压、低舒张压、高收缩压变异系数及异常的血压节律对WML的发生、发展有不良影响。     

福建沿海地区超重及肥胖人群血压、血脂现状分析

目的:调查福建沿海地区人群超重和肥胖的现状及其与血压、血脂的相关性。方法:通过横断面调查方法,纳入福建省沿海地区30岁以上人群3343例,进行身高、体质量、血压、腰围、血糖、血脂等指标检测,采用统计学方法分析BMI与血压、血脂的相关性。结果:调查地区超重及肥胖检出率为34.6%和10.0%,男性超重率显著高于女性(40.4%比30.7%,P0.05);超重和肥胖人群比例在70岁以前均随年龄增加而逐渐显著增高,70岁以后有下降趋势。与年龄匹配的正常体重人群比较,青年(40岁)超重和肥胖人群血压、腰围显著升高(P均0.01);中老年(40岁)超重和肥胖人群血压、腰围、TC、LDL-C水平显著升高,而HDL-C水平显著降低(P0.05或0.01)。偏相关分析显示BMI与腰围、收缩压、舒张压、TC、LDL-C和HbA1c水平呈显著正相关(r=0.701,0.218,0.238,0.068,0.120,0.135,P均0.01),与TG和HDL-C水平呈显著负相关(r均=-0.069,P均0.01)。多元线性回归分析显示BMI与腰围、性别、年龄、DBP、HDL-C、FBG显著相关。控制年龄、性别、血糖等混杂因素后,二元Logistic回归分析显示:超重(OR=2.283,95%CI 1.915~2.721)和肥胖(OR=4.419,95%CI 3.329~5.865)是高血压、血脂异常的危险因素[超重(OR=1.356,95%CI 1.160~1.584),肥胖(OR=1.691,95%CI 1.319~2.167)],P均0.01。结论:福建沿海地区人群超重/肥胖率较高,超重、肥胖人群中高血压、血脂异常、糖尿病、心血管危险因素聚集比例显著增高,控制体重对高血压、血脂异常及糖尿病等慢性病的防治具有重要意义。     

孕期血压控制水平对轻中度慢性高血压孕妇妊娠结局的影响

目的探讨轻中度慢性高血压患者孕期血压控制水平对妊娠结局的影响。方法 2017年9月—2019年9月海南现代妇女儿童医院妇产科接受产检并分娩的慢性高血压孕妇216例,依据孕期平均舒张压、收缩压数据,分为血压严格控制组(血压控制在130/80 mm Hg)130例和血压非严格控制组(血压≥130/80 mm Hg)86例。回顾性分析2组患者的临床资料,并比较妊娠结局;采用多因素logistic回归分析血压控制水平对不良妊娠结局的影响。结果单因素分析显示,血压严格控制组早产、小于胎龄儿(SGA)、入新生儿重症监护病房、胎儿宫内窘迫、子痫前期发生率低于血压非严格控制组(均P0.05);多因素logistic回归分析显示,在校正首次产检孕周、建卡时血压及降压药物使用情况等变量后,血压非严格控制是早产(OR=2.12, 95%CI 1.38～3.35,P=0.023)、SGA(OR=2.36, 95%CI 1.40～4.61,P=0.006)、入新生儿重症监护病房(OR=3.22, 95%CI 1.38～3.35,P=0.012)、胎儿宫内窘迫(OR=2.05, 95%CI 1.25～3.38,P=0.008)、子痫前期(OR=1.62, 95%CI 1.13～2.56,P=0.043)的危险因素。结论对于轻中度慢性高血压孕妇,血压控制在130/80 mm Hg可降低子痫前期、SGA、早产、胎儿宫内窘迫、入新生儿重症监护病房发生率,改善妊娠结局。     

Hypertension prevalence and control in Ulaanbaatar,Mongolia

This study examines the prevalence, awareness, treatment, and control of hypertension in Ulaanbaatar, Mongolia, using both the American Heart Association and conventional thresholds (130/80 and 140/90 mm Hg, respectively). In this randomized cross‐sectional study, two‐stage cluster sampling was used to obtain a sample of 4515 individuals aged ≥20 years. Hypertension was defined by the use of antihypertensives in the last 2 weeks or a blood pressure at or above the thresholds of 140/90 and 130/80 mm Hg. The mean age of the participants was 41.1 ± 14.0 years and 54.5% were women. Hypertension prevalence was 25.6% (using 140/90 mm Hg) and 46.5% (using 130/80 mm Hg). Prevalence increased with age and below 50 years men were consistently more likely to be hypertensive. Among hypertensive participants, the rates of awareness, treatment, and control were 69.7%, 46.8%, and 24.0% (using 140/90 mm Hg) and 49.1%, 25.8%, and 6.4% (using 130/80 mm Hg, respectively). Men had lower rates of awareness, treatment, and control compared with women, with the most pronounced differences at younger ages. This study shows that awareness, treatment, and control rates in Ulaanbaatar are better than in most low‐ and middle‐income countries but are still suboptimal. The largest “care gap” was in young men where a regulatory requirement for annual workplace blood pressure screening has the potential to enhance care. A major hypertension control program has just been initiated in Ulaanbaatar.     

老年高血压病患者血液流变学分析

对48例老年高血压患者（合并冠心病21例，糖尿病10例）进行血液流变学测定。结果老年高血压组纤维蛋白原（Fg）、血浆粘度（ηP）与对照组比较，P＜0．01。全血粘度（ηb）、全血还原粘度（ηh）、血沉（ESR）、血小板粘附率（PAD）及体外血栓干重（DW）与对照组比较，P＜0．05；高血压合并冠心病组与单纯高血压组比较，ηb，ηh，PAD及体外血栓长度（L）、湿重（MW）（P＜0．05），DW（P＜0．01）；高血压合并糖尿病组与单纯高血压组比较，Fg（P＜0．01），ηh，ηh，ESR，PAD，L，DW，（P＜0．05）。结果提示，老年高血压病患者血液流变学改变表现为纤维蛋白原增高、红细胞刚性增加、红细胞变形能力降低，致红细胞聚集性增强。高血压合并冠心病或糖尿病组，均以血小板反应性增高、红细胞聚集性增强、内皮功能受损及体外血栓形成能力增强更为突出。     

Is tinnitus an early voice of masked hypertension? High masked hypertension rate in patients with tinnitus

Objectives: Tinnitus is hearing a sound without any external acoustic stimulus. There are some clues of hypertension can cause tinnitus in different ways. The aim of the study was to evaluate the relationship between tinnitus and masked hypertension including echocardiographic parameters and severity of tinnitus.

Methods: This study included 88 patients with tinnitus of at least 3 months duration and 85 age and gender-matched control subjects. Tinnitus severity index was used to classify the patients with tinnitus. After a complete medical history, all subjects underwent routine laboratory examination, office blood pressure measurement, hearing tests and ambulatory blood pressure monitoring. Masked hypertension is defined as normal office blood pressure measurement and high ambulatory blood pressure level.

Results: Baseline characteristics in patients and controls were similar. Prevalence of masked hypertension was significantly higher in patients with tinnitus than controls (18.2% vs 3.5%, p = 0.002). Office diastolic BP (76 ± 8.1 vs. 72.74 ± 8.68, p = 0.01), ambulatory 24-H diastolic BP (70.2 ± 9.6 vs. 66.9 ± 6.1, p = 0.07) and ambulatory daytime diastolic BP (73.7 ± 9.5 vs. 71.1 ± 6.2, p = 0.03) was significantly higher in patients with tinnitus than control group. Tinnitus severity index in patients without masked hypertension was 0 and tinnitus severity index in patients with masked hypertension were 2 (1–5).

Conclusion: This study demonstrated that masked hypertension must be kept in mind if there is a complaint of tinnitus without any other obvious reason.     

The Use of Short-Term Ambulatory Blood Pressure Monitoring in Differing Forms of Hypertension

Single blood pressure readings represent the conventional approach for determining the presence and severity of hypertension. However, the relationship between single (casual) readings and the whole-day blood pressure average is weak, especially in patients with borderline hypertension and in the elderly. In this study we have compared casual blood pressures with the averages of blood pressures obtained during short-term (two-hour) and long-term (24-hour) ambulatory monitoring in patients with mild (n=19), moderate (n=11), or predominant systolic (n=11) essential hypertension. The blood pressure averages obtained during long-term monitoring were significantly lower than the casual blood pressure in all three subgroups. The averages of short-term monitoring in the morning were in between the other two blood pressure levels. The correlation coefficients between two-hour morning averages of pressure and whole-day averages were highly significant (p<0.01 or better), and stronger than those between casual and whole-day average pressures, in the group of patients as a whole and in all three subgroups. The slopes of the regression equations were close to unity. Therefore, ambulatory short-term monitoring of blood pressure in the morning is superior to casual blood pressure and probably is an adequate substitute for whole-day observations in quantifying whole-day blood pressure levels in hypertensive patients, especially in patients with mild hypertension and in those with predominant systolic hypertension.     

Non-interventional management of resistant hypertension

Hypertension is one of the most popular fields of re-search in modern medicine due to its high prevalence and its major impact on cardiovascular risk and con-sequently on global health. Indeed, about one third of individuals worldwide has hypertension and is under increased long-term risk of myocardial infarction, stroke or cardiovascular death. On the other hand, resistant hypertension, the "uncontrollable" part of arterial hy-pertension despite appropriate therapy, comprises a much greater menace since long-standing, high levels of blood pressure along with concomitant debilitating entities such as chronic kidney disease and diabetes mellitus create a prominent high cardiovascular risk milieu. However, despite the alarming consequences, resistant hypertension and its effective management still have not received proper scientific attention. As-pects like the exact prevalence and prognosis are yet tobe clarified. In an effort to manage patients with resis-tant hypertension appropriately, clinical doctors are still racking their brains in order to find the best therapeutic algorithm and surmount the substantial difficulties in controlling this clinical entity. This review aims to shed light on the effective management of resistant hyper-tension and provide practical recommendations for cli-nicians dealing with such patients.     

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肺动脉高压(PH)是一种潜在的致命性疾病,若未及时诊断、积极干预,大多数患者预后极差。如何早期诊断、规范治疗PH仍然是广大临床医师面临的一个重要挑战。随着现代医疗技术的进步与发展,人们对PH发病机制的认识不断深入,新的诊断技术和治疗手段不断涌现,在此基础上,基于循证医学证据的指南或专家共识不断更新。这些指南或专家共识对于促进对PH的规范化诊断和治疗,具有重要的指导价值。     

The Role of Salt in Hypertension

There is considerable evidence that salt is an important cause of hypertension. Primitive societies who ingest little or no salt have no hypertension. Also when diets very low in salt such as the rice and fruit diet are given to hypertensive patients, the blood pressure often falls toward normal. Unfortunately, when diets only moderately low in sodium have been given only minor reductions in blood pressure occur. Salt-induced hypertension has been produced in both man and experimental animals. The basic cause of the hypertension is an inability of the kidney to excrete the increased salt. Hemodynamic changes then occur which raise the blood pressure and so excrete the excess salt by pressure diuresis. The ability to excrete salt at normal levels of blood pressure varies from one individual to another. Those who require a higher than normal blood pressure are said to be “salt-sensitive”. Those who can excrete excess salt at normal levels of blood pressure are called “salt resistant”. The difference may be due to an inherited defect in the kidney to excrete salt. In any event, salt sensitive hypertension is effectively controlled with the administration of diuretics.     

我国七城市社区老年人高血压患病调查

目的抽样调查我国部分城市社区老年人高血压的流行现状及主要相关因素，以制订合理的防治对策。方法选择７个脑卒中高发城市（北京、上海、哈尔滨、长春、郑州、长沙、银川），按统一标准，测量社区人群中９５９７名老年人的血压，并对一些相关危险因素进行问卷调查。结果７个城市合计确诊高血压患病率为２６．４％，临界高血压患病率１４．１％。其中北京确诊高血压患病率高达３２．２％。女性确诊高血压高于男性，纯收缩期高血压亦明显高于男性（Ｐ值＜０．０１）。分析相关因素显示，体重指数与高血压密切相关。结论高血压是危害老年人健康的主要疾病之一，需进一步加强宣传教育力度     

Redo of percutaneous renal denervation in a patient with recurrent resistant hypertension after primary treatment success

A 79‐year‐old patient was treated with percutaneous renal denervation (RDN) due to resistant arterial hypertension in the summer of 2010. After primary treatment success with a decrease of blood pressure from 170/100 to 130/80 mm Hg 6 months postablation, the blood pressure rose again at 12 months despite maintenance of the pharmacologic regimen and the decision was made to perform a second RDN procedure. Three months following the second RDN procedure, blood pressure was lowered to 130/77 mm Hg. © 2012 Wiley Periodicals, Inc.