动脉功能评价与降压质量

高血压的治疗中降压是最重要的原则,降压达标可以带来心血管事件的下降已是不争的事实.流行病学调查证实动脉功能是心血管事件的独立预测因子.动脉功能的评价不仅可以筛查高危人群,还可作为降压质量评价的指标,临床研究已证实其意义.未来的高血压治疗领域,除监测血压外,可能需要监测和评估动脉功能.     

老年高血压降压不易达标及降压质量低的原因分析及对策

老年高血压降压不易达标或降压质量低,原因在于老年高血压的特殊性,如多发收缩期高血压、血压波动大、易发生体位性低血压、合并多脏器功能损害等。在老年高血压的治疗中,应充分认识其特殊性,开展健康教育、改善生活方式,正确选择降压药,在降压达标治疗的基础上,提高降压质量,最大限度降低患者靶器官损害,减少心血管终点事件的发生。     

如何看待老年高血压的降压目标值

卒中及心血管事件的发生,随着高血压患者血压的增加而升高。降压治疗对预防卒中及心血管事件(包括心力衰竭)是有效的。过去的几十年来,降压治疗给不同亚组人群都带来了不同的益处。但是,正如不同时期的临床诊疗指南所强调的那样,对于老年人,尤其是80岁以上,获益的临床证据还不充分。老年高血压患者多有其他伴发或并发症,不仅需用降压治疗,还应有伴发疾病的特殊处理。在这一人群最佳的目标血压是最大治疗获益时的血压。2014年中国专家建议指出,对于≥65岁的高血压患者,降压目标为150/90mmHg以下,如可以耐受,收缩压可控制在140mmHg以内,对于80岁及以上者不应低于130/60mmHg。     

高血压合并糖尿病患者的降压目标及治疗

高血压合并糖尿病是冠心病致死的危险因素。有效地控制血压可以显著地降低糖尿病病人心血管事件的发病率与病死率。高血压糖尿病病人的血压控制目标为〈130／80mmHg。为了达到这一血压水平,糖尿病病人的降压治疗包括合理的非药物治疗与药物治疗。在药物治疗中应选用血管紧张素转换酶抑制剂、血管紧张素受体拮抗剂、钙离子拮抗剂和小剂量利尿剂,并且注意联合用药。     

降压达标对器官保护的作用

高血压作为心血管事件的重要危险因素,长期发展可导致重要器官的损害及心脑血管事件的发生。目前提倡理想的降压药物除了具有良好的降压作用外,应当具有一定的器官保护作用,降压的获益体现在对器官的保护及对心脑血管事件的降低方面。     

降压达标对器官保护的作用

高血压作为心血管事件的重要危险因素,长期发展可导致重要器官的损害及心脑血管事件的发生.目前提倡理想的降压药物除了具有良好的降压作用外,应当具有一定的器官保护作用,降压的获益体现在对器官的保护及对心脑血管事件的降低方面.     

高血压患者对称动态动脉硬化指数与尿NAG的相关性研究

对称动态动脉硬化指数(S-AASI)是一种评价动脉顺应性的检测技术,具有无创、易操作、有效的特点,在预测高血压靶器官损害、心血管事件和死亡方面具有广阔的应用前景。本文通过探讨S-AASI与尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)之间的相关性,为临床使用S-AASI作为一种预测和评价高血压靶器官损害的指标提供科学的依据。     

高血压患者对称动态动脉硬化指数与尿NAG的相关性研究

对称动态动脉硬化指数(S-AASI)是一种评价动脉顺应性的检测技术,具有无创、易探作、有效的特点,在预测高血压靶器官损害、心血管事件和死亡方面具有广阔的应用前景.本文通过探讨S-AASI与尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)之间的相关性,为临床使用S-AASI作为一种预测和评价高血压靶器官损害的指标提供科学的依据.     

高血压专业管理的思考和策略

高血压专业管理在不断的循证研究和临床实践中发展,有效的专业管理是预防心脑血管并发症发生、改善高血压转归的迫切需要.最大限度降低总体心血管风险是降压治疗的目标,也是高血压专业管理的方向.     

血压变异性对高血压合并急性心肌梗死患者冠脉病变程度及近期预后的影响

探讨高血压合并急性心肌梗死患者的血压变异性对冠脉病变程度及近期预后的影响。选择2016年8月~2017年8月在郑州大学第一附属医院住院的高血压合并急性心肌梗死患者103例,基于患者冠脉造影结果进行Gensini评分,其中52例为轻度病变组(50分),51例为重度病变组(≥50分),比较两组各临床指标及血压变异性,比较两组入院30天内心血管不良事件(死亡、心力衰竭、心肌梗死后心绞痛、严重心律失常)的发生率,分析心血管不良事件的危险因素。重度病变组的全天收缩压变异性、全天舒张压变异性、白天收缩压变异性、白天舒张压变异性、夜间收缩压变异性、夜间舒张压变异性水平均高于轻度病变组,其中全天收缩压变异性、全天舒张压变异性、白天收缩压变异性差异有统计学意义(P0.05)。全天收缩压变异性、全天舒张压变异性、白天收缩压变异性升高导致心血管不良事件发生的风险增加(P0.05)。因此,在高血压合并急性心肌梗死患者中,血压变异性与冠脉病变程度相关,降压时兼顾降低血压变异性,可能有效减少心血管不良事件的发生。     

Coronary blood flow in dogs: Effect of person

Experiments on dogs with electromagnetic flow probes implanted around a coronary artery and the ascending aorta indicate that the entry of a person into the experimental chamber can cause a remarkable increase in coronary blood flow. Heart rate usually increases considerably, blood pressure increases only slightly, while aortic blood flow increases at variable times before and after coronary blood flow. It is not yet clear whether these cardiovascular effects are due purely to “effect of person” or to conditioning, with the person as the signal for the momentary coronary occlusion (which the person subsequently accomplishes by manually closing a snare).     

Coronary blood flow in dogs: Effect of person

Experiments on dogs with electromagnetic flow probes implanted around a coronary artery and the ascending aorta indicate that the entry of a person into the experimental chamber can cause a remarkable increase in coronary blood flow. Heart rate usually increases considerably, blood pressure increases only slightly, while aortic blood flow increases at variable times before and after coronary blood flow. It is not yet clear whether these cardiovascular effects are due purely to “effect of person” or to conditioning, with the person as the signal for the momentary coronary occlusion (which the person subsequently accomplishes by manually closing a snare).     

Blood pressure and pulse wave velocity measurement for operant conditioning of autonomic responding

Presently available procedures for measuring blood pressure are not completely satisfactory for Es wishing to investigate the operant conditioning of cardiovascular activity. A system is described for measuring a correlate of the blood pressure information obtained with conventional sphygmomanometric systems. The procedure involves the measurement of speed of propagation through the arterial system of the pressure pulse from the heart’s contraction. This speed, the pulse wave velocity, is closely related to cuff-derived blood pressure. Many of the problems present with current sphygmomanometric systems are absent with this apparatus and procedure. The apparatus can be assembled from common instruments or constructed from integrated circuits. Data collected with the apparatus confirm earlier studies which indicate that pulse wave velocity is correlated with sphygmomanometrically measured blood pressure and is a valuable cardiovascular response measure.     

Relationship between chronic stress and carotid intima-media thickness (IMT) in elderly Alzheimer's disease caregivers

The stress associated with providing care for a spouse diagnosed with Alzheimer's disease can have adverse effects on cardiovascular health. One potential explanation is that chronic caregiving stress may contribute to the development of atherosclerosis. The purpose of this study was to determine whether the duration that one has provided care is associated with the degree of atherosclerotic burden, as measured by carotid artery intima-media thickness (IMT). One hundred and ten Alzheimer caregivers [mean age 74?±?8 (SD) years, 69% female] underwent in-home assessment of carotid artery IMT via B-mode ultrasonography. Data regarding medical history, blood pressure, and multiple indicators of caregiving stress were also collected. Multiple regression indicated that duration of care was positively associated with IMT measured in the internal/bifurcation segments of the carotid artery (β?=?0.202, p?=?0.044) independent of risk factors such as age, gender, body mass index, smoking history, sleep quality, hypertension status, and caregiving stressors. Duration of care was positively associated with IMT in the common carotid artery, but the relationship was not significant. These findings provide more evidence of the link between chronic caregiving stress and cardiovascular disease and indicate that enduring the experience of caregiving over a period of years might be associated with atherosclerotic burden.     

Experiences of demand and control in daily life as correlates of subclinical carotid atherosclerosis in a healthy older sample.

Daily experiences of demand and control were examined as correlates of carotid artery atherosclerosis among healthy adults (ages 50-70). Mediating effects of ambulatory blood pressure (ABP) were also explored. Participants (n=337) collected ABP and recorded daily experiences, using electronic diaries, over two 3-day periods. Carotid artery intima-medial thickness (IMT) was assessed using ultrasonography. Participants reporting higher task demands during daily life showed larger IMT, after adjustment for demographic covariates. This association was not limited to workplace ratings or to employed individuals. The association was mediated, in part, by daytime systolic blood pressure. Previous findings linking job stress with cardiovascular disease may reflect the broader impact of daily psychological demands, not necessarily associated with the workplace.     

CHANGES IN BLOOD PRESSURE AND HEART RATE DURING FIXED‐INTERVAL RESPONDING IN SQUIRREL MONKEYS

Episodic and sustained increases in heart rate and mean arterial blood pressure can occur with recurring patterns of schedule‐controlled behavior. Most previous studies were conducted under fixed‐ratio schedules, which maintained a consistent high rate of responding that alternated with periods of no responding during times when the schedule was not in operation. The present study examined changes in heart rate and blood pressure under fixed‐interval schedules which maintained a range of rates that varied from little or no responding at the beginning of the fixed interval to high rates at the end of the interval. The relations of cardiovascular function to rate of responding were examined. Squirrel monkeys prepared with arterial catheters were trained to respond under fixed‐interval schedules of electric‐shock presentation. The duration of the interval was varied across sessions and cardiovascular parameters were examined. Local rates of responding were typically near zero during timeout periods, low at the beginning of each fixed‐interval cycle, and then increased as the fixed interval progressed. At most schedule durations, arterial blood pressure and heart rate levels were lowest at the beginning of the interval cycles, increased as the rate of responding increased, and then decreased during the timeout periods. At all parameters studied, there was a direct relationship between changes in response rate within fixed‐interval cycles and changes in heart rate and blood pressure. The results suggest that a much closer concordance of these cardiovascular parameters and schedule‐controlled responding is obtained by examining ongoing behavior as it occurs within the contingencies by which it is maintained.     

Are pets a healthy pleasure? the influence of pets on blood pressure

Pet owners often describe their pets as important and cherished family members who offer solace in times of stress. This article considers evidence suggesting that pets influence human blood pressure. Studies on this topic extend current research testing the hypothesis that having other people around in stressful times can buffer the negative consequences of stress. The existing data suggest that people perceive pets as important, supportive parts of their lives and that the presence of a pet is associated with significant cardiovascular benefits, among both people with normal blood pressure and those with high blood pressure. Studies about pets and blood pressure have examined both naturally occurring and randomly assigned pet ownership but are limited by their focus on responses to short-term, acute stress. Future prospective studies should explore the influence of pets on people at risk for cardiovascular disease and also consider explanatory mechanisms for the pet effect.     

脉压差变化对预测心血管疾病的研究进展

心血管疾病严重威胁人类的生命安全及身心健康,脉压差作为预测心血管疾病的指标近年来也颇受重视,研究结果显示：脉压差和冠心病的发病率呈显著正相关,脉压差升高是动脉硬化及心血管病高危的一个标志,它的作用大于舒张压甚至超过收缩压;提示：脉压差是心血管疾病的一个良好的预测因子,也是反映中老年人血管硬化的一个较好的指标。     

Resting cardiovascular levels and reactivity to interpersonal incivility among Black, Latina/o, and White individuals: the moderating role of ethnic discrimination

OBJECTIVE: The objective of this study was to examine cardiovascular responses among Black, non-Hispanic White, and Latina/o participants exposed to a potentially discriminatory situation. The study also examined the moderating role of prior history of discrimination on cardiovascular responses. DESIGN: Black, Latina/o, and White participants engaged in a resting baseline and then interacted with an uncivil White research assistant. MAIN OUTCOME MEASURES: Two measures of prior exposure to discrimination were administered. Participants' blood pressure and heart rate (HR) were monitored throughout the protocol. The primary outcomes were resting cardiovascular function and cardiovascular reactivity to the uncivil interaction. RESULTS: Past discrimination was related to higher resting systolic blood pressure (SBP) among Latina/o participants and lower resting SBP among White participants. Further, past discrimination was related to attenuated SBP and HR reactivity among Latina/o participants but was related to augmented HR reactivity among White participants. Discrimination was not related to resting levels or reactivity among Black participants. CONCLUSION: This study is the first to examine the relationship between discrimination and cardiovascular responses to interpersonal incivility among Black, Latina/o, and White individuals. Findings suggest that the relationship between discrimination and cardiovascular risk may differ by ethnicity.     

Time-series analysis of long-term cardiovascular response

The purpose of this study was to illustrate the use of time-series analysis with long-term cardiovascular responding. Analyses of two successive 1000-minute mean blood pressure and heart-rate series in five chronically instrumented dogs showed that the autocorrelation function of the original series appeared highly nonstationary and that differencing the data produced a simple autocorrelation pattern which could be successfully modeled with stepwise autoregression. Evidence for reliable individual differences as well as change over sessions is presented and discussed.