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1.
Article in Chinese | WPRIM | ID: wpr-815973

ABSTRACT

Resistant hypertension(RH) is a type of hypertension that causes progression of cardiovascular and cerebrovascular diseases. Clear diagnosis and effective treatment are essential. The article provides a detailed summary of the definition, etiology, diagnosis and treatment of RH. The treatment of RH should emphasize individualization, and it is necessary to carefully discern the cause and distinguish from secondary hypertension. Ambulatory blood pressure monitoring and home blood pressure measurement are important diagnostic tools. A combination of multiple drugs(including diuretics) that are reasonable, optimal, and of tolerable doses is the key to controlling blood pressure.

2.
Chinese Circulation Journal ; (12): 246-250, 2018.
Article in Chinese | WPRIM | ID: wpr-703848

ABSTRACT

Objective: To explore the changes of inflammatory factors and related factors in the population with overweight combining abdominal obesity and high-normal blood pressure (BP). Method: Our research included in 2 groups: Group A: n=189 subjects with high-normal BP, overweight and abdominal obesity, their BMI ≥ 24 kg/m2, waist circumference (WC) ≥ 90 cm in male, WC ≥ 85 cm in female, SBP(120-139) mmHg or DBP (80-89) mmHg; Group B, n=87 healthy subjects with matched age, BMI < 24 kg/m2, BP < 120/80 mmHg as normal control. Blood lipids and other biochemical parameters were examined; serum levels of intercellular adhesion molecule-1 (ICMA1), monocyte chemoattractant protein-1 (MCP1), chemokines-1 (CXCL-1), CXCL-2 and oxidized low density lipoprotein (oxLDL) were measured by ELISA. Results: Compared with Group B, Group A had increased TG, fasting blood glucose and non-HDL-C, all P<0.05; elevated serum levels of ICMA1 and MCP1, both P<0.05. Correlation analysis indicated that in Group A, ICMA1 was positively related to BMI, SBP, LDL-C and negatively related to age, which had gender difference; MCP1 was positively related to WC, SBP, LDL-C, non-HDL-C and negatively related to HDL-C, which also had gender difference; oxLDL was positively related to SBP, LDL-C; no evidence showed that CXCL-1 and CXCL-2 were related to obesity, BP and metabolic parameters; in Group B, no evidence showed that inflammatory factors were related to the other parameters. Linear regression analysis for inflammatory parameters found that after excluding other factors, in Group A, ICMA1 was positively related to BMI (t=2.901, P=0.005); in male gender, MCP1 was positively related to SBP (t=5.076, P=0.000), negatively related to DBP (t=-3.369, P=0.001). oxLDL was positively related to age (t=2.168, P=0.032) and LDL-C (t=2.146, P=0.034); CXCL-1 was negatively related to HDL-C (t=-2.013, P=0.047). Conclusion: The subjects with overweight abdominal obesity and high-normal BP were usually having abnormal metabolism of glucose and lipids, elevated serum levels of inflammatory parameters, blood levels of inflammatory factors were increasing with elevated BMI and SBP accordingly which implied the association with critical range of BP.

3.
Chinese Medical Journal ; (24): 1242-1246, 2013.
Article in English | WPRIM | ID: wpr-342197

ABSTRACT

<p><b>BACKGROUND</b>Aliskiren is a novel blood pressure-lowering agent acting as an oral direct renin inhibitor. The aim of this study was to assess the effect of aliskiren on arterial stiffness, compared with that of ramipril in mild to moderate essential hypertensive patients.</p><p><b>METHODS</b>Following a two week placebo run-in period, patients with a mean sitting diastolic blood pressure (ms-DBP) ≥ 95 and < 110 mmHg (1 mmHg = 0.133 kPa), and a mean sitting systolic blood pressure (ms-SBP) < 180 mmHg were randomly allocated to treatment with aliskiren (150 mg/d, n = 20) or ramipril (5 mg/d, n = 20) for eight weeks. Blood pressure, plasma renin activity, and the brachial-ankle pulse wave velocity (ba-PWV) were measured before and after eight weeks of treatment.</p><p><b>RESULTS</b>Eight weeks of treatment significantly decreased systolic blood pressure and diastolic blood pressure in both the aliskiren group and ramipril group. The hypotensive effect did not differ between the two groups. Plasma renin activity decreased after aliskiren treatment and increased after ramipril treatment. There was no significant difference in baseline ba-PWV between the aliskiren and ramipril groups (P = 0.892). The ba-PWV was significantly reduced in both the aliskiren group (1535 (1405 - 1666) vs. 1464 (1360 - 1506) cm/s) (P < 0.01) and the ramipril group (1544 (1433 - 1673) vs. 1447 (1327 - 1549) cm/s) (P < 0.01). No statistically significant difference was found in the decline of ba-PWV between the two groups (P = 0.766).</p><p><b>CONCLUSIONS</b>The current study revealed that aliskiren (150 mg/d) could ameliorate arterial stiffness and its effect was similar to ramipril (5 mg/d) in mild to moderate hypertensive patients, indicating that in addition to lowering blood pressure, aliskiren had beneficial effect on vascular protection.</p>


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Amides , Therapeutic Uses , Antihypertensive Agents , Therapeutic Uses , Fumarates , Therapeutic Uses , Hypertension , Drug Therapy , Ramipril , Therapeutic Uses , Vascular Stiffness
4.
Chinese Medical Journal ; (24): 2157-2162, 2013.
Article in English | WPRIM | ID: wpr-273019

ABSTRACT

<p><b>BACKGROUND</b>Catestatin, a chromogranin A-derived peptide, is a potent antagonist of nicotine-evoked catecholamine release. We know that catecholamine plays an important role in cardiovascular remodeling induced by hypertension, therefore we hypothesized that catestatin would affect target-organ structure during hypertension.</p><p><b>METHODS</b>Twelve spontaneously hypertensive rats (SHRs) were randomized to SHR control group and catestatin group, the normal control group was comprised of six healthy Wistar-Kyoto rats of the same age. Tail-cuff blood pressure and pulse rate were obtained at weeks 1, 4 and 8. At the end of the eight-week period, the heart, abdominal aorta and left kidney were excised and weighed, VG staining was done and the intima-media thickness of vessels and the collagen volume fraction were assessed by an image acquisition and analysis system. The proliferating cell nuclear antigen (PCNA) was observed by immunohistochemistry, and real time reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the mRNA levels of proliferative genes including cyclin A, ki67 and PCNA in the abdominal aorta.</p><p><b>RESULTS</b>All the parameters in SHR observed in the present study increased significantly compared to Wistar Kyoto rats (P < 0.01). With intervention with catestatin, the systolic blood pressure decreased slightly but it was not significantly different from the SHR control, the cardiac mass index and left ventricular mass index both decreased significant ly, the collagen volume fraction decreased by nearly 30% in the heart, by 25% in vessels and by 10% in the kidney, and the intima-media thickness and expression of proliferative genes, including cyclin A, ki67 and PCNA, in the abdominal aorta also decreased significant ly.</p><p><b>CONCLUSIONS</b>The present study indicated that catestatin could ameliorate proliferating changes of heart, kidney and vessels during hypertension, especially to the deposition of interstitial collagen. Blood pressure was not the main factor to mediate this effect, which suggested that catestatin could become a novel protective factor for hypertensive target organs.</p>


Subject(s)
Animals , Male , Rats , Aorta, Abdominal , Pathology , Blood Pressure , Cell Proliferation , Chromogranin A , Pharmacology , Heart Rate , Hypertension , Drug Therapy , Pathology , Kidney , Pathology , Peptide Fragments , Pharmacology , Rats, Inbred SHR , Rats, Inbred WKY
5.
Chinese Journal of Cardiology ; (12): 333-336, 2013.
Article in Chinese | WPRIM | ID: wpr-291976

ABSTRACT

<p><b>OBJECTIVE</b>To investigate glucose metabolism status and its relationship with blood pressure, obesity, renal function and cardio-cerebral vascular events in Chinese essential hypertensive patients.</p><p><b>METHODS</b>Essential hypertensive patients without diabetic history were enrolled in this cross-sectional survey. All patients filled in questionnaires and received physical examination and laboratory tests. Oral glucose tolerance test (OGTT, fasting and 2 hours glucose level after drinking the 75 g glucose solution) was performed in patients who signed the informed consent.</p><p><b>RESULTS</b>(1) The control rate of systolic BP was lower in patients with dysglycemia than in patients without dysglycemia (41.0% vs. 46.4%, P = 0.000). (2) The albuminuria detection rate and the abnormal rate of estimated glumerular filtration rate (eGFR) increased significantly with the deterioration of glucose metabolism. (3) Multifactor-analysis showed that abnormal waist circumference, decreased eGFR and presence of albuminuria were independent risk factors for abnormal glucose metabolism. Cardiovascular events was significantly higher in patients with abnormal glucose metabolism than patients with normal glucose metabolism.</p><p><b>CONCLUSION</b>Abnormal glucose metabolism is common in Chinese essential hypertensive patients. When complicated with abnormal glucose metabolism, essential hypertensive patients had poor blood pressure control rate and were related to higher cardiovascular risk.</p>


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Blood Glucose , Metabolism , Cross-Sectional Studies , Essential Hypertension , Glucose Metabolism Disorders , Diagnosis , Glucose Tolerance Test , Hypertension , Blood , Risk Factors
6.
Chinese Medical Journal ; (24): 562-567, 2011.
Article in English | WPRIM | ID: wpr-241556

ABSTRACT

<p><b>BACKGROUND</b>Diabetic nephropathy is a major cause of renal failure in diabetes mellitus (DM). It has been known that renin-angiotensin system (RAS) blockers have a renal protective effect. This study aimed to investigate whether treatment with angiotensin II receptor blocker, olmesartan, could modify renal hemodynamic variables and vascular structural properties, then attenuate renal injury in streptozotocin (STZ)-induced DM rats.</p><p><b>METHODS</b>DM was induced in male Wistar rats by intraperitoneal administration of STZ. The rats were then randomized to a DM group and an olmesartan treatment (OLM + DM) group. The normal group (non-DM) were administered only citrate buffer. At the end of the 14th week, blood glucose, kidney weight/body weight and urinary protein-to-creatinine ratio were determined. Further, the flow-pressure and pressure-glomerular filtration rate (GFR) relationships were determined for maximally vasodilated, perfused kidneys. From the relationship, 3 indices of vascular structural properties were estimated: slope of flow-pressure (minimal renal vascular resistance, reflecting overall luminal dimensions of preglomerular and postglomerular vasculature), slope of pressure-GFR (glomerular filtration capacity against pressure) and threshold pressure for beginning filtration at pressure-GFR (preglomerular to postglomerular vascular resistance ratio). Kidneys were then perfusion fixed for histological analysis. The renal histopathology was observed by light microscopy.</p><p><b>RESULTS</b>The body weight of DM rats was lower than that of non-DM rats. Blood glucose, kidney weight/body weight, urinary protein-to-creatinine ratio were significantly greater in DM rats than in non-DM rats. The parameters such as kidney weight/body weight, urinary protein-to-creatinine ratio in OLM + DM rats had dramatically decreased compared with those in DM rats. However, the treatment with olmesartan had no effect on blood glucose levels. The slope of flow-pressure relationship was greater in DM rats than that in non-DM rats (P < 0.05). But the slope of the pressure-GFR relationship was lower in DM rats than that in non-DM rats (P < 0.05) with the x-intercept of the line similar between the two groups. The slope of the flow-pressure relationship was decreased in DM rats group treated with olmesartan (P < 0.05). Moreover, olmesartan significantly increased the slope of the pressure-GFR relationship in DM rats (P < 0.05). The x-intercept of the pressure-GFR relationship reduced following olmesartan in DM rats.</p><p><b>CONCLUSIONS</b>Treatment with olmesartan reduced urinary protein-to-creatinine ratio independent of blood glucose and increased average renal vessel lumen diameter in the perfused kidneys of STZ-induced DM rats, predominantly in preglomerular vessels, and then improved renal excretory capability. These findings were consistent with remodeling of the preglomerular vasculature in our hisological measurements.</p>


Subject(s)
Animals , Male , Rats , Angiotensin II Type 1 Receptor Blockers , Therapeutic Uses , Blood Glucose , Diabetes Mellitus, Experimental , Drug Therapy , Metabolism , Diabetic Nephropathies , Drug Therapy , Hemodynamics , Imidazoles , Kidney , Metabolism , Pathology , Organ Size , Rats, Wistar , Tetrazoles
7.
Chinese Medical Journal ; (24): 3693-3701, 2011.
Article in English | WPRIM | ID: wpr-273990

ABSTRACT

<p><b>BACKGROUND</b>Endogenous hydrogen sulfide (H(2)S) plays an important role in hypertension. The aim of this study was to investigate the role of erythrocyte and serum H(2)S in patients with untreated essential hypertension.</p><p><b>METHODS</b>We recruited 62 patients (age 22 - 74 years) with untreated prehypertension or hypertension, and 64 normotensive subjects (age 18 - 64 years). We assessed the 3-mercaptopyruvate sulphurtransferase (MPST) protein expression in erythrocytes and measured the H(2)S production from erythrocytes and serum H(2)S levels, then analyzed the association of erythrocytic or serum H(2)S content and blood pressure or cardiovascular risk factors (e.g., age, body mass index (BMI) and dyslipidemia). A stepwise regression analysis was used to evaluate the possible relationship of erythrocytic H(2)S in hypertension.</p><p><b>RESULTS</b>In hypertensive patients, erythrocyte H(2)S production ((111.04 ± 29.20) nmol/min per 10(8) erythrocytes) was higher than that in controls ((78.85 ± 19.38) nmol/min per 10(8) erythrocytes), and serum H(2)S was also higher. The erythrocytic H(2)S production was associated with increased systolic blood pressure (sBP), diastolic blood pressure (dBP), age, BMI, level of C-reactive protein (CRP), as well as triglycerides (TG) and high density lipoprotein cholesterol (HDL-C). Serum H(2)S was not associated with age or CRP. Stepwise regression analysis showed that erythrocytic H(2)S production was correlated with sBP, TG, HDL-C, low density lipoprotein cholesterol (LDL-C) and blood urea nitrogen (BUN) and serum H(2)S was correlated with dBP and TG. Results of receiver-operating characteristic curve analysis suggested that erythrocytic H(2)S production was a more sensitive predictor of hypertension development than serum H(2)S.</p><p><b>CONCLUSION</b>Erythrocytic or serum H(2)S production is sensitive predictor of hypertension.</p>


Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Erythrocytes , Metabolism , Hydrogen Sulfide , Blood , Hypertension , Blood , Metabolism
8.
Article in Chinese | WPRIM | ID: wpr-343967

ABSTRACT

<p><b>OBJECTIVE</b>To evaluate the effect of Xinkeshu Tablet (XKS) on heart rate variability (HRV) in patients with coronary heart disease (CHD).</p><p><b>METHODS</b>Sixty patients with their diagnosis of CHD confirmed by coronary angiography were randomized into two groups equally. Besides the conventional treatment for CHD, XKS and Metoprolol were given respectively to patients in the treated group and the control group for 8 weeks. Symptoms and 24 h dynamic ECG were observed before and after treatment.</p><p><b>RESULTS</b>Episode of angina pectoris decreased obviously in both groups after treatment, from 8.8 +/- 3.2 times per week (the same hereafter) to 4.4 +/- 2.1 in the treated group (P<0.05), and from 8.4 +/- 3.1 to 3.9 +/- 2.0 in the control group (P <0.05). HRV analysis showed that after treatment the average heart rate lowered from 85.44 +/- 2.89 beat/min to 77.32 +/- 2.17 beat/min in the treated group and from 83.80 +/- 4.30 beat/min to 76.70 +/- 2.93 beat/min in the control group (both P < 0.05), showing no significant difference in extent of lowering between groups (P > 0.05). The time-domain indexes elevated in both groups, showing no statistical difference between groups (P >0.05). As for the frequency-domain indexes, low frequency (LF), high frequency (HF) and total power raised, while LF/HF and very low frequency lowered in both groups, but the changes were more significant in the treated group (P <0.05).</p><p><b>CONCLUSION</b>XKS could improve HRV in patients of CHD and reduce the episode of angina pectoris in them.</p>


Subject(s)
Humans , Cardiovascular Agents , Pharmacology , Therapeutic Uses , Coronary Disease , Drug Therapy , Depression, Chemical , Drugs, Chinese Herbal , Pharmacology , Therapeutic Uses , Heart Rate
9.
Article in Chinese | WPRIM | ID: wpr-685924

ABSTRACT

Objective To compare the prevalence rate of metabolic syndrome(MS)using the criteria of Chi- nese Diabetes Society(CDS)or International Diabetes Federation(IDF)in hypertension patients in China.Methods The prevalence of MS in hypertension patients(n=17861)in China and its relations with age,gender and levels of blood pressure were studied.Results 1)the prevalence of MS in hypertension patients was 42.2 % or 46.3 %,ac- cording to the definition of CDS or of IDF.The diagnostic rate of the definition of IDF was higher(P80 years group,the diagnostic rate by IDF definition was slightly but significantly higher in all ages groups(P0.05),on contrary,the female prevalence was increased while the male prevalence decreased by IDF. The prevalence of MS increased with levels of blood pressure by both definition.4)The prevalence rate was in- creased with the elevation of BP,compare with CDS criteria the diagnostic rate of MS was slightly higher by IDF cri- teria in all levels of BP.Conclusion Compared with the definition of CDS,the diagnostic rate of MS by the defini- tion of IDF was higher in hypertension patients,addressing more aggressively control global risk factors.

10.
Chinese Journal of Cardiology ; (12): 810-813, 2007.
Article in Chinese | WPRIM | ID: wpr-307194

ABSTRACT

<p><b>OBJECTIVE</b>To evaluate the clinical characteristics and therapy conditions in hospitalized patients with essential hypertension in Beijing.</p><p><b>METHODS</b>Patients with essential hypertension hospitalized in 20 Beijing hospitals in recent 2 years were included in this epidemiologic retrospective survey. Data on age, blood pressure level, risk factors and complicated diseases, antihypertensive medication and heart structural and functional characteristics measured by echocardiography were collected.</p><p><b>RESULTS</b>Total 5106 hospitalized patients (mean age 63.78 years) with essential hypertension were recorded. Mean blood pressure was 145.97/84.23 mm Hg (1 mm Hg = 0.133 kPa). Among them, 75.5% complicated with at least one risk factor, 30% suffered from heart failure. The atria enlargement and left ventricular diastolic dysfunction were the two most common echocardiographic pathological changes. Left ventricular hypertrophy is positively correlated with blood pressure. Logistic regression analysis showed that increased systolic blood pressure, diastolic blood pressure and plasma creatinine, old age and decreased HDL-cholesterol were risk factors of left ventricular hypertrophy. Only 32.1% patients achieved the goal blood pressure level (<140/90 mm Hg) and 38.1% patients were treated with monotherapy. The most commonly used antihypertensive drugs were calcium channel blockers and diuretics.</p><p><b>CONCLUSIONS</b>It is of importance to strictly follow the therapy guidelines on hypertension treatment and use combined drug therapy to increase the rate of patients reaching goal blood pressure level and reduce hypertensive complications.</p>


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Blood Pressure , China , Epidemiology , Hypertension , Epidemiology , Therapeutics , Hypertrophy, Left Ventricular , Epidemiology , Retrospective Studies , Risk Factors
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