哈醫(yī)大第一臨床醫(yī)學(xué)院心內(nèi)科-預(yù)覽頁(yè)
【正文】 ? CKD and endstage kidney disease ? DM ? Sleep apnea ? Autonomic neuropathy and autonomic failure ? Primary aldosteronism ? Pheochromocytoma (嗜鉻細(xì)胞瘤） ? Cushing’s syndrome ? Solid an transplantation ? Preeclampsia and eclampsia （子癇和先兆子癇） ? CHF The First Clinical College of Harbin Medical University ? 正常腎臟功能對(duì)于保證血壓晝夜節(jié)律非常重要。 p = ) . DM The First Clinical College of Harbin Medical University 阻塞性睡眠呼吸暫停低通氣綜合征 (Obstructive sleep apneahyponea syndrome, OSAHS) ? 40歲以上人群中，美國(guó)患病率為 2%4%，澳大利亞高達(dá) %，我國(guó)香港地區(qū) %，上海市 %，長(zhǎng)春市% ，男性多于女性，老年人、肥胖患病率更高 。 Hypertension Res, 2020, 32 (6) : 428 432 Sleep, 2020, 31(6) : 795800. The First Clinical College of Harbin Medical University ? 有證據(jù)提示，夜間血壓下降緩慢、夜間高血壓者與 高鹽飲食 及 鹽敏感 關(guān)系密切。12:35–39 Hypertension. 1997。 . 1996。2:99–103 The First Clinical College of Harbin Medical University ? NDIP hypertensive patients have an impaired nocturnal melatonin secretion. Blood Pressure. 2020。 Hypertension. 2020。 ? 日間血壓值相對(duì)降低、夜間血壓相對(duì)升高， 傾向非杓型 。 The First Clinical College of Harbin Medical University 生活方式干預(yù) ? 鹽敏感者應(yīng)首先限制鈉攝入，補(bǔ)充鉀鹽。96(6):185962 The First Clinical College of Harbin Medical University ? 年輕非高血壓黑人高鉀攝入（ 80mg/d) 使 所有非杓型 血壓狀態(tài) 恢復(fù)為杓型 血壓狀態(tài)，但白天血壓無(wú)明顯變化。 ? 陜西農(nóng)民調(diào)查，攝取鉀約為 35 mmol/ d ， 而鈉攝入為 230 mmol/ d , 鉀與鈉攝入比 僅 : 1。 Blood Press. 2020。 ? Evening dosing results in better nocturnal BP reduction and increased dipping than with morning dosing. Pharmaco. Ther. 111(3), 629–651 (2020). J. Hypertens. 23(10), 1913–1922 (2020). Hypertension 50(4), 715–722 (2020). Chronobiol. Int. 26(1), 61–79 (2020). The First Clinical College of Harbin Medical University ?CCB ? 180 patients (50% nondippers) receiving nifedipine GITS in a prospective, openlabel, parallelgroup design paring morning and bedtime administration. Bedtime dosing resulted in better 24h SBP control (9% vs % fall。 Circulation 100(15), 1635–1638 (1999) Chronobiol. Int. 25(6), 950–970 (2020) Hypertension 47(3), 352–358 (2020). The First Clinical College of Harbin Medical University The ABPM substudy of the AngloScandinavian cardiac outes trial (n=1905) showed a more significant reduction of nocturnal BP with an amlodipine–perindopril regimen than with atenolol–thiazide, despite the fact that the daytime BP was higher in the former group, which might account for the lower cardiovascular events in the amlodipine–perindopril group. J Hypertens 2020。 P). The First Clinical College of Harbin Medical University ? 噻唑烷二酮類 (格列酮類 ) ? Insulin resistance plays a role in elevation of BP by various mechanisms. ? 增強(qiáng)機(jī)體組織 對(duì)胰島素的敏感性 ， 改善胰島 β細(xì)胞功能。 The First Clinical College of Harbin Medical University ? 調(diào)整服藥時(shí)間 Minutolo 等發(fā)現(xiàn) （ 32例 CKD伴夜間血壓增高） 將不同降壓藥物服用時(shí)間從早改到晚 , 結(jié)果顯示： Am J Kidney Dis. 2020 Dec。 p ). The First Clinical College of Harbin Medical University ? In resistant hypertension（ 578） , receiving at least one of their medications in the evening had signiicantly lower nocturnal BP, lower prevalence of nondipping (57 vs 82%。 ? ABPM有助于夜間高血壓病人篩查并指導(dǎo)治療， 避免夜間血壓過(guò)度
教學(xué)課件相關(guān)推薦
鄂ICP備17016276號(hào)-1