Aims: The associations between the number of antihypertensive agents being taken by type 2 diabetic patients and 1) the grade of atherosclerosis according to non-invasive surrogate markers for atherosclerosis and 2) t...Aims: The associations between the number of antihypertensive agents being taken by type 2 diabetic patients and 1) the grade of atherosclerosis according to non-invasive surrogate markers for atherosclerosis and 2) the other risk factor for atherosclerosis, were cross-sectionally investigated. Methods: The association between the blood pressure control and the clinical characteristics was evaluated in 1359 patients with type 2 diabetes mellitus. Results: The number of antihypertensive agents was 1.5 ± 1.4 (2.0 ± 1.2 among the 990 patients with hypertension). The proportion of patients taking no antihypertensive agents was 29%, 22% were taking one, 29% were taking two and 21% of the patients were taking three or more antihypertensive agents. The value of the ankle-brachial pressure index significantly decreased with the increase in the number of antihypertensive agents even if the blood pressure was corrected to the target value. The values of brachial-ankle pulse wave velocity and carotid intima-media thickness were also increased. The prevalence of risk factors for atherosclerosis, such as obesity, hyperlipidemia, chronic kidney disease, hyperuricemia and anemia was significantly elevated with the number of agents. Conclusions: The number of antihypertensive agents simply reflects the grade and risk of atherosclerosis in patients with type 2 diabetes mellitus.展开更多
BACKGROUND Hypertension is commonly observed in patients living with chronic kidney disease(CKD).Finding an optimal treatment regime remains challenging due to the complex bidirectional cause-and-effect relationship b...BACKGROUND Hypertension is commonly observed in patients living with chronic kidney disease(CKD).Finding an optimal treatment regime remains challenging due to the complex bidirectional cause-and-effect relationship between hypertension and CKD.There remains variability in antihypertensive treatment practices.AIM To analyze data from the Salford Kidney Study database in relation to antihypertensive prescribing patterns amongst CKD patients.METHODS The Salford Kidney Study is an ongoing prospective study that has been recruiting CKD patients since 2002.All patients are followed up annually,and their medical records including the list of medications are updated until they reach study endpoints[starting on renal replacement therapy or reaching estimated glomerular filtration rate(eGFR)expressed as mL/min/1.73 m2≤10 mL/min/1.73 m2,or the last follow-up date,or data lock on December 31,2021,or death].Data on antihypertensive prescription practices in correspondence to baseline eGFR,urine albumin-creatinine ratio,primary CKD aetiology,and cardiovascular disease were evaluated.Associations between patients who were prescribed three or more antihypertensive agents and their clinical outcomes were studied by Cox regression analysis.Kaplan-Meier analysis demonstrated differences in survival probabilities.RESULTS Three thousand two hundred and thirty non-dialysis-dependent CKD patients with data collected between October 2002 and December 2019 were included.The median age was 65 years.A greater proportion of patients were taking three or more antihypertensive agents with advancing CKD stages(53%of eGFR≤15 mL/min/1.73 m2 vs 26%of eGFR≥60 mL/min/1.73 m2,P<0.001).An increased number of patients receiving more classes of antihypertensive agents was observed as the urine albumin-creatinine ratio category increased(category A3:62%vs category A1:40%,P<0.001),with the upward trends particularly noticeable in the number of individuals prescribed renin angiotensin system blockers.The prescription of three or more antihypertensive agents was associated with all-cause mortality,independent of blood pressure control(hazard ratio:1.15;95%confidence interval:1.04-1.27,P=0.006).Kaplan-Meier analysis illustrated significant differences in survival outcomes between patients with three or more and those with less than three antihypertensive agents prescribed(log-rank,P<0.001).CONCLUSION Antihypertensive prescribing patterns in the Salford Kidney Study based on CKD stage were consistent with expectations from the current United Kingdom National Institute of Health and Care Excellence guideline algorithm.Outcomes were poorer in patients with poor blood pressure control despite being on multiple antihypertensive agents.Continued research is required to bridge remaining variations in hypertension treatment practices worldwide.展开更多
The transport of sodium ions by erythrocytes and the plasma level of endogenous digitalis-like compound (EDLC) were assessed in 59 patients with essential hypertension before and after theadminstration of nifedipine a...The transport of sodium ions by erythrocytes and the plasma level of endogenous digitalis-like compound (EDLC) were assessed in 59 patients with essential hypertension before and after theadminstration of nifedipine and prazosin. 20 normal subjects were studied similarly and served as con-trol. It was found that (1) EH patients had a pronounced defect of both the active and passive trans-port of sodium ions by the erythrocytes; (2) a higher plasma level of EDLC was detected in EH pa-tients as compared with that of the control, but the changes of EDLC and soudium pump were notparallel; (3) after the administration of nifedipine and prazosin, the function of sodium pump wasmarkedly improved and the plasma level of EDLC decreased. In addition, the relationship betweenthe transport of sodium ions by erythrocytes and the pathogenesis of EH, and the effects of anti-hypertensive agents were discussed.展开更多
目的分析我国高龄高血压住院患者在降压标准150/90 mm Hg(1 mm Hg=0.133 kPa)下的降压达标率、用药及并发症分布情况。方法选择解放军空军特色医学中心所有科室年龄≥80岁且被诊断为高血压的409例住院患者为研究对象,将409例患者分为强...目的分析我国高龄高血压住院患者在降压标准150/90 mm Hg(1 mm Hg=0.133 kPa)下的降压达标率、用药及并发症分布情况。方法选择解放军空军特色医学中心所有科室年龄≥80岁且被诊断为高血压的409例住院患者为研究对象,将409例患者分为强化降压组(106例,收缩压<130 mm Hg)、标准降压组(155例,收缩压130~149 mm Hg)和降压未达标组(148例,收缩压≥150 mm Hg),分析各组患者血压控制现状。结果以150/90 mm Hg为降压标准时,强化降压组占25.9%,标准降压组占37.9%,降压未达标组占36.2%,降压未达标组年龄>90岁比例显著低于强化降压组和标准降压组(4.1%vs 7.5%、12.3%,P<0.05)。标准降压组一联用药比例显著高于强化降压组(46.5%vs 32.1%),强化降压组二联用药比例显著高于标准降压组(35.8%vs 22.6%),差异有统计学意义(P<0.05)。强化降压组并发心脏损害和脑血管损害比例显著高于标准降压组(43.4%vs 21.9%,26.4%vs 14.8%),合并视网膜病变比例显著低于标准降压组(11.3%vs 23.9%),差异有统计学意义(P<0.05)。结论对于高龄高血压患者,以150/90 mm Hg为启动降压标准更具有科学性、实用性,强化降压反而增加了高龄高血压患者心脑血管损害。展开更多
背景高血压是心血管疾病主要的危险因素,降压用药不仅要考虑患者血压特征,也要考虑患者合并症情况。现阶段,基于家庭医生签约服务对高血压患者的服药状况及影响因素研究比较缺乏。目的调查安徽省界首市家庭医生签约服务的高血压患者服...背景高血压是心血管疾病主要的危险因素,降压用药不仅要考虑患者血压特征,也要考虑患者合并症情况。现阶段,基于家庭医生签约服务对高血压患者的服药状况及影响因素研究比较缺乏。目的调查安徽省界首市家庭医生签约服务的高血压患者服药现状,描述患者服药行为与患者特征之间的关联,探索患者用药调整的影响因素,并分析基层高血压患者用药的合理性。方法采用整群抽样的方法,于2021年7—8月从安徽省界首市随机抽取48个行政村,通过面对面调查法采用自制问卷收集患者特征和服药数据,参照《国家基层高血压防治管理指南2020版》将问卷中患者提到的降压药分为如下5类:A类为血管紧张素转换酶抑制剂(ACEI)和血管紧张素受体阻滞剂(ARB),B类为β受体阻滞剂,C类为钙通道阻滞剂(CCB),D类为利尿剂,E类为单片复方制剂。通过科大讯飞智能语音血压计的后台获取患者上传的近1年血压数据,分析不同特征患者的服药行为。采用多因素Logistic回归分析探讨高血压患者用药调整的影响因素。本研究中联合用药是指服用复方制剂或2种以上降压药,用药调整是指患者过去服用其他降压药。结果本研究共纳入高血压患者3005例,其中男1291例(43.0%)、女1714例(57.0%),平均年龄为(65.5±9.8)岁,高血压服药率为79.1%,联合用药率为40.2%。2376例服用降压药的患者中,不同类型降压药服用率从高到低依次为(部分患者存在联合用药):E类(39.6%)、C类(35.1%)、D类(20.3%)、A类(20.1%)、B类(3.7%);服用最多的降压药为复方利血平(33.7%)。对于年均血压≥160/100mm Hg的患者,仍有12.2%和4.9%未服用降压药。患者联合用药以E类降压药为主。年均“舒张压≥100 mm Hg”且“患合并症”的患者,调整后A类和C类降压药的服用率增加相对较多,年均“收缩压≥160 mm Hg”且“未患合并症”的患者,调整后E类降压药的服用率增加相对较多。多因素Logistic回归结果显示,服药年数长(OR=1.042,95%CI=1.031~1.053,P<0.001)、初中以上文化程度(OR=1.488,95%CI=1.195~1.853,P<0.001)、合并高脂血症(OR=1.267,95%CI=1.052~1.525,P=0.013)、合并心血管疾病(OR=1.394,95%CI=1.166~1.667,P<0.001)、合并脑血管疾病(OR=1.258,95%CI=1.040~1.522,P=0.018)是患者用药调整的促进因素,高龄(OR=0.980,95%CI=0.971~0.990,P<0.001)是用药调整的抑制因素。结论界首市农村地区高血压患者的服药率较高,主要服用E类和C类降压药。服药年数长、初中以上文化程度、合并高脂血症、合并心脑血管疾病是患者用药调整的促进因素,高龄是用药调整的抑制因素。展开更多
Aiming at the problem on cooperative air-defense of surface warship formation, this paper maps the cooperative airdefense system of systems （SoS） for surface warship formation （CASoSSWF） to the biological immune s...Aiming at the problem on cooperative air-defense of surface warship formation, this paper maps the cooperative airdefense system of systems （SoS） for surface warship formation （CASoSSWF） to the biological immune system （BIS） according to the similarity of the defense mechanism and characteristics between the CASoSSWF and the BIS, and then designs the models of components and the architecture for a monitoring agent, a regulating agent, a killer agent, a pre-warning agent and a communicating agent by making use of the theories and methods of the artificial immune system, the multi-agent system （MAS）, the vaccine and the danger theory （DT）. Moreover a new immune multi-agent model using vaccine based on DT （IMMUVBDT） for the cooperative air-defense SoS is advanced. The immune response and immune mechanism of the CASoSSWF are analyzed. The model has a capability of memory, evolution, commendable dynamic environment adaptability and self-learning, and embodies adequately the cooperative air-defense mechanism for the CASoSSWF. Therefore it shows a novel idea for the CASoSSWF which can provide conception models for a surface warship formation operation simulation system.展开更多
文摘Aims: The associations between the number of antihypertensive agents being taken by type 2 diabetic patients and 1) the grade of atherosclerosis according to non-invasive surrogate markers for atherosclerosis and 2) the other risk factor for atherosclerosis, were cross-sectionally investigated. Methods: The association between the blood pressure control and the clinical characteristics was evaluated in 1359 patients with type 2 diabetes mellitus. Results: The number of antihypertensive agents was 1.5 ± 1.4 (2.0 ± 1.2 among the 990 patients with hypertension). The proportion of patients taking no antihypertensive agents was 29%, 22% were taking one, 29% were taking two and 21% of the patients were taking three or more antihypertensive agents. The value of the ankle-brachial pressure index significantly decreased with the increase in the number of antihypertensive agents even if the blood pressure was corrected to the target value. The values of brachial-ankle pulse wave velocity and carotid intima-media thickness were also increased. The prevalence of risk factors for atherosclerosis, such as obesity, hyperlipidemia, chronic kidney disease, hyperuricemia and anemia was significantly elevated with the number of agents. Conclusions: The number of antihypertensive agents simply reflects the grade and risk of atherosclerosis in patients with type 2 diabetes mellitus.
基金the National Institute of Health Research Manchester Biomedical Research Centre for their funding support in the SKS(NIHR203308).
文摘BACKGROUND Hypertension is commonly observed in patients living with chronic kidney disease(CKD).Finding an optimal treatment regime remains challenging due to the complex bidirectional cause-and-effect relationship between hypertension and CKD.There remains variability in antihypertensive treatment practices.AIM To analyze data from the Salford Kidney Study database in relation to antihypertensive prescribing patterns amongst CKD patients.METHODS The Salford Kidney Study is an ongoing prospective study that has been recruiting CKD patients since 2002.All patients are followed up annually,and their medical records including the list of medications are updated until they reach study endpoints[starting on renal replacement therapy or reaching estimated glomerular filtration rate(eGFR)expressed as mL/min/1.73 m2≤10 mL/min/1.73 m2,or the last follow-up date,or data lock on December 31,2021,or death].Data on antihypertensive prescription practices in correspondence to baseline eGFR,urine albumin-creatinine ratio,primary CKD aetiology,and cardiovascular disease were evaluated.Associations between patients who were prescribed three or more antihypertensive agents and their clinical outcomes were studied by Cox regression analysis.Kaplan-Meier analysis demonstrated differences in survival probabilities.RESULTS Three thousand two hundred and thirty non-dialysis-dependent CKD patients with data collected between October 2002 and December 2019 were included.The median age was 65 years.A greater proportion of patients were taking three or more antihypertensive agents with advancing CKD stages(53%of eGFR≤15 mL/min/1.73 m2 vs 26%of eGFR≥60 mL/min/1.73 m2,P<0.001).An increased number of patients receiving more classes of antihypertensive agents was observed as the urine albumin-creatinine ratio category increased(category A3:62%vs category A1:40%,P<0.001),with the upward trends particularly noticeable in the number of individuals prescribed renin angiotensin system blockers.The prescription of three or more antihypertensive agents was associated with all-cause mortality,independent of blood pressure control(hazard ratio:1.15;95%confidence interval:1.04-1.27,P=0.006).Kaplan-Meier analysis illustrated significant differences in survival outcomes between patients with three or more and those with less than three antihypertensive agents prescribed(log-rank,P<0.001).CONCLUSION Antihypertensive prescribing patterns in the Salford Kidney Study based on CKD stage were consistent with expectations from the current United Kingdom National Institute of Health and Care Excellence guideline algorithm.Outcomes were poorer in patients with poor blood pressure control despite being on multiple antihypertensive agents.Continued research is required to bridge remaining variations in hypertension treatment practices worldwide.
文摘The transport of sodium ions by erythrocytes and the plasma level of endogenous digitalis-like compound (EDLC) were assessed in 59 patients with essential hypertension before and after theadminstration of nifedipine and prazosin. 20 normal subjects were studied similarly and served as con-trol. It was found that (1) EH patients had a pronounced defect of both the active and passive trans-port of sodium ions by the erythrocytes; (2) a higher plasma level of EDLC was detected in EH pa-tients as compared with that of the control, but the changes of EDLC and soudium pump were notparallel; (3) after the administration of nifedipine and prazosin, the function of sodium pump wasmarkedly improved and the plasma level of EDLC decreased. In addition, the relationship betweenthe transport of sodium ions by erythrocytes and the pathogenesis of EH, and the effects of anti-hypertensive agents were discussed.
文摘目的分析我国高龄高血压住院患者在降压标准150/90 mm Hg(1 mm Hg=0.133 kPa)下的降压达标率、用药及并发症分布情况。方法选择解放军空军特色医学中心所有科室年龄≥80岁且被诊断为高血压的409例住院患者为研究对象,将409例患者分为强化降压组(106例,收缩压<130 mm Hg)、标准降压组(155例,收缩压130~149 mm Hg)和降压未达标组(148例,收缩压≥150 mm Hg),分析各组患者血压控制现状。结果以150/90 mm Hg为降压标准时,强化降压组占25.9%,标准降压组占37.9%,降压未达标组占36.2%,降压未达标组年龄>90岁比例显著低于强化降压组和标准降压组(4.1%vs 7.5%、12.3%,P<0.05)。标准降压组一联用药比例显著高于强化降压组(46.5%vs 32.1%),强化降压组二联用药比例显著高于标准降压组(35.8%vs 22.6%),差异有统计学意义(P<0.05)。强化降压组并发心脏损害和脑血管损害比例显著高于标准降压组(43.4%vs 21.9%,26.4%vs 14.8%),合并视网膜病变比例显著低于标准降压组(11.3%vs 23.9%),差异有统计学意义(P<0.05)。结论对于高龄高血压患者,以150/90 mm Hg为启动降压标准更具有科学性、实用性,强化降压反而增加了高龄高血压患者心脑血管损害。
文摘背景高血压是心血管疾病主要的危险因素,降压用药不仅要考虑患者血压特征,也要考虑患者合并症情况。现阶段,基于家庭医生签约服务对高血压患者的服药状况及影响因素研究比较缺乏。目的调查安徽省界首市家庭医生签约服务的高血压患者服药现状,描述患者服药行为与患者特征之间的关联,探索患者用药调整的影响因素,并分析基层高血压患者用药的合理性。方法采用整群抽样的方法,于2021年7—8月从安徽省界首市随机抽取48个行政村,通过面对面调查法采用自制问卷收集患者特征和服药数据,参照《国家基层高血压防治管理指南2020版》将问卷中患者提到的降压药分为如下5类:A类为血管紧张素转换酶抑制剂(ACEI)和血管紧张素受体阻滞剂(ARB),B类为β受体阻滞剂,C类为钙通道阻滞剂(CCB),D类为利尿剂,E类为单片复方制剂。通过科大讯飞智能语音血压计的后台获取患者上传的近1年血压数据,分析不同特征患者的服药行为。采用多因素Logistic回归分析探讨高血压患者用药调整的影响因素。本研究中联合用药是指服用复方制剂或2种以上降压药,用药调整是指患者过去服用其他降压药。结果本研究共纳入高血压患者3005例,其中男1291例(43.0%)、女1714例(57.0%),平均年龄为(65.5±9.8)岁,高血压服药率为79.1%,联合用药率为40.2%。2376例服用降压药的患者中,不同类型降压药服用率从高到低依次为(部分患者存在联合用药):E类(39.6%)、C类(35.1%)、D类(20.3%)、A类(20.1%)、B类(3.7%);服用最多的降压药为复方利血平(33.7%)。对于年均血压≥160/100mm Hg的患者,仍有12.2%和4.9%未服用降压药。患者联合用药以E类降压药为主。年均“舒张压≥100 mm Hg”且“患合并症”的患者,调整后A类和C类降压药的服用率增加相对较多,年均“收缩压≥160 mm Hg”且“未患合并症”的患者,调整后E类降压药的服用率增加相对较多。多因素Logistic回归结果显示,服药年数长(OR=1.042,95%CI=1.031~1.053,P<0.001)、初中以上文化程度(OR=1.488,95%CI=1.195~1.853,P<0.001)、合并高脂血症(OR=1.267,95%CI=1.052~1.525,P=0.013)、合并心血管疾病(OR=1.394,95%CI=1.166~1.667,P<0.001)、合并脑血管疾病(OR=1.258,95%CI=1.040~1.522,P=0.018)是患者用药调整的促进因素,高龄(OR=0.980,95%CI=0.971~0.990,P<0.001)是用药调整的抑制因素。结论界首市农村地区高血压患者的服药率较高,主要服用E类和C类降压药。服药年数长、初中以上文化程度、合并高脂血症、合并心脑血管疾病是患者用药调整的促进因素,高龄是用药调整的抑制因素。
文摘Aiming at the problem on cooperative air-defense of surface warship formation, this paper maps the cooperative airdefense system of systems （SoS） for surface warship formation （CASoSSWF） to the biological immune system （BIS） according to the similarity of the defense mechanism and characteristics between the CASoSSWF and the BIS, and then designs the models of components and the architecture for a monitoring agent, a regulating agent, a killer agent, a pre-warning agent and a communicating agent by making use of the theories and methods of the artificial immune system, the multi-agent system （MAS）, the vaccine and the danger theory （DT）. Moreover a new immune multi-agent model using vaccine based on DT （IMMUVBDT） for the cooperative air-defense SoS is advanced. The immune response and immune mechanism of the CASoSSWF are analyzed. The model has a capability of memory, evolution, commendable dynamic environment adaptability and self-learning, and embodies adequately the cooperative air-defense mechanism for the CASoSSWF. Therefore it shows a novel idea for the CASoSSWF which can provide conception models for a surface warship formation operation simulation system.
基金supported in part by the National Key Research and Development Program of China(No.2018YFE0177000)the National Natural Science Foundation of China(No.52075257)。
