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Blood Pressure and Mortality: Joint Effect of Blood Pressure Measures. 血压与死亡率:血压测量的联合效应
Pub Date : 2020-01-01 Epub Date: 2020-10-21 DOI: 10.31546/2633-7916.1009
Jung Ki Kim, Eileen M Crimmins

We examine how combinations of systolic and diastolic blood pressure levels and pulse pressure levels predicted mortality risk. Respondents are those aged over 50 from the Health and Retirement Study (N=10,366) who provided blood pressure measures in 2006/2008. Systolic and diastolic blood pressures were measured three times; and we averaged the three readings. Pulse pressure was calculated as systolic minus diastolic blood pressure. Seven combinations of systolic and diastolic blood pressure (low/normal/high of each) and three levels of pulse pressure (low/normal/high) were used to categorize blood pressure. Over 1 to 10 years of follow-up (average follow-up time of 7.8 years), 2,820 respondents died after blood pressure measurement in 2006/2008. Potential covariates including age, gender, education, BMI, total cholesterol, HbA1c, antihypertensive medication intake and lifetime-smoking pack years were adjusted in Cox proportional hazard models and survival curves. The blood pressure subgroup with low systolic blood pressure (<90 mmHg) and low diastolic blood pressure (< 60 mmHg) had the highest relative risk of mortality (HR=2.34, 95% CI: 1.45-3.80), followed by those with normal systolic blood pressure but low diastolic blood pressure (HR=1.45, 95% CI: 1.17-1.81) among those with cardiovascular conditions at baseline. For those without cardiovascular conditions at baseline, low blood pressure, either systolic or diastolic, was not related to mortality. Those with high levels of both systolic and diastolic blood pressure had a higher risk of mortality than those with both blood pressures normal but no other subgroups with low blood pressure differed from normal/normal in predicting mortality. Pulse pressure did not predict mortality. How high and low blood pressures are related to mortality needs to be examined by jointly looking at systolic and diastolic blood pressure.

我们研究了收缩压和舒张压水平以及脉压水平的组合如何预测死亡风险。受访者是健康与退休研究(Health and Retirement Study,N=10,366)中的 50 岁以上人群,他们在 2006/2008 年提供了血压测量数据。收缩压和舒张压测量三次,取三次读数的平均值。脉压的计算方法是收缩压减去舒张压。收缩压和舒张压的七种组合(低/正常/高)和脉压的三种水平(低/正常/高)被用来对血压进行分类。在 1 至 10 年的随访期间(平均随访时间为 7.8 年),共有 2820 名受访者在 2006/2008 年测量血压后死亡。包括年龄、性别、教育程度、体重指数、总胆固醇、HbA1c、抗高血压药物摄入量和终生吸烟包年在内的潜在协变量在 Cox 比例危险模型和生存曲线中进行了调整。收缩压较低的血压亚组 (
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引用次数: 0
Acute Effects of Smoking on the Arterial Function of Young Healthy Smokers 吸烟对年轻健康吸烟者动脉功能的急性影响
Pub Date : 2019-12-04 DOI: 10.17554/j.issn.2309-6861.2019.06.169
T. Pereira, T. Costa
Background: Several studies have supported the idea that smoking induces changes with direct impact on endothelial function and arterial stiffness. The main purpose of this study was to assess the acute effects of smoking on vascular function in healthy young adults. Methods: We designed a quasi-experimental study, including ninety participants aged between 18 and 25 years. Participants were divided into three groups: Active exposure group (AG) - 30 usual smokers; passive exposure group (PG) and non-exposure control group (CG), each including 30 non-smokers matched for age, gender and overall lifestyle. Heart rate (HR), brachial blood pressure (bBP), flow-mediated dilation (FMD), aortic pulse wave velocity (PWV) and carotid pulse wave analysis (PWA) were evaluated in two moments: baseline and 30 minutes after smoking exposition (AG and PG) or 30 minutes after the first evaluation (CG). Results: Significant changes from baseline were observed only in the AG, with an increase in PWV, from 5.6 ± 0.7 m/s to 6.1 ± 0.2 m/s post-smoking (p = 0.040), and a decrease in FMD of about -5.7 ± 2.3% after smoking one cigarette (p < 0.001). A significant increase in brachial and central BP was also observed in the AG. A trend for increase in brachial and central BP, and decrease in the FMD was observed in the PG and no significant changes were depicted in the CG. Conclusion: Just one cigarette produces significant detrimental acute effects on the vascular endothelium and hemodynamic profile of healthy young short-term smokers. Changes are also observed, although to a lesser extent, in passive smokers.
背景:一些研究支持吸烟诱导内皮功能和动脉硬度变化的观点。本研究的主要目的是评估吸烟对健康年轻人血管功能的急性影响。方法:我们设计了一项准实验研究,包括90名年龄在18 ~ 25岁之间的参与者。参与者被分为三组:主动暴露组(AG)——30名常规吸烟者;被动暴露组(PG)和非暴露对照组(CG),每组包括30名年龄、性别和总体生活方式相匹配的非吸烟者。心率(HR)、肱血压(bBP)、血流调节扩张(FMD)、主动脉脉波速度(PWV)和颈动脉脉波分析(PWA)分别在基线和吸烟后30分钟(AG和PG)或首次评估后30分钟(CG)进行评估。结果:与基线相比,仅在AG中观察到显著变化,吸烟后PWV从5.6±0.7 m/s增加到6.1±0.2 m/s (p = 0.040),吸烟后FMD减少约-5.7±2.3% (p < 0.001)。在AG中也观察到臂部和中央血压显著升高。在PG中观察到肱部和中央血压升高的趋势,FMD下降,而在CG中没有明显变化。结论:一根香烟对健康的年轻短期吸烟者的血管内皮和血流动力学有明显的急性危害。在被动吸烟者中也观察到变化,尽管程度较轻。
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引用次数: 0
Vascular Changes in Healthy Youngsters with and without Influence of Oral Contraception 有无口服避孕药影响的健康青少年血管变化
Pub Date : 2019-12-04 DOI: 10.17554/j.issn.2309-6861.2019.06.170
Anabela Araújo Pereira, H. Santos, T. Pereira, J. Conde
Introduction : Cardiovascular diseases are one of the leading causes of mortality worldwide. It is known to have a reduced incidence in premenopausal women compared to the opposite sex. This appears to be related to the female hormones and their fluctuation throughout the menstrual cycle. Objectives : To evaluate and correlate behavior patterns of cerebral dynamics and arterial reactivity throughout the menstrual cycle and to identify possible differences caused by the use of oral contraceptives (OC). Methods : The sample consisted of 21 healthy, eumenorrheic and non-smoking young womens, belonging to the 18-21 age group. There were two distinct groups: 11 in the group without oral contraceptive (SCO) and 10 in the oral contraceptive group (CCO). Both groups performed an evaluation in the menstrual phase (MP), from the 1st to the 4th day, and in the ovulatory phase (OP), from the 12th to the 16th day. The third evaluation was performed in the late luteal phase (LLP) from the 26th to the 30th day, in the SCO group and in the OC pause, from the 21st to the 28th day, in the CCO group. Four noninvasive procedures were performed: blood pressure measurement, axillary temperature, carotid and right brachial artery sonography. Results : There were no statistically significant differences in carotid parameters, however, there were variations in the velocity of the systolic peak (VPS) of the common carotid artery (CCA) and internal carotid artery (ICA) and the ICA resistance index (IR), throughout the cycle. The SCO group showed a significant increase in FMD from MF to OF (p = 0.023), decreasing in LL (p = 0.012). The CCO group demonstrated a relative stabilization of FMD values. In OP, there were statistically significant differences between the two groups in relation to the FMD value (p = 0.040). Conclusions : Cyclic fluctuations of estrogen appear to influence cerebral vascular impedance and arterial reactivity but in different proportions. In conclusion, this study supports the idea of standardizing the timing of vascular testing in a premenopausal woman.
导言:心血管疾病是世界范围内导致死亡的主要原因之一。众所周知,与异性相比,绝经前女性的发病率较低。这似乎与女性荷尔蒙及其在整个月经周期中的波动有关。目的:评估和关联整个月经周期中大脑动力学和动脉反应性的行为模式,并确定口服避孕药(OC)使用可能造成的差异。方法:选取年龄在18 ~ 21岁、健康、月经来潮、不吸烟的年轻女性21例为研究对象。无口服避孕药组(SCO) 11例,口服避孕药组(CCO) 10例。两组分别在第1 ~ 4天的月经期(MP)和第12 ~ 16天的排卵期(OP)进行评估。第三次评估于黄体晚期(LLP)(第26 ~ 30天,SCO组)和OC暂停(第21 ~ 28天,CCO组)进行。进行了四项无创手术:血压测量、腋窝温度、颈动脉和右肱动脉超声检查。结果:两组患者颈动脉参数差异无统计学意义,但颈总动脉(CCA)和颈内动脉(ICA)的收缩峰值速度(VPS)及ICA阻力指数(IR)在整个周期内均有变化。SCO组从MF到OF的FMD显著增加(p = 0.023), LL的FMD显著降低(p = 0.012)。CCO组显示口蹄疫值相对稳定。OP方面,两组间FMD值比较差异有统计学意义(p = 0.040)。结论:雌激素周期波动对脑血管阻抗和动脉反应性有影响,但影响程度不同。总之,本研究支持对绝经前妇女血管检查时间进行标准化的观点。
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引用次数: 0
The Early Outcome of Aortic Valve Replacement Surgery for Dialysis Patients 透析患者主动脉瓣置换术的早期预后
Pub Date : 2019-09-05 DOI: 10.17554/J.ISSN.2309-6861.2019.06.168
M. Iida, K. Nishimura, K. Kono, Ken Chen, Tsukasa Ikeda, Hiroo Ota, M. Uchiyama, Naomi Ozawa, T. Imazuru, T. Shimokawa
Objectives: Although the “mechanical valve” has historically been the popular choice to use as a prosthetic valve to treat dialysis patients requiring aortic value replacement (AVR) for aortic stenosis, bioprosthetic valves have also started to be considered for use, due to improvements of surgical outcomes observed through its technical improvements. In this study, we demonstrated our valve treatment strategy and investigated the early outcome to patients with dialysis. Methods: 470 patients received an AVR between January 2009 and December 2012. We retrospectively reviewed and analyzed the clinical course of 32 patients with dialysis. 15 patients were male and 17 patients were female, with an average age of 72.4 ± 7.3 years (range: 57-86 years). The mean duration of hemodialysis was 8.7 years (range: 0.1-36 years). The mean Society of Thoracic Surgery score and Euro Score II was 17.0% and 8.9%, respectively. We used a bioprosthetic valve for patients aged >65 years. Results: Mean observation period was 958 days. Regarding early mortality, there were 5 operative deaths within 30 days after operation (15.6%). There were 6 operative late deaths (20.7%). 1- and 3-year survivals in the bioprosthetic valve group were 68% and 46%, respectively. On the other hand, those in the mechanical valve group were 75% and 50%, respectively. Conclusion: The use of bioprosthetic valves should be considered due to its added benefits and because there is no statistically significant difference on survival and valve-related complications between bioprosthetic and mechanical valve group.
目的:虽然“机械瓣膜”历来是治疗因主动脉瓣狭窄而需要主动脉瓣膜置换术(aortic value replacement, AVR)的透析患者的普遍选择,但由于其技术改进观察到手术效果的改善,生物瓣膜也开始被考虑使用。在这项研究中,我们展示了我们的瓣膜治疗策略,并调查了透析患者的早期结果。方法:2009年1月至2012年12月间接受AVR治疗的470例患者。我们回顾性分析了32例透析患者的临床过程。男性15例,女性17例,平均年龄72.4±7.3岁(范围:57 ~ 86岁)。血液透析的平均持续时间为8.7年(范围:0.1-36年)。胸外科学会评分和欧洲评分II的平均值分别为17.0%和8.9%。我们对年龄>65岁的患者使用生物瓣膜。结果:平均观察时间958 d。早期死亡率方面,术后30天内手术死亡5例(15.6%)。术后晚期死亡6例(20.7%)。生物瓣膜组1年和3年生存率分别为68%和46%。另一方面,机械瓣膜组分别为75%和50%。结论:生物瓣膜与机械瓣膜组在生存和瓣膜相关并发症方面无统计学差异,可考虑使用生物瓣膜,因为其具有额外的益处。
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引用次数: 0
Soluble Suppression of Tumorigenicity 2: A Role in BiomarkerGuided Therapy of Heart Failure 可溶性抑制致瘤性2:在生物标志物引导的心力衰竭治疗中的作用
Pub Date : 2019-07-03 DOI: 10.17554/J.ISSN.2309-6861.2019.06.167
A. Berezin, A. Berezin
Current clinical guidelines of European Society of Cardiology and American Heart Association regarding the diagnosis and treatment of acute and chronic HF recommend to use natriuretic peptides (NPs) as powerful diagnostic and predictive biomarker, while other biomarkers, such as galectin-3, cardiac troponins, and soluble suppressor of tumorigenisity (ST2) are embedded onto American Heart Association statement to improve a risk stratification, as well as NPs are considered for performing biomarker-guided therapy. The aim of the Editorial is to summarize knowledge among clinical efficacy of heart failure (HF) guidance care based on serial measure of sST2. Elevated levels of sST2 are established biomarker of high risk of all-cause and cardiovascular mortality, new diagnosed HF and re-admission due to HF decompensation, Therefore, a trend to declined serum levels of sST2 was associated with improved survival and decreased re-hospitalization in patients with different phenotypes of HF. It has shown that serial measure of sST2 concentrations in HF patients can predict poor clinical outcomes and personally optimize treatment care, especially in combination with repetitive measure of NT-proBNP levels. However, the role of combined biomarker approach (sST2 + NT-proBNP) in the clinical care of the HF patient is not yet partially defined and more large clinical trials are needed.
目前欧洲心脏病学会和美国心脏协会关于急慢性心衰诊断和治疗的临床指南推荐使用利钠肽(NPs)作为强大的诊断和预测生物标志物,而其他生物标志物,如半乳糖凝集素-3、心脏肌钙蛋白和可溶性肿瘤抑制因子(ST2)被纳入美国心脏协会声明,以改善风险分层。以及NPs被认为可以进行生物标志物引导的治疗。这篇社论的目的是总结基于sST2系列测量的心力衰竭(HF)指导护理的临床疗效。sST2水平升高是全因死亡和心血管死亡高风险、新诊断的HF和因HF失代偿而再次入院的生物标志物,因此,血清sST2水平下降的趋势与不同表型HF患者的生存率提高和再次住院率降低有关。研究表明,连续测量HF患者的sST2浓度可以预测不良的临床结果,并个性化地优化治疗护理,特别是与重复测量NT-proBNP水平相结合。然而,联合生物标志物方法(sST2 + NT-proBNP)在心衰患者临床护理中的作用尚未部分确定,需要更多的大型临床试验。
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引用次数: 1
Sacubitril/Valsartan and Ivabradine: Two Compounds for Heart Failure with Low Ejection Fraction (EFrEF), Acting by Innovative Mechanisms 苏比里尔/缬沙坦和伊伐布雷定:两种治疗低射血分数心力衰竭(EFrEF)的化合物,通过创新机制起作用
Pub Date : 2019-03-11 DOI: 10.17554/J.ISSN.2309-6861.2019.06.164
F. Cacciapuoti
The role of two new compounds - Sacubitril/valsartan and Ivabradine in treatment of systolic heart failure (HFrEF) was evaluated. Sacubitril/valsartan (also called as Entresto), together the remaining optimal medical therapy, antagonize HFrEF both strengthening the beneficial effects of natriuretic peptides (NP) and acting against angiotensin II by angiotensin receptor blocker (ARB), valsartan. PARADIGM-HF study has demonstrated that Sacubitril/valsartan is superior to angiotensin-converting-enzyme (ACE) alone in reducing the risks of death and hospitalization for HFrEF. On the contrary Ivabradine, a selective inhibitor of the “funny” channel current present in the sino-atrial node, acts against HFrEF inducing a reduction of heart rate in sinus rhythm patients. This reduction yields an improvement in stroke volume due to the increased of LV diastolic filling, improving the HFrEF symptoms. The results reported in the SHIFT Trial support the importance of heart rate reduction obtained with Ivabradine for improvement of clinical outcomes in HFrEF and confirm the important role of heart rate in the pathophysiology of this disorder. Two drugs act with two diverse and innovative mechanisms and, together the remaining optimal medical therapy, represent an effective improvement in HFrEF therapy.
评价了两种新化合物——沙比利/缬沙坦和伊伐布雷定在治疗收缩期心力衰竭(HFrEF)中的作用。Sacubitril/缬沙坦(也称为enterresto),与其他最佳药物治疗一起拮抗HFrEF,增强利钠肽(NP)的有益作用,并通过血管紧张素受体阻滞剂(ARB)缬沙坦对抗血管紧张素II。PARADIGM-HF研究表明,Sacubitril/缬沙坦在降低HFrEF的死亡和住院风险方面优于单独使用血管紧张素转换酶(ACE)。相反,伊伐布雷定是一种选择性的窦房结“滑稽”通道电流抑制剂,对窦性心律患者的HFrEF起抑制作用,导致心率降低。由于左室舒张充盈增加,这种减少产生了卒中容量的改善,改善了HFrEF症状。SHIFT试验报告的结果支持伊伐布雷定降低心率对改善HFrEF临床结果的重要性,并证实心率在该疾病的病理生理学中的重要作用。两种药物以两种不同和创新的机制起作用,并与剩余的最佳药物治疗一起,代表了HFrEF治疗的有效改进。
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引用次数: 0
Atrial Fibrillation in Patients Undergoing Hip Fracture Surgery 髋部骨折手术患者心房颤动
Pub Date : 2019-02-02 DOI: 10.17554/J.ISSN.2309-6861.2019.06.157
C. Rostagno
More than 90% of hip fracture patients are older than 70 years and in most studies mean age is close to 85 years. Increasing age is also associated with a higher prevalence of atrial fibrillation (AF). In present review we will try to answer 3 main questions about the effect of atrial fibrillation in patients with hip fracture: (a) Is there a relationship between AF and risk of hip fracture? (b) Which should be perioperative management of anticoagulant treatment? (c) has AF a long term prognostic value on survival after hip fracture surgery and is there a relationship between AF and the results of rehabilitative treatment? Moreover we evaluated the few reports about incidence and prognostic value of new onset postoperative atrial fibrillation.
超过90%的髋部骨折患者年龄在70岁以上,大多数研究的平均年龄接近85岁。年龄的增长也与房颤(AF)的高患病率相关。在本综述中,我们将试图回答关于房颤对髋部骨折患者影响的3个主要问题:(a)房颤与髋部骨折风险之间是否存在关系?(b)抗凝治疗围手术期应注意哪些事项?(c)房颤对髋部骨折术后的生存有长期预后价值吗?房颤与康复治疗的结果之间是否存在关系?此外,我们评估了一些关于术后新发心房颤动的发生率和预后价值的报道。
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引用次数: 1
Prognostication of Late Cardiac Remodeling in Patients With STEMI Underwent Successful Percutaneous Coronary Intervention: the Role of Macrophage Inhibitory Factor 巨噬细胞抑制因子对经皮冠状动脉介入治疗成功STEMI患者晚期心脏重构的影响
Pub Date : 2019-01-01 DOI: 10.17554/j.issn.2309-6861.2019.06.166
Olga V. Petyunina, Mykola P. Kopytsya, Alexander E. Berezin
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引用次数: 0
Biomarker-based Prognostication of Adverse Cardiac Remodeling after STEMI: the Role of Single Nucleotide Polymorphism T786C in Endothelial NO-synthase gene 基于生物标志物的STEMI后不良心脏重构预测:内皮no合酶基因单核苷酸多态性T786C的作用
Pub Date : 2019-01-01 DOI: 10.17554/j.issn.2309-6861.2019.06.165
Olga V. Petyunina, Mykola P. Kopytsya, Alexander E. Berezin
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引用次数: 0
Acute thrombotic occlusion of Non-dominant right coronary artery presenting as acute coronary syndrome and hemodynamic instability 非显性右冠状动脉急性血栓闭塞,表现为急性冠状动脉综合征和血流动力学不稳定
Pub Date : 2018-11-24 DOI: 10.17554/J.ISSN.2309-6861.2018.05.161
Gurkirat Singh, H. Khemani, S. Shaikh, V. Deshmukh, Rahul Singla, N. Bansal
It is generally believed that the occlusion of a non-dominant right coronary artery is not associated with significant consequences. Atherosclerotic disease of non-dominant right coronary in the absence of significant left coronary artery disease is rare, and the prevalence is substantially lower as compared to dominant right coronary artery. We report a case of young male presenting with acute coronary syndrome and hemodynamically significant atrial fibrillation. Coronary angiography showed thrombotic occlusion of non dominant right coronary artery. After the stenting of this artery, patient improved hemodynamically with complte resolution of ECG changes.
一般认为,非优势右冠状动脉闭塞与显著后果无关。在没有明显左冠状动脉病变的情况下,非优势右冠状动脉粥样硬化性疾病是罕见的,其患病率明显低于优势右冠状动脉。我们报告一例年轻男性表现为急性冠状动脉综合征和血流动力学显著心房颤动。冠状动脉造影显示非优势右冠状动脉血栓闭塞。该动脉支架置入术后,患者血流动力学得到改善,心电图改变完全消除。
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引用次数: 1
期刊
Journal of clinical cardiology and cardiovascular therapy
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