Background:Blood pressure variability (BPV) is recognized as an independent risk factor for cardiovascular morbidity and mortality. However, findings regarding the association between the coefficient of variation (CV) of 24-h blood pressure and mortality in patients with acute myocardial infarction (AMI) remain inconsistent. The aim of this study was to examine the association between 24-h CV and the risk of in-hospital, 30-day, 1-year, and 3-year mortality in AMI patients. Methods:This retrospective cohort study included AMI patients who were admitted to the intensive care unit (ICU) from the MIMIC-IV 2.0 database. The CV was calculated from blood pressure measurements taken during the first 24 h. Patients were divided into three groups according to tertiles of 24-h blood pressure CV. The relationship between 24-h CV and the risk of all-cause mortality in AMI patients was analyzed using logistic regression, Cox proportional hazards regression, and Kaplan-Meier survival analyses. Results:A total of 1291 eligible AMI patients were included. Compared with Q1 (lowest CV), Q3 (highest 24-h systolic blood pressure [SBP]-CV) was significantly associated with an increased risk of in-hospital (odds ratio [OR]: 3.333, 95% confidence interval [CI]: 1.725-6.439), 30-day (hazard ratio [HR]: 1.868, 95% CI: 1.201-2.904), and 1-year (HR: 1.420, 95% CI: 1.058-1.907) mortality. Both Q2 and Q3 of 24-h diastolic blood pressure (DBP)-CV were significantly associated with an increased risk of in-hospital, 30-day, 1-year, and 3-year mortality. Kaplan-Meier survival curves demonstrated that patients in Q3 had significantly lower 30-day, 1-year, and 3-year survival probabilities than those in other tertiles for both SBP and DBP. Conclusions:Our findings suggest that 24-h SBP-CV and DBP-CV are significantly associated with both short- and long-term outcomes in AMI patients. BPV may serve as a prognostic marker for all-cause mortality in AMI patients.

AbstractWe investigated the clinical characteristics of primary aldosteronism (PA) screened from patients with hypertension in China. The participants were hypertensive patients who were suspected of PA and registered in the China Primary Aldosteronism Prospective Study. Plasma aldosterone‐to‐renin ratio (ARR) was used as the screening test. In patients screened positive for PA, that is, an ARR exceeding the thresholds and plasma aldosterone concentration (PAC) > 100 pg/mL, a confirmatory test was performed for diagnosis. Patients with PA underwent a CT scan and adrenal venous sampling for subtyping. Of the 1497 screened patients, 754 (50.4%) had an ARR exceeding the diagnostic threshold and 637 (84.5% of those eligible) were registered. These registered hypertensive patients with suspected PA had a mean (standard deviation) age of 52.6 ± 12.1 years, and included 442 (58.6%) women. In multiple stepwise logistic regression, the significant odds ratios for the presence of diagnosed (n = 490) versus suspected and non‐diagnosed PA (n = 147) were 4.54 (95% CI: 2.78‐7.39) for a history of hypokalemia, 0.79 (95% CI: 0.64‐0.98) for a 0.9 mmol/l higher serum total cholesterol, and 2.25 (95% CI: 1.63‐3.10) for a doubling of PAC in the supine or standing/sitting position. In multiple stepwise logistic regression, the significant odds ratios for the presence of unilateral (n = 135) versus bilateral PA (n = 53) were 3.04 (95% CI: 1.90‐4.87) for a 0.4 mmol/l lower minimum serum potassium concentration and 1.86 (95% CI: 1.20‐2.86) for a 0.3 mmol/l higher serum high‐density lipoprotein cholesterol. PA might be a biochemical continuum in the adrenal hypersecretion of aldosterone as well as hypokalemia.

BACKGROUND:In recent years, the mortality of patients with AMI has not declined significantly. The relationship between blood pressure variability (BPV) and acute myocardial infarction (AMI) is unclear. We explored the relationship between 24-h BPV and mortality in patients with AMI. HYPOTHESIS:The mortality of patients with AMI is related to BPV. We hope to provide therapeutic ideas for reducing the risk of death in patients with AMI. METHODS:This is a retrospective cohort study. We extracted and analyzed data from the MIMIC-IV 2.0, which was established in 1999 under the auspices of the National Institutes of Health (America). The average real variability (ARV) was calculated for the first 24-h blood pressure measurement after patients with AMI were admitted to the intensive care unit (ICU). Patients were divided into four groups according to ARV quartiles. The outcomes were 30-day, 1-year, and 3-year all-cause mortalities. Data were analyzed using Cox regression, Kaplan-Meier curves, and restricted cubic spline (RCS) curves. RESULTS:We enrolled 1291 patients with AMI, including 475 female. The patients were divided into four groups according to the qualities of diastolic blood pressure (DBP)-ARV. There were significant differences in the 30-day, 1-year and 3-year mortality among the four groups (p = .02, p < .001, p < .001, respectively). After adjustment for confounding factors, systolic blood pressure (SBP)-ARV could not predict AMI patient mortality (p > .05), while the highest DBP-ARV was associated strongly with increased 30-day mortality (HR: 2.291, 95% CI 1.260-4.168), 1-year mortality (HR: 1.933, 95% CI 1.316-2.840) and 3-year mortality (HR: 1.743, 95% CI 1.235-2.461). Kaplan-Meier curves demonstrated that, regardless of SBP or DBP, the long-term survival probabilities of patients in the highest ARV group were significantly lower than that of those in other groups. RCS curves showed that the death risk of patients with AMI first decreased and then increased with the increase in ARV when DBP-ARV < 8.04. The 30-day death risk first increased and then decreased, and the 1-year and 3-year death risks increased and then stabilized with ARV increase when DBP-ARV > 8.04. CONCLUSION:This study showed that patients with AMI may have an increased risk of short- and long-term death if their DBP-ARV is higher or lower during the first 24-h in ICU.

目的:探讨超重肥胖高血压患者证型特点及其与血流动力学参数的相关性.方法:选择中日友好医院心脏科门诊及住院部初发的原发性高血压患者213例,分为正常体重组(76例)和超重肥胖组(137例),收集患者的基本资料及实验室指标、血流动力学参数及中医临床症状等,分析超重肥胖高血压患者的证型特点及其与血流动力学的关系.结果:超重肥胖高血压患者的证型分布与正常体重组有显著差异,其构成依次为痰瘀互结证(43.10％)、肝火亢盛证(28.50％)、阴虚阳亢证(16.10％)、阴阳两虚证(12.40％).超重肥胖组患者每分钟输出量(CO)、心指数(CI)、总外周阻力指数(SVRI)、胸液含量(TFC)显著高于正常体重组(P＜0.05),超重肥胖组中痰瘀互结证SVRI、主动脉硬化指数(AS)显著高于非痰瘀互结证(P＜0.01),痰瘀互结证与SVRI(r=0.433)、AS(r=0.173)、TFC(r=0.268)正相关(P＜0.05),与 CO、CI无相关关系.结论:痰瘀互结证是超重肥胖高血压患者主要证型,超重肥胖高血压患者更易出现动脉硬化.

目的 探讨高血压合并阻塞性睡眠呼吸暂停综合征(OSAS)患者证型特点与血流动力学的关系.方法 选取2021年3-10月在中日友好医院心脏科住院的初发高血压患者214例,将患者按照是否合并OSAS分为单纯高血压组(118例)和高血压合并OSAS组(96例).收集患者的基本资料及实验室指标、血流动力学指标及中医临床证型资料.分析高血压合并OSAS患者的证型特点及其与血流动力学的关系.结果 高血压合并OSAS组男性比例、体重指数、舒张压水平高于单纯高血压组,高密度脂蛋白胆固醇水平低于单纯高血压组,差异均有统计学意义(均P＜0.05).单纯高血压组中医证型构成为肝火亢盛证(69例,58.5％)、痰瘀互结证(18例,15.3％)、阴虚阳亢证(16例,13.6％)、阴阳两虚证(15例,12.7％);高血压合并OSAS组中医证型构成为痰瘀互结证(58例,60.4％)、肝火亢盛证(17例,17.7％)、阴虚阳亢证(14例,14.6％)、阴阳两虚证(7例,7.3％).痰瘀互结证在高血压合并OSAS患者中占主导地位.高血压合并OSAS组外周血管阻力指数(SVRI)、主动脉硬化指数(AS)高于单纯高血压组,差异均有统计学意义(均P＜0.05).高血压合并OSAS组患者中,痰瘀互结证患者SVRI、AS均高于非痰瘀互结证患者,差异均有统计学意义(均P＜0.001).高血压合并OSAS组患者痰瘀互结证与SVRI、AS呈正相关(r = 0.401,P＜0.001;r = 0.378,P = 0.001).结论 痰瘀互结证是高血压合并OSAS患者的主要证型,血流动力学方面表现为"高阻"模式,可能与血管损伤有关.

我们在门诊常会遇到高血压患者漏服降压药的现象,其中许多患者认为,漏服一次药,在下一次服药时加倍剂量服用即可.这种情况尤其在老年患者中很多见. 漏服药物反映的是降压药物服药依从性问题.服药依从性是指患者按照医生的要求定时服药,服药次数、服药剂量准确,坚持长期不问断服药.

目的:采用数据挖掘的方法,探讨中医药治疗老年高血压的辨证用药规律.方法:检索医学数据库,筛选符合入排标准的老年高血压临床研究.运用频次分析、关联规则分析和聚类分析老年高血压的辨证用药规律.结果:纳入处方167张,挖掘核心药物18种,关联规则15条,核心药物聚为6类.核心药物包括牛膝、黄芪、丹参、茯苓、天麻等;常用的药物配伍有天麻+钩藤、桑寄生+牛膝以及钩藤+丹参+天麻等.结论:瘀血阻滞和脾胃虚弱、肝肾阴虚是老年高血压的主要中医证型,活血化瘀应贯穿于治疗始终,在此基础上健脾益肾以培其本,平肝熄风、化痰、通络等治其标,方可收效长远.

高血压是心脑血管疾病的重要危险因素,血压水平与心脑血管病发病和死亡风险之间存在密切的因果关系.高血压治疗的根本目标是降低高血压的心、脑、肾与血管并发症发生和死亡的总危险.因此,有效降低血压可以减少心脑血管事件的发生.那么,高血压病患者的血压水平降到多少获益更大呢?

高血压是引发冠心病、心力衰竭、肾功能衰竭、脑血管病等疾病的重要危险因素.高血压的发生受遗传和环境因素的共同影响.在环境因素中,高盐摄入是导致和加重高血压的重要饮食因素之一.因此,限盐是高血压管理中生活方式干预的重要措施,也是高血压的基础治疗.

2018年底,《2018年中国高血压防治指南修订版》正式发布.新版指南结合我国国情、我国人群高血压流行特点及新的研究证据修订.近期研究数据显示,我国90％的高血压患者伴有至少一项心血管危险因素,属心血管中高危人群;脑卒中仍是目前我国高血压人群最主要的并发症,新版指南强调预防卒中应作为治疗高血压的主要目标.

我国已步入老龄社会,老年人高血压患病率持续增加,据《中国居民营养与慢性病状况报告(2015年)》数据显示,2012年我国≥60岁人群高血压患病率上升至58.9％.与中青年高血压患者相比,老年高血压的特点主要表现为单纯收缩期高血压、脉压增大、血压波动大、易发生体位性低血压及餐后低血压、与多种疾病并存、并发症多,其中单纯收缩期高血压是老年高血压最常见的类型,需根据患者的具体情况进行个体化治疗.

患者男性,33岁,因“持续腹痛半天”于2017年10月1日就诊于我院急诊科.患者近3d大量进食油腻食物及饮酒,半天前出现上腹持续性胀痛,伴间断左上腹绞痛、大汗,持续约10余分钟未缓解;无胸闷、胸痛;无恶心、呕吐、反酸.既往体健,否认高血压史、糖尿病史、冠心病家族史及无吸烟史.入院查体:T 36.5℃,P 98次/min,R18次/min,Bp 136/90mmHg,神志清,精神差;全身皮肤黏膜无黄染,颈静脉无怒张;双肺呼吸音清,未闻及干湿啰音;心界不大,心率98次/min,律齐,各瓣膜区未闻及病理性杂音;上腹部压痛,左上腹为著,无反跳痛、肌紧张,Murphy(-),肝脾肋下未触及.

问 我患高血压已经十几年了,确诊后我一直定期测量血压、按医嘱服药,血压维持得还算不错.自从血压稳定后,我也就不再测量血压了.可近两年每到换季尤其是春夏交替时,总是出现头晕、黑蒙等不适,也没太在意.去年五六月份这些症状更为明显.去医院医生说我的血压降得太低了,估计与用药有关.请问,春夏交替之际,降压药是否还得调整?

Objective: To investigate the correlation between the distribution of Apo lipoprotein E (ApoE) gene polymorphism and the severity of chronic heart failure (CHF) secondary to non-ischemic cardiomyopathy (NICM). Methods: One hundred and twenty patients with CHF due to NICM and one hundred and eighty patients with CHF due to ischemic cardiomyopathy (ICM) treated in our hospital from January 2013 to December 2016 were selected as NICM group and ICM group, respectively. The genomic DNA of the two groups was extracted for the genotyping of epsilon locus of ApoE gene by PCR-RFLP. The left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) were measured by color Doppler ultrasonography. Results: In NICM group, the epsilon 4/4 and epsilon 3/4 genotypes and the frequency of allele epsilon 4 were significantly higher than those in ICM group (P < 0.05); epsilon 2/3 and epsilon 2/4 genotypes and frequency of allele epsilon 2 were significantly lower than ICM group (P < 0.05); but there was no significant difference between both group in epsilon 2/2 and epsilon 3/3 genotypes and e3 frequency (P > 0.05). Logistic regression analysis showed that epsilon 4/4 genotype and allele epsilon 4 were the influencing factors of CHF secondary to NICM (P < 0.05). Patients in the NICM group showed different genotypes and different features in both LVEF and LVEDD, the order of which is: LVEDD (epsilon 4/4) > LVEDD (epsilon 3/4) > LVEDD (epsilon 3/3) > LVEDD (epsilon 2/4) > LVEDD (epsilon 2/3) > LVEDD (epsilon 2/2) (P < 0.05); LVEF (epsilon 4/4) < LVEF (epsilon 3/4) < LVEF (epsilon 3/3) < LVEF (epsilon 2/4) < LVEF (epsilon 2/3) < LVEF (epsilon 2/2) (all P < 0.05). Conclusion: ApoE gene polymorphism is closely related to CHF secondary to NICM, and CHF is more severe in NICM patients with epsilon 4/4 type ApoE gene.

难治性高血压（resistant hypertension，RH）是造成心脑血管疾病及肾脏功能损伤的重要原因之一。随着人口老龄化及肥胖、慢性肾脏病患病率升高，RH成为临床中常见的问题，尽管有有效的治疗药物，但RH在治疗中仍然是一个棘手的问题。正确诊断、合理治疗并控制RH才能减少心、脑、肾、血管等靶器官的损害，从而降低临床事件的发生。

Dual antiplatelet therapy with aspirin, a platelet cyclooxygenase-1 inhibitor and P2Y12 receptor blockers, remains the major drug strategy to prevent ischemic event occurrence in patients with acute coronary syndromes and in patients undergoing coronary stenting, but there some limitations that can be overcome by targeting novel targets. Unlike direct thrombin inhibitors that bind directly to thrombin, targeting the platelet thrombin receptor, protease activated receptor (PAR)-1, may offer a better choice for the attenuation of atherosclerosis progression, thrombus-mediated ischemic events and restenosis without interfering with primary hemostasis. Vorapaxar - a synthetic analogue of himbacine, is a high affinity and highly selective PAR-1 antagonist that can effectively inhibit thrombin-induced platelet aggregation. In the TRACER trial, the addition of vorapaxar to standard therapy in patients with non-stent thrombosis-elevation- acute coronary syndromes did not significantly reduce the primary composite end point occurrence of cardiovascular (CV) death, myocardial infarction (MI), stroke, hospitalization for ischemia, or urgent revascularization, but significantly increased the GUSTO moderate and severe bleeding (p < 0.001) and intracranial hemorrhage (ICH). In the TRA 2°P-TIMI 50 trial, in patients with a history of MI and peripheral arterial disease (PAD) (67% of the total population), the end point of CV death, MI, or stroke was significantly (20%) reduced with vorapaxar whereas GUSTO moderate or severe bleeding was increased (1.5-fold), but not ICH or fatal bleeding and the net clinical outcome favoring the vorapaxar therapy. Based on these favorable results, the FDA approved vorapaxar for the reduction of thrombotic cardiovascular events in patients with prior MI or with PAD for long term therapy. A careful patient selection is needed to balance efficacy versus safety. At this time, patients with high risk for recurrent ischemic event occurrence such as patients with diabetes mellitus and previous MI can be safely treated with vorapaxar for long-term therapy.

OBJECTIVE To explore the distribution laws of TCM syndrome types and to analyze the distribution of dynamic blood pressure curve, atherosclerosis, and age in senile hypertension patients. METHODS Totally 1 131 senile hypertension patients were recruited from 7 provinces and municipal cities. Features of TCM syndromes, classification and distribution curves, and syndrome distribution laws were observed. The distribution curves of dynamic blood pressure, carotid atherosclerosis, and age were compared in each TCM syndrome types. RESULTS There were four main syndrome types in 736 cases (56.15%), i.e., excessive accumulation of phlegm-dampness syndrome (210 cases, 16.02%), yin deficiency and hyperactivity of yang syndrome (177 cases, 13.50%), Gan-Shen yin deficiency syndrome (79 cases, 6.03%), and deficiency of qi and yin syndrome (252 cases, 19.22%). Besides, there were two more sub-types, i.e., collateral obstruction by blood stasis syndrome and collateral obstruction by phlegm and stasis. Circadian blood pressure monitor was completed in 211 cases. Of them, abnormal circadian blood pressure occurred in 152 cases (accounting for 72. 38%); yin deficiency and hyperactivity of yang syndrome, excessive accumulation of phlegm-dampness syndrome, deficiency of qi and yin syndrome plus collateral obstruction by blood stasis syndrome were most often seen. Color ultrasound of carotid artery was performed in 660 patients of main syndromes. The incidence was quite higher in those of excessive accumulation of phlegm-dampness syndrome (182 cases, 27. 58%), deficiency of qi and yin syndrome plus collateral obstruction by blood stasis syndrome or collateral obstruction by phlegm and stasis (322 cases, 48.79%). Yin deficiency and hyperactivity of yang syndrome was dominant in patients 60 -79 years old, while deficiency of qi and yin syndrome and Gan-Shen yin deficiency syndrome were dominant in patients older than 80 years. CONCLUSIONS Excessive accumulation of phlegm-dampness syndrome, yin deficiency and hyperactivity of yang syndrome, Gan-Shen yin deficiency syndrome, and deficiency of qi and yin syndrome were main syndrome types in senile hypertension patients. There was statistical difference in the distribution curves of blood pressure, atherosclerosis, and age of various TCM syndrome types.

OBJECTIVE:To investigate the relationship between blood pressure variability (BPV) and left ventricular diastolic function in patients with essential hypertension.METHODS:Left ventricular diastolic function of 252 hypertensive patients were assessed by early (E) diastolic transmitral flows to early diastolic mitral annular velocity (Ea) (E/Ea) ratio derived from Doppler echocardiography. Patients were divided into two groups according to normal left ventricular diastolic function group (E/Ea<15, n = 168) and left ventricular diastolic dysfunction group (E/Ea ≥ 15, n = 84). All patients were monitored by ambulatory blood pressure. Standard deviation (SD) and coefficient of variation (CV) of blood pressure were calculated as the BPV. Relationship between BPV and left ventricular diastolic function were analyzed by multivariate logistic regression analysis.RESULTS:All-day average diastolic blood pressure(DBP), the day systolic blood pressure (SBP), night SBP, night DBP, SBPSD, DBPSD and DBPCV in the left ventricular diastolic dysfunction group were significantly higher than in the normal diastolic function group (all P < 0.05). Multivariate logistic regression analysis showed that left ventricular diastolic dysfunction was associated with SBPSD (OR:1.126, 95%CI:1.054-1.203, P < 0.01), SBPCV (OR:1.127, 95%CI:1.036-1.225, P < 0.01) in this patient cohort.CONCLUSION:High variability of SBP is correlated with left ventricular diastolic dysfunction in hypertensive patients.

<正>根据美国国家高血压预防、监测、评估和治疗委员会第七次报告(JNC7),收缩压120～139 mm Hg和(或)舒张压80～89 mm Hg称为高血压前期(prehypertension,PHT)[1],这一范围与我国2010年高血压防治指南中定义的"正常高值血压"的范围一致。PHT与临床高血压、心血管疾病(cardiovascular disease,CVD)、慢性肾脏病(chronic kidneydisease,CKD)以及肥胖、炎症等心血管事件的其他危险因素都存在密切的关系,这一概念正越来越广泛地得到人们的认可和关注,PHT的管理主要包括生活方式调整和药物治疗。我们就高血压前期的流行趋势和管理策略做一综述。

目的:探讨高敏C反应蛋白(hs-CRP)及血清尿酸(SUA)水平与原发性高血压(EH)患者颈动脉粥样硬化(CAS)的相关性.方法:对117例原发性高血压患者进行hs-CRP及SUA浓度测定,使用B型超声测定颈动脉内膜中层厚度(IMT),分析高血压合并颈动脉粥样硬化组(81例)和高血压IMT正常组(36例)间hs-CRP及SUA水平.结果:高血压合并颈动脉粥样硬化组hs-CRP及SUA水平显著高于高血压IMT正常组(P＜0.05,P＜0.01),并且IMT与hs-CRP及SUA呈显著正相关.结论:hs-CRP、SUA可能参与原发性高血压合并颈动脉粥样硬化发生.