J Am Heart Assoc:多学科讨论:中国高血压患者降压治疗 这一点马虎不得!

2017-04-24 何娜;常路 环球医学

在卒中预防中,血压是极其重要的可调控危险因素,血压变异性也是国际研究热点。2017年3月,发表在《J Am Heart Assoc》的一项研究表明,门诊-门诊收缩压变异性为中国高血压患者原发性卒中的独立预测因素。请看本期多学科讨论组临床药师各抒己见为您梳理本文看点——背景:最佳的血压变异性范围仍然未知。研究人员旨在中国32个社区的大型高血压人群中,基于门诊-门诊收缩压变异性对卒中风险程度进行分层。



卒中预防中,血压是极其重要的可调控危险因素,血压变异性也是国际研究热点。2017年3月,发表在《J Am Heart Assoc》的一项研究表明,门诊-门诊收缩压变异性为中国高血压患者原发性卒中的独立预测因素。请看本期多学科讨论组临床药师各抒己见为您梳理本文看点——

背景:最佳的血压变异性范围仍然未知。研究人员旨在中国32个社区的大型高血压人群中,基于门诊-门诊收缩压变异性对卒中风险程度进行分层。

方法和结果:研究人员回顾性分析了中国卒中一级预防试验中的20702名高血压患者的数据。参与者随机分为两组:依那普利或依那普利+叶酸。每3个月测量一次参与者的血压。结局指标为首次卒中。研究人员计算了收缩压变异性的3个参数:标准差、变异系数、实际平均变异。调整的Cox回归模型中,在测量收缩压处进行首个4、6、8、10和12次就诊时的记录用于计算收缩压变异性,预测随后的卒中风险。中位随访4.5年后,597名患者出现卒中。门诊-门诊收缩压变异性为随后卒中的独立预测因素(如,超过6次门诊时,最高五分位数的实际平均变异(22.67~61.07mmHg)的风险比为1.55;95% CI,1.07~2.25;P=0.021),独立于随访期的平均收缩压。当使用了更多的血压记录时,该值更具预测性。

结论:门诊-门诊收缩压变异性为中国高血压患者原发性卒中的独立预测因素。该预测值取决于用于计算变异性的血压测量的次数,但独立于平均收缩压。

多学科讨论记实:

目前,我国心血管疾病死亡率上升趋势明显。据测算,我国18岁以上居民中,每四个就有一个是高血压患者,高血压患病人数约2.7亿。但我国总体血压控制状况不佳,而且临床上不少血压控制良好的患者仍会发生不同程度的心脑血管事件。

近年研究表明,血压变异性与心血管事件风险相关,血压变异性是卒中风险的预测因子。血压变异性包括许多内容,在研究中最常应用的有:随诊血压间的变异性(不稳定性)、血压的季节变异性、昼夜节律变异性和亚昼夜节律变异性。

可以说,血压变异性在高血压的发展及预后中有不可或缺的重要地位。有专家强调,降压达标的同时改善异常血压变异性应成为降压治疗策略的重要内涵。也就是说,不论何种药物都应增加对治疗期间血压控制稳定性的重视。

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    2017-05-07 cuiyejia

    学习了,谢谢

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    2017-05-03 cuiyejia

    学习了,谢谢分享

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    2017-04-26 cuiyejia

    学习了,谢谢分享

    0

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    2017-04-26 zhaojie88
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    2017-04-26 slcumt

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背景:高血压患者左心房(LA)机械功能受损,并可能导致各种并发症,包括房性心律失常,卒中和心脏衰竭。不同降压药物对中枢血流动力学和左室功能的影响不同。然而它们对LA功能的影响的了解较少。方法:研究者研究212例高血压患者,这些患者无心脏衰竭或房颤。根据心脏稳态自由进洞序列MRI影像学,应用特征跟踪算法计算LA应变率。结果:在多变量模型中,校正年龄、性别、种族、体重指数、血压、糖尿病、LA体积,左心

Ann Intern Med:60岁或以上老人高血压药物治疗的目标:ACP和AAFP的临床实践指南

高血压是美国非常常见的慢性疾病。美国成人的高血压总患病率为29.0%,60岁或以上老年人则增加到64.9%。2017年3月,《Ann Intern Med》上发布了60岁或以上老人高血压药物治疗的目标为较高还是较低的血压目标:美国内科医师学会和美国家庭医师学会的临床实践指南。描述:美国内科医师学会(ACP)和美国家庭医师学会(AAFP)基于60岁或以上老年人高血压治疗的较高vs较低血压目标的风险和