氟伐他汀改善高血压患者脉压和动脉弹性临床研究

目的　观察氟伐他汀对降压治疗中高血压患者脉压和动脉弹性功能的影响。方法　选择 3 0例正在规律服用降压药物治疗并且脉压≥ 60mmHg的高血压患者 ,分为安慰剂组 (15例 )和氟伐他汀组 (15例 ) ,分别加服安慰剂 (1片每天 )或氟伐他汀 (40mg/d) ,治疗 3个月。观察治疗前、后肱动脉血压 ,脉搏波传导速度 (PWV) ,大动脉和小动脉弹性指数 (C1和C2 ) ,从桡动脉压力波形实时获得的中心动脉血压、压力反射波增强指数 (AI)。结果　安慰组治疗后各项指标均无显著改变。氟伐他汀组治疗后肱动脉收缩压与脉压分别降低 8 0± 12 9mmHg (P =0 0 3 1)与 5 7± 9 3mmHg (P =0 0 3 3 ) ,中心动脉收缩压与脉压分别降低 9 7± 12 4mmHg (P =0 0 0 9)与 7 1± 9 3mmHg (P =0 0 1) ,中心动脉下降幅度大于肱动脉 ;舒张压和心率无显著改变 ;C2 升高 (P =0 0 3 ) ;AI降低 (P =0 0 2 6) ;PWV和C1无显著改变。结论　氟伐他汀通过改善高血压患者小动脉弹性和外周压力波反射 ,具有缩小脉压的作用     

健康人与高血压患者动脉弹性功能比较

目的　比较不同年龄、血压水平的健康人和高血压患者动脉弹性功能。方法　选取健康志愿者和高血压患者共551人 ,其中男性 30 3人 ,女性 2 4 8人 ,平均年龄为 56 9± 1 3 4岁。分别根据年龄和血压水平分组 ,使用DO 2 0 2 0动脉功能测定仪检测桡动脉脉搏波形和动脉弹性指数C1 和C2 ,进行比较研究。结果　随着年龄不断增高 ,健康人和高血压病人的C1 和C2 值逐渐下降。健康组和高血压组男性的C1 和C2 均高于女性 ,P <0 0 1。校正年龄因素影响后 ,随着血压水平的升高 ,大小动脉弹性指数下降。高血压病人大动脉弹性明显比正常血压者低。处于正常高限者小动脉弹性指数C2 显著低于理想和正常血压者 ,与 1级高血压组无明显差别。简单相关分析表明年龄、收缩压、舒张压、脉压和心率与动脉弹性指数C1 和C2 存在明显负相关 ,其中脉压与C1 相关性 (r =- 0 60 2 ,P <0 0 1 )最为显著 ,而C2 与年龄相关性 (r=- 0 457,P <0 0 1 )最为明显。结论　 (1 )年龄增大、血压升高与血管弹性下降密切相关 ,血管弹性检测可能比测量血压更为有效反映血管功能状态。 (2 )小动脉弹性指数 (C2 )为一敏感反映动脉损害的指标 ,有助于筛选出处于亚临床状态的心血管病人。     

血压与动脉屈从性的相关性分析

目的　通过对健康和原发性高血压者的 C1、C2测定 ,分析研究血压、脉压与动脉屈从性的相关性。方法　采用 DO-2 0 2 0无创动脉功能测定仪对 2 0 1例健康人和 1 3 9例原发性高血压者进行血压、脉压及大、小动脉屈从性测定。结果　 1 )健康人组随着年龄增加 C1、 C2逐渐减低 ,C2比 C1的降低更早出现。高血压组中各动脉功能参数比健康人同年龄组有显著性差异 ,C1、 C2明显降低 (P<0 .0 0 1 ) ;2 )血压、脉压与 C1、 C2均呈显著性负相关 (P<0 .0 1 ) ;3 )高血压组中 ,服药者与未服药者比较 ,脉压略降低 ,C1略增高 ,C2有显著性增加 ;结论　 1 )高血压症状出现之前已有血管屈从性改变 ,以小动脉为主 ,改变的程度不受年龄的影响 ;2 )高血压经过药物治疗 ,血管屈从性可有所改善 ,首先是从小动脉开始 ;3 )可将 C2测定值作为心血管早期病变的揭示因素及疾病治疗过程中的疗效观察指标。     

正常高值血压人群动脉弹性功能的变化

目的　观察正常高值血压人群大小动脉弹性功能指数C1、C2的变化。方法　本研究分三组 ,(1)正常血压组 :收缩压 (SBP) <130mmHg ,且舒张压 (DBP) <85mmHg ,入选 72例 ,男 37例 ,女 35例 ;(2 )正常高值血压组 :SBP130～139mmHg和 /或DBP85～ 89mmHg ,入选 6 0例 ,男 31例 ,女 2 9例 ;(3)高血压组 :SBP≥ 14 0mmHg和 /或舒张压≥ 90mmHg ,入选 6 3例 ,男 31例 ,女 32例。采用HDICVProfilorDO - 2 0 2 0动脉功能检测仪测定大小动脉弹性功能指数C1、C2。结果　正常高值血压人群的C1、C2比正常血压组低 (C1:11 9± 3 4VS 15 3± 4 5 ;C2 :4 0± 2 1VS 5 6± 2 6 ) ,P <0 0 1;比高血压组高 (C1:11 9± 3 4VS 9 4± 3 1;C2 :4 0± 2 1VS 2 8± 1 3) ,P <0 0 1。C1、C2与血压呈负相关 ,即随着血压的升高而下降。结论　正常高值血压人群的动脉弹性功能下降 ,与血压水平呈负相关 ,随着血压的升高而降低     

脉压对高血压患者左室结构的影响

目的:探讨诊所脉压(PP)对高血压患者左室结构的影响。方法:选择291例高血压患者(高血压组)和107例正常血压者(正常组)。所有入选者测量非同日3次诊所血压,并进行超声心动图检查。2组均根据PP水平:<40mmHg(1mmHg=0·133kPa)、≥40~<50mmHg、≥50~<60mmHg、≥60mmHg分为A、B、C、D4个亚组。结果:高血压组左室质量指数(LVMI)随着PP增宽呈增大趋势,D亚组的LVMI为175·56±30·20;而在正常组中,不同亚组间LVMI差异无统计学意义。结论:PP升高是高血压患者左室肥厚及左室结构异常的重要危险因素。     

氟伐他汀改善高血压患者脉压和动脉弹性临床研究

目的观察氟伐他汀对降压治疗中高血压患者脉压和动脉弹性功能的影响.方法选择30例正在规律服用降压药物治疗并且脉压≥60 mmHg的高血压患者,分为安慰剂组(15例)和氟伐他汀组(15例),分别加服安慰剂(1片每天)或氟伐他汀(40 mg/d),治疗3个月.观察治疗前、后肱动脉血压,脉搏波传导速度(PWV),大动脉和小动脉弹性指数(C1和C2),从桡动脉压力波形实时获得的中心动脉血压、压力反射波增强指数(AI).结果安慰组治疗后各项指标均无显著改变.氟伐他汀组治疗后肱动脉收缩压与脉压分别降低8.0±12.9 mmHg (P=0.031) 与5.7±9.3 mmHg (P=0.033),中心动脉收缩压与脉压分别降低9.7±12.4 mmHg (P=0.009) 与7.1±9.3 mmHg (P=0.01),中心动脉下降幅度大于肱动脉;舒张压和心率无显著改变;C2升高 (P=0.03);AI降低 (P=0.026);PWV 和C1无显著改变.结论氟伐他汀通过改善高血压患者小动脉弹性和外周压力波反射,具有缩小脉压的作用.     

高血压患者脉压对尿微量白蛋白的影响

目的探讨高血压患者脉压变化对尿微量白蛋白(UmALB)排泌量的影响。方法选取160例原发性高血压患者,根据脉压(PP)水平分成PP<70mmHg组,77例和PP≥70mmHg组,83例,两组均行系统降压治疗1月,将血压达标(BP140/90mmHg)者再继续治疗观察5月,分析这些患者治疗前后PP及UmALB的变化,并进行比较。结果PP<70mmHg组治疗前后UmALB量无明显改变。PP≥70mmHg组治疗后有60例血压达标,该组总的UmALB分泌量减少,其中治疗后PP<70mmHg病例比治疗后PP≥70mmHg病例的UmALB分泌量明显减少(P<0.05)。结论高血压患者随着脉压变化可引起UmALB排泌量的变化,PP从≥70mmHg降至PP<70mmHg时UmALB排泌量显著下降。     

高血压治疗指南:英国高血压学会工作组第4次报告(2004,BHSⅣ)简介

晚近 ,英国高血压学会 (BHS)拟定并颁发了 2 0 0 4年高血压治疗新指南 ( 2 0 0 4,BHSⅣ ) ,其核心内容如下 :1　对于所有高血压、临界高血压或正常高值血压者 ,建议均应接受改善生活方式治疗 ,并应选择有效的非药物干预措施。2　对于收缩期血压持续≥ 1 6 0mmHg( 1mmHg =0 .1 3 3 3kPa)或舒张期血压持续≥ 1 0 0mmHg者 ,均应接受降压药治疗。3　对于血压持续在 1 40～ 1 5 9和 /或 90～ 99mmHg ,且伴心血管疾病 ,其它靶器官损害或心血管病 1 0年危险评分≥ 2 0 %者 ,均应接受降压药治疗。4　建议将心血管病危险取代冠心病危险进行评估 …     

氟伐他汀对高血压患者脉压和动脉弹性的影响

目的评价氟伐他汀对高血压患者脉压和动脉弹性的影响。方法选择60例正在规律服用降压药物治疗并且脉压≥60mmHg的高血压患者,随机分成治疗组和对照组,每组各30例。治疗组在服用原降压药物的基础上加服氟伐他汀（40mg／d）,对照组则继续服用原降压药物不变,在治疗前及治疗16周以后分别检测患者的血压、大动脉和小动脉弹性指数（C1和C2）。结果氟伐他汀组治疗后收缩压（135．2±12．6）mmHg、脉压（59．5±8．6）mmHg和C2（5．0±2．8）mmHg较对照组收缩压（143,4±14．7）mmHg、脉压（70．2±10.8）mmHg和C2（3．2±1．8）mmHg明显改善（P〈0．05）,C1则无显著改变（P〉0．05）。结论氟伐他汀能明显改善高血压患者的小动脉弹性,从而起到降低脉压的作用。     

动态脉压与老年高血压合并冠心病及颈动脉硬化的关系

目的研究老年高血压患者动态脉压(PP)与冠心病并发症及颈动脉粥样硬化的关系,为临床有针对性的干预PP、预防高血压并发症提供理论基础。方法对老年高血压及老年高血压合并冠心病的动态PP进行比较,同时对老年高血压颈动脉内膜中层厚度(IMT)增厚组与正常组的动态PP进行比较。结果(1)与单纯高血压组比较,高血压合并冠心病组的24h动态脉压(24hAPP)、白昼脉压(dPP)、夜间脉压(nPP)水平显著增大,24h平均收缩压(24hASBP)、夜间平均收缩压(nSBP)水平显著升高,24h平均舒张压(24hADBP)、白昼平均舒张压(dDBP)、夜间平均舒张压(nDBP)水平显著下降,而2组间dSBP比较无统计学意义;(2)老年高血压患者IMT增厚组的24hAPP、dPP和nPP水平均显著高于IMT正常组;(3)与动态PP<60mmHg者比较,动态PP≥60mmHg的高血压患者冠心病发生率显著升高;(4)与动态PP<60mmHg者比较,动态PP≥60mmHg的单纯高血压患者的IMT显著增厚。结论动态PP增大是老年高血压患者颈动脉粥样硬化及未来发生冠心病的重要危险因素。     

Small and large artery elasticity indices in peripheral arterial occlusive disease (PAOD)

In peripheral arterial occlusive disease (PAOD), arterial compliance of the central arteries has been reported to be reduced. It is, however, not clear whether, in PAOD, decreased arterial compliance is also accompanied by similar changes in the peripheral arteries. Therefore the aim of the study was to determine the large (C1) and small (C2) artery elasticity indices in PAOD and their relations to its well-accepted characteristics (ankle-brachial index, ABI; pulse pressure, PP; absolute claudication distance, ACD). A total of 43 patients with PAOD (mean age 68 +/- 9 years; ABI of the limiting leg 0.65 +/- 0.14; SBP (systolic blood pressure) 149 +/- 20 mmHg, and ACD 488 +/- 187 m) were enrolled as well as 16 control subjects of comparable age (69 +/- 4 years) and blood pressure (SBP 147 +/- 27 mmHg). All subjects underwent non-invasive pulse wave analysis in order to determine arterial compliance of the aorta and major side branches (C1) and of the distal circulation (C2), using a modified Windkessel model. In PAOD, both C1 (1.41 +/- 0.56 ml/mmHg) and C2 (0.023 +/- 0.012 ml/mmHg) were comparable to values in an age and blood pressure-matched control group (C1, 1.25 +/- 0.66 ml/mmHg; C2, 0.027 +/- 0.008 ml/mmHg). C1 was significantly correlated with ACD (r = 0.36, p = 0.02), PP (r = -0.33, p < 0.02) and only borderline with ABI (r = 0.28, p = 0.07). C2 was correlated with PP (r = -0.38, p < 0.01), ABI (r = 0.36, p < 0.02) but not with ACD. Large (C1) and small (C2) artery elasticity indices in PAOD were decreased but comparable to values in an elderly group with isolated systolic hypertension. Moreover, C1 and C2 correlated with markers (ABI and PP) of severity of vascular disease.     

高血压患者脉压与血压负荷、心率变异性及心律失常关系的探讨

目的探讨原发性高血压(EH)患者24h平均脉压(PP)与血压负荷、心率变异性(HRV)及心律失常的相关性。方法随机选择EH患者86例,同时行动态血压(ABPM)与动态心电图检查,以PP<60mmHg(A组,n=42),PP≥60mmHg(B组,n=44)分为两组,对其进行分析。结果PP增加主要因收缩压(SBP)增加所致;随PP增加,SBP血压负荷增加,HRV时域法指标均降低,而复杂性、恶性心律失常的发生率也明显增加,两组数据经统计学处理,有明显的统计学意义(P<0.05,P<0.01)。结论EH患者PP与血压负荷、HRV时域法指标及心律失常有关,临床在对其治疗中要注意缩小PP,并将PP作为评价高血压危险度和降压效果的重要指标。     

Potassium magnesium supplementation for four weeks improves small distal artery compliance and reduces blood pressure in patients with essential hypertension

It has been postulated that the loss of arterial compliance may precede cardiovascular diseases, and that arterial compliance is an important parameter to consider when evaluating arterial diseases such as essential hypertension (EH) and the effects of antihypertensive treatment. In all, 133 EH patients and 147 healthy subjects were enrolled in this study. Large arterial compliance (C1) and small arterial compliance (C2) were measured by the CVProfilor DO-2020 CardioVascular Profiling System. Thirty-five patients randomly received magnesium potassium supplementation (magnesium, 70.8 mg/d; potassium, 217.2 mg/d) for four weeks, and 32 patients received lacidipin (4 mg/d) as a control. Before and after the four weeks, blood pressure, C1, and C2 were measured. It was found that arterial compliance was significantly lower in EH patients compared with healthy subjects (C1: 12.53 +/- 0.33 vs. 15.63 +/- 0.30 ml/mmHg x 10, p < 0.01;C2: 3.79 +/- 0.17 vs. 5.69 +/- 0.25 ml/mmHg x 100, p < 0.01). On lacidipine, systolic and diastolic BP decreased 13.27 +/- 1.76 mm Hg and 6.33 +/- 1.55 mm Hg, and C1 and C2 compliance values increased 25.05% +/- 4.49% and 34.50% +/- 7.40%, respectively. On K+ and Mg2+ supplementation, systolic and diastolic BP decreased 7.83 +/- 1.87 mm Hg and 3.67 +/- 1.03 mm Hg, and C1 and C2 compliance values increased 12.44% +/- 4.43% and 45.25% +/- 6.67%, respectively. Decreases in systemic vascular resistance (mean arterial pressure divided by cardiac output) by 11.9% and 16.6 % (p < 0.01) were seen between the drug-induced changes, respectively. Both large arterial compliance and small arterial compliance were decreased in essential hypertension patients. In essential hypertension patients, magnesium and potassium supplementation could improve small arterial compliance, while lacidipine improved large arterial compliance significantly.     

Potassium Magnesium Supplementation for Four Weeks Improves Small Distal Artery Compliance and Reduces Blood Pressure in Patients with Essential Hypertension

It has been postulated that the loss of arterial compliance may precede cardiovascular diseases, and that arterial compliance is an important parameter to consider when evaluating arterial diseases such as essential hypertension (EH) and the effects of antihypertensive treatment. In all, 133 EH patients and 147 healthy subjects were enrolled in this study. Large arterial compliance (C1) and small arterial compliance (C2) were measured by the CVProfilor? DO-2020 CardioVascular Profiling System. Thirty-five patients randomly received magnesium potassium supplementation (magnesium, 70.8 mg/d; potassium, 217.2 mg/d) for four weeks, and 32 patients received lacidipin (4mg/d) as a control. Before and after the four weeks, blood pressure, C1, and C2 were measured. It was found that arterial compliance was significantly lower in EH patients compared with healthy subjects (C1: 12.53 ± 0.33 vs. 15.63 ± 0.30 ml/mmHg × 10, p < 0.01;C2: 3.79 ± 0.17 vs. 5.69 ± 0.25 ml/mmHg × 100,p < 0.01). On lacidipine, systolic and diastolic BP decreased 13.27 ± 1.76 mm Hg and 6.33 ± 1.55 mm Hg, and C1 and C2 compliance values increased 25.05% ± 4.49% and 34.50% ± 7.40%, respectively. On K⁺ and Mg²⁺ supplementation, systolic and diastolic BP decreased 7.83 ± 1.87 mm Hg and 3.67 ± 1.03 mm Hg, and C1 and C2 compliance values increased 12.44% ± 4.43% and 45.25% ± 6.67%, respectively. Decreases in systemic vascular resistance (mean arterial pressure divided by cardiac output) by 11.9% and 16.6 % (p < 0.01) were seen between the drug-induced changes, respectively. Both large arterial compliance and small arterial compliance were decreased in essential hypertension patients. In essential hypertension patients, magnesium and potassium supplementation could improve small arterial compliance, while lacidipine improved large arterial compliance significantly.     

老年高血压病及脑卒中患者动态血压分析的探讨

目的　探讨老年高血压病及脑卒中患者动态血压的特点。方法　对 30 7例高血压病患者进行动态血压监测 ,并根据年龄分为 :A组 (对照组n =16 1) ,年龄 <6 0岁 ;B组 (观察组n =14 6 ) ,年龄≥ 6 0岁。两组中又根据是否合并脑卒中 ,进一步分为 4个亚组A1 、B1 组 (无脑卒中 ) ,A2 、B2 组 (脑卒中 )。结果　B组老年高血压患者无论有无脑卒中 ,其血压昼夜节律性明显低于A组 (P <0 .0 5 )。B组脉压 [B1 组昼脉压 5 2 .9mmHg(1mmHg =0 .133kPa) ,夜脉压4 9.4mmHg;B2 组昼脉压 5 3.2mmHg ,夜脉压 5 3mmHg]较A组脉压 (A1 组昼脉压 4 3.6mmHg ,夜脉压 4 0 .3mmHg ;A2组昼脉压 4 7.2mmHg ,夜脉压 4 4mmHg)明显增大 (P <0 .0 5 )。B2 组夜间收缩压 (12 8.1mmHg)明显高于其余 3组 (A1组 117.4mmHg、A2 组 12 1.1mmHg、B1 组 12 0 .7mmHg ,P <0 .0 5 )。结论　血压昼夜节律降低、动态脉压增大及夜间收缩压增高是老年高血压患者动态血压的特点     

高血压患者脉压和脉压指数与血管内皮功能的关系

目的研究原发性高血压(EH)患者的脉压(PP)和脉压指数(PPI)与血管内皮功能的相互关系,探讨EH患者PP增大和PPI增高导致靶器官损害的机制。方法对108例EH患者进行24h动态血压监测。按动态脉压(APP)<40mmHg、40~60mmHg和>60mmHg三组;按PPI<0.35、0.35~0.45和>0.45三组进行分析。结果(1)各亚组年龄、内皮素-1(ET-1)、一氧化氮(NO)、ET-1/NO和假性血管性血友病因子(VWF)差异有显著性,随着24hAPP和PPI的增加,年龄、ET-1、ET-1/NO和VWF也增加(P<0.01或P<0.05),而NO减少(P<0.05)。(2)多元逐步回归分析显示在排除众多因素后,24h APP或PPI与ET-1和VWF呈正相关(P均<0.01),与NO呈负相关(P<0.01)。(3)在与血管内皮功能的相关性方面,PPI与PP具有很好的一致性,但PPI相关性更好(r值更接近于1)。结论PP升高和PPI增大导致血管内皮功能受损。     

降压治疗对颈动脉内膜中层厚度和动脉顺应性影响的研究

目的　探讨降压治疗对颈动脉内膜中层厚度 (IMT)和动脉顺应性影响的关系及其临床意义。方法　分别选取正常对照组 45例、高血压控制组 35例和高血压未控制组 36例 ,使用美国产CVProfilorDO 2 0 2 0动脉测试仪同步记录血压和动脉顺应性 [大动脉弹性 (C1 ) ,小动脉弹性 (C2 ) ],美国产HP5 5 0 0超声多普勒高分辨率 7 5MHz扫描探头测量颈动脉IMT和血管内径变化。结果　高血压未控制组颈动脉IMT明显增厚 ,与高血压控制组和正常对照组比较有显著性差异 (P <0 0 5 ) ,后二组间无统计学意义 (P >0 0 5 )。颈动脉内径在高血压未控制组与对照组间有显著性差异 (P <0 0 1) ,高血压未控制组与控制组间无显著性差异 (P >0 0 5 ) ,三组间收缩压 (SBP)、舒张压 (DBP)和脉压 (PP)比较均有显著性差异 (P <0 0 1) ,高血压未控制组C1 和C2 均低于对照组和高血压控制组 (P <0 0 1) ,后二组间无显著性差异 (P >0 0 5 )。三组的SBP、PP均与C1 呈负相关 (r= 0 314,P <0 0 5 ;r = 0 4 82 ,P <0 0 1;r = 0 342 ,P <0 0 5 ;r= 0 384,P <0 0 5 ;r = 0 315 ,P <0 0 5 ;r = 0 36 5 ,P <0 0 5 )。对照组颈动脉IMT与C1 呈负相关 (r = 0 36 9,P <0 0 1) ;对照组和高血压控制组的颈动脉IMT与C2 呈负相关 (r= 0 4 5     

老年原发性高血压患者血清炎性因子与动态脉压的相关性

目的:探讨老年原发性高血压(EH)患者白细胞(WBC)、超敏C-反应蛋白(hs-CRP)、白细胞介素-18(IL-18)和纤维蛋白原(FIB)与动态脉压(PP)的相关性。方法:选取174例老年EH患者,采用动态血压监测仪测量受试者全天平均收缩压(SBP)、全天平均舒张压(DBP),并计算PP值,按照PP大小分为<60 mmHg(1mmHg=0.133kPa)组和≥60mmHg组,比较不同组间患者WBC、hs-CRP、IL-18与FIB的差异。结果:两组WBC、hs-CRP、IL-18与FIB均差异有统计学意义(均P<0.05);随着PP升高,WBC、hs-CRP、IL-18与FIB均呈升高趋势;WBC(r=0.224,P<0.01)、hs-CRP(r=0.169,P<0.05)、IL-18(r=0.166,P<0.05)与SBP呈正相关,WBC(r=0.181,P<0.05)、hs-CRP(r=0.259,P<0.01)、IL-18(r=0.245,P<0.05)、FIB(r=0.159,P<0.05)与PP呈正相关;hs-CRP(回归系数=0.119,OR=1.126)与IL-18(回归系数=0.005,OR=1.005)可能为PP的危险因素。结论:老年EH患者体内存在炎症反应,炎性因子参与了老年EH患者PP升高的病理生理学过程。