Hypertensive crises are elevations of blood pressure higher than 180/120 mmHg. These can be urgent or emergent, depending on the presence of end organ damage. The clinical presentation of hypertensive crises is quite ...Hypertensive crises are elevations of blood pressure higher than 180/120 mmHg. These can be urgent or emergent, depending on the presence of end organ damage. The clinical presentation of hypertensive crises is quite variable in elderly patients, and clinicians must be suspicious of non-specific symptoms. Managing hypertensive crises in elderly patients needs meticulous knowledge of the pathophysiological changes in them, pharmacological options, pharmacokinetics of the medications used, their side effects, and their interactions with other medications. Clevidipine, nicardipine, labetalol, esmolol, and fenoldopam are among the preferred choices in the elderly due to their efficacy and tolerability. Nitroprusside, hydralazine, and nifedipine should be avoided, unless there are no other options available, due to the high risk of complications and unpredictable responses.展开更多
Hypertension is a common clinical problem in the elderly worldwide and physicians of all types are likely to encounter patients with hypertensive urgencies and emergencies in these patients. Although various terms hav...Hypertension is a common clinical problem in the elderly worldwide and physicians of all types are likely to encounter patients with hypertensive urgencies and emergencies in these patients. Although various terms have been applied to these conditions, they are all characterized by acute elevations in blood pressure and evidence of end-organ injury. Prompt, but carefully considered therapy is necessary to limit morbidity and mortality. A wide range of pharmacologic alternatives are available to the practitioner to control blood pressure and treat complications in these patients. The management of the elderly patient with hypertensive crises needs to include close monitoring and a gentle decline in blood pressure to avoid catastrophic complications, exacerbation of ischemic myopathy, and vascular insufficiency.展开更多
目的探讨多巴胺1类受体的激动剂非诺多泮对心力衰竭早期炎症反应的作用。方法8周龄雄性C57BL/6J小鼠20只,随机分为两组:假手术组和TAC组,每组10只,分别喂养6周。8周龄雄性C57BL/6J小鼠40只,完全随机分为4组:假手术联合磷酸盐缓冲溶液(P...目的探讨多巴胺1类受体的激动剂非诺多泮对心力衰竭早期炎症反应的作用。方法8周龄雄性C57BL/6J小鼠20只,随机分为两组:假手术组和TAC组,每组10只,分别喂养6周。8周龄雄性C57BL/6J小鼠40只,完全随机分为4组:假手术联合磷酸盐缓冲溶液(PBS)组、假手术联合非诺多泮组、横向主动脉弓缩窄术(TAC)联合PBS组和TAC联合非诺多泮组,每组10只。各组于手术后立即腹腔注射10 mg/kg PBS或非诺多泮,1次/d,连续注射1周。第7天时超声检查主动脉弓血流峰值和心功能,即刻处死小鼠后取心脏组织进行实时荧光定量和病理检测。提取心力衰竭小鼠心脏组织mRNA,采用实时荧光定量的方法检测多巴胺受体1-5的mRNA水平、心脏炎症因子白细胞介素1β(IL-1β)及肿瘤坏死因子-α(TNF-α)的mRNA水平。收集心力衰竭小鼠的心脏组织,免疫组化染色检查多巴胺受体的表达,伊红-苏木素染色观察心脏炎症细胞浸润。结果多普勒超声显示TAC术后1周主动脉弓血流峰值达2000 mm/s以上,假手术组小鼠主动脉弓血流峰值为800 mm/s。与假手术组比较,TAC组心脏多巴胺受体5 mRNA水平明显升高(0.21±0.02 vs 0.73±0.12,P<0.05)。与假手术组比较,TAC组免疫组化发现心脏多巴胺受体5水平增高。与假手术联合PBS组比较,TAC联合PBS组术后1周心脏炎症因子IL-1β和TNF-α的mRNA水平明显升高(4.18±0.31 vs 10.14±0.99,P<0.05;3.79±0.08 vs 14.43±2.35,P<0.05)。与TAC联合PBS组比较,TAC联合非诺多泮组术后1周心脏炎症因子IL-1β和TNF-α的mRNA水平降低(10.14±0.99 vs 4.19±0.47,P<0.05;14.43±2.35 vs 4.36±0.72,P<0.05)。与假手术联合PBS组比较,TAC联合PBS组术后1周心脏浸润的炎症细胞明显增多。与TAC联合PBS组比较,TAC联合非诺多泮组术后心脏的炎症细胞浸润减少。与TAC联合PBS组比较,TAC联合非诺多泮组术后1周射血分数和短轴缩短分数无明显变化,射血分数分别为(67.3±0.6)%和(62.8±5.3)%,短轴缩短分数分别为(32.7±2.0)%和(32.5±3.2)%。结论非诺多泮可以减轻心力衰竭早期心脏的炎症反应。展开更多
文摘Hypertensive crises are elevations of blood pressure higher than 180/120 mmHg. These can be urgent or emergent, depending on the presence of end organ damage. The clinical presentation of hypertensive crises is quite variable in elderly patients, and clinicians must be suspicious of non-specific symptoms. Managing hypertensive crises in elderly patients needs meticulous knowledge of the pathophysiological changes in them, pharmacological options, pharmacokinetics of the medications used, their side effects, and their interactions with other medications. Clevidipine, nicardipine, labetalol, esmolol, and fenoldopam are among the preferred choices in the elderly due to their efficacy and tolerability. Nitroprusside, hydralazine, and nifedipine should be avoided, unless there are no other options available, due to the high risk of complications and unpredictable responses.
文摘Hypertension is a common clinical problem in the elderly worldwide and physicians of all types are likely to encounter patients with hypertensive urgencies and emergencies in these patients. Although various terms have been applied to these conditions, they are all characterized by acute elevations in blood pressure and evidence of end-organ injury. Prompt, but carefully considered therapy is necessary to limit morbidity and mortality. A wide range of pharmacologic alternatives are available to the practitioner to control blood pressure and treat complications in these patients. The management of the elderly patient with hypertensive crises needs to include close monitoring and a gentle decline in blood pressure to avoid catastrophic complications, exacerbation of ischemic myopathy, and vascular insufficiency.
文摘目的探讨多巴胺1类受体的激动剂非诺多泮对心力衰竭早期炎症反应的作用。方法8周龄雄性C57BL/6J小鼠20只,随机分为两组:假手术组和TAC组,每组10只,分别喂养6周。8周龄雄性C57BL/6J小鼠40只,完全随机分为4组:假手术联合磷酸盐缓冲溶液(PBS)组、假手术联合非诺多泮组、横向主动脉弓缩窄术(TAC)联合PBS组和TAC联合非诺多泮组,每组10只。各组于手术后立即腹腔注射10 mg/kg PBS或非诺多泮,1次/d,连续注射1周。第7天时超声检查主动脉弓血流峰值和心功能,即刻处死小鼠后取心脏组织进行实时荧光定量和病理检测。提取心力衰竭小鼠心脏组织mRNA,采用实时荧光定量的方法检测多巴胺受体1-5的mRNA水平、心脏炎症因子白细胞介素1β(IL-1β)及肿瘤坏死因子-α(TNF-α)的mRNA水平。收集心力衰竭小鼠的心脏组织,免疫组化染色检查多巴胺受体的表达,伊红-苏木素染色观察心脏炎症细胞浸润。结果多普勒超声显示TAC术后1周主动脉弓血流峰值达2000 mm/s以上,假手术组小鼠主动脉弓血流峰值为800 mm/s。与假手术组比较,TAC组心脏多巴胺受体5 mRNA水平明显升高(0.21±0.02 vs 0.73±0.12,P<0.05)。与假手术组比较,TAC组免疫组化发现心脏多巴胺受体5水平增高。与假手术联合PBS组比较,TAC联合PBS组术后1周心脏炎症因子IL-1β和TNF-α的mRNA水平明显升高(4.18±0.31 vs 10.14±0.99,P<0.05;3.79±0.08 vs 14.43±2.35,P<0.05)。与TAC联合PBS组比较,TAC联合非诺多泮组术后1周心脏炎症因子IL-1β和TNF-α的mRNA水平降低(10.14±0.99 vs 4.19±0.47,P<0.05;14.43±2.35 vs 4.36±0.72,P<0.05)。与假手术联合PBS组比较,TAC联合PBS组术后1周心脏浸润的炎症细胞明显增多。与TAC联合PBS组比较,TAC联合非诺多泮组术后心脏的炎症细胞浸润减少。与TAC联合PBS组比较,TAC联合非诺多泮组术后1周射血分数和短轴缩短分数无明显变化,射血分数分别为(67.3±0.6)%和(62.8±5.3)%,短轴缩短分数分别为(32.7±2.0)%和(32.5±3.2)%。结论非诺多泮可以减轻心力衰竭早期心脏的炎症反应。
