Objective To explore the changes in plasma angiotensin II （Ang Ⅱ） and circadian rhythm of blood pressure among hypertensive patients with sleep apnea syndrome （SAS） before and after continuous positive airway pre...Objective To explore the changes in plasma angiotensin II （Ang Ⅱ） and circadian rhythm of blood pressure among hypertensive patients with sleep apnea syndrome （SAS） before and after continuous positive airway pressure （CPAP） or surgical treatment. Methods A total of 180 essential hypertension patients were enrolled in our study. The determination of plasma Ang Ⅱ concentration, ambulatory blood pressure （ABP）, and polysomnography （PSG） monitoring were performed before and 3 months after CPAP or surgical treatment. Results Patients were classified into three groups by their apnea-hypopnea index （AHI）： essential hypertension group （EH group, n=72; AHI〈5）, essential hypertension with mild SAS group （EH＋mild SAS group, n=60, 5≤AHI〈20）, and essential hypertension with moderate and severe SAS group （EH＋moderate-severe SAS group, n=48, AHI_〉20）. The concentrations of plasma AngⅡ in the above three groups were 13.42±3.27, 16.17±3.82, and 18.73±4.05 ng/mL respectively before treatment, and AngⅡ concentration in EH patients combined with SAS was significantly higher than that in EH group （all P〈0.05）. After treatment the values in the latter two groups significantly decreased to 14.67±2.56 and 15.03±3.41 ng/mL respectively （P〈0.05）. The incidence of non-dipper blood pressure curve in EH patients was 31.9%, and those in hypertensive patients with mild SAS and moderate-severe SAS were 51.7% and 58.3%, respectively before treatment. The incidence of non-dipper blood pressure curve in the EH patients with mild SAS was significantly higher than that of patients with EH alone （P〈0.05）. After CPAP treatment or surgery, the incidence of non-dipper blood pressure curve in the two SAS groups was significantly decreased to 38.3% and 39.6%, respectively （P〈0.05）. Conclusions Ang Ⅱ might play a role in blood pressure variability in patients with obstructive SAS. CPAP or surgical treatment can improve blood pressure disorder and decrease plasma Ang Ⅱ level in patients with obstructive SAS.展开更多
Objective：To observe the effect of Chinese herbal medicine for calming Gan（肝） and suppressing hyperactive yang（平肝潜阳,CGSHY） on arterial elasticity function and the circadian rhythm of blood pressure in patien...Objective：To observe the effect of Chinese herbal medicine for calming Gan（肝） and suppressing hyperactive yang（平肝潜阳,CGSHY） on arterial elasticity function and the circadian rhythm of blood pressure in patients with essential hypertension（EH）.Methods：Adopting a parallel,randomized design,sixty-four patients with EH of stagesⅠandⅡwere randomly divided into two groups according to a random number table,with 32 in each group.The patients in the treatment group were treated with CGSHY and those in the control group were treated with Enalapril.All patients were given 24-h ambulatory blood pressure monitoring（ABPM） before and after a 12-week treatment.Trough/peak（T/P） ratios of systolic and diastolic blood pressure（SBP DBP） of each group were calculated.The circadian rhythm of their blood pressure was observed at the same time. The changes in elasticity of the carotid artery in the patients,including stiffness parameter（β）,pressure-strain elastic modulus（Ep）,arterial compliance（AC）,augmentation index（Al）,and pulse wave velocity（PVWβ） were determined by the echo-tracking technique before and after a 12-week treatment.In the meantime,their levels of nitric oxide（NO） and endothelin-1（ET-1） were measured respectively.Results：After treatment,all parameters in the 24-h ABPM and the elasticity of the carotid artery（β,Ep,AC and PVWβ） were markedly improved,the level of NO was increased,and ET-1 was decreased in both groups as compared with values before treatment （P0.05 or P0.01）.Further,the improvements in the ratio of T/P of SBP DBP and in the level of NO and ET-1 in the treatment group were more significant than those in the control group（P0.05）.There were no significant differences in all parameters in the ABPM monitoring and the elasticity of the carotid artery,the recovery of blood pressure circadian rhythm,and the therapeutic effect of antihypertension in EH patients between the two groups （P0.05）.Conclusions：Chinese herbal medicine for CGSHY may lower the blood pressure smoothly and recover the circadian rhythm of blood pressure in EH patients.They may also improve the carotid elasticity of EH patients similar to that of Enalapril.The mechanism of action of Chinese herbs on EH might be related to the regulation of vascular endothelium function.展开更多
Background Non-dipping blood pressure(BP)pattern is a potential risk factor contributing to cardiac geometry change.Relationship between BP pattern and left atrium(LA)enlargement besides left ventricle(LV)structural c...Background Non-dipping blood pressure(BP)pattern is a potential risk factor contributing to cardiac geometry change.Relationship between BP pattern and left atrium(LA)enlargement besides left ventricle(LV)structural change is seldom studied.Methods A total of 237 hypertensive and hospitalized adults were enrolled.Left heart chamber parameters were measured by 2-dimensional echocardiography,and BP circadian rhythm was evaluated by 24-hour ambulatory blood pressure monitoring.Night-day ratios of systolic BP(NDR-SBP)were calculated and BP patterns were classified into dippers,reduced-dippers,and risers,which were defined as NDR-SBP<0.9,≥0.9 and<1,≥1,respectively.Multiple logistic regression analyses were performed to identify the factors associated with increased left ventricular end-diastolic internal diameter and left atrial diameter.Results Among enrolled participants,there were 62(26.2%)dippers,136(57.4%)reduced-dippers and 39(16.5%)risers.Briefly,57.8%were male and the mean age was 57.0±13.9 years.Compared to the dippers,both left ventricular end-diastolic diameter(44.4±4.3 mm in dippers,45.5±4.0 mm in reduced-dippers,46.5±4.5 mm in risers,P=0.045)and left atrial diameter(32.7±4.1 mm in dippers,34.3±4.7 mm in reduced-dippers,35.7±4.3 mm in risers,P=0.004)were progressively increased in reduced-dippers and risers.Logistic regression analyses showed that after adjusted for age,male gender,history of diabetes,blood lipid profiles,mean diurnal BP and estimated glomerular filtration rate,the association between increased LV diameter and riser BP pattern was significant(OR:2.621,95%CI:1.030-6.678)while the association between increased LA diameter and riser BP pattern was marginally significant.Conclusions The riser BP pattern is associated with the enlargement of LV and probably that of LA in hypertensive patients independent of 24-hour systolic BP level.展开更多
目的:探究中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)与原发性高血压患者24h动态血压变异性及血压昼夜节律的关联。方法:本研究纳入2020年1月至2021年1月,在解放军总医院第一医学中心门诊就诊的原发性高血压患者。使用...目的:探究中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)与原发性高血压患者24h动态血压变异性及血压昼夜节律的关联。方法:本研究纳入2020年1月至2021年1月,在解放军总医院第一医学中心门诊就诊的原发性高血压患者。使用标准差(standard deviation,SD)、变异系数(coefficient of variation,CV)和独立于均值的变异系数(variation independent of mean,VIM)评估患者的动态血压变异性。使用多元线性回归分析探究NLR与动态血压变异性的关联,并使用多因素Logistic回归分析探究NLR与发生非杓型或反杓型血压节律的关联。结果:研究共纳入936例原发性高血压患者,校正了相关混杂因素进行的多元线性回归分析显示,NLR与高血压患者的24h收缩压SD(B=0.25)、CV(B=0.98)、VIM(B=0.15)、舒张压CV(B=1.23),日间收缩压SD(B=0.62)、CV(B=1.11)、VIM(B=0.30)、舒张压CV(B=0.99),和夜间收缩压SD(B=0.69)、CV(B=1.39)、VIM(B=0.29)、舒张压SD(B=1.54)、CV(B=1.72)、VIM(B=0.42)均呈线性相关。多因素Logistic回归分析显示,与NLR第一分位组相比,第四分位组与出现收缩压非杓型或反杓型血压节律风险升高93%有关(OR=1.84,95%CI:1.11~3.03)。结论:NLR与原发性高血压患者动态血压变异性呈显著正相关,NLR升高与出现收缩压非杓型或反杓型血压节律风险升高显著相关。展开更多
目的探究血压昼夜节律与妊娠期高血压患者胎盘早剥的相关性,为临床提供参考。方法选取2018年1月至2022年12月广州市妇女儿童医疗中心收治的315例妊娠期高血压患者为研究对象进行回顾性分析,根据是否发生胎盘早剥将患者分为胎盘早剥组(71...目的探究血压昼夜节律与妊娠期高血压患者胎盘早剥的相关性,为临床提供参考。方法选取2018年1月至2022年12月广州市妇女儿童医疗中心收治的315例妊娠期高血压患者为研究对象进行回顾性分析,根据是否发生胎盘早剥将患者分为胎盘早剥组(71例)和无胎盘早剥组(244例)。收集两组患者的临床资料及24 h动态血压监测数据,比较两组患者血压昼夜节律类型,并分析24 h动态血压与胎盘早剥发生的相关性。结果胎盘早剥组患者剖宫产率高于无胎盘早剥组(P<0.05)。胎盘早剥组患者24 h平均动脉压(MAP)、夜间MAP、24 h舒张压平均值(mDBP)、白天mDBP、夜间mDBP、血压晨峰及最低血压均高于无胎盘早剥组(均P<0.05)。无胎盘早剥组患者血压昼夜节律分型主要为杓型和非杓型,胎盘早剥组患者主要为非杓型和反杓型,两组患者血压昼夜节律类型构成分布比较,差异有统计学意义(P<0.05)。Spearman相关性分析结果显示,24 h MAP、夜间MAP、24 h mDBP、白天mDBP、夜间mDBP、血压晨峰及最低血压与胎盘早剥发生均呈正相关(均P<0.05)。结论血压昼夜节律的改变与妊娠期高血压患者胎盘早剥的发生存在相关性,临床需给予重视。展开更多
Background The exaggerated surge in morning blood pressure （BP） that many patients experience upon awakening may be closely related to target organ damage and may be a predictor of cardiovascular complications. Howe...Background The exaggerated surge in morning blood pressure （BP） that many patients experience upon awakening may be closely related to target organ damage and may be a predictor of cardiovascular complications. However, no previous studies have evaluated the rate of this surge independently of the evening period. It remains unclear whether the rate of increase experienced during the surge is a significant or independent determinant of cardiovascular events. Methods We randomly selected 340 ambulatory BP monitoring （ABPM） patients. All subjects without type 2 diabetes mellitus were divided into two groups： hypertensive group （n=170） and normotensive group （n=170）. We analyzed ambulatory blood pressure recordings using a double logistic curve-fitting procedure to determine whether the magnitude of the surge in BP and heart rate （HR） in the morning is related to the level of BP in hypertensive individuals. We evaluated the association between the rate of the morning surge in systolic BP （SBP） and the incidence of myocardial infarction and stroke in normotensive and hypertensive subjects. Results Comparisons between hypertensive and normotensive subjects showed that the rates of the morning surges in SBP, mean BP （MBP）, and diastolic BP （DBP） were greater in the hypertensive group （P 〈0.05） than in the normotensive group. The rate of morning surge in BP was found to be correlated with the daytime SBP （r=0.236, P 〈0.01）, the difference between the day and night plateau （r=0.249, P 〈0.01）, and the night SBP （r---0.160, P 〈0.05）, respectively. After controlling for age, sex, and mean systolic pressure within 24 hours （24 h SBP）, the rate of morning surge in SBP was closely correlated with daytime SBP （r=0.463, P 〈0.001）, night SBP （r=-0.173, P 〈0.05）, and the difference between the day and night plateau （r=0.267, P 〈0.001）. Logistic regression analysis revealed that the rate of morning surge in SBP was an independent determinant of myocardial infarction （OR=1.266, 95% C1=1.153-1.389, P 〈0.001） and stroke （OR=1.367, 95% C/=1.174-1.591, P 〈0.001）. Conclusions The rate of the morning surge in BP is greater in hypertensive subjects than in normotensive subjects. Daytime SBP may be the best predictor of the rate of morning surge in SBP. The rate of the morning surge in BP is associated with cardiovascular and stroke events.展开更多
文摘Objective To explore the changes in plasma angiotensin II （Ang Ⅱ） and circadian rhythm of blood pressure among hypertensive patients with sleep apnea syndrome （SAS） before and after continuous positive airway pressure （CPAP） or surgical treatment. Methods A total of 180 essential hypertension patients were enrolled in our study. The determination of plasma Ang Ⅱ concentration, ambulatory blood pressure （ABP）, and polysomnography （PSG） monitoring were performed before and 3 months after CPAP or surgical treatment. Results Patients were classified into three groups by their apnea-hypopnea index （AHI）： essential hypertension group （EH group, n=72; AHI〈5）, essential hypertension with mild SAS group （EH＋mild SAS group, n=60, 5≤AHI〈20）, and essential hypertension with moderate and severe SAS group （EH＋moderate-severe SAS group, n=48, AHI_〉20）. The concentrations of plasma AngⅡ in the above three groups were 13.42±3.27, 16.17±3.82, and 18.73±4.05 ng/mL respectively before treatment, and AngⅡ concentration in EH patients combined with SAS was significantly higher than that in EH group （all P〈0.05）. After treatment the values in the latter two groups significantly decreased to 14.67±2.56 and 15.03±3.41 ng/mL respectively （P〈0.05）. The incidence of non-dipper blood pressure curve in EH patients was 31.9%, and those in hypertensive patients with mild SAS and moderate-severe SAS were 51.7% and 58.3%, respectively before treatment. The incidence of non-dipper blood pressure curve in the EH patients with mild SAS was significantly higher than that of patients with EH alone （P〈0.05）. After CPAP treatment or surgery, the incidence of non-dipper blood pressure curve in the two SAS groups was significantly decreased to 38.3% and 39.6%, respectively （P〈0.05）. Conclusions Ang Ⅱ might play a role in blood pressure variability in patients with obstructive SAS. CPAP or surgical treatment can improve blood pressure disorder and decrease plasma Ang Ⅱ level in patients with obstructive SAS.
基金Supported by the National Natural Science Foundation of China (No.30500644,304071125)the Science and Technology Projects of Traditional Chinese Medicine of Hunan Province(No. 2009047)
文摘Objective：To observe the effect of Chinese herbal medicine for calming Gan（肝） and suppressing hyperactive yang（平肝潜阳,CGSHY） on arterial elasticity function and the circadian rhythm of blood pressure in patients with essential hypertension（EH）.Methods：Adopting a parallel,randomized design,sixty-four patients with EH of stagesⅠandⅡwere randomly divided into two groups according to a random number table,with 32 in each group.The patients in the treatment group were treated with CGSHY and those in the control group were treated with Enalapril.All patients were given 24-h ambulatory blood pressure monitoring（ABPM） before and after a 12-week treatment.Trough/peak（T/P） ratios of systolic and diastolic blood pressure（SBP DBP） of each group were calculated.The circadian rhythm of their blood pressure was observed at the same time. The changes in elasticity of the carotid artery in the patients,including stiffness parameter（β）,pressure-strain elastic modulus（Ep）,arterial compliance（AC）,augmentation index（Al）,and pulse wave velocity（PVWβ） were determined by the echo-tracking technique before and after a 12-week treatment.In the meantime,their levels of nitric oxide（NO） and endothelin-1（ET-1） were measured respectively.Results：After treatment,all parameters in the 24-h ABPM and the elasticity of the carotid artery（β,Ep,AC and PVWβ） were markedly improved,the level of NO was increased,and ET-1 was decreased in both groups as compared with values before treatment （P0.05 or P0.01）.Further,the improvements in the ratio of T/P of SBP DBP and in the level of NO and ET-1 in the treatment group were more significant than those in the control group（P0.05）.There were no significant differences in all parameters in the ABPM monitoring and the elasticity of the carotid artery,the recovery of blood pressure circadian rhythm,and the therapeutic effect of antihypertension in EH patients between the two groups （P0.05）.Conclusions：Chinese herbal medicine for CGSHY may lower the blood pressure smoothly and recover the circadian rhythm of blood pressure in EH patients.They may also improve the carotid elasticity of EH patients similar to that of Enalapril.The mechanism of action of Chinese herbs on EH might be related to the regulation of vascular endothelium function.
基金supported by the Key Area R&D Program of Guangdong Province(No.2019B020227005)National Key Research and Development Program of China(No.2016YFC1301202)。
文摘Background Non-dipping blood pressure(BP)pattern is a potential risk factor contributing to cardiac geometry change.Relationship between BP pattern and left atrium(LA)enlargement besides left ventricle(LV)structural change is seldom studied.Methods A total of 237 hypertensive and hospitalized adults were enrolled.Left heart chamber parameters were measured by 2-dimensional echocardiography,and BP circadian rhythm was evaluated by 24-hour ambulatory blood pressure monitoring.Night-day ratios of systolic BP(NDR-SBP)were calculated and BP patterns were classified into dippers,reduced-dippers,and risers,which were defined as NDR-SBP<0.9,≥0.9 and<1,≥1,respectively.Multiple logistic regression analyses were performed to identify the factors associated with increased left ventricular end-diastolic internal diameter and left atrial diameter.Results Among enrolled participants,there were 62(26.2%)dippers,136(57.4%)reduced-dippers and 39(16.5%)risers.Briefly,57.8%were male and the mean age was 57.0±13.9 years.Compared to the dippers,both left ventricular end-diastolic diameter(44.4±4.3 mm in dippers,45.5±4.0 mm in reduced-dippers,46.5±4.5 mm in risers,P=0.045)and left atrial diameter(32.7±4.1 mm in dippers,34.3±4.7 mm in reduced-dippers,35.7±4.3 mm in risers,P=0.004)were progressively increased in reduced-dippers and risers.Logistic regression analyses showed that after adjusted for age,male gender,history of diabetes,blood lipid profiles,mean diurnal BP and estimated glomerular filtration rate,the association between increased LV diameter and riser BP pattern was significant(OR:2.621,95%CI:1.030-6.678)while the association between increased LA diameter and riser BP pattern was marginally significant.Conclusions The riser BP pattern is associated with the enlargement of LV and probably that of LA in hypertensive patients independent of 24-hour systolic BP level.
文摘目的:探究中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)与原发性高血压患者24h动态血压变异性及血压昼夜节律的关联。方法:本研究纳入2020年1月至2021年1月,在解放军总医院第一医学中心门诊就诊的原发性高血压患者。使用标准差(standard deviation,SD)、变异系数(coefficient of variation,CV)和独立于均值的变异系数(variation independent of mean,VIM)评估患者的动态血压变异性。使用多元线性回归分析探究NLR与动态血压变异性的关联,并使用多因素Logistic回归分析探究NLR与发生非杓型或反杓型血压节律的关联。结果:研究共纳入936例原发性高血压患者,校正了相关混杂因素进行的多元线性回归分析显示,NLR与高血压患者的24h收缩压SD(B=0.25)、CV(B=0.98)、VIM(B=0.15)、舒张压CV(B=1.23),日间收缩压SD(B=0.62)、CV(B=1.11)、VIM(B=0.30)、舒张压CV(B=0.99),和夜间收缩压SD(B=0.69)、CV(B=1.39)、VIM(B=0.29)、舒张压SD(B=1.54)、CV(B=1.72)、VIM(B=0.42)均呈线性相关。多因素Logistic回归分析显示,与NLR第一分位组相比,第四分位组与出现收缩压非杓型或反杓型血压节律风险升高93%有关(OR=1.84,95%CI:1.11~3.03)。结论:NLR与原发性高血压患者动态血压变异性呈显著正相关,NLR升高与出现收缩压非杓型或反杓型血压节律风险升高显著相关。
文摘目的探究血压昼夜节律与妊娠期高血压患者胎盘早剥的相关性,为临床提供参考。方法选取2018年1月至2022年12月广州市妇女儿童医疗中心收治的315例妊娠期高血压患者为研究对象进行回顾性分析,根据是否发生胎盘早剥将患者分为胎盘早剥组(71例)和无胎盘早剥组(244例)。收集两组患者的临床资料及24 h动态血压监测数据,比较两组患者血压昼夜节律类型,并分析24 h动态血压与胎盘早剥发生的相关性。结果胎盘早剥组患者剖宫产率高于无胎盘早剥组(P<0.05)。胎盘早剥组患者24 h平均动脉压(MAP)、夜间MAP、24 h舒张压平均值(mDBP)、白天mDBP、夜间mDBP、血压晨峰及最低血压均高于无胎盘早剥组(均P<0.05)。无胎盘早剥组患者血压昼夜节律分型主要为杓型和非杓型,胎盘早剥组患者主要为非杓型和反杓型,两组患者血压昼夜节律类型构成分布比较,差异有统计学意义(P<0.05)。Spearman相关性分析结果显示,24 h MAP、夜间MAP、24 h mDBP、白天mDBP、夜间mDBP、血压晨峰及最低血压与胎盘早剥发生均呈正相关(均P<0.05)。结论血压昼夜节律的改变与妊娠期高血压患者胎盘早剥的发生存在相关性,临床需给予重视。
文摘Background The exaggerated surge in morning blood pressure （BP） that many patients experience upon awakening may be closely related to target organ damage and may be a predictor of cardiovascular complications. However, no previous studies have evaluated the rate of this surge independently of the evening period. It remains unclear whether the rate of increase experienced during the surge is a significant or independent determinant of cardiovascular events. Methods We randomly selected 340 ambulatory BP monitoring （ABPM） patients. All subjects without type 2 diabetes mellitus were divided into two groups： hypertensive group （n=170） and normotensive group （n=170）. We analyzed ambulatory blood pressure recordings using a double logistic curve-fitting procedure to determine whether the magnitude of the surge in BP and heart rate （HR） in the morning is related to the level of BP in hypertensive individuals. We evaluated the association between the rate of the morning surge in systolic BP （SBP） and the incidence of myocardial infarction and stroke in normotensive and hypertensive subjects. Results Comparisons between hypertensive and normotensive subjects showed that the rates of the morning surges in SBP, mean BP （MBP）, and diastolic BP （DBP） were greater in the hypertensive group （P 〈0.05） than in the normotensive group. The rate of morning surge in BP was found to be correlated with the daytime SBP （r=0.236, P 〈0.01）, the difference between the day and night plateau （r=0.249, P 〈0.01）, and the night SBP （r---0.160, P 〈0.05）, respectively. After controlling for age, sex, and mean systolic pressure within 24 hours （24 h SBP）, the rate of morning surge in SBP was closely correlated with daytime SBP （r=0.463, P 〈0.001）, night SBP （r=-0.173, P 〈0.05）, and the difference between the day and night plateau （r=0.267, P 〈0.001）. Logistic regression analysis revealed that the rate of morning surge in SBP was an independent determinant of myocardial infarction （OR=1.266, 95% C1=1.153-1.389, P 〈0.001） and stroke （OR=1.367, 95% C/=1.174-1.591, P 〈0.001）. Conclusions The rate of the morning surge in BP is greater in hypertensive subjects than in normotensive subjects. Daytime SBP may be the best predictor of the rate of morning surge in SBP. The rate of the morning surge in BP is associated with cardiovascular and stroke events.
