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张新军教授:从ACP/AAFP指南看老年高血压治疗策略

2017-09-25 陈年老刘 医学界心血管频道

门诊经常有老人来看高血压病,他们往往血压波动大,经常半夜因为血压升高而去急诊降压,希望尽快把血压降下来,其实老年人有特殊的生理特点,降血压也要因人而异。

门诊经常有老人来看高血压病,他们往往血压波动大,经常半夜因为血压升高而去急诊降压,希望尽快把血压降下来,其实老年人有特殊的生理特点,降血压也要因人而异。

今年初,美国医师协会(ACP)/美国家庭医师协会(AAFP)联合发布≥60岁高血压老年人药物治疗目标临床实践指南,全文发表于《内科学年鉴》(Annals of Internal Medicine)杂志上。

9月21日-24日,第四届世界高血压大会、2017年中国高血压年会暨第19届国际高血压及相关疾病学术研讨会上,四川大学华西医院老年科张新军教授作《从ACP/AAFP指南看老年高血压治疗策略》的报告,从以下四点对老年高血压的治疗进行了解读,小编简要整理,以飨读者。

·降压目标值

·血压测量与稳定性评估

·心血管风险

·初始药物与联合方案

1.老年高血压患者的血压控制目标



ACP和AAFP同时推荐临床医生定期与患者讨论具体血压目标值的利弊,在此基础上选择≥60岁高血压患者的治疗。

在2016年加拿大CHEP高血压指南中,将SPRINT研究结论引入该指南,推荐将≤120 mmHg作为部分高危患者(如年龄≥75岁者)的降压目标值。

对于高危患者(存在临床型或亚临床型心血管疾病、或慢性肾病、或弗莱明翰评分10年心血管病风险>15%、或年龄≥75岁、或具有其他需要强化降压指征者),若年龄≥50岁且收缩压≥130 mmHg,应考虑予以强化降压治疗,目标值为≤120 mmHg(应用全自动血压计在诊室测量);一般高血压患者的降压目标值为<140/90 mmHg,≥80岁者的收缩压目标值为<150 mmHg。

各指南推荐的一般人群和特殊人群血压目标水平



老年人降压目标值问题的思考

60(65)岁~80岁老年人群适宜降压目标值研究结果存在不一致,可能与入选人群的基线血压水平、心血管危险程度、合并症情况、随访年限及治疗药物应用情况有关,值得进一步研究。

探讨老年人的降压目标值,不仅需结合初始血压水平,合并症情况,还应重视患者的躯体功能和精神状态、预期寿命、低舒张压情况、治疗相关反应(如低血压、头晕、跌倒、重要器官灌注不良)、药物不良反应和耐受性,甚至患者的治疗意愿。

2.血压测量与稳定性评估

《2016年ESH血压目标声明:老年高血压的治疗》认为,在老年患者及单纯收缩期高血压病患者中,ABP是独立于诊室血压和其他危险因素的心血管疾病重要预测因素。在老年患者中,诊室血压与ABP之间的差异及白大衣效应更为显着。同时相当数量的老年高血压病患者还存在“反白大衣效应”,即ABP高于诊室血压。但白大衣效应的重复性及临床应用仍存在疑问。

大部分人夜间血压降低,随年龄增长夜间血压降低的幅度逐渐减小,并在百岁老人中消失。

在Ohasama的研究中,HBP对死亡及卒中风险的预测优于诊室测量血压,提示HBP潜在的应用前景。但老年患者受到生理或智力制约的几率更大,可能限制HBP监测更广泛的应用。


血压稳定性的影响因素与调节机制

3.总体心血管风险

中华心血管病杂志2011年7月第39卷第7期chin J Candiol,July2011,Vol.39No.7

4.关于初始药物与联合方案


中华心血管病杂志2011年7月第39卷第7期chin J Candiol,July2011,Vol.39No.7

2016年CHEP指南推荐:ISH(老年)初始及联合药物推荐:

初始治疗:初始单药治疗可选用噻嗪类利尿剂、β受体阻滞剂(年龄<60岁)、ACEI、ARB或长效CCB;

联合治疗:常规剂量单药治疗后血压不能达标者应联合应用降压药物,推荐的联合用药组合包括噻嗪类利尿剂或长效CCB联合ACEI、ARB或β受体阻滞剂。慎用β阻滞剂联合非二氢吡啶类CCB,不建议联合应用ACEI与ARB。

老年人降压治疗中药物可能引起的不良反应

部分抗高血压药物的不良反应(包括但不限于)如下:

·噻嗪类利尿剂:电解质异常、胃肠道不适、皮疹或其他不适、男性性功能障碍、光敏性反应、体位性低血压;

·ACEIs:咳嗽、高血钾;

·ARBs:眩晕、咳嗽和高血钾;

·钙通道阻滞剂:眩晕、头痛、水肿、便秘;

·β受体阻滞剂:疲劳、性功能障碍;

老年高血压降压治疗中需要特别考虑:

· 高血压治疗前,准确测量血压非常重要,动态血压监测可能比较准确;

· 临床医生应考虑非药物治疗方案;

· 应考虑治疗方案和药物相互作用。

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    2018-06-25 waiwai3042
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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=247819, encodeId=30d024e81931, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Tue Sep 26 07:46:13 CST 2017, time=2017-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=247802, encodeId=2d1c24e802eb, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Tue Sep 26 07:21:35 CST 2017, time=2017-09-26, status=1, ipAttribution=)]
    2017-09-29 1e10c84am36(暂无匿称)

    文章很好.值得分享

    0

  4. 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=247819, encodeId=30d024e81931, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Tue Sep 26 07:46:13 CST 2017, time=2017-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=247802, encodeId=2d1c24e802eb, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Tue 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    2017-09-28 lietome15

    好文.值得点赞!认真学习.应用于实践!谢谢分享给广大同好!

    0

  5. 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status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=247819, encodeId=30d024e81931, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Tue Sep 26 07:46:13 CST 2017, time=2017-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=247802, encodeId=2d1c24e802eb, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Tue 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    2017-09-28 Drhzm308

    谢谢.学习了

    0

  6. 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  7. 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createdBy=c9b922043063, createdName=mxj1971619, createdTime=Thu Jan 04 05:39:00 CST 2018, time=2018-01-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=248727, encodeId=0e93248e273f, content=文章很好.值得分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Fri Sep 29 07:31:00 CST 2017, time=2017-09-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=248486, encodeId=22ee24848696, content=好文.值得点赞!认真学习.应用于实践!谢谢分享给广大同好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30251637888, createdName=lietome15, createdTime=Thu Sep 28 09:39:05 CST 2017, time=2017-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=248458, encodeId=b2042484587b, content=谢谢.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ad4c106013, createdName=Drhzm308, createdTime=Thu Sep 28 07:43:26 CST 2017, time=2017-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1478906, encodeId=332614e8906d1, content=<a href='/topic/show?id=5de08024597' target=_blank style='color:#2F92EE;'>#老年高血压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80245, encryptionId=5de08024597, topicName=老年高血压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87307462084, createdName=124985dbm08(暂无昵称), createdTime=Wed Sep 27 14:39:00 CST 2017, time=2017-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=248192, encodeId=ec85248192a8, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c9fe2157555, createdName=Bdjdnska, createdTime=Wed Sep 27 13:36:56 CST 2017, time=2017-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=247880, encodeId=ab3324e880bc, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmhead/Q3auHgzwzM6P57Bs8gOPaY1cQP9lIia0lmZOEXraGaoicqNToIslXDKw/0, createdBy=7a041951742, createdName=衣带渐宽, createdTime=Tue Sep 26 12:57:23 CST 2017, time=2017-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=247819, encodeId=30d024e81931, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Tue Sep 26 07:46:13 CST 2017, time=2017-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=247802, encodeId=2d1c24e802eb, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Tue Sep 26 07:21:35 CST 2017, time=2017-09-26, status=1, ipAttribution=)]
    2017-09-27 Bdjdnska

    学习了

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1746521, encodeId=e8921e4652102, content=<a href='/topic/show?id=df4e18e4fc' target=_blank style='color:#2F92EE;'>#ACP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1874, encryptionId=df4e18e4fc, topicName=ACP)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=234435772502, createdName=waiwai3042, createdTime=Mon Jun 25 12:39:00 CST 2018, time=2018-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1633257, encodeId=ced2163325e52, content=<a href='/topic/show?id=08a220e6ce' target=_blank style='color:#2F92EE;'>#AFP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2076, encryptionId=08a220e6ce, topicName=AFP)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c9b922043063, createdName=mxj1971619, createdTime=Thu Jan 04 05:39:00 CST 2018, time=2018-01-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=248727, encodeId=0e93248e273f, content=文章很好.值得分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Fri Sep 29 07:31:00 CST 2017, time=2017-09-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=248486, encodeId=22ee24848696, content=好文.值得点赞!认真学习.应用于实践!谢谢分享给广大同好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30251637888, createdName=lietome15, createdTime=Thu Sep 28 09:39:05 CST 2017, time=2017-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=248458, encodeId=b2042484587b, content=谢谢.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ad4c106013, createdName=Drhzm308, createdTime=Thu Sep 28 07:43:26 CST 2017, time=2017-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1478906, encodeId=332614e8906d1, content=<a href='/topic/show?id=5de08024597' target=_blank style='color:#2F92EE;'>#老年高血压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80245, encryptionId=5de08024597, topicName=老年高血压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87307462084, createdName=124985dbm08(暂无昵称), createdTime=Wed Sep 27 14:39:00 CST 2017, time=2017-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=248192, encodeId=ec85248192a8, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c9fe2157555, createdName=Bdjdnska, createdTime=Wed Sep 27 13:36:56 CST 2017, time=2017-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=247880, encodeId=ab3324e880bc, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmhead/Q3auHgzwzM6P57Bs8gOPaY1cQP9lIia0lmZOEXraGaoicqNToIslXDKw/0, createdBy=7a041951742, createdName=衣带渐宽, createdTime=Tue Sep 26 12:57:23 CST 2017, time=2017-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=247819, encodeId=30d024e81931, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Tue Sep 26 07:46:13 CST 2017, time=2017-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=247802, encodeId=2d1c24e802eb, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Tue Sep 26 07:21:35 CST 2017, time=2017-09-26, status=1, ipAttribution=)]
    2017-09-26 衣带渐宽

    学习

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1746521, encodeId=e8921e4652102, content=<a href='/topic/show?id=df4e18e4fc' target=_blank style='color:#2F92EE;'>#ACP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1874, encryptionId=df4e18e4fc, topicName=ACP)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=234435772502, createdName=waiwai3042, createdTime=Mon Jun 25 12:39:00 CST 2018, time=2018-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1633257, encodeId=ced2163325e52, content=<a href='/topic/show?id=08a220e6ce' target=_blank style='color:#2F92EE;'>#AFP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2076, encryptionId=08a220e6ce, topicName=AFP)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c9b922043063, createdName=mxj1971619, createdTime=Thu Jan 04 05:39:00 CST 2018, time=2018-01-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=248727, encodeId=0e93248e273f, content=文章很好.值得分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Fri Sep 29 07:31:00 CST 2017, time=2017-09-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=248486, encodeId=22ee24848696, content=好文.值得点赞!认真学习.应用于实践!谢谢分享给广大同好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30251637888, createdName=lietome15, createdTime=Thu Sep 28 09:39:05 CST 2017, time=2017-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=248458, encodeId=b2042484587b, content=谢谢.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ad4c106013, createdName=Drhzm308, createdTime=Thu Sep 28 07:43:26 CST 2017, time=2017-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1478906, encodeId=332614e8906d1, content=<a href='/topic/show?id=5de08024597' target=_blank style='color:#2F92EE;'>#老年高血压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80245, encryptionId=5de08024597, topicName=老年高血压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87307462084, createdName=124985dbm08(暂无昵称), createdTime=Wed Sep 27 14:39:00 CST 2017, time=2017-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=248192, encodeId=ec85248192a8, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c9fe2157555, createdName=Bdjdnska, createdTime=Wed Sep 27 13:36:56 CST 2017, time=2017-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=247880, encodeId=ab3324e880bc, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmhead/Q3auHgzwzM6P57Bs8gOPaY1cQP9lIia0lmZOEXraGaoicqNToIslXDKw/0, createdBy=7a041951742, createdName=衣带渐宽, createdTime=Tue Sep 26 12:57:23 CST 2017, time=2017-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=247819, encodeId=30d024e81931, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Tue Sep 26 07:46:13 CST 2017, time=2017-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=247802, encodeId=2d1c24e802eb, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Tue Sep 26 07:21:35 CST 2017, time=2017-09-26, status=1, ipAttribution=)]
    2017-09-26 刘煜

    谢谢分享.学习了

    0

  10. [GetPortalCommentsPageByObjectIdResponse(id=1746521, encodeId=e8921e4652102, content=<a href='/topic/show?id=df4e18e4fc' target=_blank style='color:#2F92EE;'>#ACP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1874, encryptionId=df4e18e4fc, topicName=ACP)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=234435772502, createdName=waiwai3042, createdTime=Mon Jun 25 12:39:00 CST 2018, time=2018-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1633257, encodeId=ced2163325e52, content=<a href='/topic/show?id=08a220e6ce' target=_blank style='color:#2F92EE;'>#AFP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2076, encryptionId=08a220e6ce, topicName=AFP)], attachment=null, authenticateStatus=null, createdAvatar=null, 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createdBy=30251637888, createdName=lietome15, createdTime=Thu Sep 28 09:39:05 CST 2017, time=2017-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=248458, encodeId=b2042484587b, content=谢谢.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ad4c106013, createdName=Drhzm308, createdTime=Thu Sep 28 07:43:26 CST 2017, time=2017-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1478906, encodeId=332614e8906d1, content=<a href='/topic/show?id=5de08024597' target=_blank style='color:#2F92EE;'>#老年高血压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=80245, encryptionId=5de08024597, topicName=老年高血压)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87307462084, createdName=124985dbm08(暂无昵称), createdTime=Wed Sep 27 14:39:00 CST 2017, time=2017-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=248192, encodeId=ec85248192a8, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c9fe2157555, createdName=Bdjdnska, createdTime=Wed Sep 27 13:36:56 CST 2017, time=2017-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=247880, encodeId=ab3324e880bc, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmhead/Q3auHgzwzM6P57Bs8gOPaY1cQP9lIia0lmZOEXraGaoicqNToIslXDKw/0, createdBy=7a041951742, createdName=衣带渐宽, createdTime=Tue Sep 26 12:57:23 CST 2017, time=2017-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=247819, encodeId=30d024e81931, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2017/04/21/72142930668371951a41ef4ea4b233e6.jpg, createdBy=dcbc1715228, createdName=刘煜, createdTime=Tue Sep 26 07:46:13 CST 2017, time=2017-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=247802, encodeId=2d1c24e802eb, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Tue Sep 26 07:21:35 CST 2017, time=2017-09-26, status=1, ipAttribution=)]
    2017-09-26 明月清辉

    谢谢分享.学习了

    0

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HUA的危害不容小视:它不仅是痛风发生的“导火索”,还是糖尿病、代谢综合征、高血压、慢性肾病、心血管疾病、脑卒中等进展的“催化剂”。

这例高血压患者的病因,你肯定想不到……

2017年9月21-24日,第四届世界高血压大会、2017年中国高血压年会暨第19届国际高血压及相关疾病学术研讨会在上海召开,福建医科大学附属第一医院的谢良地教授带来了《延髓心血管中枢受压导致的继发性高血压》的精彩报告

Hypertension:维生素D与高血压和缺血性卒中之间的相关性 剪不清理还乱?

一项由丹麦科学家进行的遗传研究,考察了一般人群中,116655名个体中维生素D、高血压和缺血性卒中之间的关系。观察性研究显示,较低的25-羟基-D(25(OH)D)血浆浓度与血压较高、高血压和缺血性卒中相关。然而,这些相关性之间是否存在因果关系仍然未知。研究者对来自一般人群中的丹麦血统的116655例白种人个体进行关于影响血清25(OH)D浓度的DHCR7和CYP2R1基因变异的基因分型;对355

Hypertension:脂肪细胞肾素原受体诱导性缺失可逆转肥胖相关性高血压

肥胖每年可导致约250万人死亡,与高血压等可危及生命的疾病具有相关性。ASH 2017大会上的一项最新研究发现,脂肪细胞肾素原受体(PRR)结构性缺失通过脂肪量的急剧下降来预防高脂饮食诱导的肥胖。但是,脂肪细胞PRR缺陷小鼠以脂肪肝和收缩压增高为特征,并存在脂肪营养不良的典型特征。该研究旨在确定对于肥胖小鼠而言时间控制的脂肪细胞PRR缺失能否逆转肥胖相关高血压。

利尿剂:安全、有效、毫无争议的一线降压药!

噻嗪类利尿剂具有肯定的降压效果、可靠的靶器官保护作用以及良好的安全性和耐受性,但是目前临床中应用很少。2009年China STATUS研究分析了92家三甲医院5086例高血压患者,发现我国高血压人群利尿剂使用率仅10%。利尿剂是各国高血压指南中毫无争议的一线降压药物。然而,由于很多临床医生对此来药物的安全性存在不正确的认识,导致其临床作用与优势未能充分发挥。

小壹推出6种多场景医患服务机器人

尽管医疗机器人在机器人产业和医疗产业中均属于相对较小的细分市场,但作为单位价值最高的服务型机器人,它却是当前发展的热点。据不完全统计,市面上已经有近40家医疗机器人企业,融资额度超8亿人民币。中新网报道称,到2025年医疗机器人的产值将达到170亿美元。

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