Effect of Bushen Hemai Decoction on vascular stiffness in elderly patients with isolated systolic hypertension

Objective: To investigate the effect of Bushen Hemai Decoction on the wall stiffness of middle-aged and elderly patients with isolated systolic hypertension. Methods: A total of 126 patients with middle and old systolic hypertension were selected from March 2017 to March 2018 in our hospital. According to the random table method, there were 63 cases in the observation group and 63 cases in the control group. The control group was treated with conventional western medicine, while the observation group was treated with kidney tonifying and pulse prescription hypothyroidism on the basis of the control group. The two groups were treated for 12 weeks. The changes of blood pressure, pulse conduction velocity and endothelium-dependent vasodilation function were compared between the two groups before and after treatment. Results: the systolic pressure in the two groups was lower than that before the treatment, but the diastolic pressure was not significantly changed, and the systolic pressure in the observation group was lower than that of the control group, while the diastolic pressure was not statistically significant. After treatment, the pulse conduction velocity of the two groups was lower than that before the treatment, and the pulse conduction velocity of the observation group was lower than that of the control group after treatment. After two groups of treatment, FMD was higher than before treatment, but there was no significant change in the diameter of vascular base, and FMD in the observation group was higher than that of the control group, but there was no statistical difference between the blood vessel base diameter. The total effective rate of the observation group (93.65%) was higher than that of the control group (74.60%). Conclusion: Bushen Hemai Decoction is effective in treating isolated systolic hypertension in middle-aged and old patients, and can reduce the stiffness of patients' tube wall, which is worthy of clinical reference.

Effect of Bushen Hemai decoction on vascular stiffness in elderly patients with isolated systolic hypertension

Objective: To investigate the effect of Bushen Hemai decoction on the wall stiffness of middle-aged and elderly patients with simple systolic hypertension. Methods: The 126 middle-aged and elderly patients with simple systolic hypertension admitted to our hospital from May 2010 to May 2015 were randomly divided into control group (63 cases) and observation group (63 cases). The control group was treated with conventional Western medicine, while the observation group was treated with Bushen Hemai decoction on the basis of the control group. The two groups were treated for 4 weeks. Results: The systolic blood pressure of the two groups decreased after treatment (observation group: T=16.165, control group: T=13.537, P<0.05);the systolic blood pressure of the two groups did not change significantly after treatment (observation group: T=1.857, control group: T=0.483, P>0.05);the systolic blood pressure of the observation group was lower than that of the control group after treatment (T=16.165, P<0.05). After treatment, the level of ST segment of ECG in the two groups was lower than that before treatment (observation group: T=22.145, control group: T=11.007, P<0.05);after treatment, the level of ST segment of ECG in the observation group was lower than that in the control group (T=8.130, P<0.05). After treatment, the pulse conduction velocity of the two groups was lower than that of the control group (observation group:T=8.694, control group: T=3.944, P<0.05);after treatment, the pulse conduction velocity of the observation group was lower than that of the control group (T=5.326, P<0.05). The total effective rate of the observation group (93.65%) was higher than that of the control group (76.19%) (P<0.05). Conclusion: Bushen Hemai Decoction has a significant clinical effect on middle-aged and elderly patients with simple systolic hypertension, and can improve the stiffness of the tube wall, which is worthy of clinical reference.

Influence of irbesartan combined with low dose urokinase on treatment effect and serologic indexes in elderlyisolated systolic hypertension patients

To study the influence of irbesartan combined with low dose urokinase on treatment effect and serologic indexes in elderly isolated systolic hypertension patients. Methods: One hundred and ten cases of elderly isolated systolic hypertension patients in our hospital during January 2013–January 2016 were randomly divided into observation group with 55 cases and control group with 55 cases. Patients in observation group received irbesartan combined with low dose hydrochlorothiazide treatment and those in control group received amlodipine combined with low dose hydrochlorothiazide treatment, each lasted for 4 weeks. After 4 weeks treatment, non-invasive blood pressure and blood pressure variability indexes were measured, serum endothelial function, inflammatory factors and oxidative stress indexes were measured. Results: After 4 weeks treatment, patients systolic blood pressure (SBP), 24 h mean systolic blood pressure (24 h SBP), 24 h systolic blood pressure standard deviation (24 h SSD) were significantly lower in observation group than in control group (P<0.05);serum endothelial function index EF-1 was lower in observation group than in control group, while NO and endothelial nitric oxide synthase (eNOS) were higher in observation group than in control group (P<0.05);serum high sensitivity C-reactive protein (hs-CRP), interleukin (IL)-1β, IL-6, IL-8, tumor necrosis factor-α (TNF-α) contents were lower in observation group than in control group (P<0.05);serum oxidation index such as malondialdehyde (MDA) was lower in observation group than in control group, while antioxidant indexes such as total anti-oxidative capacity (TAC), superoxide dismutase (SOD), GSH were higher in observation group than in control group (P<0.05). Conclusions: Irbesartan combined with low dose hydrochlorothiazide can effectively reduce systolic hypertension and blood pressure variability in elderly isolated systolic hypertension patients, while optimizing the systemic inflammation and oxidative stress status.

王清海教授采用益气化痰法治疗老年ISH患者的经验

(单纯收缩期高血压ISH)是老年常见病、多发病。王清海教授对ISH的诊治有丰富的临床经验,认为ISH应该归属于中医"脉胀"的范畴,ISH是高血压病中的特殊类型,主要见于老年高血压患者,其病机主要为正气虚弱,痰湿阻滞,临床上擅长采用益气化痰法治疗,并研制出用于治疗气虚痰浊型高血压的中药制剂"复方芪麻胶囊"。该药物用于治疗ISH,疗效满意。

缬沙坦与非洛地平治疗老年单纯收缩期高血压(ISH)疗效比较

目的对比缬沙坦和非洛地平对老年单纯收缩期高血压(ISH)患者收缩压的影响。方法将40例患者采用自身交叉对照方法,治疗12周,分为2个药物洗脱期,2个治疗期,洗脱期给予安慰剂(Vitc),治疗期采用随机收服用缬沙坦80mgqd,非洛地平5mgqd。结果在治疗组前后的收缩压有明显下降(P<0.01),缬沙坦与非洛地平血压下降无差异。结论缬沙坦与非洛地平均能降低ISH患者收缩压,疗效相似,副作用少,耐受性好,可以作为老年ISH患者的一线用药长期服用。

乌鲁木齐市不同民族老年ISH患病率及危险因素分析

目的：了解新疆乌鲁木齐市不同民族60岁以上老年人群单纯收缩期高血压（ISH）的患病率，观察ISH患病率与民族、性别、年龄的关系。方法2010年1月~2012年12月采用整群随机抽样方法纳入乌鲁木齐市汉族、维吾尔族和哈萨克族60岁以上老年人3416例，进行心血管疾病患病率横断面调查，统计不同民族、不同性别以及不同年龄人群ISH的患病率。结果共有2957例完成调查，应答率为86.56%（2957/3416）；人群整体ISH患病率为25.50%（754/2957）。按民族比较，汉族、维吾尔族、哈萨克族ISH患病率分别为27.67%（397/1453）、25.00%（260/1040）、20.12%（97/482），3个民族间存在统计差异（χ2=11.01，P＜0.01）；按性别比较，男性患病率为22.89%（356/1555），女性为28.39%（398/1402），女性患病率显著高于男性（χ2=11.72，P＜0.01）；按年龄比较，（61～70）岁、（71～80）岁，80岁以上ISH患病率分别为21.38%（347/1643）、29.56%（295/998）和33.33%（112/336），3个年龄段之间存在统计学差异（χ2=34.01，P＜0.01）。结论新疆乌鲁木齐ISH患病率存在民族、性别差异，且随年龄增加呈增高趋势。

不同运动强度对老年ISH患者有效性及对心脑血管事件安全的影响

目的探讨不同运动强度对老年单纯收缩期高血压(ISH)患者有效性及对心脑血管事件安全的影响。方法选取2018年1月~2019年1月本院收治的单纯收缩压升高高血压者80例,按照随机数字表法分为两组,各40例。对照组实施中等强度运动干预,观察组实施低等强度运动干预。比较两组干预后1个月血管功能相关功能指标,如踝肱指数(ABI)、脉搏波传播速度(PWV)变化,分析干预后两组收缩压、舒张压及平均动脉压变化情况,统计两组干预期间发生相关心脑血管事件,如缺血性脑卒中、脑出血、心肌梗死、心绞痛、心力衰竭等的总比例。结果观察组干预后血管功能相关功能指标中,ABI指数明显高于对照组(P<0.05),PWV显著低于对照组(P<0.05),观察组干预后24h动态血压指标中收缩压、舒张压及平均动脉压显著低于对照组(P<0.05),观察组发生缺血性脑卒中、脑出血、心肌梗死、心绞痛、心力衰竭等的总比例显著低于对照组(P<0.05)。结论针对老年单纯收缩压升高高血压患者实施低等强度的运动干预,可有效改善患者血管功能,调节血压,且安全性较高。

补肾和脉方对单纯收缩期高血压患者血压和血管功能影响的Meta分析

目的:系统评价补肾和脉方对单纯收缩期高血压患者血压和血管功能的影响及其临床用药安全性。方法:检索中国知网、维普数据库、万方数据库、中国生物医学文献数据库、PubMed、Cochrane Library、Embase、Web of Science等8个中英文数据库从建库至2022年10月关于补肾和脉方治疗单纯收缩期高血压的临床随机对照试验。首先进行文献筛选和信息提取,进行质量评价后对最终纳入的19篇文献进行Meta分析。结果:19篇文献中共1612例患者。Meta分析结果显示:相比于对照组,试验组能有效降低偶测收缩压[均数差(MD)=–7.11,95%置信区间(CI)(–9.11,–5.11),P<0.00001],且不降低偶测舒张压[MD=0.72,95%CI(–0.75,2.19),P=0.34];相比于对照组,试验组能有效降低24 h动态收缩压[MD=–7.03,95%CI(–10.88,–3.17),P=0.0004],且不降低24 h动态舒张压[MD=0.72,95%CI(–0.40,1.84),P=0.21];相比于对照组,试验组能显著降低脉搏波传导速度[MD=–147.71,95%CI(–195.16,–100.26),P<0.00001];相比于对照组,试验组能有效降低尿白蛋白/肌酐值[MD=–0.10,95%CI(–0.11,–0.09),P<0.00001];相比于对照组,试验组能有效降低不良反应事件发生率[相对危险度(RR)=0.44,95%CI(0.23,0.83),P=0.01],且差异具有统计学意义(P<0.05)。结论:相比于单纯西医常规治疗,联合治疗有更好的降收缩压效果,且不降低舒张压,可显著改善大血管弹性,还有一定的微血管保护作用,在不良反应方面,单用补肾和脉方显示出良好的临床用药安全性。

Is Chinese Herbal Medicine Effective for Elderly Isolated Systolic Hypertension? A Systematic Review and Meta-Analysis

To study the efficacy of Chinese medicine (CM) on isolated systolic hypertension. Seven electronic databases were searched for randomized controlled trials (RCTs) published until August 2015. Subgroup analyses and meta-analysis were performed to assess the efficacy and safety of the included studies. A total of 24 studies, including 2,096 patients (1,058 patients in the intervention group and 1,038 in the control group), were evaluated in the final analysis. Compared with a conventional therapy used alone, CM as additional intervention was more effective on systolic blood pressure [mean difference (MD)=-0.66, 95% confidence interval (CI)=(-0.97,-0.36), P < 0.00001] and significantly diminished the pulse pressure [MD=-7.49, CI=(-12.69,-2.29), P < 0.00001]. However it showed no additional benefit on diastolic blood pressure [MD=1.16, CI=(0.02, 2.29), P=0.87]. Adverse events were not explicitly reported in most RCTs. CM might be a promising approach for the elderly with isolated systolic hypertension, while the evidence for CM employed alone was insufficient. Considering the inherent limitations of the included studies, larger high-quality RCTs with extensive follow-up should be performed to validate our findings in the future.

苯磺酸左旋氨氯地平联合依那普利治疗老年单纯收缩期高血压的效果及对血管内皮细胞功能的影响探析

目的 探析老年单纯收缩期高血压患者应用苯磺酸左旋氨氯地平联合依那普利治疗的临床效果及对血管内皮细胞功能的影响。方法 100例老年单纯收缩期高血压患者,遵循随机数字表设计方式将其分为对照组、观察组,每组50例。对照组给予依那普利治疗,观察组给予依那普利联合苯磺酸左旋氨氯地平治疗。对比两组患者血压[日间平均收缩压(DMSBP)、夜间平均收缩压(NMSBP)、24 h平均收缩压(24 h MSBP)]水平、临床疗效、内皮功能指标[一氧化氮(NO)、血流介导的血管扩张功能(FMD)、内皮素-1(ET-1)]。结果 治疗前,两组患者DMSBP、NMSBP、24 h MSBP无显著差异(P>0.05);治疗后,两组DMSBP、NMSBP、24 h MSBP均较治疗前有所改善,其中观察组DMSBP(120.52±10.01)mm Hg(1 mm Hg=0.133 kPa)、NMSBP(113.74±11.81)mm Hg、24 h MSBP(117.54±10.87)mm Hg均低于对照组的(138.45±12.35)、(132.63±12.70)、(134.02±12.58)(P<0.05)。观察组病情控制总有效率96.0%显著高于对照组的80.0%(P<0.05)。治疗前,两组患者NO、FMD、ET-1水平无显著差异(P>0.05);治疗后,两组NO、FMD、ET-1水平均较治疗前有所改善,其中观察组NO(6.25±1.39)μmol/L、FMD(7.68±1.13)%高于对照组的(5.61±1.25)μmol/L、(5.31±1.01)%, ET-1(60.84±10.48)ng/L低于对照组的(68.15±9.59)ng/L(P<0.05)。结论 对老年单纯收缩期高血压患者给予苯磺酸左旋氨氯地平片联合依那普利治疗效果良好,可有效改善患者血压水平及内皮功能,可于此类患者群体中推广。

高血压的表现类型及临床特征分析

目的 研究上海社区人群的高血压患病率 ,各高血压亚组的临床特征及高血压发生的影响因素。方法 对 5 6 2 8例 2 0岁以上的社区人群进行血压、体重指数 (BMI)、血糖、血脂、胰岛素等测定 ,调查人群中共有高血压 2 173例 ,其中既往有明确高血压史 14 5 6例 ,新发高血压 717例 ,后者根据收缩压和舒张压值被分为单纯收缩期高血压组 (ISH)、单纯舒张期高血压组 (IDH)及收缩期高血压合并舒张期高血压组 (SH +DH) ;然后根据血糖值进一步将新发的高血压人群分成正常血糖组 (NGT)、糖调节受损组 (IGR)及糖尿病组 (DM )。结果 ①高血压的患病率为 38.6 1%。新发高血压者占高血压总人群的 33.0 0 %。新发高血压人群中ISH占 2 6 .2 2 % ,IDH占 4 1.70 % ,SH +DH占 32 .0 8%。②高血压各亚组的BMI、腰围 (W )、腰臀比 (WHR)、三酰甘油 (TG)、餐后2h血糖 (2hPG)均较正常血压组 (NBP)明显升高。③新发高血压者中ISH组年龄大 ,2hPG较高 ,但胰岛素抵抗较轻 ;IDH组年龄轻 ,较肥胖 ,胰岛素抵抗较重 ;而SH +DH组兼有年龄大、肥胖 (腹型肥胖 )及胰岛素抵抗更为严重等特点。④在糖代谢异常伴高血压者中 ,以ISH及SH +DH更为多见。结论 ①总体脂含量、体脂分布、血糖、血胰岛素、血脂是高血压发生的影响因素。

不同类型高血压人群与健康人群血脂和肾功能差异及血压影响因素分析

目的研究不同类型高血压人群血脂和肾功能差异及血压影响因素。方法选择2012年7月~2015年7月于中国中医科学院广安门医院南区的体检者1717例，详细记录病史、测量身高、体重、体质指数（BMI)、血压等，检测血常规、血液流变学等指标，应用BeckmanDXI-800全自动化学发光分析仪测定生化指标，包括三酰甘油（TG)、胆固醇（CHO)、高密度脂蛋白胆固醇（HDL-C)、低密度脂蛋白胆固醇（LDL-C)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、尿素氮（Urea)、肌酐（Cr)、尿酸（UA)。并根据健康状态和血压值分为4组，健康组（1158例），双期高血压组（254例），单纯舒张期高血压组（89例），单纯收缩期高血压组（216例），将4组间的各项检测指标进行比较研究，并运用多元逐步回归分析得出血压的影响因素。结果健康组、双期高血压组、单纯舒张期高血压组、单纯收缩期高血压组受试者平均年龄分别为（36.71±10.23)岁、（46.35±10.72)岁、（44.85±9.34)岁、（46.57±7.68)岁。经单因素方差分析检验，双期高血压组、单纯舒张期高血压组的年龄、体重、BMI、收缩压、舒张压明显高于健康组（P<0.05)。而各组性别、身高、心率比较差异无统计学意义(P>0.05)。双期高血压组、单纯舒张期高血压组、单纯收缩期高血压组3组TG、CHO、Urea、Cr、UA均明显高于健康组（P<0.05);双期高血压组、单纯收缩期高血压组LDL-C明显高于健康组（P<0.05);双期高血压组、单纯舒张期高血压组LDL-C均明显低于单纯收缩期高血压组（P<0.05);双期高血压组UA明显高于单纯舒张期高血压组（P<0.05)。相关性分析：TG、CHO、LDL-C、Urea、Cr、UA均与收缩压呈显著正相关性，TG、CHO、Cr、UA均与舒张压呈显著正相关性。多元逐步回归分析显示：年龄、体重、BMI、TG、CHO、Cr、UA是收缩压的危险因素，而年龄、BMI、TG、CHO、LDL-C、Cr、UA是舒张压的危险因素。结论在临床治疗高血压过程中，除单纯的降压药治疗外，还应同时给予调节脂质代谢和肾脏代谢的药物，更重要的是需要区别对待不同类型的高血压患者，个体化治疗，才能获得更好的疗效，进而达到真正延缓高血压的发展进程。

老年单纯收缩期高血压的动脉弹性功能变化

目的 比较老年正常血压者、单纯性收缩期高血压 (ISH)与非单纯性收缩期高血压 (NISH)患者的动脉弹性功能 ,了解不同类型老年高血压大动脉和小动脉弹性的差别。方法 选择 5 0例健康老年人 (男女各 2 5例 ,平均年龄 6 8± 5岁 )和 84例老年高血压病人 (男性 39例 ,女性 4 5例 ,平均年龄 6 8± 5岁 ) ,其中单纯性收缩期高血压 (ISH) 6 4例 ,非单纯性收缩期高血压 (NISH) 2 0例。使用DO2 0 2 0动脉功能测定仪检测桡动脉脉搏波形和动脉弹性指数C1和C2 。结果 ISH大动脉弹性指数C1(7± 2 1ml/mmHg× 10 )低于NISH组 (9 2± 3 1ml/mmHg× 10 )和正常血压对照组(12 9± 4ml/mmHg× 10 ) ,P <0 0 1;ISH小动脉弹性指数C2 (2 6± 2 2ml/mmHg× 10 0 )与NISH(2 7± 2 5ml/mmHg× 10 0 )无显著差别 ,均低于正常血压对照组 (4 3± 2 5ml/mmHg× 10 0 ) ,P <0 0 1;在正常血压对照组 ,动脉弹性指数与脉压显著负相关 (C1:r=- 0 6 2 7,P <0 0 0 1;C2 :r =- 0 389,P <0 0 0 1) ,但在ISH则并不相关 (C1:r =- 0 10 5 ,P =0 4 10 ;C2 :r =- 0 2 0 3,P =0 10 8)。

硝酸酯类药物对老年单纯收缩期高血压的有益作用

目的 观察硝酸酯类药物对老年单纯收缩期高血压 (ISH)患者降压治疗的有益作用。方法 87例ISH患者随机分为对照组 4 6例和治疗组 4 1例 ,对照组给予非洛地平缓释片 5mg ,每日一次口服 ,治疗组在上述治疗的基础上给予加用单硝酸异山梨酯 (ISMN) 2 0mg ,每日二次口服 ,疗程8周。结果 (1)治疗组从第 2周开始收缩压 (SBP)下降幅度即大于对照组 ,且先于对照组于第 4周降至正常 ,差别有显著性 (P <0 0 5 ) ;(2 )从第 2周开始治疗组舒张压 (DBP)下降幅度即小于对照组(P <0 0 5 ) ,第 6周开始差距进一步加大 ,差别有显著性 (P <0 0 1) ,整个观察期内治疗组DBP下降幅度始终小于对照组 ,且从第 4周开始处于相对稳定状态 ;(3)第 2周开始治疗组PP下降幅度即大于对照组 (P <0 0 5 ) ,第 4周开始差距进一步加大 ,差别有显著性 (P <0 0 1)。结论 硝酸酯类药物能降低ISH患者的SBP ,而对DBP影响不大 ,使PP减小 ,对ISH患者降压治疗的有益。

百色市现症高血压各亚型患病率及其与体质糖脂和血尿酸关联性的研究

目的探讨高血压患病率,现症高血压单纯性收缩期高血压亚型（ISH）、单纯性舒张期高血压亚型（IDH）和联合性高血压亚型（SDH）的患病率及其与肥胖、血糖、血脂和血尿酸的关联性。方法对百色市16－81岁居民进行血压、肥胖、血糖、血脂和血尿酸检测,计算ISH、IDH和SDH的患病率,分析ISH、IDH和SDH与肥胖、血糖、血脂和血尿酸的关系。结果受检15102例,高血压患者4427例;其中新诊2605例,已诊1822例;现症3561例,ISH、IDH和SDH的患病率分别为8.7%、6.5%和8.4%,男性以SDH为主,女性以ISH为主,与非高血压组比较,ISH组和SDH组的BMI、腰臀比、空腹血糖、血尿酸、TC、TG、LDLC和vLDLC高（P〈0.01）,HDLC低（P〈0.01）,IDH的BMI、腰臀比、血尿酸、TC、TG、LDLC和vLDLC高（P〈0.01）,HDLC低（P〈0.01）,空腹血糖差别无统计学意义（P〉0.05）;与ISH组和SDH组比较,IDH组的空腹血糖和LDLC低（P〈0.01）,TG和vLD-LC高（P〈0.01）。结论百色市社区居民高血压累计患病率为29.3%,现症患病率为23.6%,普查新发现率为12.0%,高血压现症患者IDH亚型患病率高于SDH和ISH;男性以IDH为主,女性以SDH为主;IDH组空腹血糖均值低于SDH组和ISH组,不高于非高血压组,TG和vLDLC均值高于SDH组和ISH组,不同高血压亚型临床预防与治疗方法应当分别对待,有60%的高血压患者长期处于漏诊之中,提示该地区高血压面上防治宣传仍然任重而道远。

单纯收缩期高血压病人年龄与血管内皮功能对大动脉僵硬度的影响

目的探讨单纯收缩期高血压(ISH)患者大动脉僵硬度与年龄、血管内皮功能之间的关系。方法对老年单纯收缩期高血压病人71例,进行大动脉僵硬度(主动脉脉搏波传导速度,baPWV)和内皮依赖性血管舒张功能(FMD)检测。同期年龄配对的健康老年人30例和健康中年人50例作为对照组。结果老年单纯收缩期高血压组、老年健康组、中年健康组 baPWV 依次减慢[老年 ISH:(2459.2±436.8)比老年健康:(2097.2±315.7)比中年健康:(1619.7±214.2)cm/s,P<0.01或<0.05),而 FMD 则依次增大(老年 ISH:6.2±2.2比老年健康:9.8±2.5比中年健康:14.4±1.9,P<0.05或<0.01)。在老年单纯收缩期高血压组中,baPWV 与 FMD呈显著性负相关、与收缩压(SBP)、脉压(PP)呈显著性正相关。多元逐步回归分析证明:年龄、FMD、SBP、PP 是大动脉僵硬度的危险因素。结论在老年单纯收缩期高血压病人中增龄与 FMD 失调明显增加了大动脉僵硬度,因此,在控制 ISH 的同时,改善 FMD 可以降低大动脉僵硬度,从而进一步降低心血管事件的风险。

河北省成年居民收缩期和舒张期高血压危险因素分析

目的了解河北省成年居民(18～69岁)中高血压患者危险因素状况。方法采用多阶段分层抽样的方法确定样本,统一培训调查员,采用统一的调查表进行问卷、体格和血压测量、血样检测等方法。高血压分为三类亚型,单纯收缩期高血压(ISH);单纯舒张期高血压(IDH);收缩期舒张期高血压(SDH)。结果调查的4200成年居民中有1663例高血压患者,ISH、IDH、SDH分别占26.4%、23.2%、50.5%;构成比单因素分析显示:ISH在55～64岁组(33.0%)、女性(62.2%)、小学文化(34.6%);IDH在35～44岁组(39.7%)、男性(50.1%)、初中文化(44.9%);SDH在45～54岁组(36.6%)、女性(55.4%)、初中小学文化(63.3%)占的比例最高。多因素逐步聚类分析显示:三种高血压患者危险因素有不同的聚集性。结论河北省成年居民中高血压患者以SDH为主,我们对不同的高血压患者应进行不同健康促进方式。

两种药物联合氢氯噻嗪治疗老年单纯收缩期高血压的疗效对比研究

目的比较替米沙坦和苯磺酸左旋氨氯地平联合氢氯噻嗪治疗老年单纯收缩期高血压(ISH)的临床疗效及其安全性。方法将100例老年ISH患者随机分为2组,各50例。分别给予替米沙坦和苯磺酸左旋氨氯地平联合氢氯噻嗪治疗,观察并对比2组疗效及安全性。结果试验组总有效率显著高于对照组。2组治疗后血压、平均动脉压(MAP)均较治疗前显著降低,试验组治疗后收缩压、MAP及心率显著低于对照组,且不良反应发生率显著低于对照组。结论与苯磺酸左旋氨氯地平联合氢氯噻嗪相比,替米沙坦联合氢氯噻嗪治疗老年ISH疗效更优,且不良反应发生率更低,耐受性更高,具有显著优势,值得推广。

单纯收缩期高血压患者脉搏波传导速度与心率变异性

目的研究单纯收缩期高血压患者主动脉脉搏波传导速度与心率变异性特别是低频部分(LF)的关系,评估这两个指标与心血管危险度的相关性。方法选取单纯收缩期高血压(ISH,n=89)患者及双期高血压(DH,n=98)患者,应用 SUN-8800动脉硬化检测仪检测颈股动脉脉搏波传导速度(cfPWV)及颈桡动脉脉搏波传导速度(crPWV),采用5 min 短程频域分析法分析其心率变异性(HRV)指数。89例 ISH 根据危险程度分为低危(n=3)、中危(n=17)、高危(n=35)以及极高危(n=34)4组,观察不同危险程度组间 cfPWV、crPWV 及 HRV 指数与心血管危险程度的相关性。结果 ISH 的 cfPWV 明最高于 DH[ISH:(399.6±48.2)cm/s 比 DH:(374.3±39.7)cm/s,P<0.01],而两组 crPWV 无明显差异[ISH:(371.5±37.5)比 DH:(363.5±31.5)cm/s,P>0.05];ISH 的心率变异指数、LF 以及 LF/HF 明显高于 DH[ISH:(3.28±0.86)log ms^2比 DH:(2.93±0.59)log ms^2,P<0.05]。cfPWV 与极低频功率(VLF)、LF 呈显著正相关(P<0.05)而与 TP、HF 呈显著负相关(P<0.05),crPWV与 VLF、LF、HF 及 TP 无明显相关性。ISH 患者总体心血管风险程度与 cfPWV 及 crPWV 均呈显著正相关(r=0.765、0.563,P<0.05),cfPWV 随风险程度增高而显著增加(P<0.05),crPWV 也随风险程度增高而增加,但差异无统计学意义(P>0.05);ISH 总体心血管风险程度与 LF 呈显著正相关(r=0.479),VLF、LF、LF/HF 随风险程度增高而显著增加(P<0.01),但 TP、HF 随风险程度增加而显著降低(P<0.01)。结论提示 ISH 病人只有 cfPWV加快,而 crPWV 与正常血压相同,cfPWV 加快为指标的主动脉僵硬度与 HRV 的交感神经兴奋性指标(LF)明显相关。

补肾和脉方对老年单纯收缩期高血压动脉僵硬度的干预效应

【目的】探讨补肾和脉方对高血压高危患者动脉弹性功能(管壁僵硬度)的影响。【方法】采用随机、单盲、对照研究方法。于2周洗脱期后,在年龄60～79岁、脉压(PP)≥60 mmHg的1级和2级单纯收缩期高血压(ISH)肾虚证(包括肾气虚、肾阴虚、肾阳虚)患者中,比较左旋氨氯地平+吲哒帕胺(对照组,N=58)和左旋氨氯地平+吲哒帕胺+补肾和脉方(试验组,N=57)对坐位收缩压(SBP)、PP和臂踝脉搏波传导速度(baPWV)的近期影响,疗程为24周。【结果】在意向性分析(ITT)人群中,与对照组比较,试验组baPWV降幅更为显著;校正基线差异后,组间baPWV自基线的平均降幅(95%CI)分别为-131(-193,-69)cm/s和-281(-328,-233)cm/s,差异有统计学意义(P<0.001)。此外,SBP平均降幅、PP平均降幅、血压达标率(SBP<140 mmHg且PP<60 mmHg)、SBP达标率和PP达标率的组间比较差异均有统计学意义(P<0.01)。【结论】补肾和脉方能进一步改善ISH的动脉僵硬度,提高SBP/PP的控制率,可能具有延缓血管衰老的优势。