苯磺酸氨氯地平和厄贝沙坦对老年高血压病患者血压及 血压变异性的影响

目的:比较苯磺酸氨氯地平和厄贝沙坦对老年高血压病患者血压及24小时动态血压变异性的影响。方法:研究140例年龄在60～75岁之间的患者随机分为A、B两组,每组各70例,A组予以服用苯磺酸氨氯地平片(5mg/d)、B组予以厄贝沙坦片(150mg/d),对两组病人进行服药前及服药4周后24小时动态血压检查,比较两种药物对血压及24小时动态血压变异性的影响。结果:①两种降压药物均能有效降低血压(P<0.05)。②在控制24小时血压变异性方面,苯磺酸氨氯地平优于厄贝沙坦(P<0.05)。结论:与厄贝沙坦相比,苯磺酸氨氯地平能更理想的控制血压变异性。     

贝那普利联合氨氯地平对高血压患者降压效果、血压变异性及心功能的影响

目的:探讨贝那普利联合氨氯地平对高血压患者降压效果、血压变异性(BPV)及心功能的影响。方法:选取2015年2月～2018年12月期间西安交通大学医学院附属三二〇一医院收治的131例高血压患者,根据随机数字表法分为对照组(n=65)和研究组(n=66),对照组患者给予氨氯地平治疗,研究组在对照组基础上联合贝那普利治疗。比较两组患者治疗后的降压效果、BPV以及心功能指标,记录两组患者治疗期间不良反应情况。结果:两组患者治疗4个月后收缩压(SBP)、舒张压(DBP)均下降,且研究组低于对照组(P0.05)。两组患者治疗4个月后24 h收缩压变异性(24hSBPV)、白天收缩压变异性(dSBPV)、24h舒张压变异性(24hDBPV)、白天舒张压变异性(dDBPV)均下降,且研究组低于对照组(P0.05),而夜间收缩压变异性(nSBPV)、夜间舒张压变异性(nDBPV)比较差异无统计学意义(P0.05)。两组患者治疗4个月后A峰速度、A/E峰值均下降,且研究组低于对照组(P0.05)。两组患者治疗4个月后E峰速度、EF值均升高,且研究组高于对照组(P0.05)。两组不良反应发生率比较无差异(P0.05)。结论:贝那普利联合氨氯地平治疗高血压患者的降压效果确切,可有效改善患者BPV及心功能,且安全性较好。     

Chronotherapy With Valsartan/Hydrochlorothiazide Combination in Essential Hypertension: Improved Sleep-Time Blood Pressure Control With Bedtime Dosing

Administration of angiotensin receptor blockers at bedtime results in greater reduction of nighttime blood pressure than dosing upon awakening, independent of the terminal half-life of each individual medication. To obtain blood pressure (BP) target goals most patients require treatment with more than one hypertension medication. However, the potential differing effects on BP regulation of combination therapy depending on the time-of-day of administration have scarcely been investigated. Accordingly, the authors prospectively evaluated the administration-time-dependent BP-lowering efficacy of valsartan/hydrochlorothiazide (HCTZ) combination therapy. The authors conducted a randomized, open-label, blinded-endpoint trial on 204 subjects with essential hypertension (95 men/109 women), 49.7?±?11.1 (mean?±?SD) yrs of age. The BP of participants in this trial was not properly controlled with respect to published ambulatory BP criteria after initially randomized to valsartan monotherapy (160?mg/day), whether routinely ingested upon awakening by one group or at bedtime by another group for 12 wks. Thus, HCTZ (12.5?mg/day) was added to valsartan as a single-pill formulation, maintaining the original treatment-time, i.e., upon awakening or at bedtime, of participants of the two groups, for another 12 wks. BP was measured by ambulatory monitoring for 48?h at inclusion and after each 12-wk span of therapy. Physical activity was simultaneously monitored every minute by wrist actigraphy to accurately define the beginning and end of daytime activity and nocturnal sleep so that the respective BP means for every participant at each evaluation could be precisely determined. Combination therapy resulted in a similar statistically significant reduction of the 48-h BP mean from baseline for both treatment-time groups (17.0/11.5?mm Hg in systolic/diastolic BP after combination therapy on awakening; 17.9/12.1?mm Hg reduction after combination treatment at bedtime; p?>?.542 between groups). The awake BP mean was reduced to a comparable extent in both treatment-time groups (p?>?.682). However, bedtime compared to morning dosing better reduced the asleep means of systolic BP (20.1 vs. 16.0?mm Hg; p?=?.015) and pulse pressure (6.5 vs. 4.0?mm Hg; p?=?.007 between groups). Accordingly, the proportion of subjects with a baseline non-dipper BP profile was significantly reduced from 59% to 23% only after bedtime combination treatment (p?<?.001). Moreover, the proportion of subjects with properly controlled ambulatory BP after combination therapy was significantly greater with bedtime than upon-awakening treatment (55 vs. 40%, p?=?.037). The improved efficacy in lowering the asleep BP mean, increased sleep-time relative BP decline, and greater proportion of controlled patients suggest that valsartan/HCTZ combination should be preferably administered at bedtime for treatment of subjects with essential hypertension requiring combination therapy to achieve proper BP control. (Author correspondence: rhermida@uvigo.es)     

血压晨峰与原发性高血压患者心律失常及心肌缺血的关系

目的:探讨血压晨峰与原发性高血压患者心律失常及心肌缺血的相关关系及其临床意义。方法:选取2011年1月至2013年1月原发性高血压患者168例,根据动态血压结果,将血压晨峰≥23.6mmHg或23.6mmHg分成A组(晨峰组)79例与B组(非晨峰组)89例,所有患者均同步进行24 h动态心电图和动态血压监测,比较两组心律失常与心肌缺血发生情况。结果:两组患者的一般临床情况具有可比性。与B组比较,A组的高血压患者更易发生频发房性早搏、房速、频发室性早搏和室速等心律失常情况,差异有统计学意义(P0.05)。A组患者发生心律失常总数明显高于B组(=52.19,r=0.552,P0.001)。与B组比较,A组的高血压患者容易发生ST段改变,差异有统计学意义(P0.05);ST-T改变和T波改变两组之间差异无统计学意义(P0.05)。A组患者发生心肌缺血的情况明显高于B组(=10.05,r=0.213,p=0.0015)。结论:原发性高血压患者若出现血压晨峰提示心律失常和心肌缺血的发生率增加,尤其是房性早搏的发生率明显升高。血压晨峰与患者的心律失常和心肌缺血关系密切,具有临床指导意义。     

原发性高血压患者血压昼夜节律与靶器官损害的关系研究

目的:研究原发性高血压患者血压昼夜节律异常是否与靶器官损害存在关联。方法:将2015年2~11月份在我院治疗的94例原发性高血压病人按照血压昼夜节律是否正常分为节律正常组52例和异常组42例。比较两组患者的24h、白天、夜间的收缩压(SBP)与舒张压(DBP)及血压负荷,并且比较两组患者心脏、脑、肾损伤相关指标。结果:异常组全天24h、白天、夜间SBP及DBP,血压负荷均高于正常组,差异具有统计学意义(P0.05)。异常组患者左室重量(LVM)和左室重量指数(LVMI)、发生心肌缺血次数及持续时间、发生脑梗死几率均明显高于正常组,差异有统计学意义(P0.05)。异常组尿微量白蛋白(MAU)、尿酸(UA)水平均高于正常组,差异有统计学意义(P0.05)。结论:原发性高血压患者出现昼夜节律异常,可能对相关靶器官造成损伤。     

Influence of Age and Hypertension Treatment-time on Ambulatory Blood Pressure in Hypertensive Patients

Some studies based on ambulatory blood pressure (BP) monitoring (ABPM) have reported a reduction in sleep-time relative BP decline towards a more non-dipping pattern in the elderly, but rarely have past studies included a proper comparison with younger subjects, and no previous report has evaluated the potential role of hypertension treatment time on nighttime BP regulation in the elderly. Accordingly, we evaluated the influence of age and time-of-day of hypertension treatment on the circadian BP pattern assessed by 48-h ABPM. This cross-sectional study involved 6147 hypertensive patients (3108 men/3039 women), 54.0?±?13.7 (mean?±?SD) yrs of age, with 2137 (978 men/1159 women) being ≥60 yrs of age. At the time of study, 1809 patients were newly diagnosed and untreated, and 4338 were treated with hypertension medications. Among the later, 2641 ingested all their prescribed BP-lowering medications upon awakening, whereas 1697 ingested the full daily dose of ≥1 hypertension medications at bedtime. Diagnosis of hypertension in untreated patients was based on ABPM criteria, specifically an awake systolic (SBP)/diastolic (DBP) BP mean ≥135/85?mm Hg and/or an asleep SBP/DBP mean ≥120/70?mm Hg. Collectively, older in comparison with younger patients were more likely to have diagnoses of microalbuminuria, chronic kidney disease, obstructive sleep apnea, metabolic syndrome, anemia, and/or obesity. In addition, the group of older vs. younger patients had higher glucose, creatinine, uric acid, triglycerides, and fibrinogen, but lower cholesterol, hemoglobin, and estimated glomerular filtration rate. In older compared with younger patients, ambulatory SBP was significantly higher and DBP significantly lower (p?<?.001), mainly during the hours of nighttime sleep and initial hours after morning awakening. The prevalence of non-dipping was significantly higher in older than younger patients (63.1% vs. 41.1%; p?<?.001). The largest difference between the age groups was in the prevalence of a riser BP pattern, i.e., asleep SBP mean greater than awake SBP mean (19.9% vs. 4.9% in older vs. younger patients, respectively; p?<?.001). The sleep-time relative SBP decline was mainly unchanged until ～40 yrs of age, and then significantly and progressively decreasing with increasing age at a rate of .28%/yr (p?<?.001), reaching a minimum value of 4.38%?±?.47% for patients ≥75 yrs of age. Treated compared with untreated patients showed lower awake and asleep SBP means, although the predictable changes of SBP and DBP with age were equivalent in both groups. As a consequence, there were no significant differences between untreated and treated patients in the changes of the sleep-time relative SBP and DBP declines with age. Additionally, the asleep SBP and DBP means were significantly lower and the sleep-time relative SBP and DBP declines significantly higher at all ages in patients ingesting ≥1 BP-lowering medications at bedtime as compared with those ingesting all medications upon awakening. Our findings document a significantly elevated prevalence of a blunted nighttime BP decline with increasing age ≥40 yrs. The prevalence of a riser BP pattern, associated with highest cardiovascular risk among all possible BP patterns, was 4 times more prevalent in patients ≥60 yrs of age than those <60 yr of age. Most important, there was an attenuated prevalence of a blunted nighttime BP decline at all ages when ≥1 hypertension medications were ingested at bedtime as compared with when all of them were ingested upon awakening. These findings indicate that older age should be included among the conditions for which ABPM is recommended for proper cardiovascular risk assessment. (Author correspondence: rhermida@uvigo.es)     

Associations of Body Composition with Blood Pressure and Hypertension

Objective

The present study investigated the associations of body composition, including skeletal muscle and fat mass, with blood pressure (BP) and hypertension.

Methods

Data from 3,130 participants aged 18 to 80 years were analyzed. Body composition and total skeletal muscle (TSM) were measured or calculated based on dual‐energy x‐ray absorptiometry. Multivariate linear and logistic regression models were used to analyze the associations of TSM, body fat percentage, android to gynoid fat ratio, and leg and arm lean body mass (LBM) with BP and hypertension. The Wald test was used to estimate the differences in the coefficients.

Results

TSM indices, body fat percentage, and android to gynoid fat ratio were significantly associated with higher odds ratio for prehypertension and hypertension, except for TSM/weight, after controlling for potential confounders. The standardized beta coefficients of arm LBM indices for systolic and diastolic BP were higher than relevant indices of leg LBM.

Conclusions

Different indices of TSM, especially in arm LBM, were all positively associated with elevated BP, prehypertension, and hypertension in Chinese adults, after considering potential confounding factors, including body fat and fat distribution. Future longitudinal studies are warranted to confirm our findings.

     

A Genome-Wide Association Study of Hypertension and Blood Pressure in African Americans

The evidence for the existence of genetic susceptibility variants for the common form of hypertension (“essential hypertension”) remains weak and inconsistent. We sought genetic variants underlying blood pressure (BP) by conducting a genome-wide association study (GWAS) among African Americans, a population group in the United States that is disproportionately affected by hypertension and associated complications, including stroke and kidney diseases. Using a dense panel of over 800,000 SNPs in a discovery sample of 1,017 African Americans from the Washington, D.C., metropolitan region, we identified multiple SNPs reaching genome-wide significance for systolic BP in or near the genes: PMS1, SLC24A4, YWHA7, IPO7, and CACANA1H. Two of these genes, SLC24A4 (a sodium/potassium/calcium exchanger) and CACNA1H (a voltage-dependent calcium channel), are potential candidate genes for BP regulation and the latter is a drug target for a class of calcium channel blockers. No variant reached genome wide significance for association with diastolic BP (top scoring SNP rs1867226, p = 5.8×10⁻⁷) or with hypertension as a binary trait (top scoring SNP rs9791170, p = 5.1×10⁻⁷). We replicated some of the significant SNPs in a sample of West Africans. Pathway analysis revealed that genes harboring top-scoring variants cluster in pathways and networks of biologic relevance to hypertension and BP regulation. This is the first GWAS for hypertension and BP in an African American population. The findings suggests that, in addition to or in lieu of relying solely on replicated variants of moderate-to-large effect reaching genome-wide significance, pathway and network approaches may be useful in identifying and prioritizing candidate genes/loci for further experiments.     

老年高血压患者颈动脉内膜中膜厚度与动态血压参数的相关性

目的:探究老年高血压患者颈动脉内膜中膜厚度(IMT)与动态血压参数间的相关关系,为老年高血压患者的临床治疗提供理论基础。方法:选取2015年1月至2016年1月在我院接受治疗的老年高血压患者204例,根据超声检查结果分为A、B、C三组,每组68例。24 h无创检测患者动态血压参数,包括24h平均收缩压(24h SBP),24 h平均舒张压(24h DBP)、白天平均收缩压(d SBP)、白天平均舒张压(d DBP)、夜间平均收缩压(n SBP)、夜间平均舒张压(n DBP),24h脉压(24h PP)及白天脉压(d PP)、夜间脉压(n PP),记录冠心病的发生率、杓型与非杓型高血压比例,利用Person相关性分析IMT与冠心病发生率及动态血压参数的相关性。结果:收缩压和脉压比较差异均有统计学意义(P0.05),其中B组、C组高于A组,C组高于B组,差异具有统计学意义(P0.05)。非杓型高血压在A组占54.41%,B组占60.29%,C组占79.41%,各组间差异有统计学意义(P0.05);A组、B组、C组冠心病发病率分别为41.18%、54.41%和91.18%,组间比较差异有统计学意义(P0.05)。IMT同冠心病发生率和24h SBP、d SBP、n SBP、24h PP、d PP、n PP呈正相关(r=0.876,0.448,0.378,0.476,0.443,0.491,0.438,P0.05)。结论:老年高血压患者收缩压,脉压升高以及非杓型高血压是造成颈动脉内膜中膜厚度增加的主要原因,同时,IMT与冠心病发病率和动态血压参数间呈正相关关系。     

Circadian Blood Pressure Rhythm in Primary and Secondary Hypertension

Circadian blood pressure variability was recorded in patients with primary hypertension and with different forms of secondary hypertension using ambulatory 24-h blood pressure measurement. A group of 20 patients with different forms of secondary hypertension was compared with a matched group of patients with primary hypertension. Although the mean 24-h blood pressure was not different between the two groups, the patients with secondary hypertension had significantly higher systolic blood pressure during sleep and higher systolic and diastolic blood pressure in the early morning, compared with the primary hypertension group. This nocturnal blood pressure fall was then investigated in various groups of patients with different forms of secondary hypertension and compared with normotensives and patients with primary hypertension. Patients with mild primary hypertension (n = 152) and with severe primary hypertension (n = 30) had the same blood pressure fall (14–16 mm Hg systolic and diastolic) during the night (23:OO–05:OO h) as normotensives (n = 20). However, in patients with renoparenchymal hypertension (n = 29), renovascular hypertension (n = 20), hyperaldosteronism (n = 6), and hyperthyroidism (n = 14), the nocturnal blood pressure fall was significantly (p < 0.01) reduced. One patient with coarctation ofthe aorta and nine patients with primary hyperparathyroidism and elevated blood pressure had a normal circadian blood pressure profile with a normal nocturnal blood pressure fall. The heart rate decrease during the night was equal in all patient groups. Ambulatory blood pressure measurement allows blood pressure recording under everyday conditions, including nighttime. In primary hypertension the blood pressure variability exhibits the same circadian variation as in normotension, showing a marked nocturnal fall. However, in different forms of secondary hypertension, blood pressure shows a blunted circadian curve. This could have important diagnostic and therapeutic implications.     

Effects of Amlodipine on Orcadian Rhythms in Blood Pressure, Heart Rate, and Motility: A Telemetric Study in Rats

In male Wistar rats [light (L): 07:00-19:00 h, dark (D): 19:00-07:00 h], the effects of the calcium channel blocker amlodipine (1, 3, 10 mg/kg i.p.) on blood pressure, heart rate, and motor activity were studied by telemetric monitoring. Amlodipine was injected either at 07:00 h or at 19:00 h. Systolic and diastolic blood pressure were dose-dependently decreased with more pronounced effects in the dark span, ED₅₀ values in D were about seven times lower than in L. In contrast, the dose-dependent increase in heart rate was more pronounced in L than in D. No significant effects of amlodipine were found on motor activity. The study gives evidence for a circadian phase-dependency in the cardiovascular effects amlodipine in rats.     

Effects of Amlodipine on Orcadian Rhythms in Blood Pressure,Heart Rate,and Motility: A Telemetric Study in Rats

In male Wistar rats [light (L): 07:00–19:00 h, dark (D): 19:00–07:00 h], the effects of the calcium channel blocker amlodipine (1, 3, 10 mg/kg i.p.) on blood pressure, heart rate, and motor activity were studied by telemetric monitoring. Amlodipine was injected either at 07:00 h or at 19:00 h. Systolic and diastolic blood pressure were dose-dependently decreased with more pronounced effects in the dark span, ED₅₀ values in D were about seven times lower than in L. In contrast, the dose-dependent increase in heart rate was more pronounced in L than in D. No significant effects of amlodipine were found on motor activity. The study gives evidence for a circadian phase-dependency in the cardiovascular effects amlodipine in rats.     

Age-Related Differences of Blood Pressure Profile in Essential Hypertension

The purpose was to assess age-related circadian changes of blood pressure profile (BPP) employing a truncated Fourier series with four harmonics (tFs) in patients with essential hypertension. The study was performed on 32 patients with essential hypertension divided in two groups: (A) 15 patients younger than 55 years and (B) 17 patients older than 60 years. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were monitored every 20 minutes for 24h with a noninvasive portable device (SpaceLabs 90202). To evaluate the existence of SBP and DBP circadian rhythms a one-sample runs-test was performed and the mesor, amplitude, and acrophase from the overall curve of each patient were obtained by tFs. In both groups, SBP and DBP profiles showed a first peak in the late morning and a second peak in the early evening around the same hours. The two peaks in the SBP profile were higher and the two peaks in the DBP profile were lower in older patients than in younger ones (p. 01, p <. 05, p>. 3, p>. 05). The truncated Fourier series with four harmonics evidences different age-related BP profiles characterized by two peaks with higher SBP and lower DBP in elderly patients. These changes of BPP are in accordance with the reported higher risk of cardiovascular events observed around the same hours. (Chronobiology International, 14(4), 397–407, 1997)     

Nocturnal Blood Pressure Pattern Affects Left Ventricular Remodeling and Late Gadolinium Enhancement in Patients with Hypertension and Left Ventricular Hypertrophy

Background

Left ventricular hypertrophy (LVH) is an independent predictor of cardiac mortality, regardless of its etiology. Previous studies have shown that high nocturnal blood pressure (BP) affects LV geometry in hypertensive patients. It has been suggested that continuous pressure overload affects the development of LVH, but it is unknown whether persistent pressure influences myocardial fibrosis or whether the etiology of LVH is associated with myocardial fibrosis. Comprehensive cardiac magnetic resonance (CMR) including the late gadolinium enhancement (LGE) technique can evaluate both the severity of changes in LV geometry and myocardial fibrosis. We tested the hypothesis that the nocturnal non-dipper BP pattern causes LV remodeling and fibrosis in patients with hypertension and LVH.

Methods

Forty-seven hypertensive patients with LVH evaluated by echocardiography (29 men, age 73.0±10.4 years) were examined by comprehensive CMR and 24-h ambulatory blood pressure monitoring (ABPM).

Results and Conclusions

Among the 47 patients, twenty-four had nocturnal non-dipper BP patterns. Patients with nocturnal non-dipper BP patterns had larger LV masses and scar volumes independent of etiologies than those in patients with dipper BP patterns (p = 0.035 and p = 0.015, respectively). There was no significant difference in mean 24-h systolic BP between patients with and without nocturnal dipper BP patterns (p = 0.367). Among hypertensive patients with LVH, the nocturnal non-dipper blood pressure pattern is associated with both LV remodeling and myocardial fibrosis independent of LVH etiology.