Reduction of diastolic blood pressure: Should hypertension guidelines include a lower threshold target?

Reduction of diastolic blood pressure to less than 60-80 mm Hg does not improve mortality and may lead to adversecardiovascular events in high risk patient populations. Despite a growing body of evidence supporting the J-curve phenomenon, no major society guidelines on hypertension include a lower threshold target for diastolic blood pressure. Many major society guidelines for hypertension have been updated in the last 5 years. Some guidelines include goals specific to age and co-morbid conditions. The Sixth Joint Task Force of the European Society of Cardiology and the Canadian Hypertension Education Program are the only guidelines to date that have recommended a lower threshold target, with the Canadian guidelines recommending a caution against diastolic blood pressure less than or equal to 60 mm Hg in patients with coronary artery disease. While systolic blood pressure has been proven to be the overriding risk factor in hypertensive patients over the age of 50 years, diastolic blood pressure is an important predictor of mortality in younger adults. Post hoc data analysis of previous clinical trials regarding safe lower diastolic blood pressure threshold remains inconsistent. Randomized clinical trials designed to determine the appropriate diastolic blood pressure targets among different age groups and populations with different comorbidities are warranted. Hypertension guideline goals should be based on an individual's age, level of risk, and certain co-morbid conditions, especially coronary artery disease, stroke, chronic kidney disease, and diabetes.

Correlation between Left Ventricular End Diastolic Pressure and Torsion Dynamics in Patients with Diastolic Dysfunction, Speckle Tracking Imaging Study

Background: Invasive measuring of LV end diastolic pressure (LVEDP) provides reliable assessment of LV diastolic dysfunction, but its invasive nature limits its use in daily practice. Accurate noninvasive assessment of LV diastolic dysfunction is highly desirable, and the relationship between the degree of LVEDP and LV torsion dynamics assessed by 2D speckle tracking is not clearly assessed;here in our study we aimed to assess the relation between the degree of LVEDP and torsion dynamics of left ventricle. Methods: The study included sixty patients divided equally into 3 groups according to the degree of LVEDP, group I: mmHg, group II: 12 - 18 mmHg, and group III: >18 mmHg;complete conventional echo-Doppler study includes also annular septal E wave peak velocity, E/E’ ratio and 2D-speckle tracking including parameters of LV global longitudinal strain (GLS), peak and time to peak of twist ratio (TR & TT respectively), peak and time to peak of untwist ratio (UTR & UTT respectively). Results: There was significant progressive decrease in GLS with progressive increase in LVEDP from I to III. Untwist ratio increased in group II and decreased in significant degree in group III;Twist ratio did not differ with different grades of LVEDP. LA diameter and E/E’ increase from group I to III. The LVEDP is negatively correlated with the UTR and GLS is positively correlated with UTT, E/E & LA diameter. The E/E’ ratio is correlated negatively with the UTR, GLS and positively with LVEDP & UTT and LA diameter. Conclusions: Noninvasive assessment of LV torsion and untwisting was feasible in patients with various grades of LVEDP and diastolic dysfunction;the peak untwist ratio increased in mild degree of increased LVEDP then decreased again with more increase in LVEDP;LVEDP wasnegatively correlated with the peak untwist ratio and GLS was positively correlated with UTT and E/E’.

Correlation of Invasively Estimated Left Ventricular End Diastolic Pressure with Acceleration of E’ Wave by Tissue Doppler Imaging of Mitral Annulus

Background: There is no single noninvasive index that provides a direct measure of LV filling pressure. However, invasive measuring of LV end diastolic pressure (LVEDP) provides reliable assessment of LV diastolic dysfunction, but its invasive nature limits its use in daily practice. Accurate noninvasive assessment of LV diastolic dysfunction is highly desirable, and the relationship between the degree of LVEDP and acceleration of E’ wave obtained by tissue Doppler imaging (TDI) of mitral annulus is not clearly assessed;here in our study we aimed to assess the relation between the degree of LVEDP and the acceleration rate of E’ wave of mitral annular Doppler tissue. Patients and Methods: The study included 60 patients divided equally into 3 groups according to the degree of LVEDP, group I (Normal): ’ ratio and E’ wave acceleration rate. Coronary angiography and left sided heart catheterization and measuring LVEDP were performed for correlating E’ wave acceleration rate with invasively estimated LVEDP.?Results: There was significant progressive decrease in E’ acceleration rate (E’ Acc rate) with progressive increase in LVEDP from I to III (P 0.001), while there was significant progressive increase in E/E’ ratio with progressive increase in LVEDP from I to III (P 0.003). Peak E’ acceleration rate had a significant negative correlation with LVEDP in all three groups, with p value of 0.003, 0.044 and 0.021 respectively in group I, II & III. Regarding E/E’ ratio there was a significant positive correlation in predicting normal and elevated LVEDP with p value (0.001 and 0.006) respectively while there was a non-significant correlation between E/E’ and LVEDP within grey zone group. Conclusion: E’ acceleration rate could be used as a reliable index to assess LVEDP.

Changes in plasma total bile acid level of patients with essential hyper tension and of spontaneous hypertension rats and the correlation with systolic and diastolic blood pressures

To examine the hypothesis that plasma bile acid (BA) level is correlated with essential hypertension (EH). Methods: The level of plasma total bile acid (TBA) in 88 patients with EH and in 11 spontaneous hypertension rats (SHR) were measured, and regression analysis of systolic and diastolic blood pressures with plasma TBA was performed. Results: Plasma TBA level in EH patients was significantly higher than that in normotensive subjects (7. 35±3. 38μmol/L vs 4. 94±3. 25 μmol/L, PRO. of ); Plasma TBA level in SHR was significantly higher than that in Wistar--Kyoto (WKY) rats (13. 16±3. 58 μmol/L vs 10. 42±2. 24 μmol/L,P<0. 05); Plasma TBA level in patients with EH was the highest in stage Ⅲ (9. 54±4. 12 μmol/L, n ＝25), the lowest in stage Ⅰ (5. 76±3. 33 μmol/L, n＝33), and middle in stage Ⅱ (7. 32±4. 52 μmol/L, n＝30); Plasma TBA level in patients with EH was positively correlated with both systolic (r= 0. 33, P<0. 01 ) and diastolic blood pressure (r＝0. 46, P＜0．01 ); Plasma TBA level in SHR was positively correlated with both systolic (r＝0. 82, P<0. 01 ) and diastolic blood pressures (r＝0. 69, P<0. 01). Conclusion: elevated level of plasma TBA in patients with EH and in SHR may participate in the pathogenesis of hypertension.

Acute Effects of Virtual Reality Exercise on Young Adults’ Blood Pressure and Feelings

Virtual reality(VR)seems to have the potential to provide opportunities to promote physical activity(PA)in a fun way.This paper aimed to examine the acute effects of three different virtual reality-based exercise bikes on young adults’blood pressure(BP)and feelings compared to a traditional exercise cycling session.Four exercise sessions(immersive VR cycling,two non-immersive VR cycling,and traditional cycling)were completed by 36 young adults(22 females;Mage=23.6 years).BP was measured immediately before and after each session using a BP cuff and exercise-induced feelings were assessed via an established survey immediately after each session.Parti-cipants’previous experience with VR was used as the covariate in the ANCOVA with repeated measures.Signif-icant main effects were observed across cycling sessions for systolic blood pressure[F(2,29)=3.04,p=0.02,(η^(2)=0.38)]and feelings[F(3,32)=7.74,p<0.01,η^(2)=.42].In particular,immersive VR and traditional cycling signif-icantly increased systolic blood pressure compared to the two non-immersive VR sessions.Moreover,immersive VR significantly increased feelings compared to the two non-immersive VR sessions,whereas these two non-immersive VR exercises had significantly greater increased feelings compared to traditional cycling,respectively.Findings suggest immersive VR-based exercise cycling may lead to higher exercise intensities compared to non-immersive VR cycling.Further,immersive VR cycling yielded higher feelings compared to non-immersive VR and traditional cycling.Thus,immersive VR-based exercise can be a fun and physically active health promotion tool among young adults.

Mediating function of heart failure in the causal relationship between diastolic blood pressure and hypertensive renal disease with renal failure:a mediated Mendelian randomization study

Objective:To study the causality relationship between diastolic blood pressure(DBP)and hypertensive renal disease with renal failure(HRDRF)and the mediating role of hear t failure(HF)in the causality relationship by network Mendelian randomization(MR).Methods:Genome-wide analysis of DBP,HRDRF,and HF was downloaded from the public database(Genome-Wide Analysis Study[GWAS])and was used to analyze the results and to conduct mediated MR analysis.Results:Analysis showed that DBP was positively correlated with HRDRF(OR=1.0002,95%CI:1.0001–1.0003,P=1.8076e-05)and DBP was positively correlated with HF(OR=1.0295,95%CI:1.0221–1.0370,P=2.5292e-15).HF and HRDRF had a positive causal effect(OR=1.0001,95%CI:1.0000–1.0001,P=0.0152).Mediation analysis showed that the contribution ratio of HF to the combined effect of DBP and HRDRF was 24.69%.Conclusions:DBP can increase the risk of renal disease with renal failure,and HF may play an impor tant role in mediating this causal relationship.

Significance of blood pressure variability in patients with sepsis

BACKGROUND: This study was undertaken to observe the characteristics of blood pressure variability(BPV) and sepsis and to investigate changes in blood pressure and its value on the severity of illness in patients with sepsis.METHODS: Blood parameters, APACHE II score, and 24-hour ambulatory BP were analyzed in 89 patients with sepsis.RESULTS: In patients with APACHE II score>19, the values of systolic blood pressure(SBPV), diasystolic blood pressure(DBPV), non-dipper percentage, cortisol(COR), lactate(LAC), platelet count(PLT) and glucose(GLU) were significantly higher than in those with APACHE II score ≤19(P<0.05), whereas the values of procalcitonin(PCT), white blood cell(WBC), creatinine(Cr), PaO2, C-reactive protein(CRP), adrenocorticotropic hormone(ACTH) and tumor necrosis factor α(TNF-α) were not statistically significant(P>0.05). Correlation analysis showed that APACHE II scores correlated significantly with SBPV and DBPV(P<0.01, r=0.732 and P<0.01, r=0.762). SBPV and DBPV were correlated with COR(P=0.018 and r=0.318; P=0.008 and r=0.353 respectively). However, SBPV and DBPV were not correlated with TNF-α, IL-10, and PCT(P>0.05). Logistic regression analysis of SBPV, DBPV, APACHE II score, and LAC was used to predict prognosis in terms of survival and non-survival rates. Receiver operating characteristics curve(ROC) showed that DBPV was a better predictor of survival rate with an AUC value of 0.890. However, AUC of SBPV, APACHE II score, and LAC was 0.746, 0.831 and 0.915, respectively.CONCLUSIONS: The values of SBPV, DBPV and non-dipper percentage are higher in patients with sepsis. DBPV and SBPV can be used to predict the survival rate of patients with sepsis.

Determinants of Blood Pressure Variability in Individuals with Essential Hypertension: A Survey-Based Study

Background: Blood pressure variability (BPV) in hypertensive patients is implicated as a remarkable feature leading to additional cardiovascular complications. The aim of the study was to identify the determinants influencing BPV among patients with essential hypertension seen at the Cardiology department of the faculty of medicine, University of Alexandria, Egypt. Methods: This was a descriptive cross-sectional hospital-based study conducted from August 2019 to November 2019. All the eligible patients were made to fill out a standard questionnaire to obtain family and personal clinical history and undergo routine physical examination, laboratory tests and 24-hour ambulatory blood pressure monitoring. BPV was summarized as the standard deviation (SD) of all-day systolic and diastolic BP in both normal patients (with SD 11) and abnormal patients (with SD ≥ 11). Results: Out of a total of 114 patients, 18 (15.8%) non-hypertensive patients were included in the control group and the remaining 96 (84.3%) were classified based on the degree of hypertension. BPV in all these patients was found to be significantly related to the male gender, a mild or moderate degree of hypertension, high prevalence of non-dipping, diabetes, use of beta-blockers as antihypertensive medication, heart rate variability, BMI, and increased day-time variability. Conclusion: Variability in blood pressure influenced by different intrinsic and extrinsic factors plays an important role in the management of hypertension. In order to reduce the burden of disease and for a better quality of life for hypertensive patients, it is important that physicians start considering lowering BPV in addition to reducing physiological BP levels.

Association between Mean Ocular Perfusion Pressure and Diabetic Retinopathy in a Northeastern Chinese Population

Objective To evaluate the association between diabetic retinopathy(DR) and mean ocular perfusion pressure(MOPP) in patients with type 2 diabetes mellitus(T2 DM).Methods Patients from the Fushun Diabetic Retinopathy Cohort Study(FS-DIRECT), a communitybased prospective cohort study conducted in northeast China, were included in this study. The presence and severity of DR were determined by grading fundus photographs according to the Early Treatment Diabetic Retinopathy Study(ETDRS) retinopathy scale. Systolic and diastolic blood pressure(SBP and DBP) were recorded using an electronic sphygmomanometer. Intraocular pressure(IOP) was measured using an iCare rebound tonometer. MOPP was calculated using the formula MOPP = 2/3 [DBP + 1/3(SBP-DBP)]-IOP.Results In total, 1,857 patients who had gradable fundus photography and MOPP data were enrolled in this study. Male patients had a higher MOPP than female patients(52.25 ± 8.75 vs. 50.96 ± 8.74 mmHg, P = 0.002). Overall, both male and female patients with any type of DR, non-proliferative DR(NPDR), or non-sight-threatening DR(non-STDR) had significantly higher MOPP relative to patients without DR. Increased MOPP(per 1 mmHg) was in turn associated with the presence of any type of DR[odds ratio(OR) = 1.03, 95% confidence interval(CI) : 1.02–1.04], NPDR(OR = 1.03 95% CI: 1.02–1.04),and non-STDR(OR = 1.03, 95% CI: 1.01–1.04) after adjusting for confounders. Increased MOPP(per 1 mmHg) was also associated with an increased likelihood of macular edema(OR = 1.02, 95% CI:1.01–1.04).Conclusions The results suggest that increased MOPP was associated with DR and macular edema in northeastern Chinese patients with T2 DM.

The predictive value of childhood blood pressure values for adult elevated blood pressure

Because of the paucity of serial blood pressure data on the same individuals, little is known about the accuracy of elevated blood pressure (BP) in childhood for predicting hypertension (HBP) later in life. The availability of long-term serial BP data from the Fels Longitudinal Study (FLS) presents the opportunity to link HBP in adulthood directly to BP measured decades earlier in the same individuals as children. We analyzed serial data from 965 men and 1114 women in the FLS. We used an autoregressive-moving average (1, 1) [ARMA (1, 1)] longitudinal model to predict adult HBP from childhood values. For 15-year-old boys with SBP 15 mmHg and 30 mmHg above the average SBP of 90 mmHg, the probabilities of having HBP at age 35 are 0.18 and 0.33, respectively. The corresponding probabilities for 15-year-old girls are only 0.04 and 0.08. This striking sex difference in risk of HBP at age 35 between 15-year-old boys and girls indicates that the risk of developing HBP in women is low regardless of their childhood blood pressure at any age from 2 to 17 years. Men are about 4.25 times more likely to have HBP at age 35 than women over a range of SBP of 90 - 140 mmHg at age 15. The ARMA (1, 1) model allows the identification of boys at risk for HBP as adult men.

Blood Pressure and Heart Rate Measurements Using Photoplethysmography with Modified LRCN

In this study,single-channel photoplethysmography(PPG)signals were used to estimate the heart rate(HR),diastolic blood pressure(DBP),and systolic blood pressure(SBP).A deep learning model was proposed using a long-term recurrent convolutional network(LRCN)modified from a deep learning algorithm,the convolutional neural network model of the modified inception deep learning module,and a long short-term memory network(LSTM)to improve the model’s accuracy of BP and HR measurements.The PPG data of 1,551 patients were obtained from the University of California Irvine Machine Learning Repository.How to design a filter of PPG signals and how to choose the loss functions for deep learning model were also discussed in the study.Finally,the stability of the proposed model was tested using a 10-fold cross-validation,with an MAE±SD of 2.942±5.076 mmHg for SBP,1.747±3.042 mmHg for DBP,and 1.137±2.463 bpm for the HR.Compared with its existing counterparts,the model entailed less computational load and was more accurate in estimating SBP,DBP,and HR.These results established the validity of the model.

Impact of intragastric balloon on blood pressure reduction:A retrospective study in Eastern North Carolina

BACKGROUND Obesity has evolved into a global pandemic.The prevalence of obesity and hypertension in eastern North Carolina are comparable,if not higher,than the national prevalence.In the United States,an estimated 34%of adults have hypertension,the most modifiable risk factor for heart disease and stroke.Lifestyle and pharmacological interventions often do not provide sustained weight loss in obese patients.Bariatric surgery offers an effective weight reduction with short-and long-term health improvements;however,a higher body mass index is associated with higher surgical morbidity and mortality,longer hospitalization,and increasing rates of 30-day readmission due to comorbidities.Intragastric balloon may bridge a critical gap in the treatment of obesity.The objective of this paper is to showcase the impact of endoscopic bariatric therapy on blood pressure reduction.AIM To investigate the impact of intragastric balloon on blood pressure reduction.METHODS A retrospective chart review was conducted from January 1,2016 to January 31,2019 of consecutive adults who received intragastric balloon therapy(IGBT)in a gastroenterology private practice in Eastern North Carolina.The balloon was introduced into the stomach under endoscopic guidance,and while in the region of the gastric body,inflation with saline was performed at increments of 50 mL until target volume between 500 to 650 mL of saline was attained depending on the patient's gastric capacity.No procedural complications were noted during endoscopic placement and removal of the balloon.A cohort study design was used for data analysis.A total of 172 patients had the Orbera^(■)intragastric balloon placed.Of the 172 patients who had IGBT at baseline,11 patients(6.4%)requested early balloon removal due to foreign body sensation(n=1),and/or intolerable gastrointestinal adverse events(n=10).The reported gastrointestinal adverse events were nausea,vomiting,abdominal pain,and diarrhea.Eventually,6-mo follow-up data were available for only 140 patients.As a result,only the 140 available at the 6-mo follow-up were included in the analysis.Univariate,bivariate,and multivariate statistical analyses were performed.Specifically,scatterplots were created to show the relationship between weight and blood pressure,and paired two-sample t-test was carried out to determine if there was a significant reduction in weight before and after the IGBT.Multiple regressions were also performed to examine the association between participants’total body weight and blood pressure.The outcome variables for the multiple regression were systolic and diastolic blood pressure measured as continuous variables.This was followed by logistic regression analyses to determine the association between total body weight and hypertension at 6-mo post-implantation.The outcome variables for the logistic regression were systolic blood pressure–nonhypertensive(140 mmHg or less)or hypertensive(greater than 140 mmHg),and diastolic blood pressure–non-hypertensive(90 mmHg or less)or hypertensive(greater than 90 mmHg).All authors had access to the study data and reviewed and approved the final manuscript.All statistical analyses were done using STATA 14®.RESULTS The study included 15%males and 85%females.50%of the patients were white and just over 22%were non-white,and about 27%declined to give their race.The average baseline patients’weight prior to IGBT was 231.61 Lbs.(SD=46.53 Lbs.).However,the average patients’weight after IGBT at the 6-mo follow-up was 203.88 Lbs.(SD=41.04 Lbs.).Hence,on average,the percent total body weight loss at 6-mo is 11.97 after IGBT.The logistic regression performed revealed that weight(β=0.0140,P<0.000)and age(β=0.0534,P<0.000)are important factors in determining systolic blood pressure after IGBT.None of the other demographic characteristics or indicated comorbidities were found to be significant.CONCLUSION IGBT can be an effective short-term weight reduction modality with a relatively little risk of adverse event.Due to its improvement on systolic blood pressure,IGBT may help reduce cardiovascular risk.

Effects of Almond Milk on Body Measurements and Blood Pressure

In recent years, the demand for almond milk and its sales has increased owing to consumers’ perceptions about its health benefits. Hence, we sought to measure the effect of almond milk on body measurements such as body weight, body mass index and waist and hip circumference, in addition to diastolic and systolic blood pressures. Thirty volunteers of both sexes participated in the study, with a mean age of 23.27 ± 6.20 years. The study was conducted over 4 weeks, and the results showed that daily substitution of one serving of dairy product with one cup (240 ML) of almond milk significantly decreased body weight, body mass index and waist and hip circumference, However, no effects were observed on blood pressures.

Low diastolic blood pressure and adverse outcomes in inpatients with acute exacerbation of chronic obstructive pulmonary disease: A multicenter cohort study

Background:Although intensively studied in patients with cardiovascular diseases(CVDs),the prognostic value of diastolic blood pressure(DBP)has little been elucidated in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).This study aimed to reveal the prognostic value of DBP in AECOPD patients.Methods:Inpatients with AECOPD were prospectively enrolled from 10 medical centers in China between September 2017 and July 2021.DBP was measured on admission.The primary outcome was all-cause in-hospital mortality;invasive mechanical ventilation and intensive care unit(ICU)admission were secondary outcomes.Least absolute shrinkage and selection operator(LASSO)and multivariable Cox regressions were used to identify independent prognostic factors and calculate the hazard ratio(HR)and 95%confidence interval(CI)for adverse outcomes.Results:Among 13,633 included patients with AECOPD,197(1.45%)died during their hospital stay.Multivariable Cox regression analysis showed that low DBP on admission(<70 mmHg)was associated with increased risk of in-hospital mortality(HR=2.16,95%CI:1.53–3.05,Z=4.37,P<0.01),invasive mechanical ventilation(HR=1.65,95%CI:1.32–2.05,Z=19.67,P<0.01),and ICU admission(HR=1.45,95%CI:1.24–1.69,Z=22.08,P<0.01)in the overall cohort.Similar findings were observed in subgroups with or without CVDs,except for invasive mechanical ventilation in the subgroup with CVDs.When DBP was further categorized in 5-mmHg increments from<50 mmHg to≥100 mmHg,and 75 to<80 mmHg was taken as reference,HRs for in-hospital mortality increased almost linearly with decreased DBP in the overall cohort and subgroups of patients with CVDs;higher DBP was not associated with the risk of in-hospital mortality.Conclusion:Low on-admission DBP,particularly<70 mmHg,was associated with an increased risk of adverse outcomes among inpatients with AECOPD,with or without CVDs,which may serve as a convenient predictor of poor prognosis in these patients.Clinical Trial Registration:Chinese Clinical Trail Registry,No.ChiCTR2100044625.

急性缺血性脑卒中机械取栓术后恶性脑水肿的危险因素

目的:探讨急性缺血性脑卒中(AIS)患者机械取栓术后恶性脑水肿(MCE)发生的危险因素。方法:回顾性收集2018年8月至2022年6月在温州医科大学附属第一医院接受机械取栓术并实现血管完全再通的AIS患者400例,根据术后是否发生MCE将患者分为MCE组(n=89)和非MCE组(n=311)。采用多因素Logistic回归分析确定AIS患者机械取栓术后MCE发生的独立危险因素。结果:400例行机械取栓术后血管完全再通的AIS患者中,男277例,女123例,年龄(68.09±12.17)岁。AIS患者机械取栓术后MCE组的舒张压高于非MCE组,差异有统计学意义(P<0.05)。而MCE组的ASPECT评分低于非MCE组,更可能位于前循环位置。多因素Logistic回归结果显示,AIS患者机械取栓术后舒张压(OR=1.022,95%CI=1.005~1.039,P=0.010)、术前ASPECT评分(OR=0.742,95%CI=0.655~0.840,P<0.001)、NIHSS评分(OR=1.043,95%CI=1.004~1.083,P=0.031)以及前循环血栓(OR=8.942,95%CI=2.595~30.816,P=0.001)是术后MCE发生的独立影响因素。结论:术前低ASPECT评分、高NIHSS评分以及前循环血栓是AIS患者机械取栓术后MCE的独立危险因素,且术后舒张压升高会增加术后发生MCE风险。术后血压管理尤其是降低舒张压可能减少患者术后发生MCE的风险。

袖带充气高血压与单臂缺血诱导的臂间舒张压差异关联性研究

目的探讨袖带充气高血压与单臂缺血诱导的臂间舒张压差异(dIAD)之间的关联性。方法选取2019年1月至2021年11月于南昌大学第二附属医院行冠状动脉造影的64例患者作为研究对象,根据袖带充气高血压的诊断标准分为A组(袖带充气高血压患者)与B组[非袖带充气高血压且非假性高血压(PHT)患者],每组32例。比较两组生化指标、影像学指标、内皮功能指标及血压。结果A组估算肾小球滤过率(eGFR)低于B组,差异有统计学意义(P<0.05);两组总胆固醇(TC)、甘油三酯(TG)、空腹血糖(FPG)、低密度脂蛋白胆固醇(LDL-C)水平比较差异无统计学意义。A组颈动脉内膜中层厚度大于B组,左心室舒张功能减退率高于B组,差异有统计学意义(P<0.05);两组左心室收缩末期、舒张末期内径及室间隔厚度比较差异无统计学意义。束臂前后,A组一氧化氮(NO)浓度均低于B组,内皮素(ET)浓度均高于B组,差异有统计学意义(P<0.05);束臂前后两组过氧亚硝基阴离子(ONNOO-)浓度比较差异均无统计学意义。A组袖带收缩压与腔内收缩压差值(SS)、脉压(PP)均大于B组,差异有统计学意义(P<0.05);两组袖带舒张压与腔内舒张压差值(D-D)比较差异无统计学意义。束臂前,两组dIAD比较差异无统计学意义;束臂后,A组dIAD小于B组,差异有统计学意义(P<0.05);两组束臂前后收缩压差压(sIAD)比较差异无统计学意义。结论单壁缺血诱导可减小袖带充气高血压患者的臂间舒张压差异,对诊断袖带充气高血压具有较好效果,值得临床推广应用。

高血压患者短期血压变异与左室舒张功能的相关性分析

目的探讨原发性高血压患者血压变异与左室舒张功能的关系。方法对2021年10月至2022年1月我院门诊138例初诊原发性高血压患者的临床资料进行回顾性分析,根据超声心动图测量平均E/e′结果分两组(舒张功能正常组E/e′<14、舒张功能降低组E/e′≥14),比较两组间24 h动态血压指标结果(血压变异以血压变异系数、平均收缩压及舒张压标准差表示),分析左室舒张功能与血压变异指标及临床生化指标的相关性。结果左室舒张功能降低组患者的24 h收缩压变异系数(24hSBPCV)、24 h收缩压标准差(24hSBPSD)、24 h舒张压变异系数(24hDBPCV)、日间收缩压变异系数(dSBPCV)、日间舒张压变异系数(dDBPCV)、日间收缩压标准差(dSBPSD)、24 h收缩压平均水平(24hSBP)、夜间收缩压平均水平(nSBP)均高于舒张功能正常组,24hDBP、dDBP及nDBP低于舒张功能正常组,差异有统计学意义(P<0.05)。相关性分析提示:24hSBPCV、24hSBPSD、dSBPCV、dSBPSD、24hSBP、nSBP、年龄均与E/e′呈正相关(r=0.136、0.182、0.170、0.205、0.195、0.322、0.568,P=0.032、0.004、0.007、0.001、0.022、0.000、0.000);24hDBP、dDBP及nDBP均与E/e′呈负相关(r=-0.322、-0.334、-0.198,P=0.000、0.000、0.020);Logistic回归分析显示:dSBPSD及年龄是左室舒张功能的独立影响因素[OR=3.062(1.314~7.133)、1.094(1.058~1.132)]。结论原发性高血压患者短期血压变异及年龄是左室舒张功能的影响因素。

老年人群24h动态血压监测中清晨高血压与脑血管储备功能相关性

目的研究老年人群24 h动态血压监测中清晨高血压与脑血管储备功能(CVR)的相关性。方法回顾性选取2021年1月至12月到济南市妇幼保健院行24 h动态血压监测的300例老年受试者,依据监测结果分为A组、B组和C组。A组158例为清晨血压升高的高血压患者,男88例,女70例,年龄(66.02±4.35)岁;B组74例为清晨血压正常的高血压患者,男41例,女33例,年龄(65.42±4.42)岁;C组68例为血压正常者,男37例,女31例,年龄(65.77±4.38)岁。以两侧大脑中动脉屏气指数均值<0.69%为CVR减低,屏气指数均值≥0.69%为CVR正常,将300例受试者分为CVR降低组(52例)和CVR正常组(248例)。比较A、B、C 3组患者的临床资料,CVR指标;比较CVR降低组、CVR正常组一般资料,行单因素分析、多因素分析和相关性分析。采用F检验、独立样本t检验、χ^(2)检验、logistic回归分析和Pearson相关性分析。结果300例24 h动态血压监测的老年受试者,清晨血压升高的高血压患者158例,占52.67%;清晨血压正常的高血压患者74例,占24.67%;血压正常者68例,占22.67%。3组收缩压(24 h均值、日间均值、夜间均值)、晨峰指数:A组>B组>C组(均P<0.05);舒张压(24 h均值、日间均值、夜间均值):A组>B组、C组(均P<0.05),B组、C组舒张压比较,差异均无统计学意义(均P>0.05)。CVR:A组[(21.37±7.89)%]<B组[(25.58±8.14)%]<C组[(28.56±8.10)%](均P<0.05);屏气指数:A组[(0.89±0.23)%]<B组[(1.13±0.21)%]、C组[(1.20±0.24)%](均P<0.05),B组、C组屏气指数比较,差异无统计学意义(P>0.05);脉动指数:A组[(1.49±0.36)]>B组[(1.15±0.31)]、C组[(1.06±0.29)](均P<0.05),B组、C组脉动指数比较,差异无统计学意义(P>0.05)。CVR降低组年龄[(73.14±3.21)岁]、清晨收缩压[(132.42±9.64)mmHg](1 mmHg=0.133 kPa)、清晨舒张压[(68.85±6.59)mmHg]均高于CVR正常组[(64.28±4.36)岁、(121.58±7.26)mmHg、(65.36±7.23)mmHg](均P<0.05)。logistic回归分析结果显示:年龄、清晨收缩压、清晨舒张压均为CVR降低的影响因素(均P<0.05)。清晨收缩压与屏气指数呈负相关(P<0.05),与脉动指数呈正相关(P<0.05);清晨舒张压与屏气指数呈负相关(P<0.05),与脉动指数呈正相关(P<0.05)。结论老年人群24 h动态血压监测中清晨高血压患者占比较大,清晨高血压患者CVR、屏气指数较低,脉动指数较高,清晨收缩压、清晨舒张压均与屏气指数呈负相关,与脉动指数呈正相关。

苯磺酸氨氯地平联合缬沙坦治疗老年高血压的疗效及SBP、DBP水平影响分析

目的 评价分析老年高血压用苯磺酸氨氯地平与缬沙坦联合治疗方案的临床效果以及对舒张压、收缩压影响情况。方法 选取2022年3月—2023年3月本院收治的老年高血压患者72例为研究对象,通过随机抽签分为参照组和实验组。参照组纳入36例,执行缬沙坦治疗方案;实验组归入36例,执行苯磺酸氨氯地平与缬沙坦联合治疗方案,对比两组临床治疗效果评估水平、不良反应发生情况以及治疗前后舒张压、收缩压变化差异及生活质量评分水平差异。结果 治疗后,实验组的舒张压检验水平、收缩压检验水平以及心率检验水平,与参照组相比,差异有统计学意义(P<0.05)。实验组治疗效果评估水平达到97.22%(35/36),与参照组77.78%(28/36)相比,差异有统计学意义(P<0.05)。实验组治疗不良反应发生率5.56%(2/36),与参照组13.89%(5/36)相比,差异有统计学意义(P<0.05)。干预后,与参照组相比,实验组的健康状况维度评分水平、躯体疼痛维度评分水平、生理机能维度评分水平、精神健康维度评分水平、情感功能维度评分水平更高,差异有统计学意义(P<0.05)。结论 老年高血压病患接受苯磺酸氨氯地平与缬沙坦联合治疗,能够改善血压水平,提高治疗效果,治疗安全性良好。

新疆南疆地区农村人群基于不同指南定义的单纯舒张期高血压与心血管疾病的关联

目的探索新疆南疆地区农村人群中基于不同指南定义的单纯舒张期高血压(IDH)与心血管疾病(CVD)风险的关联。方法以新疆生产建设兵团第三师51团常住人口作为研究对象。根据2017年美国心脏病学会/美国心脏协会(ACC/AHA)高血压指南和2020年中国高血压指南对IDH的定义,分别纳入研究对象6834人和8960人。采用Log-rank检验比较不同指南定义的IDH患者和血压正常者CVD事件累积发病率的差异;使用Cox比例风险回归模型探索IDH与CVD风险的关联。结果ACC/AHA指南所定义的IDH患病率比中国指南定义者高5.4%。两种指南定义的IDH患者与血压正常者的CVD累积发病率差异均无统计学意义(ACC/AHA指南,χ2=0.07,P=0.80;中国指南,χ2=3.85,P=0.05);ACC/AHA指南定义的IDH患者CVD累积发病率较中国指南定义者低(6.14%vs 9.88%,χ2=5.22,P=0.02)。与血压正常者相比,中国指南定义的IDH与CVD发生风险的关联强度高于ACC/AHA指南,但差异无统计学意义,HR(95%CI)分别为:1.411(0.999~1.993)、1.037(0.788~1.364)。结论在新疆南疆农村人群中,应用2017年ACC/AHA指南定义的血压新阈值能够筛选出更多的IDH患者,有利于早期采取有效的防控措施。