心内科老年高血压患者抗高血压药物用药的合理性与干预效果分析

以心内科老年高血压患者展开研究,观察高血压药物用药的合理性及干预效果。方法 本次研究的具体开始时间为2022年1月1日、本次研究的具体结束时间为2022年12月31日,将这一年内科室接收治疗的符合本课题研究的老年高血压患者进行定向研究,选择老年高血压患者共计78例,重点分析患者干预前后的用药情况,以表格的形式做好相应记录,比较出何种干预方法更为有效。结果 (1)干预后,将研究组、参照组老年高血压患者的用药依从性做出定向分析,相差的百分比为12.82。(2)干预后,将研究组、参照组两年高血压患者的用药满意度做出定向分析,相差的百分比为15.38.组间对比患者的用药依从性及用药满意度,P值均小于0.05。结论 对心内科老年高血压患者实施综合干预,用药合理性及干预效果大幅提升,改善了患者的临床症状,具有显著的临床推广意义。

心内科抗高血压药物的临床效果观察

探讨心内科高血压患者抗高血压药物用药合理性与干预效果分析。方法 以我院2022年五月至2023年五月间住院的90例心内科老年高血压病人为研究对象,采用随机化方法将其分成2组,对照组和观察组各45例,分别进行服药依从性和满意度调查。结果 观察组病人的遵从率比对照组好,观察组和对照组的依从率分别为97.78%和84.44%。两组间有显著的差别(P<0.05)。将两组病人进行比较,观察组病人的满意度显著好于对照组,用药的介入是有道理的,对两组病人的整体满意度进行了比较,观察组病人的总体满意度是97.78%,而对照组病人的总体满意度是82.22%。在观察组中,有1名病人不满意,而对照组有8名病人不满意。两组间比较,均有显著性差别(P<0.05)。结果 探讨对老年高血压患者进行全面的治疗方法,对其进行合理的治疗,取得了较好的疗效。

高血压发病机制及药物治疗研究

高血压病严重威胁到人类的健康，是比较顽固的病种之一，常引起心、脑、肾等重要器官的病变并出现相应的后果，需要持续服用药物以维持血压的正常，本文主要探讨了高血压发病机制及抗压药物治疗。

抗高血压药物的临床合理应用

高血压病是最常见的心血管疾病,具有发病率高等特征,可以一起心、脑、肾等并发症,甚至会造成死亡。主要以体循环动脉压增高为主要表现的临床综合征,需要正确的、有效的使用抗高血压药物。在用药过程中需要充分考虑到不同患者具有不同的特点,根据患者的特点来决定是单独用药还是联合用药,寻求最佳的治疗方法,达到最好的疗效。本文主要介绍了怎样根据高血压的特征来实施用药,还分析了两种药理作用在实际治疗中的运用,供临床参考。

Optimization of angiotensin I-converting enzyme (ACE) inhibition by rice dregs hydrolysates using response surface methodology

Angiotensin I-converting enzyme (ACE) inhibitory peptides have been shown to have antihypertensive effects and have been utilized for physiologically functional foods and pharmaceuticals. The ACE inhibitory ability of a hydrolysate is de- termined by its peptide composition. However, the peptide composition of a hydrolysate depends on proteolytic enzyme and the hydrolysis conditions. In this study, the effect of process conditions on the ACE inhibitory activity of rice dregs hydrolyzed with a trypsin was investigated systematically using response surface methodology. It was shown that the ACE inhibitory activity of rice dregs hydrolysates could be controlled by regulation of five process conditions. Hydrolysis conditions for optimal ACE inhibition were defined using the response surface model of fractional factorial design (FFD), steepest ascent design, and central composite design (CCD).

A poor performance in comprehensive geriatric assessment is associated with increased fall risk in elders with hypertension： a cross-sectional study

Background Fall and serious fall injuries have become a major health concern for elders. Many factors including blood pressure and anti-hypertensive medication application were reported as hazards of fall. The purpose of this study was to determine if age related systemic functional decline related with increased fall risks in elderly patients with hypertension. Methods A total of 342 elderly hypertension patients （age 79.5 ＋ 6.7 years, male 63.8%） were recruited to the study. Comprehensive geriatric assessment （CGA）, including measurements about activity of daily living （ADL）, nutrition, cognition, depression, numbers of prescription medication and number of clinical diagnosis, was conducted to evaluate the physical and mental status of each participants. Fall risk was evaluated by Morse fall scale, Tinetti perform- ance oriented mobility assessment （POMA） and history of fall in the recent years. Participants were grouped into tertiles according to CGA score. Correlation between CGA and fall risk was analyzed through SPSS 18.0. Results Participants with higher CGA score were likely to be older, had a lower body mass index （BMI）, and a higher prevalence of cardiovascular disease, chronic obstructive pulmonary disease （COPD）, cerebrovascular disease and osteoarthropathia. Participants in higher tertile of CGA score got increased prevalence of fall risk than those in lower tertile （P 〈 0.01 T3 vs. T1, P 〈 0.01 T3 vs. T2）. Correlation analysis and regression analysis showed significant association between CGA and Morse fall scale （P 〈 0.001）, as well as CGA and POMA （P 〈 0.001）. Meanwhile, CGA components also showed co-relationships with increase fall risks. After adjusting age, BMI, benzodiazepine use, cardiovascular disease, cerebrovascular disease, COPD and osteoarthropathia, both history of fall in the recent year and rising Morse fall scale were significantly associated with ADL im- pairment （OR： 2.748, 95%CI： 1.598-4.725）, （OR： 3.310, 95%CI： 1.893-5.788）. Decreased Tinetti POMA score was associated with Mini-Mental State Examination （MMSE） （OR： 4.035, 95%CI： 2.100-7.751）, ADL （OR： 2.380, 95%CI： 1.357-4.175） and shortened MNA form （MNA-SF） impairment （OR： 2.692, 95%CI： 1.147-6.319）. Conclusions In elderly adults with hypertension, impaired physical and mental function is associated with increased fall risk. Further study is required to investigate possible mediators for the association and effec- tive interventions.

Association between serum homocysteine and arterial stiffness：role of anti-hypertensive drugs

To the Editor I read the article of Zhang, et al. with great interest. They investigated the association of homocysteine with arterial stiffness in Chinese community-based elderly persons. The carotid-femoral pulse wave velocity （PWV） was significantly higher in the high homocyteine group than in the normal one, however, there was no differences in carotid-radial PWV between the high homocyteine group and the normal one. Homocysteine levels were strongly associated with the carotidfemoral PWV even after adjustment for classical risk factors of cardiovascular disease. I congratulate the authors for this important study. However, I want to make minor criticism for this study from the methodological aspect.

纤毛菌性阴道炎感染状况分析

目的分析阴道分泌物的结果,得出纤毛菌阴道炎的感染率。方法分析我院2010年1月眼球2010年12月12个月妇科分泌物进行涂片染色检查,观察纤毛菌。结果 10000例阴道分泌物中纤毛菌检出565例,检出率为5.65%。

Number of medications is associated with outcomes in the elderly patient with metabolic syndrome

Background The diagnosis of metabolic syndrome indicates a clustering of metabolic imbalances which in sum have been recognized as a major predictor of cardiovascular and all-cause mortality. The aim of this study was to assess the level of under-pharmacy and poly-pbarmacy and its prognostic impact in elderly patients with metabolic syndrome. Methods Retrospective chart-review at a tertiary medical center, of 324 patients greater than 65 years of age who met the International Diabetes Foundation criteria for metabolic syndrome diagnosis [Body Mass Index （BMI） 〉 30 kg/m2, diagnosis of type 2 diabetes, hypertension, and dyslipidemia]. Results There were 60 （18.5%） patients in the low （〈 5） medication burden group, 159 （49.1%） in the medium （〉 5 and 〈 10） medication burden group, and 105 （32.4%） in the high （〉 10） medication burden group. At baseline, the groups differed only by systolic blood pressure. At two years follow-up, the medium group had significantly better improvement in high density lipoprotein cholesterol （HDL-C）, low density lipoprotein cholesterol （LDL-C）, HbAlc, and systolic blood pressure compared to the low medication burden group and significantly better improvement in triglycerides, Haemoglobin Alc （HbAlc） and systolic blood pressure compared to the high medication group. Decrease in HDL-C was the only variable associated with strokes. High medication burden predicted hospitalization burden. The number of anti-hypertensives, history of tobacco use, low and high medication burdens and decrease in HDL-C were all associated with death. Conclusions Both poly-pharmacy and under-pharmacy are associated with a decreased therapeutic benefit among patients with metabolic syndrome in terms of important laboratory measurements as well as clinical outcomes such as myocardial infarctions, hospitalization, and death.

Removal of Dominant Adrenal Lateralized by Glucagon-Stimulated Adrenal Venous Sampling Alleviates Hypertension in Bilateral Pheochromocytoma

In bilateral pbeochromocytoma, localization of the dominant adrenal is challenging but highly important since the removal of dominant side can markedly improve cardiovascular outcomes. To demonstrate the usefulness of glucagon-stimulated BAVS （bilateral adrenal venous sampling） in determining the dominant adrenal to be removed, the authors reviewed records of patients who underwent BAVS with glucagon stimulation from 1997-2010. Nineteen out of 44 patients were diagnosed with bilateral pheochromocytoma. Mean age at diagnosis was 33 ± 14 years. Duration of hypertension was 5 ± 6 years with highest systolic BP （blood pressure） of 186 ±30 mmHg and diastolic BP of 113 ±18 mmHg. Headache （68%） is the most common symptom followed by paroxysmal hypertension （58%）. Majority were taking 〉 3 anti-hypertensive drugs. On glucagon-stimulated BAVS, 63% had right adrenal dominance. Three patients, who were hypertensive for 1, 6 and 12 years, underwent removal of the dominant adrenal. On follow-up （mean period = 36 months）, there was marked improvement in BP control [pre-op vs. post-op： （systolic） 160-240 mmHg vs. 120-150 mmHg; （diastolic） 90-110 mmHg vs. 70-90 mmHg] and reduction in number of anti-hypertensive medications （from 3-5 to 2 classes of drugs）. BAVS with glucagon stimulation is a valuable tool in the identification of the dominant adrenal to be removed in patients with bilateral pheochromocytoma to alleviate chronic hypertension.

Comparative study between rivaroxaban and conventional low molecular weight heparin anticoagulant in preventing thrombosis

After entering 2010, as main varieties patents of the global non-peptide angiotensin II receptor antagonists （ARB） expire, strong growth of anti-hypertensive drug market will tend to slow down. In drugs acting on the cardiovascular and blood system, antithrombotie drugs will become a new attraction on the market. Antithrombotic drugs are primarily formed by the anti-platelet aggregation, coagulation system activation of plasminogen thrombolytic drugs and the like. Antiplatelet drugs have both prevention and treatment effect, are the main category of antithrombotic drugs. According to IMS Health data, in 2008, sale of anti-thrombosis drug in global market is 180 million U.S. dollars, an increase of 16 %, while in 2009 the growth rate is only 7.95%, reaching $ 19.5 billion, growth rate of antithrombotic drugs is 7.13% in the world＇ s major pharmaceutical market.

Hypertension in the elderly： insights from recent research

Hypertension is a leading cause of mortality and morbidity around the world and,prevalence of hypertension is increasing with aging.Hypertension in the elderly is associated with increased occurrence rates of sodium sensitivity,isolated systolic hypertension,and ＇white coat effect＇.Arterial stiffness and endothelial dysfunction also increase with age.These factors should be considered in selecting antihypertensive therapy.The prime objective of this therapy is to prevent stroke.The fmdings of controlled trials show that there should be no cut-off age for treatment.A holistic program for controlling cardiovascular risks should be fully discussed with the patient,including evaluation to exclude underlying causes of secondary hypertension,and implementation of lifestyle measures.The choice of antihypertensive drug therapy is influenced by concomitant disease and previous medication history,but will typically include a thiazide diuretic as the first-line agent;to this will be added an angiotensin inhibitor and/or a calcium channel blocker.Beta blockers are not generally recommended,in part because they do not combat the effects of increased arterial stiffness.The hypertension-hypoten-sion syndrome requires case-specific management.Drug-resistant hypertension is important to differentiate from faulty compliance with medication.Patients resistant to the third-line drug therapy may benefit from treatment with extended-release isosorbide mononitrate.A trial of spironolactone may also be worthwhile.

Analysis of antihypertensive regimens and their intended patients from three hospitals in Beijing

This study aimed to investigate various regimens of antihypertensive agents for different groups of patients and the outcomes in the real world. We retrospectively collected 974 prescriptions for hypertension from three hospitals in Beijing, along with medical records of 219 hypertensive patients from one of the hospitals to study the regimens and their effects on patients. The antihypertensive regimens were classified by different combinations of subclasses of antihypertensive agents. Nearly all prescriptions can be classified into 11 different antihypertensive regimens, and most of them are combination therapy. Grade III hypertension patients significantly （P〈0.001） tend to be treated with regimens containing calcium channel blocker （CCB） and RAAS inhibitors, angiotensin II receptor blocker （ARB） or angiotensin-converting enzyme inhibitor （ACEI）. β-Blockers are more likely to be combined with CCB than with other categories of antihypertensive agents. Hydrochlorothiazide is less widely used than recommended.

Anti-inflammatory effect of cerivastatin in vascular injury independent of serum cholesterol and blood pressure lowering effects in mouse model

Objective: To observe the anti inflammatory effect of cerivastatin in a mouse model of vascular injury and its cholesterol lowering effect. Methods: We developed a mouse model of vascular remodeling induced by polyethylene cuff placement and determined the anti inflammatory effects of cerivastatin in wild mice. Cerivastatin was given by Alzet micro osmotic minipumps implanted intraperitoneally at the same time as cuff placement at doses of 0.1 mg/kg, 0.5 mg/kg and 1 mg/kg per day, respectively for 2 weeks after cuff placement. The insufficient doses of Cerivastatin to lower serum cholesterol and systolic blood pressure through the neointimal formation and BrdU index were investigated in mouse femoral injury artery induced by cuff placement. Results: There was a little change in serum cholesterol by the treatment with cerivastatin, the cross sectional area of intima of injured femoral artery was significantly increased, the neointima formation was significantly increased by the cuff induced vascular injury at day 14. The neointimal formation and BrdU index were inhibited in the 1 mg/kg cerivastatin, but not in the 0.1 mg/kg and 0.5 mg/kg cerivastatin. Furthermore, 1 mg/kg of cerivastatin significantly inhibited the expression of tumor necrosis factor α (TNF α) and interleukin 1β (IL 1β) without lowering serum cholesterol. Conclusions: These results suggest that cerivastatin can inhibit vascular inflammation and the proliferation of vascular smooth muscle cells (VSMCs) through its lipid lowering independent action. Such effects of cerivastatin may be an important mechanism, by which it prevents the development of atherosclerotic lesions.