Blood Pressure最新文献_第7页

Electrocardiographic left ventricular hypertrophy in relation to peripheral and central blood pressure indices in a Nigerian population 尼日利亚人群心电图左心室肥大与外周和中心血压指数的关系

IF 1.8 4区医学 Q3 Medicine

Blood Pressure

Pub Date : 2019-07-27 DOI: 10.1080/08037051.2019.1646610

A. Odili, B. Chori, B. Danladi, Wen‐Yi Yang, Zhenyu Zhang, L. Thijs, F. Wei, T. Nawrot, T. Kuznetsova, J. Staessen

Abstract Purpose: Previous studies that addressed whether left ventricular hypertrophy is more closely associated with central than peripheral blood pressure (BP) have been inconsistent. Radial artery wave generated by applanation tonometry and calibrated with brachial BP in 162 adult Nigerians were analysed by using generalized transfer function to derive central BP. Materials and methods: We compared the associations of ECG voltages and left ventricular hypertrophy (ECG-LVH) as continuous and binary variables respectively with central and brachial BP indices. Results: In a multivariable adjusted analysis, 1 standard deviation (SD) increase in brachial systolic, diastolic, pulse and mean arterial pressures increased the Sokolow–Lyon QRS voltage by 0.34 (CI, 0.21–0.48; p < 0.0001), 0.21 (CI, 0.07–0.36; p < 0.05); 0.22 (CI, 0.9–0.34; p < 0.001) and 0.29 (CI, 0.14–0.43) similar to (p > 0.05) corresponding Sokolow–Lyon QRS increase of 0.26 (0.12–0.40, p < 0.001); 0.14 (0.00–0.28, p < 0.05); 0.24 (0.11–0.39; p < 0.001) and 0.19 (0.05–0.34, p < 0.05) respectively observed for 1 SD increment in central pressures. The odds ratio (OR) relating ECG-LVH to 1 SD increase in brachial systolic, pulse, and mean arterial pressures were 2.62 (CI, 1.49–4.65, p < 0.001); 1.88 (CI, 1.19–2.95, p < 0.01) and 2.16 (CI, 1.22–3.82, p < 0.01) was similar to (p > 0.05) corresponding OR of 2.41 (1.33–4.36, p < 0.01); 2.04 (1.23–3.37, p < 0.01); 2.00 (1.11–3.63, p < 0.001) observed for I SD increment in central pressures. Conclusion: Central and peripheral BP are similarly associated with Sokolow–Lyon ECG voltage and hypertrophy.

摘要:目的:关于左心室肥厚与中央血压(BP)的关系是否比周围血压(BP)更密切的先前研究并不一致。本文采用广义传递函数推导中心血压，分析了162例尼日利亚成年人由压平血压计产生的桡动脉波，并与肱血压校准。材料和方法:我们将心电图电压和左心室肥厚(ECG- lvh)作为连续变量和二元变量分别与中央和肱BP指数进行比较。结果:在一项多变量调整分析中，臂膀收缩压、舒张压、脉搏压和平均动脉压每增加1个标准差(SD)， Sokolow-Lyon QRS电压增加0.34 (CI, 0.21-0.48;Sokolow-Lyon QRS相应增加0.26 (0.12-0.40,p 0.05)， OR相应增加2.41 (1.33-4.36,p < 0.01);2.04 (1.23 ~ 3.37, p < 0.01);2.00 (1.11-3.63, p < 0.001)。结论:中枢性和外周性血压与Sokolow-Lyon心电图电压和肥厚相似。

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引用次数: 2

The impact of pulsed electromagnetic field therapy on blood pressure and circulating nitric oxide levels: a double blind, randomized study in subjects with metabolic syndrome 脉冲电磁场治疗对血压和循环一氧化氮水平的影响:代谢综合征患者的双盲随机研究

IF 1.8 4区医学 Q3 Medicine

Blood Pressure

Pub Date : 2019-06-01 DOI: 10.1080/08037051.2019.1649591

Chul-Ho Kim, C. Wheatley-Guy, G. Stewart, Dongwook Yeo, W. Shen, Bruce D. Johnson

Abstract Purpose: Regulation of blood pressure (BP) is important in reducing the risk for cardiovascular disease. There is growing interest in non-pharmacological methods to treat BP including a novel approach using pulsed electromagnetic field therapy (PEMF). PEMF therapy has been proposed to impact physiological function at the cellular and tissue level and one possible mechanism is through an impact on endothelial function and nitric oxide (NO) related pathways. The focus of the present study was to evaluate the effect of PEMF on BP and NO in subjects with mild to moderate metabolic syndrome. Materials and methods: For 12 weeks, 23 subjects underwent PEMF therapy and 21 subjects underwent sham therapy. BP was measured at rest and near the end of submaximal exercise pre- and 12 week post-therapy. Additionally, plasma NO was measured at similar time points. Results: The PEMF demonstrated an increase in NO after therapy (p = .04) but SHAM did not (p = .37). For resting BP, there were no differences in systolic BP (SBP), diastolic BP (DBP) or mean arterial pressure (MAP) between groups (p > .05). During exercise, PEMF had a reduction in peak SBP (p = .04), but not SHAM (p = .57). PEMF demonstrated significant relationships between baseline SBP and change in SBP following therapy (r = −0.71, p < .01) and between MAP and change in MAP following therapy (r = −0.60, p < .01), but no such relationships were found in SHAM. Subjects with resting hypertension (SBP ≥140 mmHg) in PEMF (n = 11) had significant reductions in SBP, DBP and MAP when compared to SHAM with hypertension (n = 9) (p < .05). In this sub-group analysis, PEMF demonstrated lowered peak SBP (p = .04) at a given exercise load (p = .40) but SHAM did not (p > .05). Conclusion: PEMF may increase plasma NO availability and improve BP at rest and during exercise. However, this beneficial effect appears to be more pronounced in subjects with existing hypertension.

目的:调节血压对降低心血管疾病风险具有重要意义。人们对治疗BP的非药物方法越来越感兴趣，其中包括使用脉冲电磁场疗法(PEMF)的新方法。PEMF治疗已被提出在细胞和组织水平上影响生理功能，其中一种可能的机制是通过影响内皮功能和一氧化氮(NO)相关途径。本研究的重点是评价PEMF对轻中度代谢综合征患者血压和一氧化氮的影响。材料与方法:为期12周，23例接受脉冲电磁场治疗，21例接受假治疗。在治疗前和治疗后12周的休息和亚极限运动结束时测量血压。此外，在相同时间点测量血浆NO。结果:PEMF组治疗后NO升高(p = 0.04)， SHAM组无升高(p = 0.37)。静息血压组间收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)差异无统计学意义(p < 0.05)。在运动期间，PEMF降低了收缩压峰值(p = 0.04)，但SHAM没有(p = 0.57)。PEMF显示基线收缩压与治疗后收缩压变化之间存在显著关系(r = - 0.71, p .05)。结论:PEMF可提高静息和运动时血浆NO利用率，改善血压。然而，这种有益效果似乎在已有高血压的受试者中更为明显。

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引用次数: 13

In memoriam: Alberto Zanchetti 为了纪念阿尔贝托·赞切蒂

IF 1.8 4区医学 Q3 Medicine

Blood Pressure

Pub Date : 2018-04-26 DOI: 10.1080/08037051.2018.1464383

Sverre E. Kjeldsen, Krzysztof Narkiewicz, Michel Burnier, Suzanne Oparil

引用次数: 2

Re: “Polymorphisms of three genes (ACE, AGT and CYP11B2) in the renin–angiotensin–aldosterone system are not associated with blood pressure salt sensitivity: a systematic meta-analysis” Re:“肾素-血管紧张素-醛固酮系统中三个基因（ACE、AGT和CYP11B2）的多态性与血压盐敏感性无关：一项系统荟萃分析”

IF 1.8 4区医学 Q3 Medicine

Blood Pressure

Pub Date : 2017-07-04 DOI: 10.1080/08037051.2016.1270164

Justine R. Horne, C. O'connor, J. Madill, Sylvia Rinaldi, J. Gilliland

We read with interest the article recently published in Blood Pressure by J. Sun and colleagues.[1] The authors conducted a meta-analysis of the literature investigating genetic variations in ACE (I/D), AGT (M235T) and CYP11B2 (C344T) with salt-sensitive hypertension. According to the title and conclusions of the paper, the authors conclude that these genetic variants are not associated with salt-sensitive hypertension. However, notable limitations in the design of their study preclude making this conclusion. The main limitation is that the authors did not consider other studies that examined genetic variants that are in strong linkage disequilibrium (LD) with the 3 markers of interest and they did not identify this as a limitation in their discussion. For example, ACE I/D is in complete LD with ACE rs4343 and studies that report either of these two variants are examining essentially the same variant.[2–4] Other examples include AGT (M235T) which is in strong LD with AGT A(-6)G [5] and CYP11B2 (C344T), which is in complete LD with CYP11B2 at rs28491316 [6]. Because of this oversight, the authors failed to identify several studies. One study that was omitted was completed by Iwai et al., which found an association between the C344T variant in CYP11B2, which is in complete LD with CYP11B2 rs28491316 and salt-sensitive hypertension.[6,7] To ensure that all biologically relevant studies are included in the meta-analysis, the search terms should have included SNPs that are in complete or strong (>80%) LD with the three variants of interest in order to assess all relevant literature to appropriately and adequately address the research question. Furthermore, there was no discussion detailing the reason for excluding randomized controlled trials (RCTs), or how the exclusion of such studies may have impacted the conclusion. As RCTs did not meet the inclusion criteria, several robust studies were disregarded including a randomized, double-blinded, placebocontrolled Latin-square trial, which found a significant link between salt-sensitive hypertension and the AGT gene at M235T.[8] An additional limitation is that only one study that did not meet the inclusion criteria was cited and discussed. That study also found no significant association between the three variants of interest and blood pressure salt sensitivity.[2] However, the authors failed to discuss other opposing studies, which did find that the variants of interest affected blood pressure salt sensitivity.[8] Given the main limitation of omitting highly relevant studies, which could alter the conclusions drawn, the authors should consider updating their methods and analysis to include all relevant studies.

我们饶有兴趣地阅读了孙及其同事最近发表在《血压》杂志上的文章。[1] 作者对研究ACE（I/D）、AGT（M235T）和CYP11B2（C344T）与盐敏感性高血压的遗传变异的文献进行了荟萃分析。根据论文的标题和结论，作者得出结论，这些基因变异与盐敏感性高血压无关。然而，他们的研究设计存在明显的局限性，因此无法得出这一结论。主要的局限性是，作者没有考虑其他研究，这些研究检查了与感兴趣的3个标记具有强连锁不平衡（LD）的遗传变异，他们在讨论中也没有将其确定为局限性。例如，ACE I/D与ACE rs4343处于完全LD，报告这两种变体中任何一种的研究都在检查本质上相同的变体。[2-4]其他例子包括AGT（M235T），其与AGT A（-6）G[5]处于强LD中，CYP11B2（C344T）与CYP11B2在rs28491316[6]处于完全LD中。由于这种疏忽，作者未能确定几项研究。Iwai等人完成了一项被省略的研究，该研究发现CYP11B2中的C344T变体与盐敏感性高血压之间存在关联，CYP11B2与CYP11B2 rs28491316处于完全LD。[6,7]为了确保所有生物学相关研究都包括在荟萃分析中，搜索项应包括具有感兴趣的三种变体的完全或强（>80%）LD的SNPs，以便评估所有相关文献，以适当和充分地解决研究问题。此外，没有详细讨论排除随机对照试验（RCT）的原因，也没有讨论排除此类研究可能会如何影响结论。由于随机对照试验不符合纳入标准，几项强有力的研究被忽略，包括一项随机、双盲、安慰剂对照的拉丁方试验，该试验发现盐敏感性高血压与M235T的AGT基因之间存在显著联系。[8] 另一个限制是，只引用和讨论了一项不符合纳入标准的研究。该研究还发现，感兴趣的三种变体与血压盐敏感性之间没有显著关联。[2] 然而，作者没有讨论其他相反的研究，这些研究确实发现感兴趣的变体会影响血压盐敏感性。[8] 鉴于省略高度相关的研究可能会改变得出的结论的主要局限性，作者应考虑更新他们的方法和分析，以包括所有相关的研究。

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引用次数: 1

Hypertension and functional capacities in community-dwelling older women: a cross-sectional study 社区老年妇女的高血压与功能能力：一项横断面研究

IF 1.8 4区医学 Q3 Medicine

Blood Pressure

Pub Date : 2017-05-04 DOI: 10.1080/08037051.2016.1270163

Hélio José Coelho Junior, B. Rodrigues, S. Aguiar, I. O. Gonçalves, F. Pires, R. Y. Asano, M. Uchida

Abstract Purpose: The present study aimed to investigate the association between hypertension and physical/functional capacities in community-dwelling older females. Materials and methods: Older female volunteers were dichotomized in two groups: hypertensive (n = 134) and normotensive (n = 244). Volunteers had their medical records reviewed and underwent evaluations of anthropometric data (weight, height and body mass index) and of physical and functional capacities. Results: The results showed that hypertensive older females presented higher values for age, weight, body mass index, and resting diastolic blood pressure than normotensive older females. Normotensive older females showed a higher performance in the one-leg stand test and six-minute walk test compared with hypertensive older females. Age, body mass index, maximal walking speed, performance in the Time Up and Go and six-minute walk test, and diagnosis of diabetes mellitus type II were factors associated with hypertension using the chi-square test. However, the multivariate regression analysis indicated that performance in the six-minute walk test was the only factor associated with hypertension. Conclusions: The patients with higher scores in the six-minute walk test, which is associated with aerobic capacity, show less odds to have clinical diagnosis of hypertension. However, hypertension was not associated with poor physical and functional capacity.

摘要目的：本研究旨在调查社区老年女性高血压与身体/功能能力之间的关系。材料和方法：老年女性志愿者被分为两组：高血压（n = 134）和血压正常（n = 244）。志愿者的医疗记录被审查，并接受了人体测量数据（体重、身高和体重指数）以及身体和功能能力的评估。结果：结果显示，与血压正常的老年女性相比，患有高血压的老年女性在年龄、体重、体重指数和静息舒张压方面表现出更高的值。与高血压老年女性相比，高血压老年女性在单腿站立测试和六分钟步行测试中表现出更高的表现。年龄、体重指数、最大步行速度、Time Up and Go和6分钟步行测试的表现以及卡方检验对II型糖尿病的诊断是与高血压相关的因素。然而，多元回归分析表明，6分钟步行测试的表现是与高血压相关的唯一因素。结论：在与有氧能力相关的6分钟步行测试中得分较高的患者，临床诊断为高血压的几率较小。然而，高血压与身体和功能能力差无关。

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引用次数: 15

Higher pulse pressure/stroke volume index is associated with impaired outcome in hypertensive patients with left ventricular hypertrophy the LIFE study 高脉压/卒中容量指数与左心室肥厚高血压患者预后受损相关

IF 1.8 4区医学 Q3 Medicine

Blood Pressure

Pub Date : 2017-05-04 DOI: 10.1080/08037051.2016.1243009

C. Mancusi, E. Gerdts, G. de Simone, H. Midtbø, M. T. Lønnebakken, K. Boman, K. Wachtell, B. Dahlöf, R. Devereux

Abstract We tested the prognostic impact of a marker of arterial stiffness, pulse pressure/stroke volume index (PP/SVi), in patients with hypertension and left ventricular (LV) hypertrophy. We used data from 866 patients randomized to losartan or atenolol-based antihypertensive treatment, over a median of 4.8 years, in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study. The association of PP/SVi with outcomes was tested in Cox regression analyses and reported as hazard ratio (HR) and 95% confidence intervals (CI). In multivariate regression, reduction of PP/SVi was independently associated with male gender, reduction in systolic blood pressure (BP) and relative wall thickness and with an increase in left ventricular ejection fraction (all p < .05). After adjusting for confounders, higher baseline PP/SVi predicted a 38% higher hazard of combined major fatal and non-fatal cardiovascular events (95% CI 1.04–1.84), and higher hazard of cardiovascular mortality (HR 2.35 (95% CI 1.59–3.48) and stroke (HR 1.45 (95% CI 1.06–1.99) (all p < .05). Higher PP/SVi also predicts higher rate of hospitalization for HF (HR 2.15 (95% CI 1.48–3.12) and a 52% higher hazard of all-cause mortality (95% CI 1.10–2.09) (both p < .05). In hypertensive patients with electrocardiographic LV hypertrophy, higher PP/SVi was associated with increased cardiovascular morbidity and mortality.

摘要:我们测试了动脉硬度指标脉压/脑卒中容积指数(PP/SVi)对高血压和左心室肥厚患者预后的影响。在氯沙坦干预降低高血压终点(LIFE)研究中，我们使用了866名随机接受氯沙坦或阿替洛尔为基础的抗高血压治疗的患者的数据，中位时间为4.8年。在Cox回归分析中检验了PP/SVi与结果的关联，并以风险比(HR)和95%置信区间(CI)报告。在多元回归中，PP/SVi的降低与男性、收缩压(BP)和相对壁厚的降低以及左心室射血分数的增加独立相关(均p < 0.05)。在调整混杂因素后，较高的基线PP/SVi预测合并主要致命性和非致命性心血管事件的风险增加38% (95% CI 1.04-1.84)，心血管死亡率(HR 2.35 (95% CI 1.59-3.48)和卒中(HR 1.45 (95% CI 1.06-1.99)的风险增加(均p < 0.05)。较高的PP/SVi也预示着较高的HF住院率(HR 2.15 (95% CI 1.48-3.12)和高52%的全因死亡风险(95% CI 1.10-2.09) (p均< 0.05)。在伴有心电图左室肥厚的高血压患者中，较高的PP/SVi与心血管发病率和死亡率增加相关。

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引用次数: 16

Obituary 讣闻

IF 1.8 4区医学 Q3 Medicine

Blood Pressure

Pub Date : 2017-05-04 DOI: 10.1080/08037051.2017.1280372

P. Verdecchia, G. de Simone

Professor Giuseppe Schillaci passed away peacefully on 21 December 2016 at his home in Perugia at the early age of 55, after a four-year battle against lung cancer. Giuseppe was born on 27 September 1961. He was educated at the University of Palermo, Sicily, where he graduated in Medicine and Surgery in year 1985. In year 1990 he was appointed as Specialist in Internal Medicine in that University. In the same year he moved from Sicily to Umbria and joined our staff in the Hospital of Citt a della Pieve in Umbria, Central Italy. Throughout the next ten years Giuseppe worked on several research topics related mostly to hypertension and cardiovascular disease prevention. It was very much fun working with him. Giuseppe actively contributed to build the “Progetto Ipertensione Umbria Monitoraggio Ambulatoriale” (PIUMA), a longitudinal study in initially untreated hypertensive patients who underwent 24-h ambulatory blood pressure monitoring. In year 1994, using the PIUMA database, Giuseppe ideated and developed the “Perugia score”, a new electrocardiographic score for diagnosis of left ventricular hypertrophy in hypertensive patients [1]. Several studies conducted in independent laboratories confirmed the ability of the Perugia score to improve the sensitivity of electrocardiography for detection of left ventricular hypertrophy, without depressing specificity. In a subsequent study from our group, the Perugia score showed the highest population attributable risk for major cardiovascular events when compared to traditional electrocardiographic markers of left ventricular hypertrophy [2]. Giuseppe co-authored in the same year the first pivotal study showing the prognostic value of fully automated ambulatory blood pressure monitoring in hypertensive patients [3]. He also authored the first study strongly supporting the prognostic impact of diastolic dysfunction in hypertensive patients [4]. It is impossible to pick the most influential among the many scientific contributions that Giuseppe developed over the last two decades. Our group enormously benefitted from Giuseppe’s enthusiastic, dedicated and extremely dynamic output. He had the ability to hold and finalize multiple research projects with high competence and enthusiasm. In year 1998 Giuseppe moved to the University of Perugia, where he rapidly progressed from Researcher to Associate Professor of Medicine. In year 2011 he was appointed Director of Medicine in Terni. We remained in close contact and it was nice to see his expertise evolving toward other aspects of Cardiovascular Medicine including arterial structure and physiology. Among his numerous engagements, Giuseppe served several scientific societies including the Association for Research into Arterial Structure and Physiology (ARTERY), the Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO) and the Societ a Italiana dell’Ipertensione Arteriosa (SIIA). Overall, Giuseppe authored or co-authored more than 300 full length papers, achievin

Giuseppe Schillaci教授在与癌症进行了四年的斗争后，于2016年12月21日在佩鲁贾的家中平静地去世，享年55岁。朱塞佩出生于1961年9月27日。他在西西里岛巴勒莫大学接受教育，1985年毕业于那里的医学和外科。1990年，他被任命为该大学的内科专家。同年，他从西西里岛搬到了翁布里亚，并加入了我们在意大利中部翁布里亚的Citt a della Pieve医院的工作人员。在接下来的十年里，朱塞佩从事了几个主要与高血压和心血管疾病预防有关的研究课题。和他一起工作很有趣。Giuseppe积极参与建立了“Progetto Ipertentine Umbria Monitoraggio Ambulatoriale”（PIUMA），这是一项针对最初未经治疗的高血压患者的纵向研究，这些患者接受了24小时动态血压监测。1994年，Giuseppe利用PIUMA数据库设计并开发了“Perugia评分”，这是一种用于诊断高血压患者左心室肥大的新心电图评分[1]。在独立实验室进行的几项研究证实，佩鲁贾评分能够提高心电图检测左心室肥大的敏感性，而不会降低特异性。在我们小组随后的一项研究中，与传统的左心室肥大心电图标记物相比，佩鲁贾评分显示出主要心血管事件的人群归因风险最高[2]。同年，Giuseppe与人合著了第一项关键研究，显示了全自动动态血压监测对高血压患者的预后价值[3]。他还撰写了第一项研究，有力地支持高血压患者舒张功能障碍对预后的影响[4]。在朱塞佩在过去二十年中做出的众多科学贡献中，不可能选出最具影响力的。我们的团队从朱塞佩的热情、专注和极具活力的产出中受益匪浅。他有能力以高度的能力和热情主持并完成多项研究项目。1998年，朱塞佩转到佩鲁贾大学，在那里他从研究员迅速晋升为医学副教授。2011年，他被任命为特尼的医学主任。我们保持着密切的联系，很高兴看到他的专业知识向心血管医学的其他方面发展，包括动脉结构和生理学。在他的众多活动中，朱塞佩为多个科学学会服务，包括动脉结构和生理学研究协会（ARTERY）、国家心脏病学协会（ANMCO）和意大利动脉扩张协会（SIIA）。总体而言，朱塞佩撰写或合著了300多篇全文论文，共获得13560次引用，H指数为53。他在国内外做了许多演讲。他的喜怒无常的能量是巨大的：就在他去世前几天，他有力量在佩鲁贾的一次心血管会议上做了一场精彩的演讲，离开医院只是为了会议的目的，然后在会议结束后回到医院，在那里他作为一名病人受到了接待。朱塞佩的妻子奇亚拉和他出色的儿子卢卡、安德里亚和特蕾莎在世。我们都失去了一位伟人和一位杰出的科学家。

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引用次数: 0

Endothelin-receptor antagonist can reduce blood pressure in patients with hypertension: a meta-analysis 内皮素受体拮抗剂可以降低高血压患者的血压:荟萃分析

IF 1.8 4区医学 Q3 Medicine

Blood Pressure

Pub Date : 2017-05-04 DOI: 10.1080/08037051.2016.1208730

W. Yuan, Genyang Cheng, Bin Li, Yansheng Li, Shan Lu, Dong Liu, Jing Xiao, Zhanzheng Zhao

Abstract The aim of this meta-analysis was to assess the effectiveness and safety of endothelin-receptor antagonist (ERA) in the patients with hypertension. Searches of the PubMed, EMBASE, and CENTRAL databases were conducted to include all the randomized control trials (RCTs). Eighteen trials including 4898 patients were used in the meta-analysis, of which nine were classified as low risk of bias and the other nine as unclear risk of bias. There was no statistically significant difference in all-cause mortality between ERA and placebo groups [6 trials, fixed effects model, RR 1.53 (0.89–2.62); random effects model, RR 1.45 (0.84–2.52)]. ERA significantly reduced 24-h ambulatory blood pressure and sitting blood pressure in patients with hypertension [5 trials, 24-h SBP: WMD −7.65 (−8.95 to −6.36), 24-h DBP: WMD −5.92 (−7.50 to −4.33); 18 trials, SBP: WMD −6.12 (−7.87 to −4.36), DBP: WMD −3.81 (−4.82 to −2.80)]. However, ERA had more adverse events [within 24 h: 3 trials, RR 1.16 (0.82–1.65); after 24 h, 13 trials, RR 1.21 (1.08–1.36)] and severe adverse events than placebo controls [SAE: 9 trials, RR 1.34 (1.13–1.60)]. In addition, there is a potential need for further RCTs that focus on the use of ERA in patients with hypertension.

摘要本荟萃分析的目的是评估内皮素受体拮抗剂（ERA）在高血压患者中的有效性和安全性。检索PubMed、EMBASE和CENTRAL数据库，包括所有随机对照试验（RCT）。荟萃分析中使用了包括4898名患者在内的18项试验，其中9项被归类为低偏倚风险，另外9项被分类为不明确偏倚风险。ERA和安慰剂组之间的全因死亡率没有统计学上的显著差异[6项试验，固定效应模型，RR 1.53（0.89-2.62）；随机效应模型，RR1.45（0.84-2.52）]。ERA显著降低了高血压患者的24小时动态血压和坐位血压[5个试验，24小时SBP:WMD−7.65（−8.95至−6.36），24小时DBP:WMC−5.92（−7.50至−4.33）；18项试验，SBP:WMD−6.12（−7.87至−4.36），DBP:WMC−3.81（−4.82至−2.80）]。然而，ERA的不良事件更多[在24 h： 3个试验，RR 1.16（0.82-1.65）；24之后 h、 13项试验，RR 1.21（1.08-1.36）]和严重不良事件[SEA:9项试验，RR1.34（1.13-1.60）]。此外，还可能需要进一步的随机对照试验，重点关注ERA在高血压患者中的使用。

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引用次数: 19

Relationship between abnormal P-wave terminal force in lead V₁ and left ventricular diastolic dysfunction in hypertensive patients: the LIFE study. 高血压患者V1导联p波终末力异常与左室舒张功能不全的关系:LIFE研究

IF 1.8 4区医学 Q3 Medicine

Blood Pressure

Pub Date : 2017-04-01 Epub Date: 2016-08-09 DOI: 10.1080/08037051.2016.1215765

Michael T Tanoue, Sverre E Kjeldsen, Richard B Devereux, Peter M Okin

Background: Abnormal P-wave terminal force in lead V₁ (PTF-V₁) is an ECG marker of increased left atrial (LA) volume, elevated LA filling pressures and/or LA systolic dysfunction. Because left ventricular (LV) diastolic dysfunction is one of the potential mechanisms driving LA remodelling, we hypothesized that PTF-V₁ might be an additional ECG marker of diastolic dysfunction.

Methods: LV diastolic function after 3 years' systematic antihypertensive treatment was examined in relation to baseline PTF-V₁ in 431 hypertensive patients undergoing protocol-driven blood pressure reduction who had baseline and year-3 ECG and echocardiographic data and a preserved LV ejection fraction (EF >45%) at year-3. Abnormal diastolic function was defined by the tenth or 90th percentile values from 405 normotensive, non-obese and non-diabetic adults without overt cardiovascular disease. Abnormal PTF-V_1, defined by the presence of a negative terminal P-wave in lead V1 ≥ 4000 μV·ms, was present in 167 patients (38.7%).

Results: Abnormal PTF-V₁ was associated with worse year-3 mean diastolic first third filling time (0.43 ± 0.08 vs 0.40 ± 0.07 sec, p = 0.039), first half filling time (0.55 ± 0.07 vs 0.53 ± 0.07 sec, p = 0.041), mitral valve A velocity (86 ± 27 vs 76 ± 19 cm/sec, p = 0.009) and mitral valve E/A ratio (0.85 ± 0.22 vs 0.94 ± 0.27, p = 0.007) after adjusting for other potential predictors of diastolic dysfunction including race, and heart rate, systolic blood pressure and severity of ECG LVH by Cornell product criteria at baseline. In parallel multivariate logistic regression analysis, abnormal PTF-V₁ was associated with significantly increased odds of abnormal mitral valve E/A ratio (OR 1.55, 95%CI 1.04-2.32 p = 0.032), and a trend toward higher odds of abnormal half filling time (OR 1.42, 95%CI 0.94-2.15, p = 0.098) at year-3 of follow-up.

Conclusions: Abnormal P-wave terminal force in lead V₁ is associated with worse diastolic function and predicts abnormal LV diastolic behaviour in patients with preserved EF after 3 years of blood pressure reductive therapy.

背景:V1导联p波末端力异常(PTF-V1)是左房容积增加、左房充盈压力升高和/或左房收缩功能障碍的心电图标志。由于左室(LV)舒张功能障碍是驱动LA重构的潜在机制之一，我们假设PTF-V1可能是舒张功能障碍的另一个ECG标志物。方法:对431例接受方案驱动降压的高血压患者进行系统降压治疗3年后的左室舒张功能与基线PTF-V1的关系进行检查，这些患者有基线和3年的心电图和超声心动图数据，3年时左室射血分数(EF >45%)保持不变。舒张功能异常由405名无明显心血管疾病、血压正常、非肥胖和非糖尿病的成年人的第10或第90百分位值来定义。167例(38.7%)患者PTF-V1异常，表现为V1导联终末p波负向≥4000 μV·ms。结果:异常PTF-V1与糟糕的三年级平均舒张压前三分之一灌装时间(0.43±0.08 vs 0.40±0.07秒,p = 0.039),上半年灌装时间(0.55±0.07 vs 0.53±0.07秒,p = 0.041),二尖瓣速度(86±27 vs 76±19厘米/秒,p = 0.009)和二尖瓣E / A比值(0.85±0.22 vs 0.94±0.27,p = 0.007)调整后舒张功能不全的其他潜在的预测因子包括种族,和心率,收缩压和心电图LVH严重程度的基线康奈尔产品标准。在平行多因素logistic回归分析中，PTF-V1异常与二尖瓣E/A比异常的几率显著增加相关(OR 1.55, 95%CI 1.04-2.32 p = 0.032)，并且在随访第3年时，二尖瓣半充盈时间异常的几率有升高的趋势(OR 1.42, 95%CI 0.94-2.15, p = 0.098)。结论:V1导联p波末端力异常与舒张功能恶化有关，并可预测保留EF患者在降压治疗3年后的左室舒张行为异常。

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引用次数: 17

Performance of targeted screening for the identification of hypertension in children. 针对性筛查在儿童高血压诊断中的作用。

IF 1.8 4区医学 Q3 Medicine

Blood Pressure

Pub Date : 2017-04-01 Epub Date: 2016-08-09 DOI: 10.1080/08037051.2016.1213130

Clemens Bloetzer, Pascal Bovet, Fred Paccaud, Michel Burnier, Arnaud Chiolero

Targeted screening of hypertension in childhood might be more efficient than universal screening. We estimated the sensitivity, specificity, negative and positive predictive values of combined parental history of hypertension and overweight/obesity for the diagnosis of hypertension in 5207 children aged 10-14 years. Children had hypertension if they had sustained elevated blood pressure over three separate visits. The prevalence of hypertension was 2.2%. 14% of children were overweight or obese, 20% had a positive history of hypertension in at least one parent and 30% had either or both conditions. Targeted screening of hypertension to children with either overweight/obesity or with hypertensive parents limits the proportion of children (30%) to screen and identifies up to 65% of all hypertensive cases.

儿童期高血压的针对性筛查可能比普遍筛查更有效。我们对5207名10-14岁儿童高血压诊断的敏感性、特异性、阴性和阳性预测值进行了估计。如果儿童在三次单独的就诊中血压持续升高，他们就患有高血压。高血压患病率为2.2%。14%的儿童超重或肥胖，20%的儿童在父母中至少有一方有高血压病史，30%的儿童两者都有。对超重/肥胖或父母患有高血压的儿童进行有针对性的高血压筛查，限制了接受筛查的儿童比例(30%)，并确定了高达65%的高血压病例。

引用次数: 12