Objective To investigate the antihypertensive effects of continuous airway positive pressure( CPAP) plus antihypertensive drugs on patients with obstructive sleep apnea hypopnea syndrome ( OSAHS) and hypertension.Methods 82 OSAHS patients with hypertension were enrolled in this study. They were randomly divided into a CPAP treatment group( 44 patients, treated with antihypertensive drugs and CPAP) , and a control group( 38 patients, treated with antihypertensive drugs only) . All the patients were performed polysomnography and 24-hour blood pressure monitoring before and 12 weeks after the treatment. Results After 12 weeks treatment, except the systolic pressure in night time( nSBP) , all the parameters of 24-hour blood monitoring improved better in the CPAP group than in the control group( all P lt; 0. 05) . The blood pressure dropped to normal in 75. 0% ( 33/44) CPAP patients and in 52. 6% ( 20 /38) control patients. In the CPAP group, 8( 18. 2% ) cases were withdrawn from antihypertensive drugs, 13( 29. 5% )cases required single agents, and 9( 20. 5% ) cases required three agents to achieve blood pressure control.But in the control group, all the patients needed two or more antihypertensive agents, in which 23( 60. 6% )patients needed three agents to achieve blood pressure control. After the treatment, the patients with dipping pattern blood pressure increased from10 to 29( 22. 7% -65. 9% , P lt;0. 05) in the CPAP group, and from10to 14( 26. 3% -36. 8%, P gt;0. 05) in the control group. Conclusions Combination therapy with CPAP and antihypertensive drugs controls blood pressure better than antihypertensive medication only for OSAHS patients with hypertension with fewer types of antihypertensive agents or even withdrawal from antihypertensive medication in some patients.
【Abstract】 Objective To study the effects of obstructive sleep apnea hypopnea syndrome ( OSAHS) on blood pressure variations, and explore the possible mechanism. Methods 84 adult patients ( mean age 50. 1 ±14. 8 years, male /female 67 /17) were recruited for polysomnography ( PSG) and ambulatory blood pressure monitoring. Four groups were identified based on apnea hyponea index ( AHI) ,ie. non-OSAHS group ( n=9) ,mild group ( n=19) , moderate group ( n=23) , and severe group ( n =33) .The blood pressure levels were compared among the four groups. Correlations between PSG indexes,variations of systolic blood pressure ( SBP) and diastolic blood pressure ( DBP) were analyzed. Results Inter-group blood pressure comparison showed significant differences in SBP and DBP( P lt;0. 05) , except forthe mild and the moderate OSAHS patients. As compared with the non-OSAHS patients, SBP for those with severe OSAHS was about 15 mm Hg higher, and DBP 10 mm Hg higher. Observation on SBP non-dipping rate indicated that, except for the mild and the moderate OSAHS patients where no significant differences were found, SBP non-dipping rate increased with the severity of OSAHS( the rates were 78. 3%, 57. 1% ,54. 5%, and 32. 6% , respectively for the four groups) , whereas DBP non-dipping rate significantly increased in the severe OSAHS patients( 54. 3% ) ( P lt;0. 05) . For the mild OSAHS patients, blood pressure was found to be correlated positively with the body mass index ( correlation coefficient for day time SBP was 0. 26, and for DBP was 0. 22) , the arousal index ( correlation coefficient for day time SBP was 0. 25, and for DBP was 0. 17) , and heart rate variation ( correlation coefficient for night time SBP was 0. 18, and for DBP was 0. 17) . For the moderate OSAHS patients, a positive correlation was also found between blood pressure and AHI ( correlation coefficient for day time SBP was 0. 31, and for DBP was 0. 22, correlation coefficient fornight time SBP was 0. 26) , and between blood pressure and the longest hypopnea time during sleep ( LH) ( correlation coefficient for night time DBP was 0. 2) . For the severe OSAHS patients, blood pressure was correlated positively with apnea index ( AI) ( correlation coefficient for day time SBP was 0. 61, and for DBP was 0. 5, correlation coefficient for night time SBP was 0. 57 and for night time DBP was 0. 48) . Conclusions OSAHS has ber impact on SBP than on DBP. DBP hypertension and SBP non-dipping are usually found in early OSAHS-affected patients. Factors affecting blood pressure differ with the severity of the OSAHS.
【摘要】 目的 对脑梗死患者施行静脉溶栓治疗前后的相关状况和指标进行评价分析。 方法 2003年1月-2010年11月对神经内科收治的29例脑梗死患者予以静脉溶栓治疗及护理，并就治疗前后各相关时间点血压监测及美国国立卫生研究院卒中量表（National Institute of Health stroke scale，NIHSS）评分情况进行分析。 结果 溶栓前后血压对比显示:溶栓后2 h收缩压相对于溶栓前和溶栓后24 h升高（Plt;0.05）；溶栓前后NIHSS评分差异有统计学意义（Plt;0.05）。 结论 溶栓后患者收缩压出现升高，护理上应该加强血压监控，为临床治疗提供支持。【Abstract】 Objective To investigate the correlated condition and clinical index changes before and after the intravenous thrombolysis of the cerebral infarction patients. Methods The blood pressure and the National Institutes of Health stroke scale (NIHSS) score of 29 cerebral infarction patients with the intravenous thrombolysis treatment between January 2003 and November 2010 were measured and analyzed. Results Two hours after the thrombolysis, the systolic blood pressure significantly increased compared with those before the intravenous thrombolysis and 24 hours after intravenous thrombolysis （P＜0.05）. NIHSS score was significantly decreased after the thrombolysis （P＜0.05）. Conclusions Systolic blood pressure significantly increases after the intravenous thrombolysis. Intensive blood pressure monitoring and controlling may be beneficial to the treatment and prognosis.
ObjectiveTo investigate the value of morning blood pressure surge in the evaluation of atherosclerosis by the observation of the relationship between morning blood pressure surge and ambulatory arterial stiffness index. MethodsFrom May 2011 to March 2013, we followed up 300 hypertensive patients who received ambulatory blood pressure monitoring, and they were divide into elevated morning blood pressure surge group and non-elevated morning blood pressure surge group. The AASI value was recorded and compared between the two groups according to the grade of hypertension. ResultsMorning blood pressure surge was more common in patients with hypertension. Compared with patients in the non-elevated morning blood pressure surge group, ambulatory arterial stiffness index was significantly higher in patients in the elevated morning blood pressure surge group. ConclusionThere is a certain correlation between morning blood pressure surge and arterial stiffness, which is an important factor leading to a variety of target organ damage.