Twenty-four-hour ambulatory blood pressure changes in older patients with essential hypertension receiving monotherapy or dual combination antihypertensive drug therapy

Objective To evaluate the differences in 24-hour ambulatory blood pressure (BP) in older patients with hypertension treated with the five major classes of antihypertensive drugs,as monotherapy or dual combination therapy,to improve daytime and nighttime BP control. Methods We enrolled 1920 Chinese community-dwelling outpatients aged ≥ 60 years and compared ambulatory BP values and ambulatory BP control (24-hour BP < 130/80 mmHg;daytime mean BP < 135/85 mmHg;and nighttime mean BP < 120/70 mmHg),as well as nighttime BP dip patterns for monotherapy and dual combination therapy groups. Results Patients’ mean age was 71 years,and 59.5% of patients were women. Calcium channel blockers (CCBs) constituted the most common (60.3% of patients) monotherapy,and renin–angiotensin system (RAS) blockers combined with CCBs was the most common (56.5% of patients) dual combination therapy. Monotherapy with beta-blockers (BB) provided the best daytime BP control. The probabilities of having a nighttime dip pattern and nighttime BP control were higher in patients receiving diuretics compared with CCBs (OR = 0.52,P = 0.05 and OR = 0.41,P = 0.007,respectively). Patients receiving RAS/diuretic combination therapy had a higher probability of having controlled nighttime BP compared with those receiving RAS/CCB (OR = 0.45,P = 0.004). Compared with RAS/diuretic therapy,BB/CCB therapy had a higher probability of achieving daytime BP control (OR = 1.27,P = 0.45). Conclusions Antihypertensive monotherapy and dual combination drug therapy provided different ambulatory BP control and nighttime BP dip patterns. BB-based regimens provided lower daytime BP,whereas diuretic-based therapies provided lower nighttime BP,compared with other antihypertensive regimens.

An Analysis of the Effects of Blood Pressure and Antihypertensive Drugs on Heart Disease

Background: The American College of Cardiology (ACC), American Heart Association (AHA) and other organizations announced a new hypertension guideline (2017 ACA/AHA Guideline) in November 2017. However, other organizations such as the European Society of Cardiology and European Society of Hypertension maintained their diagnostic thresholds. It is necessary to evaluate the effects of blood pressure (BP) and antihypertensive drugs on the probability of having heart disease (HD). Data and Methods: The effects of BP, antihypertensive drugs and other factors on the probability of undergoing HD treatment were analyzed. We used a dataset containing 83,287 medical check-up and treatment records obtained from 35,504 individuals in 5 fiscal years. The probit models were used in the study. Considering the possibility of endogeneity problems, different types of models were used. Results: We could not find evidence that a higher systolic BP increased the probability of undergoing HD treatment. However, diastolic BP increased the probability in most of the models. Taking antihypertensive drugs also increased the probability of undergoing HD treatment. Diabetes was another important risk factor. Conclusion: The results of this study did not support the new 2017 ACC/AHA Guideline. It is necessary to choose proper drugs and methods to reduce the risks of side effects. Limitations: The dataset was observatory, the data were obtained from just one medical society, and sample selection bias might exist.

Effect of Antihypertensive Drug Therapy on the Blood Pressure Control among Hypertensive Patients Attending Campus’ Teaching Hospital of Lome, Togo, West Africa

High blood pressure (HBP) is a health problem world—wide. In Togo, that affection constitutes a more and more pre-occupying cause of morbidity and mortality. This study is a prospective one which intended to identify the antihypertensive regimens prescribed and evaluate their effect on patients’ blood pressure (BP) control. Out of the 204 patients enrolled (mean: 55.01 ± 12.55 years;sex ratio: 1.3), 112/176 placed on antihypertensive therapy have controlled their BP (38.39% outpatients vs 61.61% inpatients). Related to the sex factor, we didn’t observe any significant difference in the BP control. Whereas, the mean median value of BP reduction of outpatients (30.00/15.00 mmHg) (p = 0.001) was half lower than that of inpatients (60.00/30.00 mmHg (p = 0.004)). Thirty five outpatients (81.40%) vs 64 inpatients (92.75%) were placed on combination therapy. The bitherapy was prescribed to 23 outpatients (53.49%) against 27 inpatients (39.13%) while the quadritherapy and more than 4 drugs combination were prescribed exclusively to inpatients (20.29%, n = 14). That quadritherapy induced a significant mean reduction of inpatients’ SBP compared to monotherapy (p = 0.043) and to bitherapy (p = 0.004). The favorite combinations were D + CCA, D + ACEI, D + CCA + ACEI and D + CCA + ACEI + CAAD of which the quadruple therapy showed a significant inpatients’ DBP control (p = 0.015) compared to D + CCA combination. The combinations including at least one diuretic induced a significant difference between outpatients (median value: 30.000/10.000 mmHg) (p < 0.001) and inpatients (median value: 60.000 mmHg/30 mmHg) (p < 0.001). The first-line molecules and fixe combinations prescribed in decreasing frequency were among others: hydrochlorothiazide + captopril, nicardipine, α methyldopa for outpatients;furosemide, nicardipine, captopril, α methyldopa, hydrochlorothiazide + captopril for inpatients. Diuretics, CCAs and ACEIs were the 3 favorite pharmacological groups for essential hypertension management in our African resource limited context. Combined to CAAD, they represented the best quadruple combination among inpatients having showed a significant difference in DBP control compared to D + CCA combination.

Editorial on hemoglobin A1c, blood pressure, and lowdensity lipoprotein cholesterol goals in diabetics

The American Diabetes Association (ADA) 2013 guidelines state that a reasonable hemoglobin A1c goal for many nonpregnant adults with diabetes is less than 7.0% a hemoglobin A1c level of less than 6.5% may be considered in adults with short duration of diabetes, long life expectancy, and no significant cardiovascular disease if this can be achieved without significant hypoglycemia or other adverse effects of treatment. A hemoglobin A1c level less than 8.0% may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced macrovascular and microvascular complications, extensive comorbidities, and long-standing diabetes in whom the hemoglobin A1c goal is difficult to attain despite multiple glucoselowering drugs including insulin. The ADA 2013 guidelines recommend that the systolic blood pressure in most diabetics with hypertension should be reduced to less than 140 mmHg. These guidelines also recommend use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in the treatment of hypertension in diabetics unless they are pregnant. Diabetics at high risk for cardiovascular events should have theirserum low-density lipoprotein (LDL) cholesterol lowered to less than 70 mg/dL with statins. Lower-risk diabetics should have their serum LDL cholesterol reduced to less than 100 mg/dL. Combination therapy of a statin with either a fibrate or niacin has not been shown to provide additional cardiovascular benefit above statin therapy alone and is not recommended. Hypertriglyceridemia should be treated with dietary and lifestyle changes. Severe hypertriglyceridemia should be treated with drug therapy to reduce the risk of acute pancreatitis.

An Analysis of Blood Pressure Situations in Japan Using the Large-Scale Medical Checkup Dataset

Background: The high blood pressure (BP) or hypertension is a widely prevalent disease and its costs are very high, and many studies about the relationships between BP and health conditions have been done. We need to know the precise distributions of BP and factors affecting BP. Data and Methods: The distributions of BP are analyzed using 12,877,653 observations obtained from the JMDC Claims Database. The factors that may affect the BP are analyzed by the regression models using 4,615,346 observations. Results: The averages of systolic BP (SBP) and diastolic BP (DBP) are 120.4 and 74.2 mmHg with standard deviations of 15.9 and 11.3 mmHg, respectively. Among the nonmodifiable factors, age and gender are important factors. Among the modifiable factors, variables related to obesity are important risk factors. Taking antihypertensive drugs makes SBP and DBP 13.4 mmHg and 7.8 mmHg lower. Conclusion: The criteria of BP should be carefully determined considering age and gender. The effects of age may be a little different for SBP and DBP. It is necessary to use the proper model to evaluate the effect of antihypertensive drugs correctly. Limitations: The dataset is observatory. Although there are various types of treatment methods and antihypertension drugs, their effects are not evaluated.

Non-alcoholic fatty liver disease,diabetes medications and blood pressure

New glucose-lowering agents reduce liver enzyme levels and blood pressure(BP).Whether this finding can be extended to non-alcoholic fatty liver disease(NAFLD)patients,in whom a bidirectional association of NAFLD measures and BP has been also demonstrated,remains by and large unknown.

Kidney Function in Frequent Users of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are used for managing painful conditions. They are available as cheap, over-the-counter drugs, and commonly abused. NSAIDs inhibit prostaglandins (PGs) actions on the kidneys and can cause kidney disease and hypertension, especially when used in excess doses, for prolonged period or in stressed states. Methods: The descriptive study was carried at the Orthopaedic and Family Medicine units of the Federal Medical Centre, Abeokuta. Two hundred respondents participated in the study. One hundred frequent users of NSAIDs (with daily use for ≥ 4 weeks) and age and sex-matched controls with no known risk for kidney disease and had consented were consecutively recruited. Data were entered from history, examination and investigations (urinalysis, serum electrolyte, kidney scan and biopsy). Cases with estimated glomerular filtration rate (eGFR) 2) and dip strip proteinuria ≥ 1+ had kidney biopsy. Statistical analysis was with SPSS 21 software. Student t-test and Chi-square tests were used to compare means and proportions respectively. Pearson’s correlation test was used to determine the strength of association between independent risk factors and kidney dysfunction (KD). Results: Two hundred respondents participated in the study. Fifty one (51) females and Forty nine (49) males were recruited as cases and controls respectively. Thirteen (13) females had KD compared to 9 males, (P = 0.02). The mean age of cases with KD (63.04 yrs ± 4.21) was statistically higher than those without KD (P = 0.01). Majority of the cases were in the working population (30 - 59 yrs). Twenty two (22) frequent NSAIDs users had kidney dysfunction (KD) while six (6%) controls had KD. The proportion of subjects that used herbal medicines was higher in cases with KD than in cases without KD as well as in the controls respectively (P = 0.01). The mean kidney length and cortical thickness were significantly lower in cases with KD than in cases without KD, (P = 0.03) and (P = 0.017) respectively. The independent predictors of KD were increasing age, use of herbal remedies and duration of drug use. Conclusion: The prevalence of KD among frequent NSAIDs users was 22%, higher than controls. Risk factors identified include increasing age, use of herbal medicines, increasing body mass index (BMI), systolic blood pressure (SBP), anaemia, reduced cortical thickness and kidney volume. NSAIDs use in excess doses, prolonged period or in stressed state increases the risk for kidney dysfunction, caution is therefore needed to avoid taking these drugs in these conditions.

不同降压药物治疗原发性高血压患者血压变异的研究进展

血压变异性是心、脑血管疾病及肾脏损伤的独立危险因素,并在其发生、发展及严重程度方面较平均动脉压具有更高的预测价值,同时也是评价降压药物疗效的重要指标之一。所以早期判断高血压患者的血压变异情况并对其进行积极干预,防止心脑血管事件的进一步发展已成为高血压管理过程中的重要环节。本文将从血压变异性的定义及分类、控制血压变异性的意义以及常见降压药物的疗效观察这几个方面展开综述。

围手术期高血压的管理与控制

围手术期未得到控制的高血压可能影响患者手术中血流动力学稳定性,进而影响患者预后,增加其他并发症出现和死亡的风险。对于接受手术的高血压患者,都需要权衡利弊选择合适的降压药物来降低围手术期不良事件的发生率。目前我国对围手术期血压的管理尚无统一定论,该文从非心脏手术、心脏手术、妊娠、嗜铬细胞瘤4个手术类型系统梳理围手术期血压的控制目标与药物使用方案,为高血压患者的围手术期管理提供参考。

经皮去肾神经术治疗高血压临床试验的展望

高血压作为最常见的心血管疾病,存在患病率高、知晓率低、控制率低的问题。由于药物治疗的局限性,近十年来,经皮去肾神经术(RDN)作为一种新兴的治疗高血压介入手段脱颖而出。经过长达十余年的循证医学研究证明了该技术在降压方面的有效性与安全性。目前,RDN临床试验的挑战在于患者为了控制血压而无法避免对降压药物进行调整,从而对RDN降压效果产生干扰。无论是Simplicity HTN-36个月试验和REQUIRE试验等失败案例,还是SPYRAL与RADIANCE系列试验,其结果都表明RDN临床试验的结果评估需要纳入降压药物的变化。因为降压药物与介入手术治疗是影响血压水平的两个决定因素,所以评估RDN的降压疗效时不得不考虑患者降压药物的调整,还要回答一个重大临床问题即RDN术后患者是否可以少服以至不服用药物。我国的SMART研究不再以单纯的血压可以降低的mmHg数,而是以高血压防治指南中的治疗目标即诊室血压达标率为主要终点之一;引入了预设的“药物负荷指数”并将诊室收缩压(OSBP)达标率和降压用药变化作为临床试验的复合终点。其结果证明了RDN作为降压的辅助疗法,可以显著降低患者的药物负荷水平,将患者的OSBP控制达标。在未来的RDN临床试验中,应当充分考虑药物负荷的影响,明确血压指标和受试人群。RDN治疗高血压的临床试验方式会更加多元化,包括更能回答临床重大问题和符合治疗指南的有效性终点、更多种消融能量平台的尝试、术中手术终点的判定和试验对照组的设定等。

云南元江诺丽果汁对正常大鼠血压与糖尿病模型小鼠血糖的影响

为了探究云南元江诺丽果汁与其他种类诺丽果汁对正常大鼠血压与糖尿病模型小鼠血糖的影响,以正常大鼠和糖尿病模型小鼠为研究对象,观察试验前后正常大鼠血压和糖尿病模型小鼠血糖的变化。正常大鼠麻醉后经十二指肠灌注药或果汁,采用直接测压法测定血压,读取试验前后的血压值并进行数据分析;采用腹腔注射四氧嘧啶建立糖尿病小鼠模型,并分别给予造模成功的小鼠相对应的药物或果汁,每日给药或果汁1次,连续给药或果汁9 d,并在第10天采集小鼠血液测定其空腹血糖数值进行研究对比分析。分析大鼠血压发现,云南元江高剂量组在注射云南元江诺丽果汁前后血压值无显著差异;中剂量组在注射90 min前后血压值差异极显著;低剂量组在注射240 min前后血压值差异显著;中剂量组降血压效果最佳。分析糖尿病模型小鼠血糖发现,注射云南元江诺丽果汁的低、中、高3个剂量组均可不同程度地降低血糖,且低剂量组的降血糖效果最佳;大溪地诺丽果汁降糖率为0.00%。云南元江诺丽果汁具有降血糖和降血压的双重功效,且低剂量组降血糖的效果最显著;诺丽由美国夏威夷引种至云南西双版纳和元江,对其降血糖的功效并无显著影响。

杂粮饮食结合降压药对高血压患者的干预效果

目的探究杂粮饮食结合降压药对高血压患者的干预效果。方法选取2020年7月至2022年7月在本社区卫生服务中心进行常规治疗的高血压患者70例作为本次分析对象,采用随机抽样法分为两组,各35例,对照组采用常规降压药干预,观察组采用杂粮饮食结合降压药干预。对两组患者的血压控制情况、血脂情况以及患者满意度情况进行对比分析,探究其应用效果。结果干预后,观察组血压控制水平低于对照组(P<0.05);观察组TC、TG以及LDL-G水平低于对照组,HDL-C值高于对照组(P<0.05);且护理满意度,观察组高于对照组(P<0.05)。结论对于高血压患者,采用杂粮饮食结合降压药的干预方式可提升患者的治疗效果,改善患者血脂水平,降低并发症发生率;同时可稳定患者血压水平,提升患者满意度。

500张高血压处方点评及用药合理性分析

目的:点评本院500张高血压处方并分析用药合理性。方法:回顾性分析广州医科大学附属第二医院2023年1—6月开具的高血压处方500张,对其进行处方点评及合理性分析,统计患者年龄分布情况、处方药物组成及用药不合理情况。结果:>60~80岁患者299例,占比最高(59.80%);27~40岁患者7例,占比最低(1.40%)。>40~60岁患者123例,占24.6%;>80~100岁患者71例,占14.2%。常见药物包括富马酸比索洛尔片、盐酸乐卡地平片、瑞舒伐他汀钙片、阿托伐他汀钙片、硫酸氢氧吡格雷片、奥美沙坦酯片、铝镁匹林片、琥珀酸美托洛尔片、沙库巴曲缬沙坦钠片和复方血栓通胶囊。富马酸比索洛尔片占比最高,为19.53%;复方血栓通胶囊为辅助用药,占比最低,为5.51%。500张处方中共有不合理处方73张,包括用法用量不合理、适应证不合理、用药价格不合理、未写第2类精神药品标志、不良相互作用以及重复用药。结论:通过对500张高血压处方的点评和用药合理性分析,发现存在一定比例的不合理处方。临床需要进一步加强用药合理性的评估和指导,确保患者的治疗效果和用药安全性。

氧化苦参碱对大鼠血压的影响

目的:观察氧化苦参碱(OMT)对大鼠血压的影响。方法:将4 8只Wistar大鼠随机分为6组(n=8) ,即生理盐水组,OMT30、6 0和90 m g·kg- 1 组以及普萘洛尔加OMT6 0 mg·kg- 1 组和多沙唑嗪加OMT6 0 m g·kg- 1组。常规颈动脉插管,股静脉给药,应用BL- 4 2 0生物机能实验系统记录大鼠血压及心率。结果:静脉给予OMT30、6 0和90 mg·kg- 1具有剂量依赖性地降低血压的作用,OMT能增强多沙唑嗪的降压作用,但与普萘洛尔无协同降压作用。结论:OMT的降压作用呈现剂量依赖性,且与多沙唑嗪具有协同的降压效应。

谷峰比值和平滑指数在降压药物疗效评价中的应用

目的 :探讨谷峰比值合理计算方法 ,并比较其与平滑指数反映降压药物降压作用的稳定性。方法 :结合乐卡地平在高血压病人中的疗效研究 ,6 0例病人分别在治疗wk 0 ,6 ,8末进行 3次 2 4h动态血压检测。以不同方法计算服药后峰 /谷效应值、谷峰比值和平滑指数 ,并比较其重复性。结果 :以 2h时间段进行计算 ,峰 /谷效应值下降最少 ,重复性增加明显。以治疗有效病人为对象计算谷峰比值为正态分布 ,分布相对集中。治疗wk 6末和wk 8末相比 ,平滑指数重复性优于谷峰比值。结论 :建议在降压药疗效评价中取降压幅度最大的相邻 2h时间段计算峰效应值 ,下次服药前 2h时间段计算谷效应值 ,选择治疗有效病人计算谷峰比值 。

吲哒帕胺单用与合用对原发性高血压病人血压和血钾的长期影响

目的 :比较吲哒帕胺单用及与贝那普利合用对原发性高血压病人血压和血钾的长期作用。方法 :6 0例原发性高血压病人分 2组 ,吲哒帕胺单用组 (单用组 ) 30例 ,给吲哒帕胺 2 .5mg ,po ,qd× 2 4wk ;吲哒帕胺与贝那普利合用组 (合用组 ) 30例 ,在原贝那普利 10mg ,po ,qd基础上加用吲哒帕胺 (用法同上 )× 2 5wk。结果 :单用组和合用组治疗后收缩压和舒张压均较治疗前明显降低 (均P <0 .0 1) ,2组组间相比较无差异 (P >0 .0 5) ;单用组和合用组治疗后血钾均下降 (均P <0 .0 1) ;但单用组血钾水平明显低于合用组 (P <0 .0 1) ;至 2 4wk ,单用组血钾 <3.5mmol·L- 16例。结论

不同降压药物联合治疗对老年高血压患者血压变异性的影响

目的比较缬沙坦联合氨氯地平或氢氯噻嗪对老年高血压患者血压变异性的治疗作用。方法 80例老年高血压患者随机分为2组,分别给予缬沙坦联合氨氯地平(氨氯地平组)或缬沙坦联合氢氯噻嗪(氢氯噻嗪组)降压治疗,监测2组24 h动态血压,观察治疗前、治疗第6周和第12周,2组血压及血压变异性的变化。同时观察2组6周末血压达标率。记录治疗过程中的不良反应情况。结果 2组治疗6周和12周的24 h平均收缩压(SBP)、白昼SBP、夜间SBP、晨峰SBP、24 h收缩压变异性(SBPV)均较治疗前降低(P<0.05)。24 h SBP、白昼SBP、夜间SBP、24 h SBPV及白昼SBPV分组因素与时间因素存在交互作用(P<0.05)。治疗第6周和第12周,氨氯地平组24 h SBP、白昼SBP、夜间SBP及白昼SBPV较氢氯噻嗪组降低(P<0.05),治疗第12周,氨氯地平组24 h SBPV低于氢氯噻嗪组(P<0.01)。2组血压达标率和不良反应发生率差异均无统计学意义。结论缬沙坦联合氨氯地平或氢氯噻嗪均能有效控制老年高血压患者血压变异性,而缬沙坦联合氨氯地平在降低血压和血压变异性方面作用更强。

药师主导的药学服务对社区高血压病人疗效的影响

目的:评价药学服务团队对社区高血压病人药物治疗的干预效果。方法:对社区高血压病人进行高血压病的相关知识、合理用药和保健知识教育,结合随访、用药指导等干预措施,以病人血压水平、对高血压知识的认知程度和用药依从性为指标,评价干预效果。结果:干预1年后,病人血压达标率从27.59%提高到93.10%,收缩压和舒张压平均下降14.26、9.01mm Hg;用药种类和金额略有下降;病人对高血压知识的答卷分数从干预前的63.41分提高到97.27分;用药依从性显著提高;部分血液生化指标超标率下降,身体质量指数(BMI)下降(P<0.05)。干预结束后的第5、第14个月,病人血压达标率分别为89.66%和81.48%,用药依从性有所下降,但仍能维持在较高水平。结论:资深药师主导的药学服务团队实施以高血压及其药物治疗相关知识教育、随访和用药指导为核心的综合干预措施,有助于大幅提高病人的药物治疗知识水平,增强居民合理用药意识,提高病人的用药依从性、血压达标率和生活质量,而持续的干预对于长期维持血压达标率是必需的。

改变血压波动性对靶器官损伤的影响

目的：用抗高血压药尼群地平（Ｎｉｔ）及肼屈嗪（Ｈｙｄ）研究血压波动性（ＢＰＶ）的改变与靶器官损伤（ＴＯＤ）的关系。方法：将自发性高血压大鼠（ＳＨＲ）随机分３组，一组为对照组，另两组分别用Ｎｉｔ及Ｈｙｄ治疗１６周。记录２４ｈ血压，计算出ＢＰＶ；取心、脑、肾和脾做大体标本，行光镜、电镜病理检查，参照ＴＯＤ半量化指标对损伤程度评分，所得分数与ＢＰＶ作相关性分析。结果：两个治疗组血压基本相近，比对照组明显下降；ＢＰＶ：Ｎｉｔ组＜对照组＜Ｈｙｄ组；ＴＯＤ：Ｎｉｔ组＜对照组＜Ｈｙｄ组；直线相关分析显示ＢＰＶ的大小与ＴＯＤ程度呈正相关。结论：（１）ＢＰＶ与ＴＯＤ之间呈正相关，降低ＢＰＶ对靶器官有保护作用；（２）抗高血压治疗时，为了减轻ＴＯＤ程度，在降低血压的同时，应考虑降低ＢＰＶ。

高血压病人药物治疗期间动态血压变化

目的评价高血压病人药物治疗期间２４ｈ动态血压变化。方法２６例住院的高血压病人经药物治疗４周连续３ｄ随测血压，血压正常后进入本研究。治疗前后进行２４ｈ动态血压监测。结果患者随测血压（８～９ＡＭ，３～４ＰＭ）血压恢复到正常水平，但动态血压显示在一段时间内（６～８ＡＭ，６～１１ＰＭ）平均收缩和舒张压仍明显高于正常人平均水平（Ｐ＜０．０１），而该时间段易被临床医生忽视。结论随测血压不能实际全面反映高血压病人药物治疗的疗效，２４ｈ动态血压的监测可以正确评价高血压病人药物治疗的效果并根据高血压分布的时间来调整降压药的种类和剂量。