个体化降压的临床意义

高血压是由多种病因和发病机制引起的一种慢性疾病,可以导致多种靶器官功能损害,并最终导致严重的心、脑血管并发症,危及人类的健康和生命.如何做到有效的预防和治疗是目前面临的问题.本文分析了高血压控制的现状,以矛盾的特殊性原理为指导,从高血压的病因和发病机制、临床特点以及药物对个体的敏感性等诸多方面出发,阐述了高血压患者个体差异性.高血压患者个体差异性决定每一个个体综合控制策略的不同,运用"具体问题具体分析"的方法,为每一个个体制定个体化的血压控制方案,以期达到理想的高血压整体控制水平.     

降压达标治疗中的个体化原则与优化治疗

为了提高高血压患者的降压达标率、最大程度地降低靶器官损伤,一方面应强化生活方式的改变,包括戒烟限酒、低盐饮食、减轻体重和适量运动,另一方面,由于原发性高血压的发病是由多种复杂因素的不同组合引起,应根据不同个体的高血压发病机制及病因的差异,在指南的指导下,应用不同种类抗高血压药物(单用或联合用药),采用针对个体的优化治疗,才能更有效地使降压治疗达标。     

降压达标治疗中的个体化原则与优化治疗

为了提高高血压患者的降压达标率、最大程度地降低靶器官损伤,一方面应强化生活方式的改变,包括戒烟限酒、低盐饮食、减轻体重和适量运动,另一方面,由于原发性高血压的发病是由多种复杂因素的不同组合引起,应根据不同个体的高血压发病机制及病因的差异,在指南的指导下,应用不同种类抗高血压药物(单用或联合用药),采用针对个体的优化治疗,才能更有效地使降压治疗达标.     

睡眠呼吸暂停综合征与肺高血压

肺高血压是一类以肺血管阻力进行性升高为主要特征,并最终导致右心衰竭甚至死亡的恶性心血管疾病.多种疾病可导致肺高血压,其中第三大类肺高血压与肺部疾病及缺氧有关.已有许多研究得出结论睡眠呼吸暂停综合征是肺高血压的高危因素,但具体发病机制不详.本文目的是结合国外文献阐述睡眠呼吸暂停综合征致肺高血压的发病机制及干预睡眠呼吸暂停综合征对肺动脉高压的影响.     

阿尔茨海默病发病机制及治疗手段多样性研究

阿尔茨海默病(Alzheimer’s disease,AD)是一种重要的神经退行性疾病,其发病机制复杂,目前无任何一种学说可单独解释AD的病因,因而导致AD的治疗手段多样性,但无任何一种手段可完全有效治疗AD。探讨了AD的多种发病机制和治疗手段,通过其研究的复杂性说明认识事物过程的复杂性和曲折性。     

用辩证的眼光看待高血压

1　局部与整体高血压的发病是由于多种原因引起的 ,就目前所知 ,高血压是一种多基因疾病 ,这是由于它由多种基因可能存在的变异或者是多态性引起的。血压主要由神经系统、循环内分泌系统血管收缩 /舒张激素、心血管系统的结构、体液容量、肾功能及其他因素控制。它们与血压之间相互制约、相互影响 ,形成了更为复杂的调控系统 ,是一种很大范围内的新的整体 ;每个因素 ,如阻力的变化、心脏功能的变化及血容量的变化等 ,都只是这个整体中的一个局部。而在每一个这种局部之中又自成一个整体 ,因而包含了新的局部。如阻力因素中的血管张力 ,血管…     

阻塞性睡眠呼吸暂停低通气综合征导致高血压的机制

阻塞性睡眠呼吸暂停低通气综合征是重要的继发性高血压病因之一,该综合征导致血压增高的原因主要有睡眠分裂、频繁的低氧血症和高碳酸血症导致的高交感神经兴奋,呼吸暂停发生时胸腔负压的增加和回心血量的增加以及内分泌功能的失调如醛固酮的高分泌,超重肥胖和慢性非特异性炎症反应的参与,是多种升压机制共同参与的结果.     

老年术后认知功能障碍研究进展及思考

术后认知功能障碍（postoperative cognitive dysfunction,POCD）是临床上老年患者术后常见的并发症,主要表现为精神活动、人格、记忆力和社交活动以及认知能力的异常,渐渐为患者和医学工作者所重视,但其病因和发病机制尚不清楚。运用哲学的基本原理,掌握科学的方法论和辩证思维方法,有助于正确分析POCD的相关病因及其发病机制,从而更好定指导临床工作。     

老年术后认知功能障碍研究进展及思考

术后认知功能障碍(postoperative cognitive dysfunction,POCD)是临床上老年患者术后常见的并发症,主要表现为精神活动、人格、记忆力和社交活动以及认知能力的异常,渐渐为患者和医学工作者所重视,但其病因和发病机制尚不清楚.运用哲学的基本原理,掌握科学的方法论和辩证思维方法,有助于正确分析POCD的相关病因及其发病机制,从而更好定指导临床工作.     

创伤后应激障碍病因及发病机制的研究进展

创伤后应激障碍(post-traumatic stress disorder,PTSD)是一种严重的应激相关障碍,指个体面临异常强烈的精神应激后延迟发生的精神障碍,文献报告PTSD的终生患病率为1%～14%,高危人群研究发现PTSD的患病率为3%～58%,女性约为男性的两倍[1]。PTSD的病因及发病机制较为复杂,涉及很多方面,本文将对PTSD病因及发病机制的研究进展进行综述。     

Psychological factors associated with poor hypertension control: differences in personality and stress between patients with controlled and uncontrolled hypertension

Only one-third of patients with hypertension under pharmacological treatment achieve the recommended blood pressure goals. Psychological factors could partially account for poor hypertension control through the existence of personality traits related to treatment compliance (e.g., self-discipline, deliberation, impulsiveness), and the fact that stress and some personality traits (e.g., anxiety, depression, anger expression, Type A) are involved in the etiology of some hypertension cases. This study was aimed at examining the differences in personality and stress between patients taking antihypertensive medications with controlled and uncontrolled hypertension. Results revealed that after controlling sex, age, and traditional variables associated with poor hypertension control, the uncontrolled hypertension group showed higher scores on impulsiveness, depression, anger expression-out, and stress, with differences ranging between medium and large (Hedges' g effect size = 0.77 to 1.08). These results support the hypothesized relationship between psychological factors and poor hypertension control.     

Psychophysiological theories on sympathetic nervous system reactivity in the development of essential hypertension

Psychophysiological theories on the development of essential hypertension are reviewed and evaluated. Two interconnected theories that relate behavior to essential hypertension and account for individual differences in susceptibility to disease are the "hyperreactivity" theory and "the symptom specificity" theory. The "hyperreactivity" theory identifies individual differences in autonomic nervous system reactivity as the pathophysiological mechanism and the "symptom specificity" theory suggests that inflexible, stereotypical responding increases the risk to develop hypertension. Based on a literature review, these theories are examined. There exist both case/control and prospective studies on autonomic nervous system reactivity and the development of hypertension. It is concluded that a neurogenically mediated hyperreactivity to stress is a precursor and not an effect of hypertension. Tasks that call for active but not passive coping efforts are more efficient elicitors of reactivity differences between those at high and low risk to develop hypertension in case/control studies. In prospective studies, active tasks may also have a predictive advantage over passive with respect to blood pressure development. In the early phase of hypertension, an increased cardiovascular reactivity is accompanied by increased neuroendocrine activation. In the later phase, heightened reactivity is confined to the cardiovascular system. This does not prove but is consistent with the notion that transient episodes of increased cardiac output translate into essential hypertension by causing vascular hypertrophy. Case/control studies suggest that an increased "symptom specificity", with stereotypical responding across multiple stressors, is independent of cardiovascular reactivity and a precursor of hypertension. The literature lacks prospective studies on the clinical relevance of stereotypical responding. It is suggested that the presence of both hyperreactivity and symptom specificity in a single individual increases the risk to develop essential hypertension.     

Anxiety management training in the treatment of essential hypertension

The study was conducted to assess the efficacy of Anxiety Management Training as an adjunctive treatment for essential hypertension. Twenty-one patients with essential hypertension, all but one of whom were on antihypertension medication, were randomly assigned either to an Anxiety Management Training condition or a waiting-list control condition. At the time of a posttest assessment session, compared to subjects in the control condition, subjects in the Anxiety Management Training condition manifested a decrease in resting systolic and diastolic blood pressure and a decrease in systolic and diastolic blood pressure following a stressful task. At the time of a follow-up assessment session, subjects in the Anxiety Management Training condition not only manifested good maintenance of reduced blood pressure but also exhibited a further decrease in resting systolic blood pressure and a decrease in systolic blood pressure during the stressful task.     

根据血压昼夜节律选择服药时间控制血压晨峰

根据血压昼夜节律,观察给药时间对血压晨峰的影响。256例原发性高血压患者,经24h动态血压监测分为超杓型（n＝49）、杓型（n＝127）和非杓型（n＝80）3组;各组再分为清晨服药组和晚上服药组。用药6周,比较用药前后血压昼夜节律及血压晨峰的变化,发现在改变血压昼夜节律及降低血压晨峰方面,超杓型组清晨服药优于晚上服药,非杓型组晚上服药优于清晨服药;杓型组清晨服药与晚上服药均能降低晨峰值,提示根据个体血压昼夜节律选择服药时间能更好地控制血压晨峰。     

Antihypertensive treatment,compliance, and quality of life: Review of a little-understood relation

If patients notoriously violate treatment regimens known to effectively control hypertension, then there must be some subjective costs associated with adherence to these regimens. Generally speaking, there must be some reduction in quality of life associated with antihypertensive medication. Unfortunately the concept of quality of life, due to its lack of specificity, is of little help in further investigating the nature of these subjective costs. We developed a simple neuropsychophysiological model based on fundamental psychological and physiological processes: corticoinhibitory effects of phasic blood pressure elevation reduce the aversive or painful qualities of many stressors. This negative reinforcement increases the rate of the reinforced physiological behavior, i.e., phasic analgesic blood pressure increases. Such negatively reinforced operant behavior is known to be extremely resistant to extinction. Counter actions such as taking antihypertensive medication not only lead to reduced quality of life due to their cancellation of the analgesic effect of conditioned blood pressure increase, but also lead to some form of reluctance to comply with treatment. The model not only provides an innovative etiological path to the emergence of neurogenic essential hypertension, but also yields a highly specific and lean concept of quality of life. Furthermore, it supplies the health care community with a concise explanation for the well-known low compliance of patients with their antihypertensive regimens. In addition to its parsimony, the model fits well with various experimental findings and has been operationalized and tested empirically. Specific therapeutic implications can be derived.     

Hypertension reduction through forgiveness training

The objective of this study was to determine if patients with diagnosed stage-1 hypertension could benefit by a forgiveness training program to achieve measurable reductions in anger expression and blood pressure. Twenty-five participants were randomly divided into wait-listed control and intervention groups. The control group monitored blood pressure while the intervention group participated in an 8-week forgiveness training program. At the end of eight weeks, the wait listed group became an intervention group. Those who received forgiveness training achieved significant reductions in anger expression when compared to the control group. While reductions in blood pressure were not achieved by all the participants, those participants who entered the program with elevated anger expression scores did achieve significant reductions in blood pressure. It is suggested that forgiveness training may be an effective clinical intervention for some hypertensive patients with elevated levels of anger.     

Blood pressure reactivity to active and passive behavioral conditions in hypertensives and normotensives

Blood pressure reactivity and passive behavioral tasks was studied in patients with mild essential hypertension and normotensive controls. The passive condition included 10 presentations of a 6 sec, 78 dB, 1000 Hz tone without any response requirements. In the active condition subjects were given an additional 10 tone presentations and asked to press a push-button at tone termination. The absolute and percent increase in systolic blood pressure from rest was greater in hypertensives than normotensives in response to the active condition but similar to the passive condition. It is concluded that patients with hypertension compared to normotensive controls show exaggerated blood pressure reactivity to tasks involving active but not passive coping efforts. Since the tasks used to induce active and passive coping in the present study were identical apart from coping requirements, the notion that the activity dimension in and of itself modulates reactivity differences between patients and controls is supported.     

降压治疗的决策思考

尽管降压药物有了很大发展,高血压的控制率仍很低下。降压治疗中还存在包括医生和患者两方面的许多误区。目前已取得的共识是:降压治疗的益处主要来自血压控制。因此,非常重要的是要达到血压的有效和长期稳定的降低。根据患者的年龄、基线血压、伴随的临床状况等,因人而异地选择副作用小、降压效果好的药物,提高顺应性是改善高血压控制率的关键。     

Restricted environmental stimulation therapy in the treatment of essential hypertension

Restricted Environmental Stimulation Therapy (REST) has been useful in treating a variety of health-related problems, including obesity and cigarette smoking. The pilot project described in this paper used 24 hr of REST (darkness and silence) with four patients suffering from essential hypertension. Long-term changes have included lower blood pressure, a reduced need for medication, and improved coping with stressful life events.