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.

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.

The Correlation between Morning Blood Pressure Surge, Homocysteine and Left Ventricular Hypertrophy in Elderly Patients with Primary Hypertension

Objective: To investigate the correlation between morning blood pressure surge, homocysteine (Hcy) and left ventricular hypertrophy (LVH) in elderly patients with primary hypertension. Method: 215 cases of patients with hypertension from January 2015 to June 2016 were randomly selected from TianYou Hospital attached to WUST.Blood pressure was monitored 24 hours;according to the results, patients were divided into 81 cases of morning blood pressure surge group (study group) and 134 cases of non-morning blood pressure surge group (control group). Biochemical indicators of the two groups were measured, such as Hcy, Glu, blood lipid (TC, TG, LDL-C, HDL-C). The ventricular structure index (IVST, LVDD, LVPWT, LVMI) were measured by color doppler ultrasound.Result: 1) The IVST, LVDD, LVPWT and LVMI were significantly higher in study group than in control group (P 0.05), and the incidence of left ventricular hypertrophy (LVH) (74.1%) was significantly higher in study group than in control group (22.4%) (P 0.05). 2) There was no statistical difference in TC, TG, LDL-C and HDL-C between the two groups (P > 0.05). The serum levels of Hcy [(16.89 ± 5.84) mmol/L] in study group were significantly higher than those in control group [(10.88 ± 4.07) mmol/L] (P 0.05). 3) Multivariate logistic regression analysis showed that morning blood pressure surge and Hcy were the risk factors of left ventricular hypertrophy. Conclusion: In elderly patients with?hypertension, the higher the morning blood pressure surge and Hcy level, the more probability of left ventricular hypertrophy and the more obvious degree.

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.

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.

A STUDY ON THE RELATIONS BETWEEN DIETARY PARAMETERS AND BLOOD PRESSURE IN 8 CHINESE COMMUNITIES

Relations between 67 dietary parameters and blood pressure in 8 Chinese communities （745 men aged 40～59 years） were studied. Results showed. UNa, Na/K, Ca, Ca/Mg, parameters reflecting the protein-intake, serum levels of Sr, valine, cysteine,threonine, Vit A, Vit E, cholesterol, C16:0, C18:0, （saturated fatty acid）/（polyunsaturated fatty acid）,（C20:5+C22:6 （ω3））/（C18:2+C20:3+C20:4 （ω6））, γ-glutamyl transferase （an index of alcohol consumption） and plasma glucose correlated positively with BP, while serum levels of K, Mg, glycine, phenylalanine, leucine, VitC, C18:2, Ni, V, Co, Cr and Cd, inversely. And also, a metabolic imbalance among BP, blood glucose and lipids was exhibited.

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.

Single-Arm Clinical Study of Combination Perindopril-Amlodipine Tablets in the Treatment of High-Altitude Hypertension

Objective:To evaluate the efficacy of combination perindopril/amlodipine tablets in patients with high-altitude hypertension who were previously unable to control their blood pressure with monotherapy.Methods:A total of 151 patients with high-altitude hypertension whose blood pressure remained inadequately controlled with previous monotherapy were enrolled in this study.All patients received an 8-week treatment with a combination of perindopril/amlodipine tablets,consisting of perindopril 10 mg/day and amlodipine 5 mg/day.Blood pressure measurements,including both diastolic and systolic pressures,were taken at baseline,and after 2,4,6,and 8 weeks of treatment.Results:After 8 weeks of treatment,there was a significant reduction in both average systolic and diastolic blood pressure compared to baseline(P<0.0001).Specifically,the average systolic blood pressure decreased by 24.45±13.75 mmHg,and the average diastolic blood pressure decreased by 13.37±8.40 mmHg.The overall heart rate showed no significant changes during the treatment period.Conclusion:A combination of perindopril/amlodipine tablets significantly improved blood pressure control in patients with high-altitude hypertension after 8 weeks of treatment.These results support the efficacy of combination perindopril/amlodipine as a viable treatment option for high-altitude hypertension.

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。

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。

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。

原发性高血压患者Lp(a)、Lp-PLA2水平与血压变异性的相关性

目的通过研究原发性高血压(EH)患者的血清Lp(a)、Lp-PLA2水平与血压变异性(BPV)的特征,进一步探讨EH患者血清中Lp(a)和Lp-PLA2水平与BPV之间的关系。方法选取2022年9月至2023年9月于内蒙古自治区人民医院门诊及住院诊疗的EH患者240例。将患者分为A组:Lp(a)、Lp-PLA2均正常,115例;B组:仅Lp(a)升高,48例;C组:仅Lp-PLA2升高,42例;D组:Lp(a)、Lp-PLA2均升高,35例。探索Lp(a)和Lp-PLA2水平与血压变异性之间的相关性。结果B组各时段变异系数(CV)均高于A组(P<0.05);C组24 h SBPCV、24 h DBP CV、nSBP CV、dDBP CV、dSBP CV高于A组(P<0.05);D组各时段CV均高于A组(P<0.05)。Lp(a)、Lp-PLA2与BPV呈正相关(rs>0,P<0.05)。B组、C组以及D组的Lp(a)、Lp-PLA2和24 h SBP CV、24 h DBP CV间均呈显著正相关关系(rs>0,P<0.05)。结论EH患者血清Lp(a)、Lp-PLA2水平与BPV呈正相关,且血清Lp(a)、Lp-PLA2均升高的患者BPV也升高。

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。

老年高血压患者苯磺酸氨氯地平联合厄贝沙坦的临床治疗效果分析

目的分析老年高血压患者应用苯磺酸氨氯地平联合厄贝沙坦的临床治疗效果。方法本次研究选入158例研究对象,均是2022年4月至2023年4月入院并明确诊断为高血压的老年患者,用随机数字表法划分成两组,常规组患者采用厄贝沙坦治疗,试验组则联合苯磺酸氨氯地平治疗,对比两组疗效差异。结果试验组老年患者治疗后的收缩压和舒张压均低于常规组,统计学比较结果为P<0.05。试验组老年患者治疗总有效率为93.67%,高于常规组的67.09%,统计学比较结果为P<0.05。试验组老年患者用药后不良反应率为2.53%,低于常规组的12.66%,统计学比较结果为P<0.05。结论老年高血压患者在临床中采用苯磺酸氨氯地平联合厄贝沙坦的治疗方案,能够提高血压控制效果,还有助于减少用药不良反应。

血压节律与水平和左心室舒张功能的相关性分析

目的 探讨原发性高血压患者的血压昼夜节律、不同血压水平与左室舒张功能之间的关系。方法 纳入解放军总医院第一医学中心心内科2022年1月~2023年4月收治的678例原发性高血压住院患者,所有患者均接受动态血压监测(ambulatory blood pressure monitoring, ABPM)和超声心动图检查。根据血压昼夜节律分为杓型血压组(n=46)、非杓型组(n=451)、反杓型组(n=181)。采用左房容积指数(left atrial volume index, LAVI)、二尖瓣口舒张早期血流峰值速度/二尖瓣环处侧壁和间隔舒张早期速度的平均值(E/e′)、二尖瓣环处侧壁和间隔舒张早期速度的平均值(e′)评估3组患者左室舒张功能。采用方差分析和多元线性回归分析诊室血压、24 h收缩压平均值(24 h-mSBP)、24 h舒张压平均值(24 h-mDBP)、日间收缩压平均值(D-mSBP)、日间舒张压平均值(D-mDBP)、夜间收缩压平均值(N-mSBP)、夜间舒张压平均值(N-mDBP)、24 h收缩压变异性(24-SBPV)、24 h舒张压变异性(24-DBPV)、日间收缩压变异性(D-SBPV),日间舒张压变异性(D-DBPV),夜间收缩压变异性(N-SBPV),夜间舒张压变异性(N-DBPV)与左室舒张功能之间的关系。结果 反杓型血压组的LAVI明显高于杓型血压组,差异有统计学意义(P<0.05)。多元线性回归的结果显示,24 h-SBP、D-mSBP和N-mSBP与LAVI独立相关(B=0.06,P<0.05);24 h-mSBP、D-mSBP、N-mSBP、诊室收缩压、24-SBPV、24-DBPV、D-SBPV和D-DBPV与E/e′独立相关(B=0.03、0.03、0.02、0.01、0.09、0.10、0.05、0.07,P<0.05);24 h-mSBP、24 h-mDBP、N-mDBP和诊室舒张压与e′独立相关(B=-0.01、-0.02、-0.02、-0.01,P<0.05)。结论 反杓型血压节律和收缩压平均值(mSBP)与左房扩大相关。mSBP及诊室收缩压均与左室舒张功能相关,且mSBP与左室舒张功能的相关性强于诊室血压。ABPM可用于早期识别高血压患者中左房扩大和左心室舒张功能障碍的高风险人群。

动态血压监测对高血压患者的管理及效果评价

目的对动态血压监测(ABPM)对高血压患者的管理及效果进行评价。方法200例高血压患者,电脑随机分为对照组和观察组,每组100例。对照组采取偶测血压(CBP)监测肱动脉血压,观察组使用24 h动态血压监测,两组根据血压监测情况进行降压药物治疗。比较两组患者治疗前后血压、满意度以及观察组中低龄组和高龄组的动态血压参数。结果治疗后,观察组患者收缩压(112.13±7.56)mm Hg(1 mm Hg=0.133 kPa)、舒张压(80.92±7.45)mm Hg均明显低于对照组的(121.77±7.87)、(88.02±8.99)mm Hg(P<0.05)。观察组患者总满意度95.00%显著高于对照组的80.00%(P<0.05)。低龄组收缩压的日间均压、夜间均压、24 h均压分别为(114±12)、(101±10)、(106±11)mm Hg,舒张压的日间均压、夜间均压、24 h均压分别为(88±8)、(86±7)、(87±10)mm Hg;高龄组收缩压的日间均压、夜间均压、24 h均压分别为(120±10)、(108±12)、(114±12)mm Hg,舒张压的日间均压、夜间均压、24 h均压分别为(80±7)、(77±5)、(79±5)mm Hg。低龄组收缩压的日间均压、夜间均压、24 h均压低于高龄组,舒张压的日间均压、夜间均压、24 h均压高于高龄组(P<0.05)。结论高血压患者采取动态血压监测对于改善患者的血压水平,增加满意度具有显著的价值。

基于Orem自护理论的自护模式在高血压患者中的应用

目的:探讨基于Orem自护理论的自护模式在高血压患者中的应用效果。方法:选取2019年1月1日~2022年6月30日收治的60例高血压患者作为研究对象,按照随机数字表法分为观察组和对照组各30例,对照组实施常规护理,观察组实施基于Orem自护理论的自护模式,于入院当日、出院前1 d比较两组血压指标[包括舒张压(DBP)、收缩压(SBP)]、自我护理能力[采用丹尼斯自我护理测评量表(DSCAI)]及行为依从性[采用高血压患者行为依从性量表(CHPS)]。结果:出院前1 d,两组DSCAI评分高于入院当日(P<0.05),DBP、SBP及CHPS评分均低于入院当日(P<0.05),且观察组优于对照组(P<0.05,P<0.01)。结论:基于Orem自护理论的自护模式能够改善高血压患者的舒张压、收缩压,提升其自我护理能力和行为依从性。

老年人高血压临床用药情况及血压控制效果分析

目的分析老年人高血压临床用药情况及血压控制效果。方法回顾性分析2019年2月至2020年6月于荆州市第三人民医院北京路分院内科治疗的78例老年高血压患者的临床资料,统计患者具体用药情况,比较药物治疗前后收缩压与舒张压。结果78例老年高血压患者中,单一药物治疗13例,二联用药54例,三联用药11例;使用钙离子拮抗剂54例,利尿剂33例,血管紧张素转换酶抑制剂21例,β-受体阻滞剂38例,α-受体阻滞剂2例。治疗后,患者舒张压、收缩压均低于治疗前,差异有统计学意义(P<0.05)。结论长期、规律口服降压药,可有效降低老年高血压患者血压,其中二联用药患者最常见,应积极开展健康教育,严格控制饮食,保证患者合理、安全与科学用药。

福辛普利钠联合多沙唑嗪治疗对肾性高血压患者血压控制及相关生物活性因子的影响

目的探讨福辛普利钠与多沙唑嗪联合对肾性高血压的治疗效果,并分析治疗后患者血压控制情况及相关活性因子变化。方法前瞻性选取天津市北辰区北辰医院2020年10月—2023年10月收治的98例肾性高血压患者,以随机数字表法作为分组方式,分为观察组(n=49)与对照组(n=49)。对照组患者采取福辛普利钠治疗,观察组在对照组基础上增加多沙唑嗪治疗。对比两组的血压控制效果,治疗前后一氧化氮(NO)、内皮素(ET)、血管紧张素Ⅱ(AngⅡ)相关生物活性因子水平变化,肾功能变化,不良反应发生情况。结果观察组总有效率89.79%,高于对照组的73.47%(χ^(2)=4.356,P=0.037);治疗后两组AngⅡ、ET水平均降低,且观察组[(13.62±2.24)ng/mL、(68.62±6.66)ng/L]低于对照组[(16.25±4.32)ng/mL、(74.26±9.35)ng/L],对比差异有统计学意义(t_(1)=3.783,t_(2)=3.439,P<0.001);NO水平升高,观察组[(54.26±3.42)μmol/L]高于对照组[(50.51±2.37)μmol/L],对比差异有统计学意义(t=6.309,P<0.001);治疗后两组血肌酐(Scr)、尿素氮(BUN)、胱抑素C(CysC)水平均降低,且观察组[(404.36±92.12)μmoI/L、(13.34±4.31)mmol/L、(2.19±0.24)mg/L]低于对照组[(443.49±80.19)μmoI/L、(15.07±4.23)mmol/L、(2.87±0.38)mg/L],对比有统计学意义(t_(1)=2.243,P_(1)=0.027;t_(2)=2.005,P_(2)=0.048;t_(3)=10.591,P_(3)<0.001);两组不良反应发生率对比差异无统计学意义(10.20%vs 8.16%,P>0.05)。结论对肾性高血压患者,采取福辛普利钠与多沙唑嗪联合治疗可提升其血压控制效果,改善血管内皮功能,降低血管紧张素Ⅱ表达水平,改善肾功能,且不增加不良反应。

个性化认知干预对老年高血压患者血压、自护力及睡眠质量的影响

目的:研究老年高血压患者护理中开展个性化认知干预的效果及临床价值。方法:选取2022年1月至2022年12月福建省泉州市第一医院收治的老年高血压患者100例作为研究对象,按照随机数字表法分为对照组和观察组,每组50例。对照组实施常规护理,观察组实施常规护理+个性化认知干预护理,在护理前和护理后2个时间点对患者的血压值、自护能力以及患者的睡眠情况进行系统、科学地评估,并将护理前后的3项检测指标结果进行统计分析。结果:护理前对照血压值,差异无统计学意义(P>0.05),观察组护理后的收缩压和舒张压均小于护理前和对照组,差异均有统计学意义(均P<0.05);2组患者护理前的自我管理能力评分比较,差异无统计学意义(P>0.05),而观察组护理后的自我管理能力(行为管理、情绪管理、用药管理、病情监测)评分均大于对照组,差异均有统计学意义(均P<0.05);护理前比较患者的睡眠情况,均伴有睡眠障碍,差异无统计学意义(P>0.05),而观察组护理后的睡眠质量评分小于对照组,差异有统计学意义(P<0.05)。结论:对老年高血压患者实施个性化认知干预护理的优势显著,值得推广。