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Apparent mineralocorticoid excess (AME) is an autosomal recessive inheritance caused by 11β－hydroxysteroid dehydrogenase 2 gene mutation.It may occur in newborn and adult.AME was first reported in 1977 by Werder et al.Its clinical features include hyporenin type hypertension , hypoaldosteronemia, metabolic alkalosis, hypernatremia and hypokalemia.In recent years,with the improvement of clinical diagnosis ,especially gene detection , AME has been reported one after another.In this paper,the pathogenesis,clinical manifestation ,diagnosis and therapy of AME were reviewed in order to improve the understanding of this disease and provide reference for its clinical diagnosis and treatment.
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Objective:To explore value of vector flow mapping (VFM) technique in quantitative determination of left ventricular flow energy loss (LVFEL) in different phases and segments in hypertensive patients.Methods:A total of 130 hypertensive patients treated in our hospital from Jan 2014 to Jan 2017 were enrolled as hypertension group.Another 130 healthy subjects undergoing physical examination simultaneously were enrolled as healthy control group.According to clinical pattern,hypertension group was further divided into normal structure group (NS group,n＝40),concentric remodeling group (CR group,n＝ 56) and concentric hypertrophy group (CH group,n＝34).LVFEL of different phases and segments were measured and compared by VFM technique among all groups.Re-sults:LVFELs of different phases and segments in hypertension group were significantly higher than those of health-y control group,P＝0.001 all.Compared with NS group,there were significant rise in [ (15.10 ± 1.22) N·m-1· s-1vs.(17.94 ± 1.28) N·m-1·s-1vs.(16.76 ± 1.24) N·m-1·s-1] in CR group and CH group,and that of CR group was significantly higher than that of CH group,P＝0.001 all;compared with NS group and CH group,there was significant rise in middle segment flow EL [ (8.10 ± 1.20) N· m-1·s-1,(8.22 ± 1.18) N· m-1· s-1vs.(8.94 ± 1.16) N· m-1·s-1] in CR group,P＜ 0.01 all;apical segment flow EL of CH group was significantly higher than that of NS group [ (4.59 ± 1.07) N·m-1·s-1vs.(3.91 ± 1.09) N·m-1·s-1],P＝0.006;mid-di-astolic flow EL of CR group was significantly higher than that of NS group [ (8.87 ± 1.03) N·m-1·s-1vs.(8.25 ± 1.05) N·m-1·s-1],P＝0.006.Conclusion:Vector flow mapping technique can accurately and quantitatively determine LVFEL in different phases and segments in hypertensive patients,which provides reliable evidence for early revealing hemodynamic changes.
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Objective:To study influence of nifedipine combined metoprolol sustained release tablets on blood pressure and heart rate in hypertensive patients with coronary heart disease (CHD).Methods:A total of 120 hypertensive patients with CHD were selected,randomly and equally divided into nifedipine group (n＝60,received nifedipine monotherapy) and combined treatment group (n＝60,received nifedipine combined metoprolol ),both groups were treated for 12 weeks.Blood pressure,heart rate and indexes of heart rate variability (HRV) were measured and compared between two groups.Results:Compared with before treatment,after treatment,there were significant reductions in 24h mean heart rate (24h HR AV) and mean arterial pressure (MAP),P＝0.001 both,and significant rise in standard deviation of normal to normal RR intervals calculated over the 24h period (SDNN),standard devia-tion of normal to normal RR intervals in all 5min segments of the entire recording (SDANN),root-mean square of differences between successive normal to normal intervals (rMSSD) and adjacent normal RR interval difference ＞50ms stroke accounted for a percentage of 24h total RR interval (PNN50) in two groups,P＜ 0.05 or ＜ 0.01.Compared with nifedipine group after treatment,there were significant reductions in 24hmHR [ (69.24 ± 10.67) beats/min vs.(64.08 ± 8.94) beats/min] and MAP [ (98.06 ± 5.18) mmHg vs.(92.64 ± 4.43) mmHg,P＜0.01 all],and significant rise in SDNN [ (113.89 ± 20.93) ms vs.(124.57 ± 25.34) ms,P＜0.05],SDANN [ (108.31 ± 20.26) ms vs.(119.29 ± 19.37) ms,P＝0.001],rMSSD [ (29.67 ± 11.92) ms vs.(36.23 ± 12.34) ms,P＝0.001] and PNN50 [ (11.25 ± 4.03)% vs.(15.37 ± 4.82)%,P＝0.001] in combined treatment group.There was no significant difference in total effective rate between two groups,P＝ 0.272.Conclusion:Nifedipine combined Metoprolol sustained release tablets possesses significant therapeutic effect on hypertensive patients with CHD.It can effectively control heart rate and blood pressure,and contribute to improving HRV and prognosis,which is worth extending.
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Objective:To study influence of amlodipine combined enalapril antihypertensive therapy on renal function in aged patients with essential hypertension (EH) complicated coronary heart disease (CHD).Methods:A total of 120 aged EH + CHD patients in our hospital from Feb 2014 to Apr 2016 were enrolled.Patients were randomly and equally divided into amlodipine group,enalapril group and combined treatment group (received amlodipine com-bined enalapril treatment ),all groups were treated for 12 weeks.Total effective rate,standard-reaching condition of blood pressure,urinary albumin excretion rate (UAER),levels of serum creatinine (Scr),cystatin C (CysC) and blood urea nitrogen (BUN) before and after treatment,and incidence of adverse reactions were measured and com-pared among three groups.Results:There was no significant difference in total effective rate among three groups,P＝0.139.Compared with amlodipine group and enalapril group,there was significant reduction in standard-reaching time of blood pressure [ (10.84 ± 2.79) months vs.(10.75 ± 3.31) months vs.(8.20 ± 1.46) months] in com-bined treatment group,P＝0.001 all.Compared with before treatment,after 12-week treatment,there were sig-nificant reductions in UAER,levels of Scr,serum CysC and BUN in amlodipine group and combined treatment group,P＜0.05 or ＜ 0.01;compared with amlodipine group and enalapril group after 12-week treatment,there were significant reductions in UAER [(130.55 ± 12.72) μg/min vs.(135.63 ± 17.64) μg/min vs.(112.25 ± 13.34) μg/min],levels of Scr [ (79.32 ± 6.13) μmol/L vs.(80.25 ± 5.97) μmol/L vs.(68.04 ± 5.56) μmol/L],serum CysC [ (1.14 ± 0.23) mg/L vs.(1.21 ± 0.26) mg/L vs.(0.76 ± 0.17) mg/L] and BUN [ (5.16 ± 1.13) mmol/L vs.(5.79 ± 1.03) mmol/L vs.(4.23 ± 0.56) mmol/L] in combined treatment group,and BUN level of amlodip-ine group was significantly lower than that of enalapril group,P＜0.05 or ＜0.01.There was no significant differ-ence in incidence rate of adverse reactions during treatment among three groups,P＝0.757.Conclusion:Small dose amlodipine combined enalapril is effective on controlling blood pressure in aged EH + CHD patients.Compared with monotherapy,it possesses better protection on renal function with high safety,which is worth extending.
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Objective:To explore safety of benapril combined amlodipine on hypertension and its influence on levels of plasm total cholesterol (TC) and triglyceride (TG).Methods:A total of 180 hypertensive patients treated in our hospital were selected,randomly and equally divided into amlodipine group and combined treatment group (received amlodipine combined benapril therapy ),both groups were continuously treated for one month.Therapeutic outcome and incidence of adverse reactions were compared between two groups.Results:After treatment,compared with amlo-dipine group,there were significant reductions in systolic blood pressure [(146.3 ± 11.9) mmHg vs.(133.4 ± 15.1) mm-Hg],diastolic blood pressure [(90.5 ± 5.9) mmHg vs.(81.4 ± 6.1) mmHg],heart rate [(85.4 ± 10.8) beats/min vs.(74.5 ± 12.6) beats/min],levels of plasm TC [(5.17 ± 1.75) mmol vs.(3.52 ± 1.85) mmol] and TG[(1.64 ± 0.14) mmol vs.(1.32 ± 0.32) mmol] in combined treatment group,P＝0.001 all.Total incidence rate of adverse reactions of combined treatment group was significantly lower than that of amlodipine group (3.3% vs.15.6%,P＝0.005).Conclu-sion:Benapril combined amlodipine can significantly reduce heart rate,blood pressure and levels of plasm total cholesterol and triglyceride in hypertensive patients.It＇s safe and effective,which is worth extending.
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Objective:To explore effect of walking on rehabilitation in aged patients with hypertension complicated anxiety.Methods:A total of 160 aged patients with hypertension complicated anxiety were enrolled,randomly divided into medica-tion group (n＝80,received routine medication ) and exercise group (n＝80,received walking exercise based on routine medication),both groups were treated for four months.Carotid intima-media thickness (IMT) and ZUNG self-rating anxi-ety scale (SAS) score before and after treatment,incidence rate of cardiovascular events after one-year follow-up were compared between two groups.Results:Compared with before treatment,there were significant reductions in IMT and SAS score in two groups after treatment,P＝0.001 all;compared with medication group after treatment,there were significant reductions in IMT [ (1.05 ± 0.26) mm vs.(0.90 ± 0.46) mm] and SAS [ (38.07 ± 0.25) scores vs.(23.02 ± 0.46) scores] in exercise group,P＜0.01 both.During one-year follow-up,total incidence rate of cardiovascular events in exer-cise group was significantly lower than that of medication group (30.67% vs.69.74%,P＝0.001).Conclusion:Walking helps to improve anxiety,reduce incidence of adverse cardiovascular events in aged patients with hypertension complicated anxiety.It’ s safe and reliable,which is worth extending.
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Objective To investigate the effect of calcium supplementation during pregnancy on clinical symptoms,the incidence of gestational hypertension and childbirth labor. Methods A set of pregnant women in the same season and the same gestation age(20 weeks later) with the age of 20?35 years old in Maternal and Child Health Care Hospital of Haidian District of Beijing were selected as research subjects,according to its cal?cium circumstances,divided into calcium group with 220 cases,who took 600 mg calcium every day from 20 week of pregnancy to delivery,and control group with 192 cases who didn't supplement calcium or supplement calcium but not regular or amount was not up to standard. The serum calcium of 20 weeks and 36 weeks of pregnancy were measured,the incidence of calcium deficiency symptoms during pregnancy, the incidence of hypertension during pregnancy,the termination of pregnancy and the labor time were observed. Results The incidence of lumbar and sacral pain,gastrocnemius muscle spasm and calcium deficiency symptoms accompanied with diffi?culty walking of calcium group were 21. 4%( 47/220) ,6. 8%( 15/220) and 1. 4%( 3/220) ,significantly lower than the control group(53. 1%(102/192),20. 8%(40/192) and 4. 7%(9/192)),the differences were signifi?cant(χ2=44. 62,17. 40,3. 92;P0. 05) . Conclusion Cal?cium supplementation during pregnancy helps reduce system hypocalcemia symptoms, reduce the incidence of gestational hypertension,but have no effect on pregnancy outcome.
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Aim To investigate the modulation effects of NaHS on arterial vasodilatation functions of renal hy-pertensive rats .Methods Two-kidney , one-c lip ( 2K1C ) renovascular hypertension was induced .Rats were randomly divided into four group:sham group , two-kidney one-clip model ( 2K1C ) group, 2KIC +NaSH( H2 S donor ) group, PPG group.The systolic blood pressure ( SBP ) was measured before the opera-tion and each week after the operation .The carotid ar-tery was collected for morphometric parameters ( outer radius, wall thickness, the radio of wall thickness to outer radius) and the tension of the carotid artery was observed with the isolated artery ring technique .Immu-nohistochemistry was used to determine the protein ex-pression of eNOS , ET-1 protein in carotid artery .Re-sults The blood pressure of 2K1C group and PPG group was higher than that of sham group ( P<0.05) . Compared with 2K1C group,the blood pressure and the rat arteria carotis communis of the radio of wall thick-ness to outer radius of 2K1C+NaHS group decreased significantly , while the relaxation of carotid artery to ACh in NaHS group increased .According to the immu-nohistochemistry results , eNOS expression was upregu-lated while ET-1 was downregulated in 2K1C +NaHS group as compared with 2K1C group.Conclusions Chronical administration of NaHS can decrease blood pressure in renovasocular hypertensive rats .The anti-hypertensive effect of H 2 S maybe associated with im-provement of the arterial functions .
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Aim To investigate the effects of saponin of sea cucumber ( SSC ) on the blood pressure in obese mice. Methods C57BL/KsJ(db/db) mice were ran-domized into 3 groups ( 8 mice each ): model group, low-dose SSC group and high-dose SSC group. Normal C57BL/KsJ mice were used as control. The low and high SSC groups were fed on basal diets incorporated with 0. 02% and 0. 04% SSC. Different treatments were administered for 6 weeks and arterial pressure was measured in the third and sixth weeks. The abundance of renal ACE, ACE2 and REN mRNA was detected by real time PCR . Results Compared with control group, the blood pressure of model group mice was ob-viously raised ( P<0. 01 ) . Low-dose SSC group mice showed lower blood pressure than model group without statistically significant differences, and the blood pres-sure of high-dose SSC group mice was similar to that of control group and significantly lower than model group. ( P<0. 05 ) There were no remarkable differences a-bout ACE and REN mRNA among the groups, howev-er, ACE2 mRNA level was significantly increased in high-dose SSC group. Conclusion SSC plays a vital role in decreasing blood pressure, which probably re-lates to the regulating function of renin-angiotensin sys-tem( RAS) .
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OBJECTIVE:To explore the safety,superiority and reliability of the application of dexmedetomidine-assisted con-trolled anti-hypertension combined with high capacity hemodilution in spinal surgeries. METHODS:40 patients with spinal surger-ies under general anesthesia were randomly divided into dexmedetomidine group (group D) and normal saline (group S) with 20 cases in each group. Both groups were given controlled anti-hypertension combined with high capacity hemodilution to carry out blood conservation and intraoperative wakeup experiment. Group D was given 1 μg/kg dexmedetomidine within 10 min by micro pump 10 min before anesthesia induction;maintained with 0.4-0.8 μg/(kg·h)during controlled anti-hypertension;injected with dex-medetomidine 0.2 μg/(kg·h) during wakeup experiment and anesthesia maintenance period until tracheal catheter was extracted. Group S was given normal saline instead,and the usage was same as group D. Heart rate (HR),mean arterial pressure (MAP) and central venous pressure(CVP)of patients were observed and recorded before pump injection of dexmedetomidine(T0),1 min after tracheal intubation(T1),10 min after anesthesia induction(T2),30 min after anesthesia induction(T3),wakeup(T4),at the end of controlled anti-hypertension(T5),at the end of operation(T6),during tracheal extubation(T7). Meanwhile,the wakeup ex-periment time,blood loss when wakeup,total amount of nitroglycerin,mean density of inhaled isoflurane,total amount of nitro-glycerin,total blood loss,and post-operative wakeup time of both groups were recorded. The case number of post-operative de-layed wakeup chill and dysphoria were calculated in both groups. RESULTS:Compared with at T0,HR of both groups at T1 and T7 were faster,and MAP and CVP increased,and that of group S was more significant than that of group D(P<0.05). HR and MAP of both groups at T3 were significantly lower than T0(P<0.05). Compared to group D at T4,MAP and CVP of group S at T4 were increased and HR were faster (P<0.05);the wakeup experiment time and post-operative wakeup time of group D were shorter than those of group S (P<0.05);the blood loss when awaken and total blood loss were less than group S (P<0.05);the total amount of nitroglycerin,mean density of inhaled isoflurane and total amount of remifentanil were all lower than those of group S (P<0.05);the incidence of post-operative delayed wakeup,chill and dysphoria in group D were significantly lower than those of group S (P<0.05). CONCLUSIONS:The application of dexmedetomidine-assisted controlled anti-hypertension combined with high capacity hemodilution in spinal surgeries can bring more stable and effective controlled anti-hypertension. It can also reduce the amount of nitroglycerin,remifentanil,propofol and isoflurane significantly. It is a reliable and safe drug to be applied in assist-ed controlled anti-hypertension combined with high capacity hemodilution in spinal surgeries.
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Protein disulfide isomerase (PDI) is one of thiol-disulfide oxidoreductases that mainly located in the endo?plasmic reticulum (ER). It is generally known that PDI caralyzes the formation,rearrangement,breakage of disulfide bonds, and this enzyme is effective in regulation of protein folding. Now it is also known as a biomarker of cardiovascular disease. Protein disulfide isomerase can reduce infarct size and myocardial apoptosis in acute myocardial infarction (AMI). PDI can also improve changes of cardiac vulnerability in diabetic cardiomyopathy (DCM). Further more, it is also shown that PDI play an important role in hypertension and thrombosis. Therefore, this paper review the effects of protein disulfide isomerase in cardiovascular diseases.
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Aim To evaluate the time-course curve of expression of TRPC1 and vascular tone of pulmonary arteries(PAs)mediated by SOCE in chronic hypoxia pulmonary hyperte-nsion rats.Methods Both tension of PA rings and expression of TRPC1 were tested in CH exposure (1 0.0 % ±0.5 %partialpressure ofoxygen ) induced pulmonary hypertensive (PH)rats,and the time-course curve(detected respectively in CH 1 ,3,5, 7,1 4,21 d)was traced.Results ①CH could up-regulate the mean right ventricular pressure(mRVSP) ,which was increased significantly on 1 d,and reached the maximum on 7d;right ventricular weight index (RV-MI)began increase on 3d,and kept rising;②semi-quantitative reverse transcription polyme-rase chain reaction (RT-PCR)was performed to detect the expression of TRPC1 in PAs.The expression of TRPC1 increased significantly on 1 d,and reached the maxi-mum on 3d;③CH could up-regulate the vascular tone of PAs mediated by SOCE,which was increased signif-icantly on 3d,and reached the maximum on 7d.Con-clusions TRPC1 /SOCE increases significantly in the early days of CH,and the time-course curve of the two has correlation,which reflects the important role of the upregulation of TRPC1 /SOCE in the process of chronic hypoxia pulmonary hypertension.
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Aim To investigate the effect of angioten-sin 1-7 (Ang 1-7 )on the cardiac hypertrophy and my-ocardial fibrosis in deoxycorticosterone acetate (DOCA)-salt hypertensive rats and its possible mecha-nism.Methods Male Sprague-Dawley rats were used to establish DOCA-salt hypertensive model,which un-derwent uninephrectomy surgery and were subcutane-ously injected with a DOCA,and replaced drinking water with 1% saline solution for 4 weeks.DOCA-salt animals were implanted with osmotic minipumps, which delivered Ang 1-7 chronically for 4 weeks (200 ng ·kg-1 ·min-1 ).Arterial blood pressure,left ven-tricular function in rats,the area of myocardial cells in HE stained specimens,and the area of myocardial fi-brosis Sirius red staining specimens were measured. Real time PCR was used to detect the expression of at-rial natriuretic factor (ANF ) and β-myosin heavy chain (β-MHC)mRNA in heart,and TGF-β1 protein expression was observed by Western blot in myocardial tissue.Results In the first week,DOCA salt rat had a significant increase in arterial blood pressure,and reached a peak in the fourth week;while the left ven-tricular end-systolic pressure (LVESP),left ventricu-lar end-diastolic pressure (LVEDP ) and ventricular contraction the maximum rate of pressure rise (+dp/dt)had also undergone significant changes in DOCA salt rats. After chronic infusion of Ang 1-7 for 4 weeks,the arterial pressure,LVESP and LVEDP were significantly reduced and +dp/dt were increased sig-nificantly in DOCA salt rats (P<0.05 ,n=7 ).Ang 1-7 significantly reduced the cardiac index and myocar-dial cell area,as well as the up-regulated expression of ANF and β-MHC mRNA in DOCA salt rats (P <0.05 ,n =7 ).Meanwhile,Ang 1-7 also significantly decreased the perivascular fibrosis and interstitial fibro-sis area, and significantly inhibited the increase of TGF-β1 expression in DOCA salt rats (P<0.05 ,n=7 ).Conclusion These results indicate that Ang 1-7 has a cardioprotective effects through reducing arterial pressure and improving cardiac fibrosis and hypertro-phy in the DOCA-salt model of hypertension.
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Objetivo: Determinar factores asociados al síndrome metabólico, tomando como base la población de personas entrevistadas durante la feria de la salud efectuada en el Hospital México, febrero del 2007. Materiales y Métodos: Estudio transversal y analítico. Se entrevistó a 285 personas durante la feria de la salud del Hospital México del 19 a 22 de febrero del 2007. Se efectuó un análisis univariado y multivariado de las principales variables registradas para determinar factores asociados al síndrome metabólico. Resultados: La provincia de San José presentó el mayor porcentaje de entrevistados con un 40.7 por ciento, 116/285, seguido por Heredia con un 26.0 por ciento, 76/285, y Alajuela con un 24.9 por ciento, 71/285, mientras que la provincia de Limón aportó solamente un 0.4 por ciento, 1/285. La mayoría de los entrevistados son costarricenses con un 94.0 por ciento, 268/285, además, las mujeres predominaron con un 72.6 por ciento, 207/285. El análisis univariado y multivariado muestra asociación entre la presión arterial, OR: 4.7, IC95 por ciento 3.5-5.8, p<0.01, la glicemia, OR: 3.4, IC95 por ciento 2.1-4.5, p< 0.01, y el índice de masa corporal, OR: 3.3, IC95 por ciento 2.0-4.0, p<0.01, respecto al síndrome metabólico. Conclusión: La presión arterial, la glicemia y el índice de masa corporal deben ser tomados en cuenta como parte de los factores asociados al síndrome metabólico.
Objective: to determine the prevalence of risk factors associated with metabolic syndrome in a population interviewed during a health fair carried out at the Hospital México during February, 2007.Materials and Methods: this was a cross-sectional, analytical study; 285 people were interviewed during the health fair which took place at Hospital México from February the 19th through the 22nd, 2007. A univariate as well as a multivariate statistical analysis were carried out on the main variables identified as risk factors associated with the metabolic syndrome. Results: the provinces with the highest percentages of subjects were San José with 40,7% (116 out of 285), followed by Heredia with 26,0% (76 out of 285) and Alajuela with 24,9% (71 out of 285) while Limón province had only 0,4% of the subjects (one out of 285.) The large majority of the subjects were Costa Rican: 94,0 % (268 out of 285); in addition, women constituted a majority with 72,6% of the sample (207 out of 285.) A univariate as well as multivariate statistical analysis showed an association between blood pressure (odds ratio: 4,7 with a 95% confidence interval between 3,5 and 5,8 and a p value less than 0,01), blood glucose (odds ratio: 3,4 with a 95% confidence interval between 2,1 and 4,5 and a p value also less than 0,01) and, finally, body mass index (odds ratio: 3,3 with a 95% confidence interval between 2,0 and 4,0 and a p value less than 0,01) and the metabolic syndrome. Conclusion: blood pressure, blood glucose and body-mass index must be considered as risk factors for the metabolic syndrome.